Functional activity changes after vergence and accommodative rehabilitation of concussion-related convergence insufficiency: CONCUSS clinical trial fMRI results.

Introduction: The CONCUSS clinical trial examined the neural changes associated with office-based vergence/accommodative therapy with movement (OBVAM) in concussion-related convergence insufficiency (CONC-CI). Methods: The following assessments were collected at baseline and post-OBVAM therapy: activity evoked from a functional MRI vergence oculomotor task, near point of convergence (NPC), positive fusional vergence (PFV), vergence facility (VF), and visual symptoms from a sensorimotor vision exam. Fifty-four CONC-CI participants, diagnosed with persisting concussion symptoms between one- and six-months post-injury, were analyzed in group-level results. Results: Functional activity in the vergence oculomotor network, specifically the frontal eye fields, supplemental eye fields, parietal eye fields, cerebellar vermis (CV), and visual cortex, increased post-OBVAM compared to baseline assessments. Significant increases in post-OBVAM compared to baseline assessments were observed in the visual cortex (bilateral V3 and right area PH) and the CV, via a paired t-test with family-wise error corrected for multiple comparisons ( Discussion: Results support that OBVAM improves functional brain activity in CONC-CI correlated with NPC, PFV, and VF.