"Along with my perseverance and my vision therapy team’s dedication, I can proudly say that my continued improvement has been possible because I have been changed for the better as a person. If I were to see myself a year ago, I would not recognize the person I was then. She was hopeless, confused, and tired, but now she is optimistic and thriving."
Acquired Brain Injury (ABI)/concussion is an all-encompassing/umbrella term for damage to the brain that occurs after birth. Typically this damage is sudden, non-progressive, non-degenerative, and leads to abnormalities in neurological processing. These neurological changes can adversely affect the way a person functions in their activities of daily living, i.e., thought process, emotional behavior, speech ability, and physical changes such as impaired motor function, problems with a person’s visual system including, but not limited to:
Eye tracking problems
Eye teaming problems
Eye focusing problems
Visual field problems
Visual information processing problems
An ABI can be from an external traumatic injury (where the brain encountered physical trauma from such incidents as a motor vehicle or bicycle accident, a fall, an assault, contact sports, or neuro-surgery, etc.) or it can be from an internal cause (a stroke, an aneurysm, a brain tumor, a viral infection or inflammation such as meningitis, a vestibular dysfunction such as Ménière’s disease, or any post-surgical complications leading to an anoxic or hypoxic event in the brain).
A concussion is typically caused by an external physical trauma to the head/brain. The visual and related consequences can be temporary or long term.
Common symptoms of a concussion include physical, cognitive, and emotional changes, as well as changes in one’s sleep pattern.
Physical changes may include:
Headache or pressure around the head
Visual problems
Nausea or vomiting
Sensitivity to light, sound, etc.
Difficulty with balance and/or coordination
Speech difficulties
Distorted sense of taste and smell
Ringing in the ears
Excessive tiredness/fatigue
Cognitive changes may include:
Difficulty thinking (feeling of being in a “fog”)
Delayed response to questions
Slowed thinking/thought process
Feeling “dazed”
Difficulty concentrating
Trouble remembering new information
Emotional changes may include:
Irritability or other personality changes
Depression or sadness
Increased emotional behavior
Difficulty adjusting psychologically
Being abnormally nervous or anxious
Changes in sleep pattern may include:
Needing more sleep than usual
Needing less sleep than usual
Difficulty falling asleep
The signs and symptoms of mTBI/concussion may be experienced immediately, but they also may be delayed by hours, days, or even weeks after the injury.
A whiplash injury occurs when the head and neck are rapidly and forcefully moved in a back and forth motion, such as in a rear-end motor vehicle accident, physical assault, or contact sports. It can cause damage to the soft tissue of the neck and brain. Typically the recovery process takes a few months, but the prognosis is generally good. Similar to concussions, the symptoms of a whiplash injury can occur immediately or can be delayed. These symptoms include:
Visual problems
Neck pain that may increase with moving the neck
Limited range of motion of the neck
Stiffness or pain in the neck, shoulder, upper back, or arms
It can also include symptoms similar to that of a concussion including ringing in the ears, tiredness/fatigue, dizziness, mood changes, sleep disturbances, and difficulty with memory and concentration.
A stroke, as known as a cerebrovascular accident, is caused when the blood flow to any portion of the brain is blocked or significantly reduced. This lack of blood flow deprives that particular portion of the brain of necessary nutrients and oxygen. There are two types of strokes: an ischemic stroke which is typically caused by a blocked artery, or a hemorrhagic stroke which is typically caused by a leaking or bursting blood vessel. Eighty-five percent of strokes are ischemic in nature. Common symptoms of a stroke are:
Visual problems such as blurred vision, double vision, or dimming vision
Trouble with walking/coordination
Difficulty speaking
Numbness of paralysis of the face, arm, or leg
It can also include symptoms similar to that of a concussion including ringing in the ears, tiredness/fatigue, dizziness, mood changes, sleep disturbances, and difficulty with memory and concentration.
There are many types of brain tumors. In general, a tumor is an abnormal growth of new cells that buildup to form to a mass of tissue, or a tumor. When this process occurs in the brain, then a brain tumor is formed. These tumors can be benign (noncancerous) or malignant (cancerous). How rapidly the tumor grows, the size of it, how it affects the person, and which treatment is selected depends on the tumor. Symptoms of a brain tumor can include:
Visual problems including blurred vision, double vision, and visual field loss
Headaches that are new or have changed pattern and are worsening or more frequent in nature
Unusual nausea and vomiting
Difficulty with balance/coordination
Numbness or paralysis of an arm or leg
Trouble with hearing and speech
Confusion
Change in personality or behavior
Seizures when no history of seizures exist
Viral infections of the brain include such conditions as encephalitis, meningitis, and inner ear infections. Signs and symptoms include:
Visual problems
Tiredness/fatigue
Problems with balance/coordination and muscle strength
Cognitive and memory problems
Personality or behavior changes
Problems with hearing, speech
The vestibular system is responsible for balance and coordination. It is located in the brain and inner ear. The vestibular and visual systems are neurologically interconnected. Symptoms of a vestibular disorder include:
Problems with vision and hearing
Headaches
Feeling of fullness in the ears
Vertigo, dizziness
General imbalance
Feeling of being “seasick”
Motion sickness
Nausea, vomiting
Changes in mood
Difficulty with thinking
The majority of the hardwiring of the brain involves the visual pathway, so it is common to experience a visual problem after a brain injury. The most common visual symptoms/visual problems associated with acquired brain injury (ABI) are:
Blurred vision at distance viewing
Blurred vision at near viewing
Slow shift of focus from near-to-far or far-to-near
Difficulty copying or taking notes
Double vision
Pulling or tugging sensation around eyes
Unable to sustain near work or reading for periods of time
Loss of place while reading
Eyes get tired while reading
Headaches while reading
Covering/closing one eye
Easily distracted when reading
Decreased attention span
Reduced concentration ability
Difficulty remembering what has been read
Loss of balance
Face/head turn or head tilt
Bothered by movement in environment and/or by crowded environments
Light sensitivity
A sensation of the floor, ceiling, or walls tilting
Dizziness
A sensation of the room spinning
A sensation of not feeling grounded
Postural shifts/veering off when walking
An optometrist who has specific interest in diagnosing and managing problems with binocular vision and provides vision rehabilitation in the form of special glasses (that include a specific prescription, prisms, tints, and/or coatings) or in the form of in-office or out-of-office visual rehabilitation. When scheduling an eye examination, ask if the optometrist provides evaluation services for binocular vision problems and neuro-optometric rehabilitation.
Lens---a specifically prescribed optical device that focuses light onto the retina to obtain a clear image; at times, lenses are used at near to help the eye focus more easily and efficiently with increased comfort.
Prism---a specialized optical device that deviates/'bends' light; prisms are frequently prescribed as a component of the treatment for binocular vision problems and to eliminate double vision, as well as to provide comfort for near visual tasks such as reading.
Tint/coating---an optical component that alters the amount of light to the eyes; at times, it may also alter the color of the object; they are used to help those with light sensitivity/glare problems.
Selective occlusion---the use of specially graded filters to help patients who are experiencing double vision or visual confusion.
----a series/sequence of scientifically-proven, brain-based, sensory-motor-perceptual procedures and techniques that remediate visual dysfunctions/deficits, which improves one's visual efficiency and visual comfort.
Neuro-Optometric Rehabilitation (NOR) represents a specialized area of optometry, which addresses the oculomotor, accommodative, visuomotor, binocular, vestibular, perceptual/visual information processing, and specific ocular/neurological sequelae of the acquired brain injury population. This includes the diagnoses of concussion, traumatic brain injury, cerebrovascular accident/stroke, post-surgical brain complications, encephalopathy, vestibular dysfunction, and neurological conditions adversely affecting the visual system. NOR includes standard optometric modalities, such as corrective lenses, prisms, tints and coatings, selective occlusion, and optometric vision therapy. Optometric vision therapy incorporates both in-office and out-of-office procedures for the remediation and management of the associated visual problems listed above with the goal to improve activities of daily visual living and performance. Optometric vision therapy is based on sound principles of neuroscience involving visual motor and perceptual learning reflective of the underlying visual/neural system plasticity. It frequently is provided in conjunction with other rehabilitation and health care professionals.
When a person has an acquired brain injury, often one type of rehabilitation is not enough to address all his or her needs, since so many of their brain processing systems have been affected (i.e. vision, hearing, speech, motor control, etc.). Oftentimes there needs to be a rehabilitation team to address their needs. The members of this team include, but are not limited to the following providers:
Optometrist who specializes in Neuro-Optometric Rehabilitation
Physiatrist
Neurologist
Neuropsychologist
Physical Therapist
Occupational Therapist
Cognitive Therapist
Vestibular Therapist
Speech/Language Therapist
Typically, early intervention is more beneficial, but it’s never too late to seek rehabilitation after a brain injury. If you or someone you know is having visual problems from an acquired brain injury, we are here to help.
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