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Concussions, TBI, Reading, Balance, Car-Sickness, Attention, Visual Fatigue Problems Vision Therapy 101 for the Primary Care Practitioner By Stan Appelbaum, OD
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Presentation at the 9th World Conference of the International Brain Injury Association meeting in Edinburgh, Scotland ABSTRACT Objectives: Few reports in the literature note how optometric vision therapy (OVT) can improve the quality of life for those with traumatic brain injury (TBI). This presentation discusses the significant improvements of signs and elimination of symptoms noted after a regimen of OVT that resulted in improved oculomotor skills, attention, reading and driving ability in a patient with TBI. Case Report: PA, a university professor, is a 53 y/o WF with a history of traumatic brain injury due to a car accident. Her symptoms included falling asleep while reading, avoidance of reading, decreased attention, and major problems parking her car. The TOVA (Test of Variables Attention) showed an ADHD Score of -4.00 while the Visagraph revealed significant problems in span of recognition, fixation, reading rate/comprehension, efficiency and fluency. She was diagnosed with convergence insufficiency, oculomotor dysfunction (pursuits/saccades), and attention deficit. Optometric vision therapy sessions followed a standard format that included monocular, biocular, binocular and an integration/stabilization therapy phase. Computer aided OVT included the use of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the EyePort. After 27, 45 min OVT sessions both the TOVA and Visagraph showed normal attention and oculomotor skills, convergence insufficiency resolved, reading ability improved and parking problems eliminated. All other symptoms were either improved or eliminated. PA currently successfully teaches at a major USA university. Conclusions: Individuals with TBI often exhibit marked problems in oculomotor skills, binocular vision dysfunction, attention, and other visual abilities that affect their quality of life. Primary eye care providers, in general, do not diagnosis or manage the many vision function, functional vision and vision information processing disorders associated with TBI. Primary eye care providers can utilize this case as a starting point to help them do so in the future or to motivate them to refer to those who have experience and expertise in this area. This case demonstrates that with OVT both symptoms and signs that adversely affect an individual’s quality of life after traumatic brain injury can be improved.
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In this captivating lecture, Dr. Faiza, an esteemed Assistant Professor of Physiology, embarks on a comprehensive journey into the multifaceted realm of local blood flow regulation. With meticulous detail and clarity, she unravels the intricate mechanisms that govern the dynamic balance between tissue perfusion and vascular resistance, shedding light on both acute and chronic aspects of blood flow control. Beginning with an exploration of acute influences, Dr. Faiza elucidates how physiological factors such as metabolic demand, myogenic responses, and autoregulatory mechanisms orchestrate rapid adjustments in local blood flow. Students gain insight into the vasodilator theory, which elucidates the role of metabolic byproducts and vasoactive metabolites in promoting vasodilation, alongside the oxygen demand theory, which underscores the interplay between tissue oxygenation and nutrient demand. Delving deeper, the lecture delves into the fascinating realm of humoral control, where hormones and vasoactive substances wield significant influence over vascular tone. Dr. Faiza navigates through the intricacies of endothelial-derived factors like nitric oxide (NO) and histamine, alongside hormonal regulators such as angiotensin II and vasopressin. Through vivid explanations and illustrative examples, she unveils the intricate dance of vasodilation and vasoconstriction orchestrated by these biochemical messengers. Moreover, the lecture extends its gaze to the extrinsic control of blood flow, where sympathetic innervation exerts a profound impact on vascular dynamics. Dr. Faiza elucidates the role of sympathetic tone in modulating vascular resistance, highlighting its implications in diverse physiological and pathological scenarios. From skin perfusion to coronary circulation, students gain a nuanced understanding of how neural inputs shape local blood flow patterns. Enriched with clinical insights and contemporary research findings, this lecture equips students with a holistic understanding of blood flow regulation. By exploring concepts like active and reactive hyperemia, vascular remodeling, and collateral circulation, Dr. Faiza fosters a deeper appreciation for the adaptive responses of the cardiovascular system to changing physiological demands and pathological insults.
Control of Local Blood Flow: acute and chronic
Control of Local Blood Flow: acute and chronic
MedicoseAcademics
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Tbi military 1
1.
Diagnosis and Management
of TBI-Related Vision Problems Mitchell Scheiman, OD
2.
3.
4.
Overview of
Traumatic Brain Injury
5.
6.
7.
8.
9.
10.
Post Traumatic
Amnesia (PTA) Scale PTA Score Severity of Injury < 10 minutes Very mild 10 to 60 minutes Mild 1 to 24 hours Moderate 1 to 7 days Severe > 7 days Very severe
11.
12.
13.
Recent Prevalence Studies
in Military/VA Populations
14.
15.
Results Problem All
Subjects (n=46) Blast (n=21) NonBlast (n=25) Convergence Insufficiency 30% 24% 36% Accommodative Dysfunction 22% 24% 20% Pursuit/Saccade Dysfunction 20% 5% 32% Visual Field Defects 21% (100 Eyes)
16.
17.
18.
19.
20.
21.
22.
Optometric Role
TBI-Related Vision Disorders
23.
24.
25.
26.
27.
Model of Care
28.
29.
30.
Proposed Model
31.
32.
33.
34.
35.
Three Component Model
of Vision Visual Integrity Visual Efficiency Visual Information Processing
36.
Visual Integrity
37.
Visual Efficiency Skills
38.
Visual Information Processing
Disorders
39.
40.
41.
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