what is near point of convergence

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Therapy also improved symptoms, verbal memory, balance, and other visual measures.50 Most studies used a combination of office-based therapy and home reinforcement. In visual perception, the near point is the closest point at which an object can be placed and still form a focused image on the retina, within the eye's accommodation range. Near point - Wikipedia PubMed ID: 26444405 doi:10.1055/s-00000071, Scheiman M, Gallaway M, Frantz KA, etal. 2015;35(5):599606. PubMed ID: 29864101 doi:10.1097/NPT.0000000000000230. Physiology The coordinated turning of the eyes inward to focus on an object at close range. Near point of convergence (NPC) - measurement of the point where the visual axes intersect under the maximum effort of the convergence. var doi = encodeURIComponent(document.querySelector('meta[name="citation_doi"]').content); PubMed ID: 28511593 doi:10.1177/0363546517705640, Thiagarajan P, Ciuffreda KJ, Cap-Aponte JE, Ludlam DP, Kapoor N. Oculomotor neurorehabilitation for reading in mild traumatic brain injury (mTBI): an integrative approach. Visual dysfunctions and symptoms during the subacute stage of blast-induced mild traumatic brain injury. Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study. This is a well-known property of several important economic applications: For example, under sequential social learning, later agents' actions reveal less and less about their private information, as they increasingly base their action If there was not sufficient information in the title and abstract to determine whether or not inclusion criteria were met, a full-text evaluation was performed. Brain Inj. Several studies have demonstrated that CI is treatable in an otherwise healthy population through vision therapy.2426 These findings cannot be directly applied to a concussed population, because CI following concussion appears to be due to a different mechanism.27 Therefore, it is important to determine if oculomotor or vision therapy is effective in improving convergence in patients with receded NPC following concussion. 2017;7(9):119. PubMed ID: 25820456 doi:10.1007/s40279-015-0325-8, Kontos AP, Sufrinko A, Elbin RJ, Puskar A, Collins MW. Please enable it to take advantage of the complete set of features! Now the eyes diverge, accommodation is inhibited, and the . None of the studies were double blinded, and very few studies (n=3) were single blinded. Validity and reliability of the revised convergence insufficiency symptom survey in children aged 9 to 18 years. In order to aid in interpretation and clinical implications of findings, future studies should specify the target type and methods used for the assessment of NPC. Near Point of Convergen ce Definition: Convergence Is the only disjunctive movement that is under conscious control. PubMed ID: 25314613 doi:10.3109/02699052.2014.965207, Collins MW, Kontos AP, Reynolds E, Murawski CD, Fu FH. PubMed ID: 27391530 doi:10.1097/OPX.0000000000000910, Returning to learning following a concussion, . PubMed ID: 28742610 doi:10.1097/JSM.0000000000000439, Post-concussion: receded near point of convergence is not diagnostic of convergence insufficiency, . It was three days jam-packed with riveting keynotes, inspiring speakers and boisterous parties. Longitudinal changes in oculomotor function in young adults with mild traumatic brain injury in Sweden: an exploratory prospective observational study. The following studies did not report means or SDs: Connolly and Lyon,39 Scheiman etal,24 and Thiagarajan and Ciuffreda.43,44 For all included studies, NPC was significantly better (smaller) following vision therapy. 2016;55(3):260267. Methods: In this cross-sectional study, samples were randomly selected from the population of Mashhad city in the northeast of Iran through stratified cluster sampling. NeuroRehabilitation. PubMed ID: 26156977 doi:10.1177/0009922815594367, The concussion toolbox: the role of vision in the assessment of concussion, . Its assessment is widely used in clinical practice, as a remote NPC value is the sign most frequently used by optometrists for the diagnosis of convergence insufficiency (Rouse, Hyman, & CIRS Study Group, 1997). The near point of convergence (NPC) subjectively evaluates the ability to comfortably, efficiently and binocularly converge one's eyes to a punctum proximum of convergence. It also has the name of the accommodation-convergence reflex or the near reflex. Abbreviations: BESS, Balance Error Scoring System; CISS, Convergence Insufficiency Symptom Survey; mTBI, mild traumatic brain injury; NCAA, National Collegiate Athletic Association; NPC, near point of convergence; mTBI, mild traumatic brain injury; VOMS, Vestibular/Ocular-Motor Screening. PubMed ID: 29190849 doi:10.1055/s-0043-118339, Hellerstein LF, Freed S, Maples WC. For example, college athletes typically recover from sport-related concussion in about 7 days, while high school athletes typically recover in 15 days.49 Therefore, referral should be considered sooner for college athletes. To diverge, the opposite of the near triad must occur. A brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. 2013;132(5):948957. The majority of the articles satisfied the requirements for selection bias, study design, confounders, and data collection. 2018;183(suppl 1):917. Near point of convergence - Gold Standard eye examination - 1Library J Optom Vis Perform. By school age, a child should be able to appreciate 20 seconds of arc. A total of 18 studies met the inclusion criteria for this review; 11 articles assessed the effects of concussion/mTBI on NPC break and 7 articles addressed the effect of oculomotor or vision therapy on NPC break measurements in concussion/mTBI patients. Therefore, the findings from studies with lower levels of evidence need to be cautiously evaluated, before they are implemented into clinical practice. Have them touch the target with a finger to see if convergence improves. Two reviewers (A.L.S. Office-based treatments are typically administered by a vision therapist (O.D., M.D., orthoptists, or vision therapytrained technicians) and often includes the use of Brock Strings, Barrel Cards, Vectograms, and Life-Saver cards.26 Home-based therapy is often prescribed by optometrists and ophthalmologists, and it provides a cost-effect option.53 Home-based therapies typically include simple exercises, such as pencil push-ups and computer-based software. belief convergence vanishes near point-mass beliefs. Study with Quizlet and memorize flashcards containing terms like What is convergence?, What 4 components is convergence driven by?, What is near point of convergence? Is performance on NPC break negatively affected in patients diagnosed with a concussion compared to pre-injury levels or healthy control participants? There is moderate evidence that clinicians should implement NPC as part of a visual screening following concussion. In patients diagnosed with concussion, what is the effect of oculomotor or vision therapy on NPC break measurements? 3. PubMed ID: 13444415 doi:10.1016/0002-9394(57)90012-0, Cap-Aponte JE, Urosevich TG, Temme LA, Tarbett AK, Sanghera NK. Sports; Study; Study: Chronic Cannabis Use Shows Promise to Prevent Brain Damage in Athletes. 2015;43(12):30553061. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. PDF Near Point of Convergence Decits and Treatment Following Concussion: A It is a fusional movement that may be stimulated by volition, disparate stimulation, and accommodation. J Rehabil Res Dev. [ 11 ] Meta-analyses were not performed, because studies were heterogeneous in sample (participant age and general characteristics) and methodology. Near Point of Convergence after Concussion in Children. This review evaluated the available literature on the effect of concussion on NPC break measures and the effect of oculomotor or vision therapy on NPC break measurements. Epub 2019 Apr 17. Conclusion: Interventions such as oculomotor therapy with a focus on vergence could promote recovery in concussed individuals. Convergence dysfunction is treatable in otherwise healthy patients; the effectiveness of oculomotor therapy following concussion is unclear. It is possible that a baseline postinjury comparison would be more accurate than clinical cutoffs at diagnosing deficits in athletes. At the conclusion of the search, duplicates were removed. Four studies did not specify how long following injury the assessments were conducted. PubMed ID: 28742610 doi:10.1097/JSM.0000000000000439, Raghuram A, Cotter S, Gowrisankaran S, etal. PubMed ID: 29635578 doi:10.1093/milmed/usx172, Thiagarajan P, Ciuffreda KJ. 11 The results suggest that individuals have impaired NPC following concussion, and that vision therapy improves NPC in concussion patients. Neurobehavioral concomitants of chronic post-concussion syndrome. The NPC values of concussed participants mentioned in this review ranged from 5.3733 to 13.98cm,37 indicating that the scores were considered abnormal in all of the studies. The act, condition, quality, or fact of converging. 2003;74(1):2534. Toronto, ON: Effective Public Health Practice Project; 2003. Determining Near Point of Convergence: Exploring a Component of the Given the available evidence, we conclude that NPC should be included as an assessment following concussion in order to determine the patients who need referral for further evaluation and may benefit from vision or oculomotor therapy to promote recovery. [4,5,6,7] The near point of convergence (NPC) is an indicator for the diagnosis of CI and is a good measure for differentiating symptomatic from asymptomatic cases. 2015;45(6):893903. Convergence dysfunction is treatable in otherwise healthy patients; the effectiveness of oculomotor therapy following concussion is unclear. Abstract: RAF near point rule (RNPR) is a routinely used instrument in ophthalmology and optometry practice as well as for research purposes to measure the near point of convergence (NPC). A Framework to Advance Biomarker Development in the Diagnosis, Outcome Prediction, and Treatment of Traumatic Brain Injury. Kontos etal41 prescribed targeted therapies based upon the patients deficits, and included behavioral, vestibular, vision, and exertion therapies. MeSH All of the means presented for NPC during initial assessments following injury were abnormal (>5cm). doi:10.1136/bmj.321.7259.504. The patient population should be considered when determining the timing of referral. The near point of convergence (NPC) is the nearest point on which the eyes can converge (Scheiman & Wick, 2014). 4. The overall rating of evidence for the clinical recommendations presented in this paper based on GRADE is low to moderate. Reduced NPC Second, people who suffer from convergence insufficiency have a reduced near the point of convergence (NPC). 2015;22(1):97102. Even though NPC improved, the posttreatment NPC measures in studies that reported NPC measurements were still considered abnormal (>5cm) in 3 of the studies4143 and normal (5cm) in 3 of the studies.24,39,40 The lengths of the interventions were not specified in many of the studies; those that reported information had total interventions lasting from 9 hours over 6 weeks of therapy42 to 12 to 20 hours over 12 weeks of therapy.24, Summary of Studies Examining the Effect of Oculomotor of Vision Therapy on NPC Break Measurements in Concussion Patients. J Eval Clin Pract. For all included studies, NPC was significantly better (smaller) in the control group. The distance measured from the target to the patients nose when it appears double or exophoria is noticed and recorded as the NPC break. 2014;28(7):930943. Study selection process. doi:10.7205/MILMED-D-12-00061, Goodrich GL. BMJ Best Pract. Trajectories of Visual and Vestibular Markers of Youth Concussion. Incidence of Remote Near-Point of Convergence in University Athletes After Sport-Related Concussion. Effectiveness of computerized oculomotor vision screening in a military population: pilot study. 2018;39(2):141147. This site needs JavaScript to work properly. TBI is common in sports and can be difficult to diagnose. Follow-up assessments occurred from 1-week postinjury to 10-month postinjury. Jump convergence - assessment of the convergence quality of fixation when moving quickly from distance to the near target. Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Context: Although all of the studies demonstrated an improvement in NPC values following therapy, the mean NPC values were still considered abnormal in several studies.24,40,51 Thiagarajan and Ciuffreda44 suggests that the oculomotor therapy needs to be longer in order for scores to normalize. Therefore, it has been suggested that clinicians should use vision or oculomotor assessments to aid in the diagnosis and treatment of concussion.7. PubMed ID: 27505624 doi:10.1097/OPX.0000000000000935, Kontos AP, Collins MW, Holland CL, etal. While the results of this systematic review are promising, showing that impaired NPC following concussion can be improved through oculomotor therapy, more research in this area is needed. PDF Nearpoint of Convergence: Test Procedure, Target Selection, and J Athl Train. Nearpoint of Convergence: Test Procedure, Target Selection, and to save searches and organize your favorite content. Similarly, a test battery of NPC, and number of symptoms following the rapid eye horizontal, optokinetic stimulation, and gaze stabilization tests differentiated between healthy and concussed athletes with an accuracy of 90%.33 Additionally, the Vestibular/Ocular-Motor Screening, which includes NPC, demonstrated internal consistency and sensitivity in identifying concussion patients.7 This suggests that while NPC is a very valuable concussion assessment, clinicians should continue to use a multifaceted approach that incorporates multiple systems of the body. Near Point of Convergence Test: Diagnosing Convergence - YouTube Focus on the Near Point of Convergence. 2019. https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/. {\displaystyle {\frac {1}{11\ {\text{cm}}}}=9\ {\text{diopters}}} Optom Vis Sci. BMC Neurol. This systematic review is not without its limitations. Near point of convergence after concussion in children. PubMed ID: 27391530 doi:10.1097/OPX.0000000000000910, Halstead ME, Mcavoy K, Devore CD, Carl R, Lee M, Logan K. Returning to learning following a concussion. We limited extraction and presentation of the outcomes to those that fit the clinical questions of interest for this review. Arbogast KB, Ghosh RP, Corwin DJ, McDonald CC, Mohammed FN, Margulies SS, Barnett I, Master CL. Conclusions: CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. For example a normal eye would have a near point of GRADE has 4 levels of evidence, including very low, low, moderate, and high.30 Levels of evidence were agreed upon by 2 reviewers. Convergence Insufficiency - EyeWiki Only the studies that reported means and SDs pretreatment and posttreatment were included, as mean difference could otherwise not be calculated. [1] The near point is highly age dependent (see accommodation). Convergence insufficiency identifies athletes at risk of prolonged recovery from sport-related concussion. It is suggested that a history of ocular motor dysfunction, such as nystagmus or strabismus may be risk factors for poor outcomes following concussion.5 Therefore, future studies should take these potential confounding variables into account when evaluating NPC postconcussion. Near point of convergence norms measured in elementary school - PubMed 2019;206:235244. While the results of the review are promising, there is a lot of heterogeneity in the patient populations and methodology in the studies included in this review. You can help Wikipedia by expanding it. Epub 2022 Dec 30. Clinical Procedures for Ocular Examination. Near point of convergence (NPC) is a quick and easy assessment that may detect oculomotor dysfunction such as convergence insufficiency (CI), but NPC measurements are rarely reported. What Is Near Point Of Convergence? Convergence Definition & Meaning - Merriam-Webster Some individuals experience lasting impairments, potentially for several years following concussion.2 Unfortunately, there is no gold standard for the assessment of concussion. It is important to identify if impairments in NPC exist following concussion so that patients with receded NPC can be referred to an eye care specialist for further evaluation and possibly treatment. 2017;94(1):7488. Comment on Rauchman et al. Physical Activity and Intermittent Postconcussion Symptoms After a Period of Symptom-Limited Physical and Cognitive Rest. Additionally, one of the articles is a case report, and is therefore a low level of evidence and is not sufficient to generate clinical recommendations. Additionally, the effect of age on NPC measures should be further established. This point is usually 8-10cm from the spectacle plane (Millodot, 2000). A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. doi:10.1001/archopht.126.10.1336, Scheiman M, Mitchell GL, Cotter S, etal. Near Point of Convergence Flashcards | Quizlet Abbreviations: CI, convergence insufficiency; CISS, Convergence Insufficiency Symptom Survey; mTBI, mild traumatic brain injury; NPC, near point of convergence; OMT, oculomotor training; VOMS, Vestibular/Ocular-Motor Screening. Mil Med. Purpose While vision assessments, such as NPC, are starting to be implemented in clinical concussion evaluations, there is little information about how these measures should be used in the evaluation and treatment of concussion. The measurement of NPC is an important criterion for diagnosis and management of convergence insufficiency. HHS Vulnerability Disclosure, Help J Rehabil Res Dev. 2014;22(2):235246. Point of convergence definition in American English | Collins English The site is secure. PubMed ID: 23341281 doi:10.1682/JRRD.2010.07.0129, Visual-vestibular processing deficits in mild traumatic brain injury, . 2007;78(4):155161. 2018;8:e018734. Assessment of study quality for systematic reviews: a comparison of the cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: methodological research. PubMed ID: 25314613 doi:10.3109/02699052.2014.965207, A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion, . The length of reported interventions ranged from 9 to 20 hours over 6 to 12 weeks.24,27 In individuals diagnosed with CI who are otherwise healthy, oculomotor therapy administered over 12 weeks resulted in a normalization of scores.52 This may suggest that receded NPC in concussed patients may be due to a different mechanism than in an otherwise healthy population.27 However, the improvements in NPC following oculomotor therapy were still present 6 months following therapy in concussion patients.44 The persisting effect of oculomotor therapy suggests that mechanisms of neuroplasticity and motor relearning remain intact in concussion patients.44 There are a variety of treatments available for addressing impaired NPC, including both office- and home-based programs. Seven studies evaluated the effect of oculomotor or vision therapy on NPC break measurements in concussion/mTBI patients (Table3). Brain Sci. What is the definition of sports-related concussion: a systematic review. PubMed ID: 27176886 doi:10.1055/s-0042-100470, Szymanowicz D, Ciuffreda KJ, Thiagarajan P, Ludlam DP, Green W, Kapoor N. Vergence in mild traumatic brain injury: a pilot study. 1. Convergence insufficiency is a common problem with the eyes, and is the main culprit behind eyestrain, blurred vision, and headaches. There is some variability in the criteria used for CI, such as measurement parameters of abnormal NPC (eg,>5cm7,14,16,17 vs 17.5cm18). Initial assessments were performed anywhere from 1-day postinjury to 6-month postinjury. NeuroRehabilitation. Matuseviciene etal35 demonstrated a significant improvement in the mTBI group between baseline and follow-up, but no statistically significant difference between or within the control groups. (pnt ) countable noun You use point to refer to something that someone has said or written. 2023 May 1;33(3):258-263. doi: 10.1097/JSM.0000000000001102. 2019 Oct;206:235-244. doi: 10.1016/j.ajo.2019.04.008. and more. PubMed ID: 29635578 doi:10.1093/milmed/usx172, Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury, . Would you like email updates of new search results? Thomas H, Ciliska D, Dobbins M. Quality Assessment Tool for Quantitative Studies. 2008;15(1):2436. Vergence - Wikipedia A corrective lens can be used to correct hyperopia by imaging an object at the typical near point distance D onto a virtual image at the patient's actual near point, at distance NP. Convergence dysfunction following concussion is common. Am J Sports Med. Tagged: Convergence, Near, Point A normal eye is considered to have a near point at about 11 cm (4.3 in) for a thirty year old. The patient or participant sample (number, sex, age, and health status), study design, instrumentation, or intervention used, and main results were extracted from each article. McDevitt etal36 demonstrated that the mean NPC distance was larger in the concussed group compared with the control group, but it was not statistically significant. and more. This article is about a measure of an individual's ability to see close (near) objects as clear and in focus. Identifying domains of impairment following concussion can lead to establishment of targeted active interventions. PubMed ID: 24337463 doi:10.1007/s00167-013-2791-6, Craton N, Ali H, Lenoski S. COACH CV: the seven clinical phenotypes of concussion. The https:// ensures that you are connecting to the 2003;80(3):214225. Norwalk, CT: Appleton & Lange; 1990. Unable to load your collection due to an error, Unable to load your delegates due to an error. The convergence ability should be a part of routine examinations. 2009;44(7):929936. PubMed ID: 28446457 doi:10.1136/bjsports-2017-097699, Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment, . PubMed ID: 24284470 doi:10.3233/NRE-131025, Visual skills of athletes versus nonathletes: development of a sports vision testing battery, Objective assessment of vergence after treatment of concussion-related CI: a pilot study, . J Rehabil Res Dev. PubMed ID: 20698919 doi: 10.1111/jep.2012.18.issue-1, Effectiveness of computerized oculomotor vision screening in a military population: pilot study, Validation of visual objective biomarkers for acute concussion, Concussion recovery phase affects vestibular and oculomotor symptom provocation, . Hutchison MG, Di Battista AP, Pyndiura K, Blanc S, Quaid PT, Richards D. Clin J Sport Med. | Meaning, pronunciation, translations and examples PubMed ID: 12637833 doi:10.1097/00006324-200303000-00011, Adler PM, Cregg M, Viollier AJ, Margaret Woodhouse J. 2016;37(9):738747. The key findings of this systematic review are that concussion patients have impaired NPC acutely following concussion, and oculomotor rehabilitation can improve NPC break measurements in concussion patients. gence the point to which the visual lines are directed when convergence is at its maximum. Pediatrics. Br J Sports Med. Currently, the recommendation is to use a multitude of assessments, including a clinical examination, symptoms, neurocognitive, and balance assessments.3 Several researchers and clinicians have suggested that instead of categorizing concussion as a single diagnosis, health care professionals may be able to identify specific clinical trajectories or subtypes of concussion.46 Proposed subtypes of concussion include cervical, cardiovascular, cognitive/fatigue, mood/affective, headache/migraine, vestibular, and visual/oculomotor.46 In order to identify these various trajectories, a comprehensive evaluation including assessments in several clinical domains must be used. Therefore, only articles published from database inception to April 1, 2019 were included in this review. An official website of the United States government. Objectives: PubMed ID: 25624682 doi:10.4103/0974-9233.148357, Blinding in clinical trials and other studies, https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/, Concussion AND convergence AND rehabilitation or therapy or treatment, Concussion AND vision AND rehabilitation or therapy or treatment, Concuss* AND convergence AND rehabilitation or therapy or treatment, Concuss* AND vision AND rehabilitation or therapy or treatment, Mild traumatic brain injury AND convergence, Mild traumatic brain injury AND convergence AND rehabilitation or therapy or treatment, Mild traumatic brain injury AND vision AND rehabilitation or therapy or treatment, Design: prospective, within-subject, repeated-measures correlational, There was a statistically significant difference between the mTBI group and control group on NPC (, Design: case-control correlational design, Measured using Royal Air Force near point rule, The acute mTBI group had receded NPC compared with controls (, Design: prospective repeated-measures design with a known-groups approach, There were differences between groups on NPC at the initial visit (, Scores at both time points postinjury were significantly worse compared with baseline (, Significant differences were found between the 2 groups in NPC break (, Design: prospective, controlled, observational study, Measured using the push-up method (Royal Air Force ruler), NPC was receded in the mTBI group at baseline and statistically significantly improved at follow-up (, Design: cross sectional with known groups approach, Measured using convergence ruler (Bernell Corporation, Mishawaka, IN), The mean NPC distance was larger in the concussed group compared with the control group, but was not statistically significant (, Participant and examiner were seated, and the participant was focused on small 14-point font target at arms length and slowly bring it toward the tip of nose, The mean NPC distance was significantly greater in the concussed group compared with the control group (, The concussed group with visual symptoms had significantly worse NPC compared with the control group (.

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what is near point of convergence