Reviewing Past Studies For a Glimpse Into the Future of mTBI

It’s always exciting when you can obtain a sneak preview of an article in press (pun intended), and even more so when the article is dated for the following calendar year. Somehow one gets the feeling of glimpsing into the future, akin to Doc Brown’s time travel, when authors effectively re-visit past publications to suggest what might occur in their field down the road. Such is the case for this article shared by Ken Ciuffreda in advance of its publication in Vision Research in February 2022.

Through the link provided by the journal with encouragement to share it in advance of publication, you can read the article in its entirety and it certainly speaks for itself. There is however one reference I’d like to highlight which serves as the basis for Figure 3 in this paper. It is labeled as “Proposed underlying mechanisms of vergence-based oculomotor rehabilitation”, adapted with permission from the PhD thesis of Dr. Ciuffreda’s co-author, Dr. Preethi Thiagarajan. Published in 2012, her thesis stands as a monumental work at a hefty 314 pages titled Oculomotor Rehabilitation For Reading Dysfunction In Mild Traumatic Brain Injury, and you can download it in its entirety via this link. The figure from which Figure 3 was adapted is this one:

There are several other images from Dr. Thiagarajan’s thesis that are particularly informative, and I’ll take the opportunity to reproduce them here for your viewing pleasure:

The next figure (3.15) is similar to figure 4.13 above, but adds something crucial to the subject of vision-based interventions for reading difficulty. It is a concept that is likely exacerbated in mTBI, but applies to the population at large. When the patient experiences instability or variability in binocular function, underlying visual processes involved in reading that should be automatic are inefficient. This results in subconscious attention, effort and concentration allocated toward keeping print clear, single and stable that would otherwise be allocated toward comprehension and fluency. By restoring automatic control, whether that is done through lenses, prisms, filters, or active vision therapy, attention can be reallocated toward comprehension which directly accounts for improved capacity to read.

In the conclusion of Dr. Ciuffreda and Dr. Thiagarajan’s article, they note the remarkable degree of underlying neural plasticity in the damaged adult brain, even in the late chronic phase of mTBI. Dr. Barry Tannen (who collaborated extensively with Dr. Ciuffreda during their time at SUNY) and I were chatting during a break at our recent VHG meeting, and we were discussing this concept of residual neural plasticity. Scottsdale in the fall is a lovely place to fire up brain cells, and as always some of the best discussions take place in the spaces between formal presentations.

Figure 2.1 above, showing the spectrum of general deficits in TBI, reminded me of our conversation about the emotional, cognitive, and behavioral elements that patients and their families deal with. As professionals we address these components of patient care to the best of our ability, but there are elements beyond our skill set that may hinder transfer of visual gains to the patient’s daily environment. In that regard, cognitive and behavioral therapists from other fields who are well-schooled in these matters are welcome collaborators. The challenge is that these individuals are hard to find.

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