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Multisensory integration relevant for balance and gait in patients with glaucoma

O'Connell, Caitlin (2018) Multisensory integration relevant for balance and gait in patients with glaucoma. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Falls are a concern in glaucoma. Visual field (VF) loss in glaucoma is traditionally thought to be the main cause of falls. However, glaucoma is not only an eye disease but also a brain syndrome. Thus, impairments of central sensory integration processes important for balance/gait may also be a contributing factor. These processes require higher cognitive resources related to attention. Research has shown that patients with glaucoma have worse balance when standing on foam, which alters proprioceptive information, and cognitive impairments related to executive function.
The overarching goal of this study was two-fold: (1) to examine how glaucoma impacts the interference between balance/gait and attention, and (2) to determine if this interference could be linked to brain alterations. To achieve this goal, balance/gait assessments with and without an information-processing (IP) task were conducted and a brain MRI scan was collected in a sample of patients with glaucoma. The findings suggest that glaucoma severity negatively impacts balance but only when proprioception is minimized and attentional resources are diverted from postural control. In addition, brain connectivity measures were correlated with the IP task performance, but only in conditions where proprioception is minimized. Gait assessments also suggest that challenging proprioceptive conditions are associated with worse gait performance in glaucoma.
Additionally, this project examined the impact of acute VF loss in adults with healthy vision in an attempt to identify the impact of sudden VF loss without the longer-term adaptation effects of glaucoma. Sudden VF loss had the greatest impact when proprioception is minimized, suggesting that sudden VF loss may affect central sensory integration processes. Further, peripheral vision may be more sensitive to movement in the visual environment than central vision. Lastly, falls incidence and fear of falling (FoF) were assessed in patients with glaucoma. The incidence of recurrent falls and FoF increased with more advanced glaucoma. In summary, this study may have identified underlying central mechanisms that contribute to falls in glaucoma. This information is important to future efforts focused on the development of effective management, rehabilitation and treatment protocols of patients with glaucoma.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
O'Connell, Caitlincmboconnell@gmail.comcaitlino
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCham, Rakiercham@pitt.eduRCHAM
Committee MemberChan,
Committee MemberConner,
Committee MemberRedfern, Markmredfern@pitt.edumredfern
Committee MemberWollstein,
Date: 24 January 2018
Date Type: Publication
Defense Date: 9 August 2017
Approval Date: 24 January 2018
Submission Date: 27 November 2017
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 156
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Bioengineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: glaucoma, balance, gait, multisensory integration, vision, brain connectivity
Date Deposited: 24 Jan 2018 21:18
Last Modified: 24 Jan 2020 06:15

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