Name: Vision Training Methods for Sports Concussion Mitigation and Management (Video) | JoVE Journal
Uploaded: 2015-05-05T14:00:00.000+00:00
Duration: 12 min 54 s
Description: Learn vision training methods for sports concussion mitigation using touch responsive lightboards and quantitative monitoring. This protocol enhances eye-hand coordination and visual processing in athletes.

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5 minutes

This work was supported, in part by the NIBIB (EB007954) and a charitable donation from Geraldine Warner.

The protocol described below has components of a vision training program that is a part of the baseline testing performed on all UC athletes. Some of the components have been studied in research trials and in these instances the protocols were approved by the UC Institutional Review Board and the subjects signed informed consent statements.
1. Light Board Vision Training
It takes about 8 min to complete this training.
<ol>
	<li>*A Program8-11
	<ol>
		<li>Direct the subject to stand about 18 inches away from the light board and have the subject try to reach the lights in the outer ring. Move the subject closer or farther away if needed in order to reach all of the lights. Additionally, move the light board up and down using a power switch on the side so the subject is at eye-level with the screen in the board. 
		Have the subject stand in a ready position to be able to hit the lights. Have the subject hold his/her hands up to chest level to position the hands in the center of the rings.</li>
		<li>Instruct the subject to hit the lights using both hands as fast as possible and deactivate as many as possible in one minute. Each light will remain illuminated until hit. 
		Note: When a subject successfully hits a light there is a beep that they can hear in addition to the light turning off.</li>
		<li>Have the clinician select the *A program and have the subject hit (deactivate) as many lights as possible in one minute. With experience a subject will become comfortable with the menu for the system and be able to start the *A without assistance from the clinician, if desired.</li>
		<li>Record the number of hits per minute for each session to track progress along with the average reaction time in seconds for the hits during the one minute test.</li>
	</ol>
	</li>
	<li>Reaction Test Program11 
	Note: The Reaction Test Program consists of six different tests, three for the right hand and three for the left hand.
	<ol>
		<li>Instruct the subject to select the Reaction Test and hit start. The lights for Test 1R (right hand) will light sequentially three times to show the subject which lights they will be hitting. Once the lights are done flashing in sequence, there will be a light to the right that will be lit for the first test. Four horizontal lights to the left of the center ring are utilized for Test 1R and the four to the right of the center are utilized for Test 1L.</li>
		<li>Instruct the subject to hold down the lit light to the right (with right hand) and stand in front of and in the middle of the row of lights that lit up during the demonstration. Have the subject hold the left hand behind his/her back.</li>
		<li>Have the subject scan the four horizontal lights that light up during the demonstration sequence. One of the four lights will come on randomly within five seconds. The distance between each light in the horizontal row is 14 inches. Have the subject move the right hand from the initial light to the reaction light as quickly as possible and deactivate it (Figure 1A-C).</li>
		<li>Once the subject completes a pre-determined number of hits, typically 5 times, instruct him/her to press the GREEN light at the bottom of the inner ring of lights. This will show the subject which lights for the next test will be involved. When ready, the subject holds down the lit light on the left, holds the right hand behind the back, and follows the above procedures. Point out to the subject to disregard the bottom green light during these tests as it is used to change from one test to another but is not one of the lights to be hit. 
		Note: Tests 1R and 1L involve a linear random target switch. Tests 2R and 2L are again random, unknown targets, which will appear along an arc in one of eight different planes. It is the middle ring of lights that is used for Test 2R and 2L. Tests 3R and 3L are a simple one light choice using the lights to the right and left of the t-scope.</li>
		<li>Record the average reaction time for each Test plus an overall Reaction Time.</li>
	</ol>
	</li>
	<li>Concussion 1-3 Programs (novel programs developed by author JFC). 
	Note: The three programs are designed to be performed in sequence. The learning effect is seen in normal individuals. However, in concussion patients the learning effect is not seen and is considered as diagnostic for concussion. These programs are used for testing, not training. For the concussion testing the Dynavision *A and Dynavision Reaction Test can be used for baseline assessments. The three concussion tests are also used for concussion assessment but are generally not done by subjects in advance. The three concussion tests are designed to be multi-tasking and executive function tests that the subjects have not seen before7.
	<ol>
		<li>Conduct the Concussion 1 program, a one minute test that uses only the middle three concentric rings. The test is similar to the *A test, except the subject has single digit numbers (random numbers 1 through 9) flashing on the programmable screen for one second at eight second intervals. Ask the subject to read the numbers flashed on the screen out loud to the tester while still hitting the buttons that are lighting. The resultant score is the number of hits per minute and a report of missed numbers (if any).</li>
		<li>Conduct the Concussion 2 program, which is similar to Concussion 1 in that single digit numbers flash on screen. Instruct the subjects to call out the first number while still hitting buttons, remember it, and then when the second number flashes, add the first and second numbers together and call out the sum of the numbers. The subject continues to hit buttons while calling and adding numbers in pairs.</li>
		<li>Conduct the Concussion 3 program, which is similar to Concussion 2 with one additional task; 20% of the buttons are green. The subject is instructed to hit buttons and add numbers in pairs similar to the instructions in 1.3.2. In addition to those tasks, instruct the subject to hit the green buttons and also call out green. Therefore, there are two speaking tasks, calling green while calling and adding numbers in pairs. This is all done while hitting the both colors of buttons.</li>
	</ol>
	</li>
</ol>
2. Brock&#8217;s String6,10,12
<ol>
	<li>Hold one end of the Brock string on the tip of the subject&#8217;s nose while the other end is tied to a fixed point. The fixed point can be horizontal, elevated or declined with respect to the height of the nose point. Neutral is straight ahead (horizontal). The up or down angle should not be more than 45&#176; in either direction. Initially the string is held in the horizontal position and then typically the elevation is progressed from 10&#176; to 25&#176; to 45&#176; over a time frame where the tasks are challenging but still comfortable. With some people who have prominent noses or eye brows there may be anatomic limitations that need to be observed.</li>
	<li>Space the five colored beads on a length of string at least 12 inches apart starting about 10 inches from the nose. Instruct the subject to alternate &#64257;xation and focus from one bead to the next while noting the visual input of each eye and sensation of convergence (formation of an image at a single point). A measurement is not recorded as this is used as an exercise instead of a test.
	<ol>
		<li>Vary the spacing according to subject&#8217;s needs. Needs may be based on sport or task. For example, combat sports such as boxing may need more beads less than 3 feet away, whereas field sports such as football and soccer might need beads around 10 feet (Figure 2A-C).</li>
	</ol>
	</li>
	<li>Alternatively, use a task where the string is six feet and tied off at one end. Many people have a reach from their nose to the tip of their fingers of 4 feet. The farthest bead is placed at the extreme reach of the index finger. The subject touches the bead with his index finger and returns it to the side of the leg, alternating the right and left hands.</li>
	<li>Alternatively, use a wand with tape the color of the ball on the Brock string. Space the tape three inches apart. When performing the exercise, instruct the subject to match the color of the tape on the wand to the color of the ball, calling out each color as he matches ball to tape.</li>
</ol>
3. EYEPORT Training13
<ol>
	<li>For training 1, place alternating red and blue linear lights in the horizontal position and instruct the subject to sit 24 to 30 inches from the system. Have the subject hit the enter button to hear ten beeps and then follow the lights with his/her eyes. When the exercise is over the subject will hear a beep and should then close his/her eyes and rest until the next exercise.</li>
	<li>For training 2, place the linear lights in the vertical position and repeat steps for Exercise 1.</li>
	<li>For training 3, rotate the linear lights to the left from the vertical position and repeat steps for Exercise 1. Rotation is done in stages through 360&#176;. Common stages are 20 degrees at a time providing it is comfortable for the subject.</li>
	<li>For training 4, rotate the linear lights to the right from the vertical position and repeat steps for Exercise 1.</li>
	<li>For training 5, reposition the linear lights so the system touches the end of the subject&#8217;s nose. Instruct the subject to follow the lights from near to far and far to near. 
	Note: Instruct the subject to rest after each exercise before going to the next one. A measurement is not recorded as this is used as an exercise instead of a test.</li>
</ol>
4. Accommodative Flippers
<ol>
	<li>Allow the subject to wear his/her habitual prescriptions. Perform all training binocularly. The power of the flipper lenses used is varied to optimize the training effect. The two powers used should be challenging but not onerous to focus on an object as the flippers are alternated.</li>
	<li>Instruct the subject to hold a 10 x 10 saccades chart at 14 inches from the spectacle plane.</li>
	<li>Instruct the subject to read from left to right while moving the flippers up and down repeatedly. The flippers are moved only after the subject can focus on and read the saccade card.</li>
	<li>Test for one minute or until the 100th character is reached.</li>
	<li>Count and record the number of characters read in the one minute or note the time it takes to read 100.</li>
</ol>
5. Tachistoscope
Note: This training uses a PowerPoint presentation designed by author J Clark.
<ol>
	<li>Have the subject watch the timed presentation and make note of one or two specific bits of information based on questions posed after the flash. Typically several subjects can work on the projected tachistoscope training simultaneously.</li>
	<li>As the flashed pictures have numbers and or letters randomly distributed throughout the pictures, have the subject note the numbers/letters. Also, ask additional questions such as player numbers from the photos, teams being played, etc.</li>
	<li>Make the tachistoscope training progressively more complicated, by making the flash time shorter and/or the information to be obtained more complicated. (Figure 3A and B). The percentage of questions answered correctly can be recorded.</li>
</ol>
6. Pinhole Glasses or Strobe Glasses with Pitch and Catch
<ol>
	<li>Give groups of subjects, typically two to six subjects, with 1 or 2 balls, pinhole glasses (Figure 4A) or strobe glasses (Figure 4B) and advise to throw the ball(s) around for approximately 2-5 min per session. (Figure 4C and 4D) Two to three sessions per week can be performed.</li>
	<li>If strobe glasses and pinhole glasses are available, have subjects rotate strobes and pinhole glasses every minute or two. Strobe glass flash speeds start at the faster speeds and are slowed to make the tasks more challenging. Current strobe glasses have 8 speeds so typical starting speeds are 1 or 2, and are slowed to speeds 4 to 6.</li>
	<li>Progress through the pitch and catch tasks throughout the sessions by varying the speed of the flash with the strobes or narrowing the visual field of the pinhole glasses.</li>
	<li>Also, make the pitch and catch routines more complicated by having subjects turn away from their partner and having to turn and catch. A measurement is not recorded as this is used as an exercise instead of a test.</li>
</ol>
7. Saccadic Eye Movement Training6,10,14
<ol>
	<li>Position the subject eight feet away from the saccadic eye charts and centered between two saccadic charts, which are positioned about eight feet from the center line. Prior to beginning the exercise, ensure that the subject has full range of eye motion in order to see all letters on the saccadic chart. Adjust the distance from the charts accordingly to gain full vision of the chart. 
	Note: It is important to change distances to add a dynamic component to the accommodative systems and therefore subjects are asked to stand 8 feet away as opposed to the 18 inches used for light board training. There are vision training programs out there that use only a computer and computer screen and do not exercise the accommodative systems. So vary the lengths at which the tasks are performed. Each saccadic chart is constructed on an 8.5 x 11 inch sheet of paper. Each chart has 10 letters in a 36 point font per vertical line with 10 vertical lines on the chart (Figure 5).</li>
	<li>Instruct the subject to read the charts for one minute each while keeping his/her head still and only moving his/her eyes. Ask the subject to read the first letter on the first line on the first chart and then alternate to the second chart to read the first letter of the first line. This completes one cycle.</li>
	<li>Instruct the subject to read the second letter of the left chart followed by the second letter of the right chart. This completes another cycle. Alternate between charts and letters progressing across the line horizontally. As the subjects complete the first line on both charts, instruct them to move to the next line, etc., for one minute. Record the number of cycles completed in the one minute.</li>
	<li>Place the charts at eye level and distance them six feet apart. A progression of this training exercise includes using unstable surfaces and varying placement of the charts to enhance eye speed and visual focus.</li>
</ol>
8. Near Far Training6,10,14
<ol>
	<li>Utilize two charts for this exercise - a large chart and a smaller one. Use the saccadic eye chart for the large chart. Construct the small chart on a 3.5 x 2.5 inch sheet of paper where there are 10 letters in a 12 point font per vertical line with 10 vertical lines on the chart.</li>
	<li>Fix the far chart at eye level with the subject positioned 10 feet from the chart. Have the subject hold the near chart with one hand approximately 4-6 inches from the nose. This allows the subject to see over the near chart to see the far chart (Figure 6A).</li>
	<li>Instruct the subject to keep his head still and only move the eyes. Ask the subject to read the first letter on the first line of the far chart and then alternate to the near chart to read the first letter of the first line. This completes one cycle (Figure 6B and 6C).</li>
	<li>Have the subject scan the eyes to read the second letter of the far chart followed by the second letter of the near chart. This completed another cycle.</li>
	<li>Instruct the subject to alternate between charts and letters progressing across lines horizontally. As the first line on both charts is completed, have the subject move to the next line until the time expires for the one minute session. Record the number of cycles completed in the one minute.</li>
	<li>Instruct the subject to be sure that both eyes come into focus on the near target as well as the far target when alternating from chart to chart.</li>
</ol>
9. Stereopsis
<ol>
	<li>Place polarizing glasses on the subject and ask if &#8220;the Stereo Fly&#8217;s wings appear to be standing up at them and in three dimensions?&#8221;</li>
	<li>Instruct subjects to observe the Stereo Fly at a distance of 14 inches from their nose. If the response is positive, instruct subjects to &#8220;reach out and point with a pen to the Stereo Fly&#8217;s right wing tip and to hold that position&#8221; (Figure 7A).</li>
	<li>Record the distance between the photo and the center of the pinch with a millimeter ruler (Figure 7B). 
	Note: The higher the number, in mm, is indicative of better stereopsis when measured on the Stereo Fly15. Based on our experience we have found that 85 mm appears to be the upper limit of the distance from the photo to the center of the pinch3.</li>
</ol>

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<li>Zupan, M., Wile, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Eyes+on+the+prize%5BTitle%5D)+AND+%22Training+and+Conditioning%22%5BJournal%5D)">Eyes on the prize.</a> Training and Conditioning. 21 (2), 11-15 (2015).</li>
<li>Clark, J. F., Ellis, J. K., Bench, J., Khoury, J., Graman, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((High+performance+vision+training+improves+batting+statistics+for+University+of+Cincinnati+baseball+players%5BTitle%5D)+AND+%22PLoS+ONE%22%5BJournal%5D)">High performance vision training improves batting statistics for University of Cincinnati baseball players.</a> PLoS ONE. 7 (1), e29109(2012).</li>
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<li>Ramsey, K. See the hit, save the brain game plan at cautious UC. , Available from: 
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<li>Harmon, K. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((American+Medical+Society+for+Sports+Medicine+position+statement%3A+concussion+in+sport%5BTitle%5D)+AND+%22Br+J+Sports+Med%22%5BJournal%5D)">American Medical Society for Sports Medicine position statement: concussion in sport.</a> Br J Sports Med. 47, 15-26 (2013).</li>
<li>Klavora, P., Gaskovski, P., Forsyth, R. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Test-retest+reliability+of+three+Dynavision+tasks%5BTitle%5D)+AND+%22Percept+Mot+Skills%22%5BJournal%5D)">Test-retest reliability of three Dynavision tasks.</a> Percept Mot Skills. 80 (2), 607-610 (1995).</li>
<li>Ghasemi, A., Momeni, M., Jafarzadehpur, E., Rezaee, M., Taheri, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Visual+skills+involved+in+decision+making+by+expert+referees%5BTitle%5D)+AND+%22Percept+Mot+Skills%22%5BJournal%5D)">Visual skills involved in decision making by expert referees.</a> Percept Mot Skills. 112 (1), 161-171 (2011).</li>
<li>Klavora, P., Gaskovski, P., Forsyth, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Test-retest+reliability+of+the+Dynavision+apparatus%5BTitle%5D)+AND+%22Percept+Mot+Skills%22%5BJournal%5D)">Test-retest reliability of the Dynavision apparatus.</a> Percept Mot Skills. 79 ((1 Pt 2)), 448-450 (1994).</li>
<li>Schwab, S., Memmert, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+impact+of+a+sports+vision+training+program+in+youth+field+hockey+players%5BTitle%5D)+AND+%22J+Sports+Sci+Med%22%5BJournal%5D)">The impact of a sports vision training program in youth field hockey players.</a> J Sports Sci Med. 11, 624-631 (2012).</li>
<li>Somers, W. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Estimation+of+the+stereoscopic+threshold+utilizing+perceived+depth%5BTitle%5D)+AND+%22Ophthal+Physiol+Opt%22%5BJournal%5D)">Estimation of the stereoscopic threshold utilizing perceived depth.</a> Ophthal Physiol Opt. 4 (3), 245-250 (1984).</li>
<li>Bigsby, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effects+of+postural+control+manipulation+on+visuomotor+training+performance%3A+comparative+data+in+healthy+athletes%5BTitle%5D)+AND+%22Int+J+Sports+Phys+Ther%22%5BJournal%5D)">Effects of postural control manipulation on visuomotor training performance: comparative data in healthy athletes.</a> Int J Sports Phys Ther. 9 (4), 436-446 (2014).</li>
<li>Wells, A. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Reliability+of+the+Dynavision+D2+for+Assessing+Reaction+Time+Performance%5BTitle%5D)+AND+%22J+Sports+Sci+and+Med%22%5BJournal%5D)">Reliability of the Dynavision D2 for Assessing Reaction Time Performance.</a> J Sports Sci and Med. 13, 145-150 (2014).</li>
<li>Guskiewicz, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((National+Athletic+Trainers%E2%80%99+Association+Position+Statement%3A+Management+of+Sport-Related+Concussion%5BTitle%5D)+AND+%22J+Athletic+Training%22%5BJournal%5D)">National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion.</a> J Athletic Training. 39 (3), 280-297 (2004).</li>
<li>Kuhn, A. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Supervision+and+computerized+neurocognitive+baseline+test+performance+in+high+school+athletes%3A+an+initial+investigation%5BTitle%5D)+AND+%22J+Athl+Train%22%5BJournal%5D)">Supervision and computerized neurocognitive baseline test performance in high school athletes: an initial investigation.</a> J Athl Train. 49 (6), 800-805 (2014).</li>
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<li>Fleisig, G. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Kinetic+comparison+among+the+fastball%2C+curveball%2C+change-up%2C+and+slider+in+collegiate+baseball+pitchers%5BTitle%5D)+AND+%22Am+J+Sports+Med%22%5BJournal%5D)">Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers.</a> Am J Sports Med. 34 (3), 423-430 (2006).</li>
<li>Gray, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((How+do+batters+use+visual%2C+auditory%2C+and+tactile+information+about+the+success+of+a+baseball+swing%5BTitle%5D)+AND+%22Res+Q+Exerc+Sport%22%5BJournal%5D)">How do batters use visual, auditory, and tactile information about the success of a baseball swing.</a> Res Q Exerc Sport. 80 (3), 491-501 (2009).</li>
<li>Kato, T., Fukuda, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Visual+search+strategies+of+baseball+batters%3A+eye+movements+during+the+preparatory+phase+of+batting%5BTitle%5D)+AND+%22Mot+Skills%22%5BJournal%5D)">Visual search strategies of baseball batters: eye movements during the preparatory phase of batting.</a> Mot Skills. 94 (2), 380-386 (2002).</li>
<li>Howard, I. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aHoward%2C+I+%22Perceiving+in+Depth%22">Perceiving in Depth</a>. , Oxford University Press. New York. 978-970 (2012).</li>
</ol>

The authors have nothing to disclose.
The Dynavision D2 may be a tool that clinical practitioners can use to provide added information concerning neurologic health of the athlete with a concussion10,22,23,27. The device does not make the diagnosis but assists the clinician in making a clinical decision by providing objective measures of the performance parameters for that patient or athlete.

Vision training, when initiated as a team wide exercise, decreases the incidence of concussions in those players when compared to players who do not receive the vision training7. Vision training produces functional and performance changes that can be quantitatively monitored to assess the success of the training and can be initiated as part of a sports medical intervention for concussion prevention. Functional changes are changes in the measurement, for example faster reaction times documented during vision tr...

Vision training, including the use of light board vision systems, has gained popularity as a means to improve sports performance1,2. Light board systems are often used for rehabilitation following brain injury2,3 and for sports performance enhancement as part of a vision training regimen1,4,5. Vision training has also been used as a means of injury prevention6.
The University of Cincinnati (UC) Division of Sports Medicine has used a light board vision tool for concussion management, diagnosis, return to play decision making, injury prevention and rehabilitation of athletes and performance enhancement3,5,7. Each athlete has baseline measurements collected at the beginning of the season and these values are used as a part of the concussion management program and specifically for an athlete&#8217;s post-concussion evaluation and treatment. One of the strengths of the tool is the objective data collected: number of hits per unit time, location within the visual field of each hit, average reaction time per hit, multi-tasking drills and temporal output for observing progress.
The UC sports medicine team has used the *A and Reaction Test as part of concussion baseline assessments. Three additional, purpose built, programs are also used for concussion diagnosis. These are called Concussion 1, Concussion 2 and Concussion 3. The 3 concussion tests do not need to be included among the preseason baseline tests, because their differing levels of complexity allow each test result to serve as a reference for the others in the set.
When the programs are complemented with additional vision training methods the athlete gets a thorough training and the clinician obtains a wealth of baseline data in the event of a concussion. Several additional vision training methods complete the comprehensive program: Brock&#8217;s string, EYEPORT training, accommodative flippers, tachistoscope, pinhole glasses or strobe glasses with pitch and catch, saccadic eye movement training, and near far training. This paper presents vision training methods with and without a light board system, normative data for baseline results for Division 1 college football players, and expectations and protocols concerning the use of the vision training protocol as part of a concussion management program.

<table><tbody><tr><td>Dynavision D2</td><td>Dynavision International</td><td></td><td>&lt;a href=&quot;http://dynavisioninternational.com/shop.html&quot;&gt;External Link&lt;/a&gt;</td></tr><tr><td>EYEPORT Vision Training System</td><td>Exercise Your Eyes, Dove Canyon, CA</td><td></td><td>&lt;a href=&quot;http://www.promolife.com/cart/eyeport-vision-training-system&quot;&gt;External Link&lt;/a&gt;</td></tr><tr><td>accommodative flippers</td><td>Various manufacturers</td><td></td><td>&lt;a href=&quot;http://www.amconlabs.com/product.asp?pid=4511&amp;amp;categoryname=&amp;amp;prodCatFrom=206&quot;&gt;External Link&lt;/a&gt;</td></tr><tr><td>pinhole glasses</td><td>Various manufacturers</td><td></td><td>&lt;a href=&quot;https://www.bernell.com/product/394/335&quot;&gt;External Link&lt;/a&gt;</td></tr><tr><td>strobe glasses - Nike Sparq</td><td>Nike&amp;nbsp;</td><td></td><td>&lt;a href=&quot;http://palmensports.com/order-the-nike-sparq-vapor-strobes-eyewear/&quot;&gt;External Link &lt;/a&gt;</td></tr></tbody></table>

vision training methods for sports concussion mitigation and management

Vision Training Methods for Sports Concussion Mitigation and Management

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool and potentially as a supportive component to concussion prevention strategies. This paper is focused on providing detailed methods for select vision training tools and reporting normative data for comparison when vision training is a part of a sports management program. The overall program includes standard vision training methods including tachistoscope, Brock&#8217;s string, and strobe glasses, as well as specialized light board training algorithms. Stereopsis is measured as a means to monitor vision training affects. In addition, quantitative results for vision training methods as well as baseline and post-testing *A and Reaction Test measures with progressive scores are reported. Collegiate athletes consistently improve after six weeks of training in their stereopsis, *A and Reaction Test scores. When vision training is initiated as a team wide exercise, the incidence of concussion decreases in players who participate in training compared to players who do not receive the vision training. Vision training produces functional and performance changes that, when monitored, can be used to assess the success of the vision training and can be initiated as part of a sports medical intervention for concussion prevention.

Baseball, football and volunteer subjects have participated in the vision training program. All subjects have been college age men or women, between the ages of 18- and 26 years-old.
Football
The average *A score for 101 UC Football players the first time they performed it was 74.2 ± 10.3 hits per min (hpm) and the average Reaction Test time for their first time performing it was 0.34 ± 0.03 sec (n = 79, note not all 105 players had a chance to complete the Reaction...

This paper describes a protocol to conduct, quantitatively monitor, and assess the success of vision training initiated as part of a sports medical management program including intervention for concussion prevention and performance enhancement.

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool ...

The overall goal of these training methods are to improve eye coordination, eye hand coordination, and eye brainin processing of visual information. Improving the processing of visual information from the periphery is often encouraged by coaches, by advising, use your peripheral vision but without a method to improve that performance. However, by implementing training tools like a touch responsive lightboard reaction, time to peripheral events can be improved.This video demonstrates several such methods and shows how these methods can also be used in sports medical intervention for concussion prevention. So vision training is brain training. 85%of the sensory information that comes into the brain comes from the visual system.The main advantage of our training method is that we integrate all the main tasks that the eyes do for the brain, such that the brain gets more and better information faster and then can use that information better and more effectively. So visually demonstrating how to do the vision training is critical. cause without seeing how to do this, you'll miss, many people will miss the little nuances of what I discipline is when the eyes are actually engaged and not engaged.People can call numbers and people can call colors of balls, but are they actually seeing and taking that information in? cause when the eyes are working and you see the eyes are working, then you can take the next step and make sure that the brain is getting that information from the eyes. So demonstrating how to run and perform these tasks.We have two athletes. We have Carly Hassel Feld, who is a recreational athlete, and we also have Robert Hassel Feld, who is an intercollegiate athlete, a soccer goalie, and they will be performing and demonstrating these vision training tasks. The following program takes about two minutes to complete.First, stand the subject about 18 inches away from the lightboard. Adjust the height of the lightboard. So the screen in the board is about eye level and the central horizontal row of lights is about shoulder level.Next, the subject must reach the lights in the outer ring of the lightboard. Move the subject so the subject can reach all of the lights. Now the subject puts their hands at chest level and prepares to hit the lights using either hand as fast as possible.In one minute, when a light is hit, it will turn off and there will be an accompanying beep. To start the task, select the A star program. With experience, the subjects will be able to start the computer and do the task themselves.Record the number of hits per minute for each session. The reaction test program consists of six tests, three with the right hand and three for the left. Hand select and start the reaction test.The program begins with a demonstration that sequentially illuminates which lights to hit, and then a light to the right is illuminated. To begin, the subject holds down the lit light with the right hand stands directly behind the lights that light up and puts their other hand behind their back. Now the subject scans the lights that were just lit up and prepares to press those buttons as they randomly light up as quickly as possible.After going through the predetermined sequence, usually five times press the green light at the bottom of the inner ring of lights to start the next test. Next the subject is shown the involved lights by a flash sequence. Then when ready, the subject should hold down the lit light on the left side and put their right hand behind their back.The next two tests use lights along the arc of the middle ring and the last two tests Utilize the light to the left and right of the T scope record the average reaction time for each test, plus the overall reaction time, which is calculated by the computer and shown on the home screen. So concussion programs one through three are a series of multitasking, multifactorial one minute programs that get more complicated. We use these to help diagnose and manage concussion patients.A normal patient will often get better with the three tasks because there's a practice effect. The concussion patient, however, will often get frustrated, will not be able to multitask and start to do more poorly. As the task progresses and gets more complicated.That decrease in performance is actually diagnostic and very indicative of a person having a concussion In preparation. The previously described tests should be used for training and making a baseline assessment. Now begin with the concussion.One program, which is a one minute test that uses only the middle three concentric rings. It is like the A star test, except that the subject sees single digit numbers. Flash for one second at eight second intervals on the center screen, the subject must read the numbers flashed on the screen out loud while also pressing the buttons that are lighting up.The resultant score is the number of hits per minute and a report of any missed numbers. For concussion two program, the same single digits flash on screen and for each pair of numbers. The second number is added to the first Five 14.The subject should still hit the lit button as well. For the third program, the task builds from the second program by making 20%of the buttons green. Now the subject must also call out green when hitting a green button.In addition to calling out the paired summation of the numbers, green nine Green 17 use Brock's string as a training method, not a test. The subject holds one end of the string to the tip of his or her nose while the other end is tied to a fixed point. Initially, the string is straight ahead and can be angled up or down when progressing the exercise.Meanwhile, the head is kept straight ahead. The steeper the angle, the more challenging the task. Next spread five colored beads that are threaded on the string along the string at least 12 inches apart.Starting about 10 inches from the nose, instruct the subject to alternate fixation and focus from one bead to the next. While noting the visual input of each eye convergence should occur and be verified by the instructor. This is done for one minute at a time.Vary the spacing as needed to facilitate the exercise. For combat sports like wrestling, it may require beads less than three feet away. Whereas for field sports space, the beads up to 10 feet away position the subject eight feet from the psychotic eye charts centered between two psychotic charts, eight feet apart.Each psychotic chart is constructed on an 8.5 by 11 inch sheet of paper. Each chart has a 10 by 10 grid of letters in a 36 point font per vertical line with 10 vertical lines on the chart. Adjust the chart's position so it is legible.Then let the subject read it for one minute, staying still after a minute. The subject reads aloud the first letter on the first line of the first chart. And then on the second chart, the subject then reads aloud, the second letter on the first chart, and then the second letter on the second chart and so forth.Record the number of letter pairs the subject can read in one minute. For the next phase, put one chart on the floor and one eight feet high and repeat the training. To progress this training, introduce unstable standing surfaces and continue to vary.Placement of the charts across the midline data was collected from 63 football players who trained on the lightboard for three or more years. Outer rings were hit more slowly than inner rings. The peripheral vision reaction score is a ratio of the mean reaction time of the outer two rings compared to the inner three rings.Using data from 10 players who took part in four years of training the time to hit different rings was compared at the start of vision training prior to the pre-season. Across the four years, sustained benefits to the training are apparent By the fourth year, 20 non-football playing volunteers. 10 of each sex participated in concussion program measurement.With the increased multitasking of the concussion tests, there was no significant decrement in performance. From January of 2011 to May of 2013, the hitters of the Division one baseball team at the University of Cincinnati underwent 20 minute training sessions twice per week on the off season and once per week. In season stereos, a component of depth perception consistently increased from 22 to 25 millimeters to 45 to 50 millimeters over the course of a training season.Once the methods are mastered where the person doesn't need repeat instructions, they can do this whole series of events in 15 minutes. And that training can be done 15 minutes once or twice a week over about four or six weeks. It shouldn't be done all at once.You need the time over four to six weeks to actually develop the benefit from the training. After watching this video, you should be able to stand next to an athlete and instruct that person on performing these vision training techniques. You should be able to watch them and make sure that they're doing them correctly and when they are done correctly, they athlete will be able to perform those tests quickly and appropriately and with training their performance on the field or whatever their sport is will improve and their abilities to compete will get better.

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Research

JoVE Journal

Behavior

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Modified Drop Tower Impact Tests for American Football Helmets

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Revised and Neuroimaging-Compatible Versions of the Dual Task Screen

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Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury

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Impact Mitigation in Modern Football Helmets: Advances and Limitations of Position-Specific Designs

Learn vision training methods for sports concussion mitigation using touch responsive lightboards and quantitative monitoring. This protocol enhances eye-hand coordination and visual processing in athletes.

Vision Training Methods for Sports Concussion Mitigation and Management

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