Traumatic & Acquired Brain Injury

Vision problems are among the most common problems associated with acquired brain injuries. Causes of brain injury can include trauma, auto accidents, suffocation, drug reaction and strokes. Initially symptoms may be subtle but often become more of a concern with time. Specific problems can include poor memory, disorientation, loss of reading skills or poor word recall.  Click for a recent article from England.

Head Injury and Stroke Vision Rehabilitation
(Neuro-Optometric Rehabilitation)

Post Trauma Vision Rehabilitation

Dr. Mayer treats visual problems of people with strokes, head injuries and other major disorders. Treatment and results include knowing where straight ahead is, knowing where things really are located, correction of double vision and the ability to have a person's eyes land on the right spot when reading or looking around the environment. This contributes to balancing problems. If you or a loved one has had a stroke or head injury, you need this type of evaluation and treatment to improve recovery and perhaps even drive again.

Common symptoms include:

  • Double vision
  • Headaches
  • Blurry vision
  • Dizziness or nausea
  • Attention or concentration difficulties
  • Staring behavior (low blink rate)
  • Spatial disorientation
  • Lose place when reading
  • Can't find beginning of next line when reading
  • Comprehension problems when reading
  • Visual memory problems
  • Pulling away from objects when they are brought close

People who have sustained head injuries, strokes or other neurological impairments often find that their vision has been affected as a result. Dr. Mayer has received special training in neuro-optometric rehabilitation and treatment. The following information may be a first step in determining if visual difficulties are interfering with the rehabilitation progress.

Insults or injuries to the cortex produced by a traumatic brain injury cause stress in the central and autonomic nervous systems. The effect on vision seems to be an interference with the visual processes. As a result, a head injured person may experience double vision, binocular dysfunction or concentration difficulties.

In the past, these symptoms were diagnosed as individual eye problems or muscle imbalances.  However, the visual system is really a relationship of sensory-motor functions which are controlled and organized in the brain. The eye alignment imbalances and other reported difficulties that result from a head injury often occur because of dysfunction of the ambient visual process affecting sensory-motor spatial disorganization. This causes an eye to turn outward or a strong tendency for both eyes to diverge. The resulting binocular problems are characteristic of what is known as the Post Trauma Vision Syndrome.


Visual Midline Shift Syndrome

After a neurological impairment such as a stroke or TBI, disorders of vision can also occur which cause shifts in concept of a person's midline. This can cause the person to shift their body laterally or in other ways which affect balance, posture and gait. This shift in visual midline has been termed the Visual Midline Shift Syndrome.

Rehabilitation: Due to the major impact of the visual system on cognitive and motor function, the visual rehabilitative needs of a person with a head injury, stroke, or a neurological impairment must be addressed as early as possible. Neuro-optometric rehabilitation is an individualized treatment regimen for patients with visual deficits as a result of such injuries. The treatment plan improves specific acquired vision dysfunctions determined by standardized diagnostic criteria. Treatment regimens encompass medically necessary non-compensatory lenses and prisms with and without occlusion and other appropriate rehabilitation strategies.

Behavioral observations during therapy sessions or medical examinations, in-depth interviews and screenings provide information about potential visual and neuro-motor dysfunctions.

  • Dizziness or nausea
  • Spatial disorientation
  • Consistently stay to one side of hallway or room
  • Bump into objects when walking
  • Poor balance or posture
    For example: leaning back on heels, forward, or to one side when walking, standing or seated in a wheelchair)

Yoked Prism Glasses

Yoked prism glasses are utilized therapeutically to alter the visual midline concept of a person who has suffered a neuro-motor imbalance as a result of a cerebral vascular accident, traumatic brain injury, or who has had a physical disability from multiple sclerosis or cerebral palsy to name several causes.  Persons who have a hemiparesis or hemiplegia will have a shift in their concept of their visual midline usually away from their effected side. These shifts in midline can also occur anteriorally or posteriorally.

When the visual midline shifts, it causes the person to unconsciously think that their body center is shifted in the direction of their midline. In turn, the person will lean toward the midline shift and essentially reinforce their own hemiparesis or hemiplegia.
 
The visual midline shift has been documented in literature and neuro-motor problems affecting posture and balance have also been written extensively about in journals of rehabilitation regarding physical and occupational therapy.

Through the use of yoked prism glasses, the visual midline can be shifted to increase the person's ability to transfer weight over to the affected side. Yoked prism lenses have been used effectively through neuro-optometric rehabilitation in hospitals and rehabilitation programs throughout the United States.

When a person has a visual midline shift, physical therapy will frequently plateau and reach a limit if the visual midline is not effected through the use of medically necessary yoked prism lenses. These yoked prism lenses are therapeutic and are not compensatory in nature. The purpose of these special prisms are to shift the visual midline thereby enhancing the effect of the physical and occupation therapy. It has been determined that the potential for physical and occupation therapy can be increased and reached more quickly when incorporated with the use of yoked prisms.


 
Links: 
 American Optometric Association
           
Neuro-Optometric Rehabilitation Association
            Medical News Today:  Visual Inputs Can Reorganize
            Navy Times:  Link Between TBI & Blindness
            TMC Net:  Focus On Vision Problems For Troops With Brain Injuries