This project will establish the Vision and Neural Engineering Laboratory at NJIT. The PI has already established a working oculomotor research laboratory. The PI proposes a set of experiments to assess vergent (depth) eye movement mechanisms in motion tracking. The core of her proposed techniques is based around learning a motor control task under paradigms of reinforcement and interference learning. Visual tracking as well as fMRI diagnostics will be used, followed by subsequent analysis via ICA.
Significance: Health care professionals have a daunting task when diagnosing mild traumatic brain injury (mTBI) because the epidemiology, imaging and behavioral assessment lack cohesive neurophysiological explanation.(Maruta et al. 2010) Within the US, the latest CDC survey reports there are 1.7 million TBI cases annually from the civilian population (Coronado et al. 2011) where 70-80% are classified as mild. (Numminen 2011) The cost of mTBI in the civilian population is an estimated $26.4 billion annually. (Thurman 2001) The military population also has a considerable number of veterans with TBI -- the signature injury from the wars in Iraq and Afghanistan. (Hoge et al. 2008) An estimated 320,000 personnel screened positive for a probable TBI, typically from blast injuries. (Tanielian and Jaycox 2008) The Department of Defense estimates that health care cost of TBI in the first year following deployment is about $900 million. (Tanielian and Jaycox 2008) Reports indicate that TBI resulting from combat in Afghanistan and Iraq will present major diagnostic, therapeutic and economic challenges for many years to come and many believe current statistics underestimate the problem. (Sayer et al. 2009) This problem is not only being reported in scientific literature but is also highlighted in the mainstream media. Common symptoms in mTBI patients include blurred vision and visual fatigue, decreased concentration and processing speeds, memory difficulties, and headaches. (Chen and Huang 2011) These symptoms all have a negative impact on performing near work, such as reading or computer use, which negatively impact employment and academic performance as well as recreational enjoyment. Many mTBI patients even years post injury report symptoms and have the visual dysfunction known as convergence insufficiency (CI). The prevalence rates of CI range from 42% to 56% in civilian (Cohen, et al. 1989; Ciuffreda, et al. 2007) and 28% to 64% in military (Brahm et al. 2009; Stelmack et al. 2009) mTBI populations. Clinicians recommend oculomotor rehabilitation to alleviate symptoms in mTBI patients (Thiagarajan et al. 2011) yet how rehabilitation ‘rewires’ the brain is not fully understood. Recent reviews highlight the need for scientific evidence that will enhance rehabilitation and management thus improving activities of daily living for those suffering with mTBI. Intellectual Merit: The CAREER award entitled "Mapping the Mind in Search of Oculomotor Learning Strategies" funded the first pilot data taking a critical step in understanding the underlying neural substrates of how oculomotor rehabilitation retrains the brain to promote neuroplasticity. Our team is composed of engineers and clinical researchers. We published these data in the December 2010 issue of Optometry and Vision Science. (Alvarez et al. 2010) We integrated functional magnetic resonance imaging, eye movements, conventional vision parameters and a standardized symptom survey to compare those with the vision dysfunction of CI to those without neurological damage or visual dysfunctions. The CI patients participated in 18 hours of oculomotor rehabilitation designed to enhance the preprogrammed and feedback portions of the convergence system. After training, functional imaging showed an increase in spatial extent with increases in correlation with the experimental protocol. Convergence eye movements were significantly slower in CI patients before training compared to the movements after training or eye movements from age matched healthy control subjects. An independent component analysis of the eye movements revealed that the preprogrammed component significantly changed during rehabilitation. The conventional vision parameters included the near point of convergence (the distance along midline when a target become double), positive fusional range (the range of the convergence system) and symptoms. These signs and symptoms were recorded based upon the National Institute of Health Convergence Insufficiency Treatment Trial guidelines. (Scheiman et al. 2010) They developed the CI Symptom Survey (CISS) which is reported to have 98% sensitivity and 87% specificity in adults. (Rouse et al. 2004) Future direction of this research includes more systematic study with larger populations of patients with mTBI from both the civilian and military populations. Broader Impact: This NSF CAREER proposal funded 17 accepted / published peer-reviewed journal papers, one peer reviewed manuscript that is under review and three that are in preparation. It has funded 43 peer reviewed conference papers which were between 2-6 pages each. These conference papers were written mostly by students. Specifically, nine papers were written and presented from undergraduate and 28 were from graduate students. The PI presented the remaining six papers where one was an invited conference paper. This work led to three graduate and two undergraduate student paper awards. In addition, the outreach activities had a variety of students from fourth grade to high school participate in a field trip to the Vision and Neural Engineering Laboratory. Students participated in age appropriate interactive exercises and had a tour of the laboratory where approximately 75 students per year through various pre-college programs participated or 450 students.
