Neuro-Vision Rehabilitation

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What is a Brain Injury?

  • Insult to the brain which is caused by an external force
    • Can cause diminished or alerted states of consciousness
    • May result in an impairment of cognitive abilities or physical function
    • Every 9 seconds someone in north America sustains an brain injury
  • This amounts 1.7 million per year

Acquired brain injury can be broken down into 2 types

    • Non-Traumatic Acquired Brain Injury
      • Something that happens inside the body or a substance introduced into the body that damages brain tissues.
        • Causes can Include: Stroke, Aneurysm, Brain tumor, Encephalitis
    • Traumatic Acquired Brain Injury
      • Something that comes from outside the body, such as a blow, bump, or jolt. It can result in temporary injury, or more serious, long-term damage to brain cells
        • Causes can include: MVA, Falls, Assaults, Sports injuries
        • About 80-90% of TBIs fall in the mild category, which is most responsive to vision therapy and rehabilitation.
  • Over 50% of brain pathways relate to visual function, and when our eyes are open 2/3 of our brain activity is devoted to vision. This can explain why many patients with TBI may experience one or more of the following vision problems. Studies indicated that 30-80% of patients will have symptoms of post trauma vision syndrome with up to 90% showing ocular motor problems

 

These specific areas can include the following:

  • Light and Visual Sensitivity: Many brain-injured patients develop a hypersensitive visual system. Even slight changes in prescription, lighting, and overall visual environment can be very noticeable to these patients. As a result, some of these patietns are unable to filter out extra visual noise and have trouble in crowded places, such as malls and govery stores. They can also have a hard time organize themselves with in a space, and keeping themselves balanced.
  • Eye Tracking: This is the  eye’s ability to fixate (locking on to an object) and make saccades (changing fixation from one object to another) or pursuits (following an object through space). These movements are very important activities of daily living. For example, reading involves a combination of fixation and saccades. Fixations allow our brain to process the information that we area seeing in the world, they are a ‘pause’. With out these movements, higher level brain function, such as understanding material would not be possible.
  • Eye Teaming:  Also known as binocular vision training or vergence training. This is how the eyes coordinate  with on and other to both: convergence (crossing the eyes together to aim at a near object) and divergence (relaxing the eyes to aim at a more distant object). Problems in this area can result in: Blurry vision, headache, ocular discomfort, double vision, motion sickness, loss of concentration etc.
  • Neurocognition and Visual Perception: This the brains ability to make sense of what the eye sees. Not the same as visual acuity (how clearly a person sees). A person may have good visual acuity but have problems with visual perceptual processing. This is how we understand our world and learn information. Common areas that are affected in a brain injury include: Speed of information processing, visual memory, spatial deficits, perceptual organization.
  • Spatial Relationships: is our ability to perceive relationships of objects position in space EgoCenter is the perception of your bodies location in space, how we establish a constant relationship with our surroundings. Our center of gravity. Visual midline shift syndrome occurs when our bodies perceived midline is not in alignment with the actual midline of a person. Change in what we perceive to be straight ahead of us. Patients will often have difficulty walking in a straight line and notice problems with their visual field Reported cases of visual midline shift  are around 93% in the brain injured population, compared to 13% in the non-brain injured population
  • Visual field loss: This is when patients experience a loss of their visual field. Most commonly due to a non-traumatic brain injury. Neuro-vision rehabilitation works with patients in order to access the useable vision that patients have retained. We can utilize various vision training techniques  as well as lenses such a prisms to help patients rehabilitate from injury.

What is a Neuro-Optometrist?

  • A neuro-optometrist is an Doctor who specializes in the assessment of individuals who have vision related problems associated with neurological disease, trauma, metabolic or congenital conditions. When the visual system is disturbed neurologically, it can adversely affect activities of daily living for both children and adults Neuro-optometric services include:

    • Comprehensive evaluations of sensory motor, visual field, accommodative, and oculomotor function
    • Visual processing evaluations.
    • Ocular health examinations
    • Special testing, such as electrodiagnostic services
    • Therapy options
    • Coordination of care with other health care professionals and rehabilitation specialists, such as occupational, physical and speech therapist

    What is neuro-vision rehabilitation?

    Is an individualized treatment regime for patients with visual deficits as a result of physical disabilities, traumatic brain injuries and other neurological insults (ex. Stroke, Cerebral Aneurysms, cerebral palsy, multiple sclerosis etc.)

    Studies show that at least 50 percent of Traumatic Brain Injury patients suffer from visual dysfunctions.

    Visual problems are often overlooked during initial evaluation as symptoms may not be present until days, weeks or even longer following the incident. A regular eye exam often does not reveal the extent that the visual process is affected by a concussive injury. More extensive visual processes in the brain may be affected, known as Post Trauma Vision Syndrome (PTVS)

    Neuro-Vision Rehabilitation focuses directly with the rehabilitation of Post Trauma Vision Syndrome.

    6 out of 12 cranial nerves are involved in processing vision, these form over 300 neural pathways

    Up to 50% of patients with a brain injury will have 1 or more visual symptom

    Some studies have shown up to 90% incidence of post- trauma visual complications

    Visual symptoms can include and are not limited to common vision problems as listed on our website. 

How Does Vision Rehabilitation Work?

We know that our brain in plastic, and it can learn to rewire itself throughout life. After a brain injury our brains ‘normal’ paths of processing, may be turned off due to damage, or inability to communicate with other parts of the brain due to severed connections. Vision training aims to rehabilitee these pathways to aid the brain in ‘rewiring’ have had better communication with itself. This is done through various therapy techniques.

 

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