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>

<ol>
	<li>Vesia, M., Esposito, J., Prime, S. L., Klavora, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correlations+of+selected+psychomotor+and+visuomotor+tests+with+initial+Dynavision+performance.">Correlations of selected psychomotor and visuomotor tests with initial Dynavision performance.</a> Percept. Mot. Skills. 107 (1), 14-20 (2008).</li><li>Zupan, M., Wile, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Eyes+on+the+prize.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High+performance+vision+training+improves+batting+statistics+for+University+of+Cincinnati+baseball+players.">High performance vision training improves batting statistics for University of Cincinnati baseball players.</a> PLoS ONE. 7 (1), e29109 (2012).</li><li>Wilkerson, G. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurocognitive+reaction+time+predicts+lower+extremity+sprains+and+strains.">Neurocognitive reaction time predicts lower extremity sprains and strains.</a> IJATT. 17 (6), 4-9 (2012).</li><li>Clark, J. F., Graman, P., Ellis, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Possible+stereopisis+enhancement+in+collegiate+baseball+players+with+vision+training.">Possible stereopisis enhancement in collegiate baseball players with vision training.</a> Optometry and Visual Performance. 3 (1), (2015).</li><li>Ramsey, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> See the hit, save the brain game plan at cautious UC. , (2014).</li><li>Clark, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+exploratory+study+of+the+potential+effects+of+vision+training+on+concussion+incidence+in+football.">An exploratory study of the potential effects of vision training on concussion incidence in football.</a> Optometry and Visual Performance. 3 (1), (2015).</li><li>Thorpe, S., Fize, D., Marlot, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Speed+of+processing+in+the+human+visual+system.">Speed of processing in the human visual system.</a> Nature. 381 (6582), 520-522 (1996).</li><li>Hayes, A., Chen, C. S., Clarke, G., Thompson, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+improvements+following+the+use+of+the+NVT+Vision+Rehabilitation+program+for+patients+with+hemianopia+following+stroke.">Functional improvements following the use of the NVT Vision Rehabilitation program for patients with hemianopia following stroke.</a> NeuroRehabilitation. 31 (1), 19-30 (2012).</li><li>Harmon, K. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+Medical+Society+for+Sports+Medicine+position+statement:+concussion+in+sport.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Test-retest+reliability+of+three+Dynavision+tasks.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+skills+involved+in+decision+making+by+expert+referees.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Test-retest+reliability+of+the+Dynavision+apparatus.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+a+sports+vision+training+program+in+youth+field+hockey+players.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimation+of+the+stereoscopic+threshold+utilizing+perceived+depth.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+postural+control+manipulation+on+visuomotor+training+performance:+comparative+data+in+healthy+athletes.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+Dynavision+D2+for+Assessing+Reaction+Time+Performance.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=National+Athletic+Trainers&#8217;+Association+Position+Statement:+Management+of+Sport-Related+Concussion.">National Athletic Trainers&#8217; 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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Supervision+and+computerized+neurocognitive+baseline+test+performance+in+high+school+athletes:+an+initial+investigation.">Supervision and computerized neurocognitive baseline test performance in high school athletes: an initial investigation.</a> J Athl Train. 49 (6), 800-805 (2014).</li><li>Reed, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+multi-modal+approach+to+assessing+recovery+in+youth+athletes+following+concussion.">A multi-modal approach to assessing recovery in youth athletes following concussion.</a> J Vis Exp. (91), 51892 (2014).</li><li>Fleisig, G. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kinetic+comparison+among+the+fastball,+curveball,+change-up,+and+slider+in+collegiate+baseball+pitchers.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+do+batters+use+visual,+auditory,+and+tactile+information+about+the+success+of+a+baseball+swing.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+search+strategies+of+baseball+batters:+eye+movements+during+the+preparatory+phase+of+batting.">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://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Perceiving in Depth. , 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 border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Name of Material/ Equipment</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments/Description</td>
		</tr>
		<tr>
			<td>Dynavision D2</td>
			<td>Dynavision International</td>
			<td></td>
			<td><a href="http://dynavisioninternational.com/shop.html">External Link</a></td>
		</tr>
		<tr>
			<td>EYEPORT Vision Training System</td>
			<td>Exercise Your Eyes, Dove Canyon, CA</td>
			<td></td>
			<td><a href="http://www.promolife.com/cart/eyeport-vision-training-system">External Link</a></td>
		</tr>
		<tr>
			<td>accommodative flippers</td>
			<td>Various manufacturers</td>
			<td></td>
			<td><a href="http://www.amconlabs.com/product.asp?pid=4511&amp;categoryname=&amp;prodCatFrom=206">External Link</a></td>
		</tr>
		<tr>
			<td>pinhole glasses</td>
			<td>Various manufacturers</td>
			<td></td>
			<td><a href="http://www.amazon.com/SaveGoodBuy-Exercise-Eyesight-Improving-Glasses/dp/B0090BXVVK/ref=sr_1_1?ie=UTF8&amp;qid=1409165383&amp;sr=8-1&amp;keywords=pinholes+glasses">External Link</a></td>
		</tr>
		<tr>
			<td>strobe glasses - Nike Sparq</td>
			<td>Nike&#160;</td>
			<td></td>
			<td><a href="http://palmensports.com/order-the-nike-sparq-vapor-strobes-eyewear/">External Link </a></td>
		</tr>
	</tbody>
</table>

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 &#177; 10.3 hits per min (hpm) and the average Reaction Test time for their first time performing it was 0.34 &#177; 0.03 sec (n = 79, note not all 105 players had a chance to complete th...

Watch this Scientific Journal Video about Vision Training Methods for Sports Concussion Mitigation and Management at JoVE.com

Vision Training Methods for Sports Concussion Mitigation and Management

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 ...

vision-training-methods-for-sports-concussion-mitigation

Research

JoVE Journal

Behavior

17.3K Views.  University of Cincinnati. 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.

Video: Vision Training Methods for Sports Concussion Mitigation and Management

Combined Shuttle-Box Training with Electrophysiological Cortex Recording and Stimulation as a Tool to Study Perception and Learning

Shuttle-box avoidance learning is a well-established method in behavioral neuroscience and experimental setups were traditionally custom-made; the necessary equipment is now available by several commercial companies. This protocol provides a detailed description of a two-way shuttle-box avoidance learning paradigm in rodents (here Mongolian gerbils; Meriones unguiculatus) in combination with site-specific electrical intracortical microstimulation (ICMS) and simultaneous chronical electrophysiological in vivo recordings. The detailed protocol is applicable to study multiple aspects of learning behavior and perception in different rodent species.
Site-specific ICMS of auditory cortical circuits as conditioned stimuli here is used as a tool to test the perceptual relevance of specific afferent, efferent and intracortical connections. Distinct activation patterns can be evoked by using different stimulation electrode arrays for local, layer-dependent ICMS or distant ICMS sites. Utilizing behavioral signal detection analysis it can be determined which stimulation strategy is most effective for eliciting a behaviorally detectable and salient signal. Further, parallel multichannel-recordings using different electrode designs (surface electrodes, depth electrodes, etc.) allow for investigating neuronal observables over the time course of such learning processes. It will be discussed how changes of the behavioral design can increase the cognitive complexity (e.g. detection, discrimination, reversal learning).

Shuttle-box avoidance learning is well-established in behavioral neuroscience. This protocol describes how shuttle-box learning in rodents can be combined with site-specific electrical intracortical microstimulation (ICMS) and simultaneous chronical in vivo recordings as a tool to study multiple aspects of learning and perception.

Shuttle-box avoidance learning is a well-established method in behavioral neuroscience and experimental setups were traditionally custom-made; the ...

The Social Dimension of Stress: Experimental Manipulations of Social Support and Social Identity in the Trier Social Stress Test

In many situations humans are influenced by the behavior of other people and their relationships with them. For example, in stressful situations supportive behavior of other people as well as positive social relationships can act as powerful resources to cope with stress. In order to study the interplay between these variables, this protocol describes two effective experimental manipulations of social relationships and supportive behavior in the laboratory. In the present article, these two manipulations are implemented in the Trier Social Stress Test (TSST)&#8212;a standard stress induction paradigm in which participants are subjected to a simulated job interview. More precisely, we propose (a) a manipulation of the relationship between different protagonists in the TSST by making a shared social identity salient and (b) a manipulation of the behavior of the TSST-selection committee, which acts either supportively or unsupportively. These two experimental manipulations are designed in a modular fashion and can be applied independently of each other but can also be combined. Moreover, these two manipulations can also be integrated into other stress protocols and into other standardized social interactions such as trust games, negotiation tasks, or other group tasks.

Previous research on the social dimension of stress has focused on two important variables: social identity and social support. This protocol introduces an effective experimental manipulation of these two social variables and describes their implementation in a standard stress induction paradigm (Trier Social Stress Test).

In many situations humans are influenced by the behavior of other people and their relationships with them. For example, in stressful situations ...

Implantation and Recording of Wireless Electroretinogram and Visual Evoked Potential in Conscious Rats

The full-field electroretinogram (ERG) and visual evoked potential (VEP) are useful tools to assess retinal and visual pathway integrity in both laboratory and clinical settings. Currently, preclinical ERG and VEP measurements are performed with anesthesia to ensure stable electrode placements. However, the very presence of anesthesia has been shown to contaminate normal physiological responses. To overcome these anesthesia confounds, we develop a novel platform to assay ERG and VEP in conscious rats. Electrodes are surgically implanted sub-conjunctivally on the eye to assay the ERG and epidurally over the visual cortex to measure the VEP. A range of amplitude and sensitivity/timing parameters are assayed for both the ERG and VEP at increasing luminous energies. The ERG and VEP signals are shown to be stable and repeatable for at least 4 weeks post surgical implantation. This ability to record ERG and VEP signals without anesthesia confounds in the preclinical setting should provide superior translation to clinical data.

We show surgical implantation and Recording procedures to measure visual electrophysiological signals from the eye (electroretinogram) and brain (visual evoked potential) in conscious rats, which is more analogous to the human condition where recordings are conducted without anesthesia confounds.

The full-field electroretinogram (ERG) and visual evoked potential (VEP) are useful tools to assess retinal and visual pathway integrity in both ...

Using Gold-standard Gait Analysis Methods to Assess Experience Effects on Lower-limb Mechanics During Moderate High-heeled Jogging and Running

A limited number of studies have explored lower-limb biomechanics during high-heeled jogging and running, and most studies have failed to clarify the wearing experience of subjects. This protocol describes the differences in lower-limb kinematics and ground reaction force (GRF) between experienced wearers (EW) and inexperienced wearers (IEW) during moderate high-heeled jogging and running. A three-dimensional (3D) motion analysis system with a configured force platform was used to synchronously capture lower-limb joint movements and GRF. 36 young females volunteered to participate in this study and were asked about high-heeled shoe-wearing experience, including frequency, duration, heel types, and heel heights. Eleven who had the experience of 3 to 6 cm heels for a minimum of three days per week (6 h per day) for at least two years and eleven who wore high heels less than twice per month participated. Subjects performed jogging and running at comfortable low and high speeds, respectively, with the right foot completely stepping onto a force platform when passing by along a 10 m walkway. EW and IEW adopted different biomechanical adaptations while jogging and running. IEW exhibited a generally larger range of joint movement, while EW showed a dramatically larger loading rate of GRF during running. Hence, further studies on the lower-limb biomechanics of high-heeled gait should strictly control the wearing experience of the subjects.

This study investigated lower-limb kinematics and ground reaction force (GRF) during moderate high-heeled jogging and running. Subjects were divided into groups of experienced wearers and inexperienced wearers. A three-dimensional motion analysis system with a configured force platform captured lower-limb joint movements and GRF.

A limited number of studies have explored lower-limb biomechanics during high-heeled jogging and running, and most studies have failed to clarify the ...

A Community-based Stress Management Program: Using Wearable Devices to Assess Whole Body Physiological Responses in Non-laboratory Settings

A pragmatic breath-based intervention to benefit human performance and stress management is timely and valuable to individuals seeking holistic approaches for emotional regulation and optimizing compensatory reserve mechanisms. This protocol is designed to not only teach mind-body awareness but also to provide feedback utilizing physiological data and survey results. The primary findings of this study showed that heart coherence and alpha variables were significantly correlated after four weeks of the breath-based meditation stress protocol. Meditation and rhythmic breathing produced significant increases in alpha brain activity. These brain physiological responses conformed to the Pleth Variability Index (PVI) changes, suggesting the ability of the human body to enter into a meditative state and effectively manage stress. When assessed after four weeks of daily practicing the techniques employed in the stress management protocol, based on the Five Facet Mindfulness Questionnaire, subjects improved in applying mindfulness skills. The overall mindfulness score, Pleth variability index (PVI), and perfusion index (PI) increased after the 4-week intervention period. Results from electroencephalography (brain waves) were consistent with a meditative state during the post-study follow-up session. This provides evidence that wearable devices are feasible for data collection during a breath-based stress management intervention. This protocol can be easily and efficiently implemented into any study design in which physiological data are desired in a non-laboratory-based setting.

Stress is an unavoidable and persistent component of life and holistic approaches for its management are being considered. A standardized methodology was created to demonstrate the feasibility of a breath-based stress management protocol that can be used with commercially available portable technology.

A pragmatic breath-based intervention to benefit human performance and stress management is timely and valuable to individuals seeking holistic approaches ...

A Vibrotactile Feedback Device for Seated Balance Assessment and Training

Postural perturbations, motion tracking, and sensory feedback are modern techniques used to challenge, assess, and train upright sitting, respectively. The goal of the developed protocol is to construct and operate a sitting platform that can be passively destabilized while an inertial measurement unit quantifies its motion and vibrating elements deliver tactile feedback to the user. Interchangeable seat attachments alter the stability level of the device to safely challenge sitting balance. A built-in microcontroller allows fine-tuning of the feedback parameters to augment sensory function. Posturographic measures, typical of balance assessment protocols, summarize the motion signals acquired during timed balance trials. No dynamic sitting protocol to date provides variable challenge, quantification, and sensory feedback free of laboratory constraints. Our results demonstrate that non-disabled users of the device exhibit significant changes in posturographic measures when balance difficulty is altered or vibrational feedback provided. The portable, versatile device has potential applications in rehabilitation (following skeletal, muscular, or neurological injury), training (for sports or spatial awareness), entertainment (via virtual or augmented reality), and research (of sitting-related disorders).

A sitting platform has been developed and assembled that passively destabilizes sitting posture in humans. During the user&#39;s stabilizing task, an inertial measurement unit records the device&#39;s motion, and vibrating elements deliver performance-based feedback to the seat. The portable, versatile device may be used in rehabilitation, assessment, and training paradigms.

Postural perturbations, motion tracking, and sensory feedback are modern techniques used to challenge, assess, and train upright sitting, respectively. ...

Biomechanical Analysis Methods to Assess Professional Badminton Players' Lunge Performance

Under the condition of simulating a badminton court in the laboratory, this study used the injury mechanism model to analyze the maximal right lunge movements of eight professional badminton players and eight amateur players. The purpose of this protocol is to study the differences in kinematics and joint moment of the right knee and ankle. A motion capture system and force plate were used to capture data of the joint movements of the lower extremity and the vertical ground reaction force (vGRF). Sixteen young men who did not have any sports injuries in the past 6 months took part in the study. The subjects performed a maximal right lunge from the start position with their right foot, stepping on and fully contacting with the force plate, hit the shuttlecock with an underhand stroke to the designated position in the backcourt, and then returned to the start/end position. All subjects wore the same badminton shoes to avoid a difference in impact from different badminton shoes. The amateur players showed a greater range of ankle movement and reverse joint moment on the frontal plane, and a larger internal joint rotation moment on the horizontal plane. The professional badminton players exhibited greater knee moment on the sagittal and frontal planes. Therefore, these factors should be considered in the development of the training program to reduce the risk of sports injuries in knee and ankle joints. This study simulates the real badminton court and calibrates the range of activities of each movement of the subjects so that the subjects complete the experimental action in a natural state with high quality. A limitation of this study is that it does not combine joint load and muscle activity. Another limitation is that the sample size is small and should be expanded in future studies. This research method can be applied to the lower limb biomechanical research of other footwork in the badminton project.

Biomechanical Analysis Methods to Assess Professional Badminton Players&#039; Lunge Performance

Here, we present a protocol to evaluate the differences in injury mechanisms between professional and amateur players when performing a badminton maximal right lunge movement by analyzing lower limb kinematics.

Under the condition of simulating a badminton court in the laboratory, this study used the injury mechanism model to analyze the maximal right lunge ...

Using Looming Visual Stimuli to Evaluate Mouse Vision

The visual system in the central nervous system processes diverse visual signals. Although the overall structure has been characterized from the retina through the lateral geniculate nucleus to the visual cortex, the system is complex. Cellular and molecular studies have been conducted to elucidate the mechanisms underpinning visual processing and, by extension, disease mechanisms. These studies may contribute to the development of artificial visual systems. To validate the results of these studies, behavioral vision testing is necessary. Here, we show that the looming stimulation experiment is a reliable mouse vision test that requires a relatively simple setup. The looming experiment was conducted in a large enclosure with a shelter in one corner and a computer monitor located on the ceiling. A CCD camera positioned next to the computer monitor served to observe mouse behavior. A mouse was placed in the enclosure for 10 minutes and allowed to acclimate to and explore the surroundings. Then, the monitor projected a program-derived looming stimulus 10 times. The mouse responded to the stimuli either by freezing or by fleeing to the hiding place. The mouse&#39;s behavior before and after the looming stimuli was recorded, and the video was analyzed using motion tracking software. The velocity of the mouse movement significantly changed after the looming stimuli. In contrast, no reaction was observed in blind mice. Our results demonstrate that the simple looming experiment is a reliable test of mouse vision.

To examine mouse vision, we conducted a looming test. Mice were placed in a large square arena with a monitor on its ceiling. The looming visual stimulus consistently evoked freezing or flight reactions in the mice.

The visual system in the central nervous system processes diverse visual signals. Although the overall structure has been characterized from the retina ...

Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training

An elevation in cardiac troponin T (cTnT), as a highly specific biomarker of cardiomyocyte damage, after moderate-intensity continuous exercise (MCE) has been described. The exercise-induced cTnT response distorts the diagnostic role of the cTnT assay. Although high-intensity interval exercise (HIE) is growing in popularity and concerns remain about its safety, available data related to cTnT release after HIE is limited, which hampers the use of HIE as a health intervention. Here, we present three representative HIE protocols [traditional HIE (repeated 4 min cycling at 90% V&#775;O2max interspersed with 3 min rest, 200 kJ/session); sprint interval exercise (SIE, repeated 1 min cycling at 120% V&#775;O2max interspersed with 1.5 min rest, 200 kJ/session); and repeated sprint exercise (RSE, 40 x 6 s all-out sprints interspersed with 9 s rest)] and one representative MCE protocol (continuous cycling exercise at an intensity of 60% V&#775;O2max, 200 kJ/session). Forty-seven sedentary, overweight young women were randomly assigned to one of four groups (HIE, SIE, RSE, and MCE). Six bouts of respective exercise were performed by every single group, with each being 48 h apart. Meanwhile, for four groups, the duration of the entire testing period was identical, being 10 days. Before and after the first and final exercise bouts, an assessment was conducted of cTnT. The current study provides a frame of reference giving a clear picture of how a specific exercise session affects the circulating cTnT concentration at the early stage of training. The information may assist with clinical interpretations of post-exercise cTnT elevation and guide the prescription of exercise, especially for HIE.

Here, we present protocols of high-intensity interval and moderate-intensity continuous exercise to observe the response of circulating cardiac troponin T (cTnT) concentration to acute exercise over 10 days. The information may assist with clinical interpretations of post-exercise cTnT elevation and guide the prescription of exercise.

An elevation in cardiac troponin T (cTnT), as a highly specific biomarker of cardiomyocyte damage, after moderate-intensity continuous exercise (MCE) has ...

A Standardized Protocol for Preference Testing to Assess Fish Welfare

Animal welfare assessment techniques try to take into consideration the specific needs and wants of the animal in question. Providing enrichment (the addition of physical objects or conspecifics in the housing environment) is often a way to give captive animals the opportunity to choose who or what they interact with and how they spend their time. A fundamental component of the aquatic environment that is often overlooked in captivity, however, is the ability for the animal to choose to engage in physical exercise. For many animals, including fish, exercise is an important aspect of their life history, and is known to have many health benefits, including positive changes in the brain and behavior. Here we present a method for assessing habitat preferences in captive animals. The protocol could easily be adapted to look at a variety of environmental factors (e.g., gravel versus sand as a substrate, plastic plants versus live plants, low flow versus high flow of water) in different aquatic species, or for use with terrestrial species. Statistical assessment of preference is carried out using Jacob&#39;s preference index, which ranks the habitats from -1 (avoidance) to +1 (most preferred). With this information, it can be determined what the animal wants from a welfare perspective, including their preferred location.

A fundamental aspect of assessing the welfare of animals in captivity is to ask whether the animals have what they want. Here, we present a protocol to determine housing preference in the zebrafish (Danio rerio) with respect to the presence/absence of environmental enrichment and access to flowing of water.

Animal welfare assessment techniques try to take into consideration the specific needs and wants of the animal in question. Providing enrichment (the ...