Virtual-Reality Assessment and Treatment of Binocular Vision Impairment in Traumatic Brain Injury

创伤性脑损伤双眼视觉障碍的虚拟现实评估和治疗

• 批准号: 10259948
• 负责人: MARK F. WALKER
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259948
• 关键词: 3-Dimensional; Acute; Address; Adherence; Affect; Area; Assessment tool; Binocular Vision; Blunt Trauma; Clinical; Clinical Trials; Cognitive; Convergence Insufficiency; Custom; Data; Diagnosis; Diagnostic; Diplopia; Exercise; Eye; Eye Movements; Feedback; Functional disorder; Funding; Future; Goals; Image; Impairment; Improve Access; Individual; Injury; Left; Link; Measurement; Measures; Military Personnel; Monitor; Myopia; Neurologic; Optometrist; Participant; Patients; Performance; Performance at work; Pilot Projects; Play; Population; Post-Concussion Syndrome; Preparation; Protocols documentation; Reading; Recording of previous events; Reporting; Research; Resolution; Schools; Speed; Supervision; Symptoms; System; Technology; Testing; Therapeutic; Therapeutic Intervention; Training; Traumatic Brain Injury; Veterans; Vision; Vision Disorders; Vision Disparity; Visual; Visual Acuity; Visual impairment; accurate diagnosis; base; blast trauma; clinical diagnostics; compare effectiveness; compliance behavior; experience; feasibility testing; functional improvement; gaze; improved; military veteran; nervous system disorder; novel; patient home care; portability; prototype; reading difficulties; success; tool; treatment response; virtual environment; virtual healthcare; virtual reality; virtual reality game; virtual reality headset; virtual reality system; visual control; visual tracking; visual-vestibular

Traumatic Brain Injury (TBI) is a common problem that affects both military and civilian populations. Although most individuals with TBI recover from the acute cognitive effects of the injury, persistent sensorimotor symptoms are not uncommon. One frequently occurring post- concussive symptom is impairment of near vision. This may manifest as overt diplopia or as new difficulties reading and maintaining focus on near objects. Such symptoms have been attributed to TBI-related convergence insufficiency, but this remains controversial given limited data and the lack of robust and reliable tools to measure vergence function in routine clinical settings. Even when accurately diagnosed, treatment options for convergence insufficiency are limited and generally require direct supervision of a trained optometrist or vision therapist. Moreover, current therapy is limited by the fact that exercises cannot be precisely matched to a particular patient's vergence deficit, there are few objective measures of functional improvement to judge progress and titrate therapy, and it is difficult to monitor whether a patient is following the therapy plan and performing the exercises correctly. This project will address diagnostic and treatment gaps for vergence impairment after TBI by developing a set of novel virtual-reality tools for the assessment of vergence and binocular visual function and for game-based therapy to improve vergence performance. There are two aims to this pilot study. The first aim will employ a virtual-reality headset with integrated eye tracking to test static and dynamic vergence and visual function in a group of veterans with historical TBI and persistent binocular symptoms, comparing the results to veterans with TBI and no visual symptoms and to participants with no history of TBI or binocular issues. In the second aim, a virtual-reality game will be developed and piloted to provide vision exercises to veterans with convergence impairment after TBI, primarily as a test of feasibility but also to acquire preliminary data for future larger scale clinical trials.

创伤性脑损伤 (TBI) 是影响军事和民用的常见问题 人口。尽管大多数患有 TBI 的人可以从创伤性脑损伤的急性认知影响中恢复过来。 受伤后，持续的感觉运动症状并不少见。一种经常出现的事后 震荡症状是近视力受损。这可能表现为明显的复视或新的复视 阅读和保持对近处物体的注意力困难。此类症状被归咎于 与 TBI 相关的收敛不足，但鉴于有限的数据和 缺乏稳健可靠的工具来测量常规临床环境中的聚散功能。 即使准确诊断，收敛不足的治疗选择也是有限的，并且 通常需要受过训练的验光师或视力治疗师的直接监督。此外，当前 治疗受到以下事实的限制：锻炼无法精确匹配特定患者的情况 聚散缺陷，很少有客观的功能改善指标来判断进展 和滴定疗法，并且很难监测患者是否遵循治疗计划和 正确进行练习。该项目将解决以下疾病的诊断和治疗差距： 通过开发一套新颖的虚拟现实工具来评估 TBI 后的聚散损伤 聚散度和双眼视觉功能以及基于游戏的治疗来改善聚散度 表现。 这项试点研究有两个目标。第一个目标将采用虚拟现实耳机 集成眼动追踪，测试一组人的静态和动态聚散度以及视觉功能 有历史 TBI 和持续双眼症状的退伍军人，将结果与退伍军人进行比较 患有 TBI 但没有视觉症状的参与者以及没有 TBI 病史或双眼问题的参与者。在 第二个目标是开发并试行一款虚拟现实游戏，为人们提供视觉练习。 TBI 后出现收敛障碍的退伍军人，主要是为了测试可行性，但也为了获得 为未来更大规模的临床试验提供初步数据。