1. Visual Diagnosis and Dominick M. Maino, O.D., M.Ed., F.A.A.O.,
F.C.O.V.D-A.
Care of the Patient with Professor,
Pediatrics/Binocular Vision Service
Special Needs Illinois College of Optometry
Illinois Eye Institute
3241 S. Michigan Ave. Chicago, Il. 60616
Syndromes/Genetic Anomalies/Brain Injury 312-949-7280 (Voice) 312-949-7358 (fax)
dmaino@ico.edu MainosMemos.com
www.ico.edu LyonsFamilyEyeCare.com
Taub M, Bartuccio M, Maino D. (Eds)
Visual Diagnosis and Care of the Patient Children with Special Needs
with Special Needs. Lippincott, Williams &
Wilkins. New York, NY;2012.
Steel G, Maino D. The Life Cycle Approach to Care for Patients with
Special Needs.
Taub M, Reddell AS. Cerebral Palsy.
•Learning Disability
Woodhouse M. Maino D. Down Syndrome.
Berrry-Kravis E, Maino D. Fragile X •ADHD
Coulter RA. Autism
Schnell PH, Maino D, Jespersen R. Psychiatric Illness and Associated
Oculo-visual Anomalies.
•Cerebral Palsy
Bartuccio M, Browing RT, Howell AC. ADHD
Ciuffreda K, Kapoor N. Acquired Brain Injury. •Down Syndrome
Maino D, Donati, R, Pang, Viola S, Barry S. Neuroplasticity.
Lran BS, Mayer DL. Vision Impairment and Brain Damage
•Fragile X Syndrome
Children with Special Needs Learning Disabilities
•Autism
•Mental Retardation/Intellectual Reading/Dyslexia
Disability Dyscalculia
•Acquired/Traumatic Brain Injury Dysgraphia
•Mental Illness/Psychiatric Illness
1

2. Learning Disabilities Learning Disabilities
Reading/Dyslexia Reading/Dyslexia
Language Based
Vision Based
Reading disabilities common
Combination of Language/Vision
Dyslexia rare
Learning Disabilities Learning Disabilities
Dyscalculia (Math Disability) Dysgraphia
3 and 6% of the population Working memory (orthographic coding)
Neurological Dyscalculia
Motor planning
Deficits in working & short term memory Attentional issues
Congenital/hereditary (Gerstmann syndrome: Dyscalculia + Dysgraphia)
Learning Disabilities Learning Disabilities
ADHD/ADD Etiology ADHD/ADD Not Caused By:
Brain Functioning Diet
Heredity Hormones
Exposure to Toxic Substances Vestibular dysfunction
Brain Trauma, Tumors, Strokes or Disease Poor parenting
Functional Vision Problems Television
2

3. Learning Disabilities
ADHD/ADD Treatment
Medication
Psychotherapy
Education or Training
A combination of treatments
Oculomotor therapy/Vision Therapy
Cerebral Palsy Cerebral Palsy
• What is it? • Cerebral Palsy is a persistent, but not
• What is it’s etiology? unchanging, disorder of movement and
• What is it’s prevalence/incidence? posture appearing in the early years of life
• How is it classified?
due to traumatic or inflammatory brain
• What are it’s visual characteristics?
damage.
• Affects virtually all motor systems
• Can be acquired
Cerebral Palsy Etiology Cerebral Palsy Incidence/Prevalence
Something goes awry just before, during or
• 764,000+ children and adults
just after birth:
• 500,000 children under age of 18
• 2-3 children out of 1,000 (as low as 2.3 per 1,000 to 3.6
Prenatal per 1,000)
Neonatal • 10,000 babies born each year
Postnatal • 8,000 - 10,000 babies and infants are
diagnosed per year
3

4. Cerebral Palsy Incidence/Prevalence Cerebral Palsy Incidence/Prevalence
• Around 1,200 to 1,500 preschool-aged • 75% of CP occurs during pregnancy , 5% during childbirth
and/or 15% after birth up to age 3
children are diagnosed per year • 80% the etiology is unknown
• births 10% of cases are acquired • The number of new cases have increased 25% during the
past decade (1990’s)
(trauma)
• Average lifetime cost per person of $921,000 (in 2003
• Normal life spans, 40% live to age 40, dollars)
many living into their senior years
Cerebral Palsy Classifications Cerebral Palsy Visual Characteristics
Wesson M, Maino D. Oculovisual findings in children with Down syndrome, Cerebral
Palsy, and mental retardation without specific etiology. In Maino, D. (ed)
Diagnosis and management of special populations. 1995. St. Louis, Mo. , Mosby-
• Spastic - 61% to 76.9% Yearbook Inc.:17-54.
• Binocular acuity could be evaluated in
• Dyskinetic/Athetoid - 10-15% 45% of individuals below age 13
• Ataxic - <5% • For CP patients VAs are generally
decreased when compared to those
• Mixed measured for individuals with Down
Syndrome
• Much higher incidence of ocular disease
and neurological dysfunction
Cerebral Palsy Refractive Characteristics Cerebral Palsy Refractive Characteristic
Scheiman MM. Optometric findings in children with cerebral palsy. Am J Optom Physiol
Opt 1984;61:321-333
• 60% significant refractive error • Hyperopia present 3Xs
more than when compared
• Hyperopia (>+1.50) 3X more common among to myopia
CP children than in non-affected individuals
• Other studies (Black, Breakey et al, Duckman, • Wesson & Maino note:
• many more hyperopes
LoCasio) support increased refractive error than myopes
being present • average amount of
significant myopia is
greater
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5. Cerebral Palsy Binocular
Cerebral Palsy InteractionTips
Characteristics
• Prevalence of strabismus exceeds that of
general population by a factor of 10! • Positioning
• Slightly more esotropia than exotropia • Right tools (objective)
• Dyskinetic Strabismus • No sudden movement
• slow tonic deviation similar to • No loud, unexpected noises
vergence
• change from ET to XT • Speak smoothly, soothingly, softly….if
• usually associated with athetoid appropriate, sing to the patient!
classification • Smile, smile SMILE!!!
Cerebral Palsy Cerebral Palsy
Barca L, Cappelli FR, Di Giulio P, Staccioli S, Castelli E. Outpatient assessment of
neurovisual functions in children with Cerebral Palsy. Res Dev Disabil. 2010 Mar-
• Saunders KJ, Little JA, McClelland JF, Jackson AJ. Profile of refractive errors in cerebral palsy:
impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome. Invest
Apr;31(2):488-95. Epub 2009 Dec 5.
Ophthalmol Vis Sci. 2010 Jun;51(6):2885-90. Epub 2010 Jan 27.
….Overall, 73% patients had . … A significantly higher prevalence and magnitude
of refractive error was found in the CP group …..
impairments …..the majority of Higher spherical refractive errors were
which presenting difficulties on significantly associated with the nonspastic CP ….
The presence and magnitude of astigmatism were
both visuoperceptual and greater when intellectual impairment was more
visuospatial tasks (79%).. … severe, …. High refractive errors are common in
CP, pointing to impairment of the
emmetropization process. ….
Cerebral Palsy Cerebral Palsy
Ross LM, Heron G, Mackie R, McWilliam R, Dutton GN.
McClelland JF, Parkes J, Hill N, Jackson AJ, Saunders KJ. Reduced accommodative function in dyskinetic cerebral palsy: a novel
management strategy. Dev Med Child Neurol. 2000 Oct;42(10):701-3. Links
Accommodative dysfunction in children with cerebral palsy:
a population-based study. Invest Ophthalmol Vis Sci. 2006 ….The near-vision symptoms were completely
May;47(5):1824-30. removed and reading dramatically improved with
the provision of varifocal spectacles. Varifocal
Brain injury such as that present in CP has a lenses provide an optimal correction for far,
intermediate (i.e. for computer screens), and
significant impact on accommodative near distances (i.e. for reading). Managing this type
function. These findings have implications of patient with varifocal spectacles has not been
for the optometric care of children with CP previously reported. It is clearly very important
and inform our understanding of the impact to prescribe an optimal spectacle correction
to provide clear vision to
of early brain injury on visual development.
optimize learning.
5

6. Down Syndrome
From: http://www.ndss.org/aboutds/aboutds.html#Down
Children with Down syndrome have been included in regular academic
classrooms in schools across the country. In some instances they are
integrated into specific courses, while in other situations students are
fully included in the regular classroom for all subjects. The degree of
mainstreaming is based in the abilities of the individual; but the trend is
for full inclusion in the social and educational life of the community.
Down Syndrome Down Syndrome
• What is it? • Langdon Down 1866
• What is it’s etiology?
• What is it’s prevalence/incidence? • “Mongolism” no longer used
• What are it’s physical/visual characteristics? • Most common genetic anomaly
• Variable levels of ability & disability
Down Syndrome Down Syndrome Prevalence/Incidence
From 1979 to 2003 the prevalence of • 1 in 12 for older mothers (>=49yrs of age)
Down syndrome increased by 31.1%, • Most babies with Down syndrome born to
younger mothers (80% born to moms younger than 35)
from 9.0 to 11.8 per 10,000 live births.
• Most frequently encounter “viable” genetic
In 2002 prevalence among children and anomaly
adolescents aged 0 to 19 was 1 in 971, or • Most frequently encounter “special” patient
approximately 83,400 children and • Prevalence increasing (improved survival rates)
adolescents living with Down syndrome http://www.nichd.nih.gov/publications/pubs/downsyndrome.cfm
in the Unites States.
6

7. You will see individual with Down Down Syndrome Etiology
Syndrome in Your Office
• Genetics
• 95% demonstrate non-disjunction of one
chromosome during meiosis (Trisomy 21)
• 2-4% mosaicism
• 3-4% Robertsonian translocation of the long
arm of chromosome 21 to another
chromosome usually #14
• risk of having a second child with Trisomy
21 or mosaic Down syndrome is 1 in 100.
The risk is higher if one parent is a carrier of a translocated cell.
Down Syndrome Etiology Down Syndrome Refractive Error
• Genetics: Trisomy 21
Many more hyperopes than
myopes, but those with myopia
tended to have higher
magnitudes
Up to 49% may exhibit some
astigmatism
Down Syndrome Binocular
What’s New in Down Syndrome
Characteristics
23-44% have strabismus Al-Bagdady M, Stewart RE, Watts P, Murphy PJ, Woodhouse JM. Bifocals
and Down's syndrome: correction or treatment? Ophthalmic Physiol
(Wesson & Maino) Down syndrome and Opt. 2009 Jul;29(4):416-21. Epub 2009 May 11.
strabismus shows a constant unilateral Accommodation is reduced in approximately 75% of
esotropia of less than 20 PD at near. children with Down's syndrome (DS). Bifocals have
(Greatly reduced number show ET at distance) been shown to be beneficial and they are currently
prescribed regularly.. … Bifocals are an effective
It’s suggested that the etiology is a high correction for the reduced accommodation in children
ACA ratio rather that of a basic ET with DS and also act to improve accommodation with
a success rate of 65%. ….
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8. What’s New in Down Syndrome
Haugen OH, Hovding G, Eide GE. Biometric measurements of the eyes in teenagers and
Haugen OH, Hovding G, Lundstrom I.Refractive development in children
young adults with Down syndrome.Acta Ophthalmol Scand. 2001 Dec;79(6):616-25.
with Down's syndrome: a population based, longitudinal study. Br J Ophthalmol.
2001 Jun;85(6):714-9.
Thinning of the corneal stroma may
account for the steeper cornea and the ….Accommodation weakness may be of
high frequency of astigmatism in Down aetiological importance to the high
syndrome due to lower corneal rigidity. frequency of refractive errors
It may also be of etiological importance encountered in patients with Down's
to the increased incidence of syndrome.
keratoconus in Down syndrome.
Haugen OH, Hovding G.Strabismus and binocular function in children with
Down syndrome. A population-based, longitudinal study.Acta Ophthalmol
Scand. 2001 Apr;79(2):133-9.
Stewart RE, Woodhouse JM, Cregg M, Pakeman VH. Association
between accommodative accuracy, hypermetropia, and strabismus …The majority of the Down syndrome
in children with Down's syndrome Optom Vis Sci. 2007 children with strabismus have an
Feb;84(2):149-55.
acquired esotropia and hence a
….This study demonstrates the marked potential for binocularity.
association between under- Hypermetropia and accommodation
weakness are probably important
accommodation, hypermetropia, and
factors in esotropia …….
strabismus in children with Down's
syndrome. ….
Stewart RE, Woodhouse MJ, Trojanowska LD. In focus:
the use of bifocal spectacles with children with Down's
syndrome.Ophthalmic Physiol Opt. 2005 Nov;25(6):514-22
…….Based on the results of this
study, eye examinations of children
with Down's syndrome should
routinely include a measure of
accommodation at near, and bifocal
spectacles should be considered for
those who show under-
accommodation.
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9. Fragile X Syndrome Fragile X Syndrome
• What is it? Most frequently encountered inherited form of
• What is it’s etiology? mental retardation (X-linked MR)
• What is it’s prevalence/incidence? Often misdiagnosed in the past
• What are it’s physical/visual characteristics? “New” syndrome that has caught the
imagination of researchers around the world
1st human disease shown to be caused by a
repeated nucleotide sequence
Fragile X Syndrome Fragile X Syndrome Characteristics
X-linked MR 1:600 in affected males • Large prominent ears
1/2500-4000 males 1/7000-8000 females • Long narrow face
female carriers 1/130-250 population • Macro-orchidism
male carrier 1/250-800 (80% affected men)
10% of undiagnosed ID in males
Other: hypotonia, seizures,
3% of previously undiagnosed ID in females recurrent otitis
media
Fragile X Syndrome Characteristics Fragile X Syndrome Characteristics
• Large prominent ears • Large prominent ears
• Long narrow face • Long narrow face
• Macro-orchidism (80% • Macro-orchidism (80%
affected men) affected men)
Other: hypotonia, seizures, Other: hypotonia, seizures,
recurrent otitis media recurrent otitis media
9

10. Fragile X Syndrome Characteristics Fragile X Syndrome Characteristics
• First demonstrated genetic etiology of Gaze Avoidance
learning disability
• Variable mental retardation
• Math, language delay How do you conduct an
• Sensory integration problems examination on an individual
• Attentional deficits that won’t look at you?
• Psychiatric illnesses (shy)
Fragile X Syndrome Diagnosis
Genetics
• Triplet nucleotide repeated sequence
• cytosine, guanine, guanine (CGG)
• 0-50 CGG repeats normal, 50-200
premutation, > 200 full syndrome
• Fragile site on X chromosome (band
q27.3)
Fragile X Syndrome Ocular Findings What’s New in Fragile X Syndrome
• Hatton DD, Buckley E, Lachiewicz A, Roberts J. Ocular status of boys with fragile X syndrome: a
• Strabismus (33-50%) prospective study. J AAPOS. 1998 Oct;2(5):298-302.
• Nystagmus …observe a higher prevalence of strabismus than
that found in the general population (8% vs 0.5%
• Refractive error to 1…., 17% of the sample did have significant
• Accommodative dysfunctions? refractive errors. In addition to evaluating the
• Oculomotor anomalies ocular motility of children with fragile X
syndrome, cycloplegic refraction should also be
• Ocular Health? performed to determine whether refractive
• Perceptual dysfunction problems are present.
10

11. What’s New in Fragile X Syndrome What’s New in Fragile X Syndrome
Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM, Treitman TM.Cognitive and visual processing Effect of CX516, an AMPA-modulating compound, on cognition
skills and their relationship to mutation size in full and premutation female fragile X carriers.Optom Vis Sci.
2000 Nov;77(11):592-9. and behavior in fragile X syndrome: a controlled trial. Berry-
Kravis E, Krause SE, Block SS, Guter S, Wuu J, Leurgans S,
….full mutation female carriers performed more Decle P, Potanos K, Cook E, Salt J, Maino D, Weinberg D, Lara
poorly in visual-motor processing and analysis- R, Jardini T, Cogswell J, Johnson SA, Hagerman R. J Child
synthesis on the Woodcock-Johnson Psycho- Adolesc Psychopharmacol. 2006 Oct;16(5):525-40.PMID:
Educational Battery-Revised, The Developmental 17069542
Test of Visual Motor Integration, and on five of the Cognitive and visual processing skills and their relationship to
seven subtests of the Test of Visual-Perceptual mutation size in full and premutation female fragile X carriers.
Skills. Regression analyses revealed significant Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM,
negative correlations between mutation size and Treitman TM. Optom Vis Sci. 2000 Nov;77(11):592-9.PMID:
cognitive ability. … 11138833
What’s New in Fragile X Syndrome Fragile X-associated tremor/ataxia syndrome
(FXTAS)
The fragile X female: a case report of the visual, visual perceptual,
reported in 33-40% of men older than 50 years and, less
and ocular health findings. Amin VR, Maino DM. J Am Optom
frequently (4-8%), in older women with premutations in the
Assoc. 1995 May;66(5):
fragile X mental retardation (FMR1) gene.
Optometric findings in the fragile X syndrome. Maino DM, Wesson Clinical features (FXTAS): incontinence, impotence, cerebellar
M, Schlange D, Cibis G, Maino JH. Optom Vis Sci. 1991 ataxia, peripheral neuropathy, autonomic dysfunction/orthostatic
Aug;68(8): hypotension, severe intention tremor, and other signs of
Mental retardation syndromes with associated ocular defects. Maino neurodegeneration (brain atrophy, memory loss and dementia,
DM, Maino JH, Maino SA. anxiety, depression, and irritability). Premature ovarian failure
J Am Optom Assoc. 1990 Sep;61(9):707-16. in 25% of women with premutations; this represents a 30-fold
Ocular anomalies in fragile X syndrome. Maino DM, Schlange D, increase compared with the general population.
Maino JH, Caden B. J Am Optom Assoc. 1990 Apr;61(4):316-23
Autism Autism
Do Parents cause their children to be autistic ?
There are autistic children born to parents who do not fit the autistic parent personality pattern.
Parents who do fit the description of the supposedly pathogenic parent have normal, non-autistic
children.
Frequently siblings of autistic children are normal.
Autistic children are behaviorally unusual "from the moment of birth." ***
There is a consistent ratio of three or four boys to one girl.
Virtually all cases of twins reported in the literature have been identical, with both twins
afflicted. ***
Autism can occur or be closely simulated in children with known organic brain damage. ***
The symptomatology is highly unique and specific.
Factors such as younger age of diagnosis, broadening of diagnostic criteria, improvements in the availability There is an absence of gradations of infantile autism which would
of services, and better awareness of the disorder have all been attributed to the change in autism
create "blends" from normal to severely afflicted.
prevalence. However, recent epidemiological studies indicated that, while these factors do account for a
portion of the change, they cannot account for all of the increase alone
11

12. Autism Etiology Autism Etiology
Yeast infections
Intolerance to specific food substances Brain injury, Constitutional vulnerability
(Gluten intolerance ("Leaky Gut Syndrome"/Casein intolerance causing
intestinal permeability and allowing improperly digested peptides to enter
Developmental aphasia , Deficits in the reticular
the bloodstream and cross the blood-brain barrier which may mimic activating system, An unfortunate interplay
neurotransmitters and result in the scrambling of sensory input. I've also
heard "Leaky Gut Syndrome" described as lack of the beneficial bacteria between psychogenic and
that aids digestion, and that the resulting matter in the bloodstream invokes
an unnecessary immune reaction)
neurodevelopmental factors, Structural
Phenolsulphertransferase (PST) deficiency--theory that some with autism are cerebellar changes, Genetic causes, Viral
low on sulphate or an enzyme that uses this, called phenol-
sulphotransferase-P. This means that they will be unable to get rid of amines causes, Immunological ties, Vaccines,
and phenolic compounds once they no longer have any use for them. These
then stay in their body and may cause adverse effects, even in the brain.
Seizures
Autism Etiology Autism Etiology
My Goodness! What the research
shows…
Maino DM, Viola, SG, Donati R. The
Etiology of Autism. Optom Vis
Dev 2009:(40)3:150-156.
Autism Autism
Asperger
Impairment in social interactions Childhood Syndrome
Impairment in communication Disintegrative
Disorder Autism
Restricted repertoire of activities
Rett Syndrome
12

13. Autism Autism US FDA Statement
IOM Report: No Link Between Vaccines and Autism
By Michelle Meadows
There is no link between autism and the
Childhood measles-mumps-rubella (MMR) vaccine or the
Childhood
Disintegrative Disintegrative
Disorder vaccine preservative thimerosal, according to a
Disorder
report released by the Institute of Medicine's
(IOM) Immunization Safety Review
Committee.
http://www.fda.gov/fdac/features/2004/504_iom.html
Autism Autism
Thompson WW, Price C, Goodson B, Shay DK, Benson P, Hinrichsen
VL, et al. Early thimerosal exposure and neuropsychological outcomes at 7 Andrew Wakefield (born 1956) is a British former
to 10 years. N Engl J Med. 2007 Sep 27;357(13):1281-92
surgeon and researcher best known for his discredited
Childhood work regarding the MMR vaccine and its claimed connection
Childhood
Our study does not support
Disintegrative
Disorder
Disintegrative
with autism and inflammatory bowel disease. Wakefield was the lead author
Disorder
of a 1998 study, published in The Lancet, which reported bowel symptoms in
a causal association between early
twelve children diagnosed with autism spectrum disorders, to which the authors
suggested a possible link with the MMR vaccine. Though stating "We did not
exposure to mercury from thimerosal-containing vaccines and immune prove an association between measles, mumps, and rubella vaccine and the
globulins and deficits in neuropsychological functioning at the age of 7 to syndrome described," the paper tabulated parental allegations, and adopted these
10 years. allegations as fact for the purpose of calculating a temporal link between receipt
of the vaccine and the first onset of what were described as "behavioural
symptoms“.
Summary Mental Retardation without Specific Etiology
Most frequently encountered form of Intellectual
Autism?
Disability
4000 known Online Mendelian Inheritance
in Man
http://www.ncbi.nlm.nih.gov/omim
25% of the etiologies are unknown!
13

14. Mental Retardation Classification Acquired/Traumatic Brain Injury
Neuroplasticity
Classification IQ Maino D. Neuroplasticity: Teaching an Old Brain New Tricks. Rev Optom
Mild/Educable Mentally Handicapped 50-70 2009. 46(1):62-64,66-70.
(http://www.revoptom.com/continuing_education/tabviewtest/lessonid/106025/)
Moderate/Trainable Mentally Handicapped 35-55
Severe 20-40
Profound below 20
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
Neuroplasticity & Rehabilitation Neuroplasticity & Rehabilitation
Use it or lose it. If you do not drive specific brain functions, functional Time matters. Different forms of plasticity take place at different times
loss will occur. during therapy.
Use it and improve it. Therapy that drives cortical function enhances that Salience matters. It has to be important to the individual.
particular function. Age matters. Plasticity is easier in a younger brain, but is also possible in an
adult brain.
Specificity. The therapy you choose determines the resultant plasticity and
function. Transference. Neuroplasticity, and the change in function that results from
one therapy, can augment the attainment of similar behaviors.
Repetition matters. Plasticity that results in functional change requires Interference. Plasticity in response to one experience can interfere with the
repetition. acquisition of other behaviors.
Intensity matters. Induction of plasticity requires the appropriate amount
Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for
of intensity. rehabilitation after brain damage. J Speech Lang Hear Res 2008 Feb;51(1):S225-39.
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
Post Trauma Vision Syndrome Symptoms/Signs • Staring behavior (low blink rate)
Double vision • Spatial disorientation
Headaches • Losing place when reading
Blurred vision • Can’t find beginning of next line when
Dizziness or nausea reading
Light sensitivity • Comprehension problems when reading
Attention or concentration difficulties • Visual memory problems
14

15. Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
• Pulls away from objects when they are
brought close to them
• Associated neuromotor
difficulties with balance,
• Exotropia or high exophoria
• Accommodative insufficiency coordination and posture
• Convergence insufficiency • Perceived movement of
• Poor fixations and pursuits stationary objects
• Unstable peripheral vision
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
Visual Midline Shift Syndrome Visual Midline Shift Syndrome
• Dizziness or nausea • Poor walking or posture: leans back on
heels, forward, or to one side when
• Spatial disorientation walking, standing or seated in a chair
• Consistently stays to one side of • Perception of the floor being tilted
hallway or room
• Associated neuromotor difficulties with
• Bumps into objects when walking balance, coordination and posture
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
References References
TBI a Major Cause of Disability • Myopia and Accommodative Insufficiency
by Marc B. Taub, OD, FAAO, FCOVD Associated with Moderate Head Trauma
Clinical Oculomotor Training in Traumatic Brain by Steve Leslie, B Optom, FACBO, FCOVD
Injury by Kenneth J. Ciuffreda, OD, PhD, FAAO, • Neuro-Optometry and the United States Legal
FCOVD-A, Diana P. Ludlam, BS, COVT, Neera System
Kapoor, OD, MS, FAAO by Theodore S. Kadet, OD, FCOVD, R. E.
Bodkin, JD, MBA, Attorney-at-Law
15

16. Acquired/Traumatic Brain Injury Questions? Contact:
References Dominick M. Maino, OD, MEd, FAAO,FCOVD-A
• Oculo-Visual Evaluation of the Patient with Professor, Pediatric/Binocular Vision Service
Illinois Eye Institute Illinois College of Optometry
Traumatic Brain Injury 3241 S. Michigan Ave. Chicago, Il. 60616
by Maria Mandese, OD 312-949-7280 (phone) 312-949-7660 (fax)
• Traumatic Brain Injury and Binasal Occlusion dmaino@ico.edu
by Alissa Proctor, OD www.ico.edu LyonsFamilyEyeCare.com
MainosMemos.com
http://www.covd.org/Home/OVDJournal/OVD401/tabid/263/Default.aspx
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