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Edmonton Vision Therapy for TBI’s

Vision therapy is very effective for the treatment of individuals with traumatic brain injuries. That’s why Vision by Design has committed to providing optometric vision therapy for patients in the Edmonton and surrounding areas under the direct supervision of Dr. Sarah Keep, an optometrist qualified as a vision therapy practitioner.

What is Traumatic Brain Injury?

Traumatic brain injury (TBI) such as a concussion occurs when there is sudden damage to the brain, caused by an external force such as motor vehicle accidents, falls, and sports injuries. Injuries range from mild to severe permanent brain damage. Most concussions fall within the mild category which are often very responsive to vision therapy rehabilitation if visual issues occur.

What Are The Side Effects of TBI?

Our vision is highly dependent on our brain. In fact, half of our brain pathways relate to visual function. As a result, patients suffering with TBI can experience:

Eye Tracking

Eye movements, or ocular motor skills, are important for our eyes to be able to gather visual information. We have to be able to maintain a steady gaze on a target, following a moving object, or shift our eyes from one target to another. Activities like reading and driving greatly depend on these skills. When a patient has suffered a concussion or other traumatic brain injury these skills can be greatly affected. Patients with difficulties with theses ocular motor skills may lose their place when they read, skip words or lines, or read words out of order. Deficiency in these skills can also affect coordination in sports or for activities such as driving. Some patients can experience nystagmus, an ocular condition that affects visual clarity and balance as the eyes continually move on and off their intended target repeatedly.

Eye Focusing

Our eyes have to be able to change focus from one distance to another in order to create a clear image. Patients who have sustained a traumatic brain injury often lose the ability and endurance to switch focus between objects at various distances. The resulting symptoms include fluctuating blurry vision, headaches, eye strain, and difficulty performing near work for extended periods of time.

Patients who have suffered a traumatic brain injury will often have difficulty with visual perceptual processing. Visual perceptual skills allow us to make sense of the visual information received by the brain. Difficulty with visual perceptual processing can result in a TBI patient experiencing a cognitive “fog”. This “fog” affects several aspects of vision including:

  • Visual attention span
  • Visual processing speed
  • Visuo-spatial memory
  • Visual memory

Light & Visual Sensitivity

It is quite common for patients with TBI to develop a hypersensitive visual system. Sensitivity to light and other changes to the visual environment can be especially challenging. The ability to filter out visual noise is impaired, which can make large crowds and visual motion especially overwhelming for TBI patients because they are unable to ignore irrelevant visual input. Additionally, patients can experience balance issues as they are unable to rely on the visual input that allows us to recognize our body’s position in space.

Visual Hallucination

TBI sufferers can experience visual hallucinations that appear as stars, flashes or spots as well as perceived motion of objects. These hallucinations may occur when the brain misunderstands visual information due to damage of the brain tissue. This results in disruptions to how the brain processes information.

Eye Teaming

The ability for the eyes to coordinate are commonly affected by a traumatic brain injury. Effective eye-teaming occurs when both of our eyes have to move in a coordinated manner to ensure they are pointing at the same target. The inward movement of our eyes to aim at a near target is called convergence and the outward movement to aim our eyes at a distant target is called divergence. Accurate eye teaming is often lost following a traumatic brain injury such as a concussion. Patient with reduced convergence or divergence may experience double vision, eye strain, words moving on a page and/or reduced depth perception.

Visual Field Loss

It is possible for a patient with a traumatic brain injury to have a hemianopsia, or a visual field defect. When this occurs, a patient will either have the vertical half, or horizontal half of their vision missing. Patients who have visual field loss often have difficulty with certain daily activities, or may be at risk for a fall or injury. Certain accommodations can be taught to patients to help them better perform activities with a field defect. It can also be possible to see some improvement to the visual field with by performing certain scanning activities.

Treatment Options

Traumatic brain injuries often have multiple trajectories. Rehabilitation often has the best outcome with a multi-disciplinary approach. The best approach can vary and are dependent upon each patient’s particular symptoms and diagnoses. Disciplines participating in the rehabilitation of traumatic brain injury should include, optometrists, physiotherapists, physicians, occupational therapists, psychologists, speech pathologists, and chiropractors. Other professions may be required depending on the patient’s specific symptoms.

What is the prognosis for recovery?

The prognosis for most mild traumatic brain injuries such as a concussion depends on how long symptoms are present. If symptoms persist greater than three months past the initial injury the progness tends to be worse, or may require additional rehabilitation to improve symptoms. Other individual factors can also affect prognosis, such as the number of previous head injuries, a history of anxiety or depression, the severity of injury, prior neurological disease, persistent physical illness, or advanced age.

How does neuro-optometric vision therapy work?

When a patient suffers a traumatic brain injury there can be damage to various pathways in the brain. This prevents our brain from being able to use these damaged connections to pass information. When we do neuro-optometric rehabilitation we are able to train the brain to rewire the connections and use other areas of the brain to compensate for areas of damage. This results in better communication throughout the brain, which results in improvement of symptoms.

How long should one expect to see results?

Each case presents with varying degrees of symptoms however, studies show that one can anticipate at least 6-10 weeks of visual rehabilitation before improvements can be seen. It is common to require additional weeks in order to embed the new skills so that regression does not occur once rehabilitation is complete.

References
Neuro-ophthalmologist at the Wilmer Eye Institute of Johns Hopkins University, Dr. Eric Singman, writes on Vision Rehab and Brain Injury.

Dr Singman authored a three part article on Vision and Rehabilitation after Brain Trauma that you can access online via brainline.org

Brasure, M., Lamberty, G., Sayer, N. and et al, (2012). Multidisciplinary postacute rehabilitation for moderate to severe traumatic brain injury in adults. Rockville, MD: Agency for Healthcare Research and Quality.

Ciuffreda KJ,et al.: Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis; Optometry. 2008 Jan;79(1):18-22.