Assessment of neuro-optometric rehabilitation using the Developmental Eye Movement (DEM) test in adults with acquired brain injury

Purpose: This pilot study sought to determine the efficacy of using the Developmental Eye Movement (DEM) test in the adult, acquired brain injury (ABI) population to quantify clinically the effects of controlled, laboratory-performed, oculomotor-based vision therapy/vision rehabilitation. Methods: Nine adult subjects with mild traumatic brain injury (mTBI) and five with stroke were assessed before and after an eight-week, computer-based, versional oculomotor (fixation, saccades, pursuit, and simulated reading) training program (9.6 h total). The protocol incorporated a cross-over, interventional design with and without the addition of auditory feedback regarding two-dimensional eye position. The clinical outcome measure was the Developmental Eye Movement (DEM) test score (ratio, errors) taken before, midway, and immediately following training. Results: For the DEM ratio parameter, improvements were found in 80–89% of the subjects. For the DEM error parameter, improvements were found in 100% of the subjects. Incorporation of the auditory feedback component revealed a trend toward enhanced performance. The findings were similar for both DEM parameters, as well as for incorporation of the auditory feedback, in both diagnostic groups. Discussion: The results of the present study demonstrated considerable improvements in the DEM test scores following the oculomotor-based training, thus reflecting more time-optimal and accurate saccadic tracking after the training. The DEM test should be considered as another clinical test of global saccadic tracking performance in the ABI population. Resumen: Objetivo: Este estudio piloto trató de determinar la eficacia del uso de la prueba DEM (Developmental Eye Movement) en la población adulta con daño cerebral adquirido (DCA) para cuantificar clínicamente los efectos de la rehabilitación/terapia visual controlada, realizada en laboratorio, y de carácter oculomotor. Métodos: Se valoraron nueve sujetos adultos con daño cerebral traumático leve (mTBI) y cinco con ictus, con anterioridad y posterioridad a un programa de entrenamiento de ocho semanas, informático oculomotor y versional (movimientos de fijación, sacádicos, de persecución y lectura simulada, de 9,6 horas en total). El protocolo incorporó un diseño cruzado e intervencional, con y sin adición de retroalimentación auditiva en relación a la posición bi-dimensional de los ojos. La medida del resultado clínico se llevó a cabo mediante la puntuación de la prueba DEM (Developmental Eye Movement) (ratio, errores) realizada con anterioridad, en el punto medio, e inmediatamente tras el entrenamiento. Resultados: Para el parámetro de ratio DEM, se encontraron mejoras en el 80-89% de los sujetos. Para el parámetro de error DEM, se encontraron mejoras en el 100% de los sujetos. La incorporación del componente de retroalimentación auditiva reveló una tendencia hacia la mejora del rendimiento. Los hallazgos fueron similares para ambos parámetros DEM, así como para la incorporación de la retroalimentación auditiva, en ambos grupos diagnósticos. Discusión: Los resultados del presente estudio demostraron mejoras considerables de las puntuaciones de la prueba DEM tras la terapia oculomotora, lo que refleja una mayor optimización y precisión del seguimiento sacádico en el tiempo tras la terapia. Deberá considerarse la prueba DEM como una prueba clínica para valorar el rendimiento del seguimiento sacádico global en la población de DCA. Keywords: Traumatic brain injury (TBI), Cerebral vascular accident (CVA)/stroke, Developmental Eye Movement (DEM) test, Eye movements, Neuro-optometric rehabilitation, Palabras clave: Daño cerebral traumático (DCT), Accidente cerebro-vascular (ACV)/ictus, Prueba DEM (Developmental Eye Movement), Movimientos oculares, Rehabilitación neuro-optométric

Liver environment and HCV replication affect human T-cell phenotype and expression of inhibitory receptors

There is an unclear relationship between inhibitory receptor expression on T cells and their ability to control viral infections. Studies of human immune cells have been mostly limited to T cells from blood, which is often not the site of infection. We investigated the relationship between T-cell location, expression of inhibitory receptors, maturation, and viral control using blood and liver T cells from patients with hepatitis C virus (HCV) and other viral infections

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

BACKGROUND: Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. OBJECTIVE: To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. METHODS: On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. RESULTS: A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. CONCLUSION: Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments