Sunday, November 4, 2012

Brain injuries and vision problems - vision therapy and developmental optometry

Brain injuries Brain injuries can result from impacts during sports, car accidents or falls and they can also result from events like a stroke, aneurysm or due to degenerative diseases that affect the brain. A brain injury caused by an external trauma to the head is called a “traumatic brain injury” or “TBI”.

Brain injuries and vision

It is estimated that 20%-40% of people with brain injuries suffer vision related disorders.  

At our Vancouver developmental optometry clinic, we have treated patients with brain injuries resulting from car accidents, viral brain infections, sports related injuries such as concussions and more with vision therapy.

In many brain injury cases, eye muscles or the nerves controlling the eye muscles are damaged, resulting in problems with teaming, movement and focusing of the eyes. These disorders include binocular vision problems, visual information processing disorders, convergence insufficiency and accomodative insufficiency.
A number of published research studies support vision therapy as a and effective treatment for vision disorders caused by brain injuries.  One study presented  4 cases of pediatric brain injury patients aged 6-18 years who were examined at an optometry clinic of a local hospital.  The author found that the children suffered from a variety of ocular and visual disorders and three of them were having difficulties academically. Academic problems are no surprise since 80% of our learning happens through our visual system.  The patients benefited from vision therapy.

Symptoms of brain injury caused vision disorders

The most common vision related symptoms of brain injuries include the following:
  • Double vision
  • Poor eye tracking ability
  • Difficulties with shifting gaze quickly from one point to another
  • Focusing
  • Loss of binocular vision (eye alignment)
  • Eye strain
  • Fatigue
  • Glare, or light sensitivity
  • Inability to maintain visual contact
  • Headaches
  • Blurred near vision
  • The extent of the injury can also impact a person’s visual information processing ability.  This can cause the following symptoms:
  • Spatial disorientation
  • Shifts in ability to judge location of objects
  • Difficulties with balance and posture
  • Poor depth perception
  • Memory loss
  • Poor handwriting

Studies on the treatment of vision problems caused by brain injury

For more information on the treatment of vision problems caused by brain injuries, check out the following published scientific studies on the topic:

Brodak, M.I. Pediatric acquired brain injury. Optometry 2010 81: 516-527. DOWNLOAD.

Green, W., Ciuffreda, K.L., et al. Accomodation in mild traumatic brain injury. Journal of Rehabilitation Research & Development. 2010. 47: 183-200. DOWNLOAD.

Ciuffreda KJ, Ludlam DP, Kapoor N. Clinical oculomotor training in traumatic brain injury. Optom Vis Dev 2009;40(1):16-23. DOWNLOAD.

Cockerham, G.C., Goodrich, G.L., et al. Eye and visual function in traumatic brain injury. Journal of Rehabilitation Research & Development. 2009. 46: 811-818. DOWNLOAD.

Julie L., Julie, B-T, et al. Deficits in complex visual information processing after mild TBI: Electrophysiological markers and vocational outcome prognosis Brain Injury.March 2008; 22(3): 265–274. DOWNLOAD.

Stanley, Paul. Effects of computer assisted visual scanning training on visual neglect: three case studies. Physical & Occupational Therapy in Geriatrics,1996 Vol. 14(2) 33-44. DOWNLOAD.

Sharieff K. From braille to quilting: a neuro-optometric rehabilitation case report. Optom Vis Dev 2010;41(2):81-91. DOWNLOAD.

Schlageter, K. Gray, B. Incidence and treatment of visual dysfunctoin in traumatic brin injury. Brain Injury. 1993, 7:439-448. Download.

Brosseau-Lachaine, O. Gagnon, I. et al. Mild traumatic brain injury induces prolonged visual processing deficits in children. Brain Injury.August 2008; 22(9): 657–668. DOWNLOAD.

Leslie S. Myopia and accommodative insufficiency associated with moderate head trauma. Opt Vis Dev 2009;40(1):25-31.DOWNLOAD.

Gottlieb, D.D., Fuhr, A., et al. Neuro-optometric facilitation of vision recovery after acquired brain injury. NeuroRehabilitation. 1998. 11: 175-199. DOWNLOAD.

Mandese M. Oculo-visual evaluation of the patient with traumatic brain injury. Optom Vis Dev. 2009;40(1):37-44. DOWNLOAD.

Raymond, M.J., et al. Rehabilitation of visual processing deficits following brain injury. NeuroRehabilitation. 1996. 6: 229-240. DOWNLOAD.

Proctor A. Traumatic brain injury and binasal occlusion. Optom Vis Dev 2009;40(1):45-50.DOWNLOAD.

Tong D, Zink C. Vision dysfunctions secondary to motor vehicle accident: a case report. Optom Vis Dev 2010;41(3)158-168. DOWNLOAD.

Tassinari JT. Vision Therapy for sensory fusion disruption syndrome: two case reports. Optom Vis Dev 2010;41(4):215-221.DOWNLOAD.

Hellerstein L.F., Freed S., Maples, W.C., Vision profile of patients with mild brain injury. J Am Optom Assoc. 1995; 66: 634-39. DOWNLOAD.

Freed, S. Hellerstein, LF, Visual electrodiagnostic findings in mild traumatic brain injury, Brain Injury. 1997, VOL. 11, NO. 1, 25-36. DOWNLOAD.

Rowe, F. Visual perceptual consequences of stroke. Strabismus. 2009 Jan-Mar;17(1):24-8. DOWNLOAD.

Han, E., The role of the neuro-rehabilitation optometrist. DOWNLOAD.

Suchoff, I., Gianutosos, R., Rehabilitative optometric interventions for the adult with acquired brain injury. DOWNLOAD.