Sea Change Origin Neuroplasticity-A Paradigm Sea From Shakespeare's - - PDF document

2/10/2010 1

Neuroplasticity-A Paradigm Sea Change

Dominick M. Maino, OD MEd FAAO OD, MEd, FAAO, FCOVD-A

Disclosure Statement: Nothing to disclose

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Sea Change Origin

From Shakespeare's The Tempest, 1610: ARIEL [ sings] :

Full fathom five thy father lies; Of his bones are coral made; Of his bones are coral made; Those are pearls that were his eyes: Nothing of him that doth fade But doth suffer a sea-change Into something rich and strange.

• I. Sea Change

(Meaning)

A radical, and apparently mystical, change.

h f h d h It is change of such magnitude that it alters the way we think and what we do in a sweeping, far ranging, mind expanding, mega-behavior transformative fashion.

Neuroplasticity

Up until recently… .apparently unknown to many within the professions of optometry and ophthalmology… ..

The Brain

• A. …

is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case

• B. …

can change its form and resultant function through neuroplasticity The Brain

• A. …

is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case

• B. …

can change its form and resultant function through neuroplasticity The Brain

• A. …

is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case

• B. …

can change its form and resultant function through neuroplasticity The Brain

• A. …

is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case

• B. …

can change its form and resultant function through neuroplasticity

I I . The Brain … is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case y … can change its form and resultant function through neuroplasticity

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I I I . Critical/ Sensitive Periods

• A. A critical period occurs when the individual is

sensitive to environmental influences and stimulation

• 1. The Precritical period: The initial formation of

p neuronal circuits that is not dependent on visual experience.

Critical/ Sensitive Periods

• 2. The Critical period: A distinct onset of robust

plasticity in response to the visual experience when the initially formed circuit can be modified by experience experience

• 3. Closure of the critical period: After the end of

the critical period, the same visual experience no longer elicits the same degree of plasticity.

Critical/ Sensitive Periods

• B. The concept of a critical period does not

imply that neuroplasticity ends after a certain age.

• C. Sensitive period begins and ends

gradually (not abruptly like the critical period) and provides for maximum sensitivity to stimuli. VI . Neuroplasticity and the Brain

• A. Can adult brain neurons actually exhibit

neuroplasticity? The short answer is yes. B Resultant changes are noted in not

• B. Resultant changes are noted in not
• nly functional outcomes but also in brain

anatomy and structure. B: Examples of Changes in Function and Structure 1.) Jugglers 2.) Typists B: Examples of Changes in Function and Structure 1.) Jugglers

One study suggested that adults taught how to juggle demonstrated a significant transient bilateral expansion of gray matter in the mid-temporal area and the left posterior intraparietal sulcus between baseline brain scan and follow-up. The findings were specific to training stimulus; individuals who were not instructed how to juggle demonstrated no change in gray matter over the same

• period. These findings oppose the conventional

understanding that the anatomical structure of the adult brain

does not change over time

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B: Examples of Changes in Function and Structure 2.) Typists …

long-term bimanual training also increases gray matter volume in experienced adult typists.

These results suggest that learning not

• nly affects function, but also structure in

adult brains.

• V. Neuroplasticity and Optom etry
• A. Evolutionary neuroplasticity

…. is ideally suited for the developmental O.D. who specializes in vision function as it changes over time specializes in vision function as it changes over time, either with or without intervention.

• V. Neuroplasticity and

Optom etry

• B. Reactive plasticity

… .. can be thought of as the immediate effect that initial optometric treatment may have on a system. This can be reflected in an immediate, but often transient, change in the individual’s accommodative system—i.e., when an uncorrected myope initially puts on his or her new spectacles.

• V. Neuroplasticity and

Optom etry

• C. Adaptational plasticity

… . could describe the long-term effects of in-office

• ptometric vision therapy on disorders of the binocular

vision system.

• V. Neuroplasticity and

Optom etry

• D. Reparation plasticity

… in contrast to adaptational plasticity, reparation plasticity may occur during may occur during treatment by a low vision specialist or an O.D. working with those who have experienced a traumatic brain injury (TBI).

• V. Neuroplasticity and Optom etry

The effects of plasticity can lead to either positive or negative changes during development (evolutionary plasticity), after short-term exposure (reactive plasticity), after long term or continuous stimuli after long-term or continuous stimuli (adaptational plasticity), and during functional or structural recovery of damaged neuronal circuits (reparation plasticity).

http://www.citeulike.org/user/jasoneprior/article/2856526

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VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity

• A. Refractive error development

B Amblyopia

• B. Amblyopia
• C. Strabismus
• D. Non-strabismus, non-amblyopic

binocular vision disorders

• E. Learning related vision anomalies

F . Vision development/ perception disorders

VI . Managem ent and Treatm ent of Disorders

• f the Visual System and Neuroplasticity
• A. Refractive error developm ent

Several recent studies have noted that neuroplasticity may play a role in refractive error development. retinal defocus use of progressive addition lenses retinal defocus, use of progressive addition lenses, drug studies (M1-antagonist/2% pirenzepine ) slow myopia progression demonstrated nearly a 50% reduction in myopia progression over a two-year period

(Randomized trial of effect of bifocal and prismatic bifocal spectacles on myopic progression: two-year results: change in the amount of myopia and length of eye)

VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity

• B. Am blyopia

Scheiman MM, Hertle RW, Beck RW, et al. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 2005 Apr;123(4):437-47. Wallace DK, Chandler DL, Beck RW, et al. Treatment of bilateral refractive amblyopia in children three to less than 10 years of age. Am J Ophthalmol 2007 Oct;144(4):487-96. C SA d d A A ld l f bi i bl i i h f i i Cotter SA, Edwards AR, Arnold RW, et al. Treatment of strabismic amblyopia with refractive correction. Am J Ophthalmol 2007 Jun;143(6):1060-3. Repka MX, Wallace DK, Beck RW, et al. Two-year follow-up of a 6-month randomized trial of atropine

• vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2005 Feb;123 (2):149-

57. Wallace DK, Edwards AR, Cotter SA, et al. A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. Ophthalmology 2006 Jun;113(6):904-12. Treatment of severe amblyopia with weekend atropine: results from 2 randomized clinical trials. Levodopa/carbidopa in the treatment of amblyopia.

VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity

• B. Am blyopia

Bottom Line Bottom Line Amblyopia can be treated at any age May be able to use neuro-enhancing drugs as a part of basic amblyopia therapy

VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity

• C. Strabismus and non-strabismic, non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction ith h th ) t f ffi th l Th t d l d d th t t t i with home therapy) vs. out-of-office therapy alone.The study concluded that optometric vision therapy/orthoptics was more effective than pencil push-ups or placebo vision therapy/orthoptics in reducing symptoms and improving clinical signs of convergence insufficiency Long-term effectiveness of treatments for symptomatic convergence insufficiency in children (Optom Vis Sci. 2009 Sep;86(9):1096-103) CITT patients improvements lasted a year

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VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the treatment effects are long lasting E/ F . Learning related vision anomalies/ Vision development/ perception disorders

…..research includes an examination of the role vision l i di h ff f l d plays in reading, the effect of oculomotor, vergence and accommodative/coherent motion therapy on reading eye movements and reading speed, the diagnosis and treatment

• f perceptual disorders, and the effect of therapy on

various learning anomalies.

E/ F . Learning related vision anomalies/ Vision development/ perception disorders

magnocellular (MC) deficit in dyslexia L/M speed-matching ratio predicts reading in children.Chase C, Dougherty RF, Ray N, Fowler S, Stein J.Optom Vis Sci. 2007 Mar;84(3):229-36. Effect of attention therapy on reading comprehension. Solan HA, Shelley-Tremblay J, py g p , y y , Ficarra A, Silverman M, Larson S. J Learn Disabil. 2003 Nov-Dec;36(6):556-63. Is there a common linkage among reading comprehension, visual attention, and magnocellular processing? Solan HA, Shelley-Tremblay JF, Hansen PC, Larson S. J Learn Disabil. 2007 May-Jun;40(3):270-8. Lawton, T. Filtered Text and Direction Discrimination Training Improved Reading Fluency for Both Dyslexic and Normal Readers. Optom Vis Dev 2008;39 (3):114. Fischer B, Hartnegg K. Saccade control in dyslexia: Development, deficits, training and transfer to reading. Optom Vis Dev 2008:39(4):181-190.

VI I . Vision dysfunction association w ith acquired brain injury

• A. Exotropia (or high exophoria/ CI)
• B. Accommodative dysfunction
• C. Convergence insufficiency
• D. Decreased blink rate
• E. Spatial disorientation

F . Pursuit/ saccade dysfunction

• G. Unstable ambient vision

(Magnocellular pathway).

VI I . Vision dysfunction association w ith acquired brain injury

Current Research/ Literature Review s/ I nternet Resources Stelmack JA, Frith T, Van Koevering D, Rinne S, Stelmack TR. Visual function in patients followed at a Veterans Affairs polytrauma network site: an electronic medical record review.

• Optometry. 2009 Aug;80(8):419-24.

RESULTS: Visual symptoms were self-reported by 76% of patients with polytrauma and 75% of the patients with TBI. Problems with reading (polytrauma 60% and TBI 50%) and accommodation (polytrauma 30% and TBI 47%) were frequently found on eye examinations. Spectacles were the treatment most frequently prescribed (polytrauma 62% and TBI 78%). CONCLUSIONS: It is important for optometrists to be aware of the high rates of self-reported symptoms and visual problems in military personnel returning from deployment to the wars in Iraq and Afghanistan. Post- traumatic stress disorder and depression may complicate optometric evaluation and management.

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VI I . Vision dysfunction association w ith acquired brain injury

Avoidance of near tasks Oculomotor-based reading difficulties Eye tracking problems Eye focusing problems Eyestrain, Diplopia Dizziness, Vertigo Vision-derived nausea

VI I . Vision dysfunction association w ith acquired brain injury Increased sensitivity to visual motion Visual inattention and distractibility Short-term visual memory loss Difficulty judging distances (relative and absolute iffi l i h l b l i Difficulty with global scanning Difficulty with personal grooming, especially involving the face Inability to interact/cope visually in a complex social situation (e.g., minimal eye contact) Inability to tolerate complex visual environments (e.g., grocery store aisles and highly-patterned floors) VI I . Vision dysfunction association w ith acquired brain injury

Current Research/ Literature Review s/ I nternet Resources Ciuffreda KJ, Ludlam DP, Kapoor N. Clinical oculomotor training in traumatic brain injury. Optom Vis Dev 2009;40(1):16-23.

Individuals with traumatic brain injury present with a constellation of j y p

• culomotor dysfunctions and correlated symptoms. Simple and

effective clinical oculomotor-based training procedures will be presented with respect to the versional, vergence, and accommodative systems, and their interactions. These therapeutic procedures can also be applied as needed to individuals with either low vision, neurological dysfunctions, or general visual skills cases manifesting similar oculomotor deficits. VI I . Vision dysfunction association w ith acquired brain injury

Current Research/ Literature Review s/ I nternet Resources

Leslie S. Myopia and accommodative insufficiency associated with moderate head trauma. Opt Vis Dev 2009;40(1):25-31. The majority of subjects reviewed had developed a stable degree of myopia between 1.00 and 2.00 diopters, as well as an abnormally high lag of accommodation. When their distance and near spatial area

• f focus was compared, the majority were focused at an intermediate

area in space, suggesting a loss of control of accommodation in space. VI I I . I m proving Brain Function and Neuroplasticity

• A. Brain Foods
• B. Drugs
• C. Exercise
• D. Learning new and challenging things

VI I I . I m proving Brain Function and Neuroplasticity

• A. Brain Foods

Jia X, McNeill G, Avenell A. Does taking vitamin, mineral and fatty acid supplements prevent cognitive decline? A systematic review of randomized controlled trials. J Hum Nutr Diet 2008 Aug;21(4):317-36. H ik C H h lt K Li d M I d iti d l t Henriksen C, Haugholt K, Lindgren M. Improved cognitive development among preterm infants attributable to early supplementation of human milk with docosahexaenoic acid and arachidonic acid. Pediatrics 2008 Jun;121(6):1137-45. Kidd PM. Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids. Altern Med Rev 2007 Sep;12(3):207-27. Gomez-Pinilla F. Brain foods: the effect of nutrients on brain function. Neuroscience 2008;9(7)568-78.

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VI I I . I m proving Brain Function and Neuroplasticity

• B. Drugs

Maya Vetencourt JF, Sale A, Viegi A, et al. The antidepressant fluoxetine (Prozac) restores plasticity in the adult visual cortex. Science 2008 Apr 18;320 (5874):385-8. Kasper S, McEwen BS. Neurobiological and clinical effects of the id i i ( ) antidepressant tianeptine. CNS Drugs 2008;22(1):15-26. Adamcio B, Sargin D, Stradomska A, et al. Erythropoietin enhances hippocampal long-term potentiation and memory. BMC Biol 2008 Sep 9;6:37. Chilosi A, Leuzzi V, Battini R, et al. Treatment with L-arginine improves neuropsychological disorders in a child with creatine transporter defect. Neurocase 2008;14(2): 151-61. VI I I . I m proving Brain Function and Neuroplasticity

• C. Exercise

Hunsberger JG et al. Antidepressant actions of the exercise- regulated gene VGF. Nat Med 2007 Dec 2; 13:1476. VGF may be a common pathway by which exercise induces neuroplasticity and growth-factor genes; at least one of these might act similarly to antidepressants in promoting an adaptive response to stress. However, the tests used here may be modeling stress-induced helplessness, not depression. ….exercise seems to induce multiple interacting genes that enhance neuronal resilience VI I I . I m proving Brain Function and Neuroplasticity

• D. Learning new and challenging things

What have we (optometry & ophthalmology) been thinking all these years? been thinking all these years? Where did we miss the news about neuroplasticity?

I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Huang JC. Neuroplasticity as a proposed m echanism for the efficacy of optom etric vision therapy and

• rehabilitation. J Bev Optom 2 0 0 9 ;2 0 ( 4 ) :96 -10 0

Hom ologo s a ea adaptation Hom ologous area adaptation Com pensatory m asquerade Cross-m odal reassignm ent Map expansion Equipotentiality Vicariation I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Hom ologous area adaptation: a transfer of function f om a dam aged b ain a ea to a non dam aged b ain a ea from a dam aged brain area to a non-dam aged brain area. May be lim ited to early stages of hum an developm ent and m ay crow d a new brain area resulting in reduced functionality of that brain area. ( Com petition betw een spatial & verbal functioning) I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Com pensatory m asquerade: reorganizing of existing neuro-pathw ays to use alternative cognitive strategies to perform a task.

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I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Cross-m odal reassignm ent: using new sensory input in a brain structure deprived of its m ain input source ( changing processing from visual to tactile stim uli in the blind) I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Map e pansion inc ease in b ain m ass d e to Map expansion: increase in brain m ass due to repeated behavior or exposure to stim uli I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Equipotentiality: anatom ical areas of the brain can perform disparate functions Vicariation: redundant neural system s can operate under abnorm al conditions This m ay explain w hy recovery is noted for m any neurological conditions ( degenerative, psychiatric, developm ental, vascular, traum atic) I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications

Const aint the ap Use it and im p o e it Constraint therapy: Use it and im prove it Patching, penalization, “near activities” during am blyopia therapy I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications/ Optom etric Vision Therapy Kleim & Jones:

Use it or lose it. If you do not drive specific brain functions, functional loss will occur. If you want to improve oculomotor brain neuroplasticity function/structure, therapy should be specific for that brain function. , py p Use it and improve it. Therapy that drives cortical function enhances that particular function. If you use therapy to improve oculomotor dysfunction, it should improve.

• Specificity. The therapy you choose determines the resultant

plasticity and function. You must choose therapy that is appropriate.

I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications Kleim & Jones:

Repetition matters. Plasticity that results in functional change requires repetition. Do the therapy. Do it again. Do it yet again. No quick fix. Intensity matters Induction of plasticity requires the appropriate Intensity matters. Induction of plasticity requires the appropriate amount of intensity. Intensity means strength, force, concentration, power and passion. Without these plasticity may not occur. Function may not improve, Time matters. Different forms of plasticity take place at different times during therapy. Do the basics, than the more advanced therapeutic procedures.

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I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications Kleim & Jones:

Salience matters. It has to be important to the individual. Make the therapy matter to the patient. Age matters. Plasticity is easier in a younger brain, but is also possible in an adult brain. Do not let age determine what therapy options you offer your

• patients. Think of Susan Barry, PhD (StereoSue) and her success.

Offer your patients options. Let them choose. Be realistic about

• utcomes….have outcome measures built into therapy program

I X. I m proving Brain Function and Neuroplasticity

Optom etric Clinical Applications Kleim & Jones:

• Transference. Neuroplasticity, and the change in function

that results from one therapy, can augment the attainment

• f similar behaviors.

What you do during oculomotor therapy may affected vergence therapy outcomes

• Interference. Plasticity in response to one experience can

interfere with the acquisition of other behaviors.

• Monitor. Evaluate progress. Discuss function in other areas
• f your patients’ life.

Presenter, Title, Contact info

Questions About :

Neuroplasticity- A Paradigm Sea Change? A Paradigm Sea Change?

Dominick M. Maino, OD, MEd, FAAO, FCOVD-A

Professor, Pediatrics/ Binocular Vision Illinois Eye Institute/ Illinois College of Optometry dmaino@ico.edu

http: / / www.MainosMemos.blogspot.com