Improving vision function in the patient with Traumatic Brain Injury

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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.

Published in: Health & Medicine

Improving vision function in the patient with Traumatic Brain Injury

  1. 1. Improving Vision Function in the Patient with Traumatic Brain Injury Dominick M. Maino, OD, MEd, FAAO, FCOVD-A;Professor of Pediatrics/Binocular Vision, Illinois Eye Institute/Illinois College of Optometry; Chicago, Il. USA Darrell G. Schlange, OD, FAAO; Associate Professor/Ocular Motility & Binocular Vision, Illinois Eye Institute/Illinois College of Optometry; Chicago, Il. USA
  2. 2. ABSTRACTObjectives: 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 andelimination of symptoms noted after a regimen of OVT that resulted inimproved oculomotor skills, attention, reading and driving abilityin a patient with TBI.Case Report: PA, a university professor, is a 53 y/o WF with a history oftraumatic brain injury due to a car accident. Her symptoms included fallingasleep while reading, avoidance of reading, decreased attention, and majorproblems parking her car. The TOVA (Test of Variables Attention) showed anADHD Score of -4.00 while the Visagraph revealed significant problems in spanof recognition, fixation, reading rate/comprehension, efficiency and fluency.She was diagnosed with convergence insufficiency, oculomotor dysfunction(pursuits/saccades), and attention deficit. Optometric vision therapy sessionsfollowed a standard format that included monocular, biocular, binocular and anintegration/stabilization therapy phase. Computer aided OVT included the useof Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and theEyePort…...
  3. 3. …..After 27, 45 min OVT sessions both the TOVA and Visagraphshowed normal attention and oculomotor skills, convergenceinsufficiency resolved, reading ability improved and parking problemseliminated. 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 oculomotorskills, binocular vision dysfunction, attention, and other visual abilities thataffect their quality of life. Primary eye care providers, in general, do notdiagnosis or manage the many vision function, functional vision and visioninformation processing disorders associated with TBI. Primary eye careproviders can utilize this case as a starting point to help them do so in thefuture or to motivate them to refer to those who have experience andexpertise in this area. This case demonstrates that with OVT both symptomsand signs that adversely affect an individual’s quality of life after traumaticbrain injury can be improved.
  4. 4. Other Eye/Vision PresentationsNeuro-Optometric Rehabilitation of ABI/TBIInduced Vision impairmentSteen Aalberg, FCOVD-IKraskin & Skeffington Institute, Slangerup, Denmark
  5. 5. Other Eye/Vision PresentationsA Retrospective Analysis of Vertical HeterophoriaTreatment and Amelioration of Post-concussive DisorderSymptoms Via a Multifaceted Assessment BatteryMark Rosner, Debby Feinberg, Jennifer Doble,Arthur RosnerUniversity of Michigan, Ann Arbor, MI, USA, St Joseph Mercy Hospital, Ann Arbor, MI,USA, William Beaumont Hospital, Royal Oak, MI, USA, Vision Specialists Institute,Bloomfield Hills, MI, USA
  6. 6. A Retrospective Analysis of Vertical Heterophoria Treatment andAmelioration of Post-concussive Disorder Symptoms Via aMultifaceted Assessment BatteryMark Rosner, Debby Feinberg, Jennifer Doble, Arthur RosnerConclusions: In the subset of patients with TBI simultaneously diagnosed with VH, treatment of VHwith prismatic lenses resulted in marked reduction of all metrics for headache, dizziness andanxiety, which coincided with the patient’s perception of overall VH symptom reduction.Identification of VH in patients with TBI with prolonged post-concussive symptoms should becomea high priority, as effective treatment is available for VH which significantly reduces post-concussive symptoms. ….anecdotally, while there is significant improvement in gait, balance,reading comprehension/speed and cognitive performance, further studies will be needed toascertain whether these types of functional improvements are to be routinely expected withcorrection of VH.
  7. 7. How did the internationalaudience respond to thisinformation ?
  8. 8. ICO/IEI’s Brain Injury Team Dr. Dominick Maino Dr. Darrell Schlange Dr. Len Messner Dr. Tracy Machinski Dr. Navjit K. Sanghera
  9. 9. What can you do?Become a Student memberof the Neuro-OptometricRehabilitation Association.
  10. 10. References:Ciuffreda KJ, Ludlam DP, Kapoor N. Clinical oculomotor training in traumaticbrain injury. Optom Vis Dev 2009;40(1):16-23.Leslie S. Myopia and accommodative insufficiency associated with moderatehead trauma. Opt Vis Dev 2009;40(1):25-31. Mandese M. Oculo-visual evaluation of the patient with traumatic braininjury. Optom Vis Dev. 2009;40(1):37-44.Proctor A. Traumatic brain injury and binasal occlusion. Optom Vis Dev2009;40(1):45-50.
  11. 11. Shameless Plug Alert!Visual Diagnosis and Care of the Patient with SpecialNeedsEdited by Drs. Marc Taub, Mary Bartuccio, DominickMainoPublished by Lippincott, Williams & Wilkins May 2012Acquired Brain Injury: Kenneth Ciuffreda, NeeraKapoorCortical Visual Impairment (CVI): Barry Kran, LuisaMayerNeuro-plasticity and the Patient with Special Needs:Dominick M. Maino, Robert Donati, Yi Pang, StephenViola, Susan Barry
  12. 12. Laddies, and Lassies….if you have questions, please feel free to ask: Dominick “The Bruce” MacMainoLord of Scotchland; Duke of Haggis and 9th Earl of the MacMaino Clan
  13. 13. What is Neuro-Optometric Rehabilitation?• Rehabilitation of the neurologically challenged patient – TBI or ABI – Lenses, prisms, low vision aids, special activities• Vision plays huge role patients’ quality of life, but is usually neglected during rehabilitation therapy
  14. 14. NORA• Neuro-Optometric Rehabilitation Association – Multidisciplinary – Mission to serve physically and cognitively disabled persons and provide quality visual rehabilitation – Educate professionals (including optometrists) and develop INTER and INTRA-professional networks that include Neuro-Optometric and Vision Rehabilitation Services
  15. 15. NORA Student Group• Raise awareness of neuro-optometric rehabilitation, and its importance in the care of TBI and ABI patients.• Keep the ICO community informed about news from NORA.• Potentially help you differentiate yourself from other optometrists and create a demand
  16. 16. NORA Student Group Possible Upcoming Meetings• What you can expect from TBI and ABI patients – Psychiatrists – Neurologists• Patient perspective of neuro-optometric rehabilitation – Wounded Warriors – Athletes• Private Practice Management of patients with TBI and ABI• And More: – Chicago Concussion Coalition – Sports Legacy Institute – Speech and Language Therapists – Occupational and Physical Therapists – Neurosurgeons
  17. 17. NORA Student Group• How to Get Involved in: – Become a Student Member of NORA – Class Representative – Social Media Representative – Treasurer
  18. 18. 21st Annual NORA Multi-Disciplinary Conference• April 19th-April 22nd• University of Memphis Holiday Inn• Topics include: – Hospital Based Visual Neuro-rehabilitation – Concussions – Overview of Current Knowledge and Treatment – Neurotransmitters in Rehabilitation – Nutritional Considerations in Neuro-rehabilitation
  19. 19. Questions? Suggestions? Ideas?• Lisa Wong – Lwong@eyedoc.ico.edu• Jennifer Tai – Jtai@eyedoc.ico.edu• Hanna Froehlich – Hfroehlich@eyedoc.ico.edu• Dr. Dominick Maino (Faculty Advisor) – Dmaino@ico.edu

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