2/10/2010 Sea Change Origin Neuroplasticity-A Paradigm Sea From Shakespeare's The Tempest , 1610: Change ARIEL [ sings] : Dominick M. Maino, Full fathom five thy father lies; OD MEd FAAO OD, MEd, FAAO, Of his bones are coral made; Of his bones are coral made; FCOVD-A Those are pearls that were his eyes: Nothing of him that doth fade But doth suffer a sea-change Disclosure Statement: Nothing to disclose Into something rich and strange. Please silence all mobile devices. Unauthorized recording of this session is prohibited. 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. The Brain The Brain The Brain The Brain A. … A. … A. … A. … is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case is not just a static, soft, round mass, bathed in a fluid and surrounded by a hard case B. … B. … B. … B. … can change its form and resultant function through neuroplasticity can change its form and resultant function through neuroplasticity can change its form and resultant function through neuroplasticity 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 Neuroplasticity Up until recently… .apparently unknown to many within the professions of optometry and ophthalmology… .. 1
2/10/2010 I I I . Critical/ Sensitive Periods Critical/ Sensitive Periods A. A critical period occurs when the individual is sensitive to environmental influences and stimulation 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 1. The Precritical period: The initial formation of p experience experience neuronal circuits that is not dependent on visual 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 VI . Neuroplasticity and the Brain B. The concept of a critical period does not A. Can adult brain neurons actually exhibit imply that neuroplasticity ends after a certain neuroplasticity? The short answer is yes. age. B. Resultant changes are noted in not B Resultant changes are noted in not C. S ensitive period begins and ends only functional outcomes but also in brain gradually (not abruptly like the critical period) anatomy and structure. and provides for maximum sensitivity to stimuli. B: Examples of Changes in Function B: Examples of Changes in and Structure Function and Structure 1.) Jugglers 1.) Jugglers One study suggested that adults taught how to juggle 2.) Typists 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 2
2/10/2010 B: Examples of Changes in Function and Structure V. Neuroplasticity and Optom etry 2.) Typists A. Evolutionary neuroplasticity …. is ideally suited for the developmental O.D. who … long-term bimanual training also increases gray matter specializes in vision function as it changes over time specializes in vision function as it changes over time, volume in experienced adult typists. either with or without intervention. These results suggest that learning not only affects function , but also structure in adult brains. V. Neuroplasticity and V. Neuroplasticity and Optom etry Optom etry C. Adaptational plasticity B. Reactive plasticity … .. can be thought of as the immediate effect that … . could describe the long-term effects of in-office initial optometric treatment may have on a system. This can be reflected in an immediate, but often transient, change in optometric vision therapy on disorders of the binocular the individual’s accommodative system—i.e., when an vision system. uncorrected myope initially puts on his or her new spectacles. V. Neuroplasticity and V. Neuroplasticity and Optom etry Optom etry The effects of plasticity can lead to either D. Reparation plasticity positive or negative changes during development (evolutionary plasticity), after … in contrast to adaptational short-term exposure (reactive plasticity), plasticity, reparation plasticity may occur during may occur during after long term or continuous stimuli after long-term or continuous stimuli treatment by a low vision (adaptational plasticity), and during specialist or an O.D. working functional or structural recovery of damaged with those who have experienced a traumatic brain injury (TBI). neuronal circuits (reparation plasticity). http://www.citeulike.org/user/jasoneprior/article/2856526 3
2/10/2010 VI . Managem ent and Treatm ent of D. Non-strabismus, non-amblyopic Disorders of the Visual System and binocular vision disorders Neuroplasticity A. Refractive error development E. Learning related vision anomalies B Amblyopia B. Amblyopia F . Vision development/ perception disorders C. Strabismus VI . Managem ent and Treatm ent of Disorders VI . Managem ent and Treatm ent of Disorders of of the Visual System and Neuroplasticity the Visual System and Neuroplasticity A. Refractive error developm ent B. Am blyopia Several recent studies have noted that neuroplasticity may play a Scheiman MM, Hertle RW, Beck RW, et al. Randomized trial of treatment of amblyopia in children aged role in refractive error development. 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. retinal defocus, use of progressive addition lenses, retinal defocus use of progressive addition lenses Cotter SA, Edwards AR, Arnold RW, et al. Treatment of strabismic amblyopia with refractive correction. C SA d d A A ld l f bi i bl i i h f i i Am J Ophthalmol 2007 Jun;143(6):1060-3. drug studies (M1-antagonist/2% pirenzepine ) slow myopia Repka MX, Wallace DK, Beck RW, et al. Two-year follow-up of a 6-month randomized trial of atropine progression demonstrated nearly a 50% reduction in myopia vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2005 Feb;123 (2):149- progression over a two-year period 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. ( Randomized trial of effect of bifocal and prismatic bifocal spectacles on Treatment of severe amblyopia with weekend atropine: results from 2 randomized clinical trials. myopic progression: two-year results: Levodopa/carbidopa in the treatment of amblyopia. change in the amount of myopia and length of eye) VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity VI . Managem ent and Treatm ent of Disorders of the Visual System and Neuroplasticity C. Strabismus and non-strabismic, non-amblyopic binocular vision disorders B. Am blyopia Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has Bottom Line Bottom Line clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction with home therapy) vs. out-of-office therapy alone.The study concluded that optometric ith h th ) t f ffi th l Th t d l d d th t t t i Amblyopia can be treated at any age vision therapy/orthoptics was more effective than pencil push-ups or placebo vision therapy/orthoptics in reducing symptoms and improving clinical signs of convergence May be able to use neuro-enhancing drugs insufficiency as a part of basic amblyopia therapy 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 4
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