Acquired Brain Injury/Traumatic Brain Injury

Our brains are very delicate and extremely complex. Our process of vision, which moment to moment takes in light, gives it meaning, and uses that derived meaning to direct most of our purposeful movement, is intertwined throughout the brain. It is nearly impossible to suffer a significant brain injury and not affect some aspect of vision. Fortunately, throughout our lives our brain retains a degree of plasticity, which means it can learn new tricks at any age. When you or a loved one comes to the office following a brain injury my task will be to first understand exactly what happened to the brain. I want to establish some match between what we know happened to the brain and the clinical picture I will get through my testing. Too often I see mismatches in what people were told about what happened and what we see clinically. At the time of the injury generally the larger more profound questions are being asked and the many subtleties of how vision has been affected are not asked and cannot be asked. Often, it is only after a prolonged period of recovery with many therapies helping you or your loved one rebuild, that visual problems surface. Some problems, such as double vision or missing areas of the visual field or restrictions in movement of one eye or both eyes are quite obvious to see. Unfortunately, far too often acute care facilities just hand out a patch and ask the patient to make the best of it. My philosophy of vision care for someone with ABI/TBI is to relieve any double vision problems as quickly as possible with prisms. Prisms shift the image to allow the person to use both eyes together, even when one eye is turned. We have found that it is much easier to help reduce the amount of eye turn if both eyes have had a chance to work together, rather than simply handing out a patch. After restoring single vision then we need to reestablish the ability to look, to fixate, to lock onto an object for inspection. Helping a person to simply be able to look at something and to sustain their looking means that all other therapies will be more effective. Once they can look then we work on being able to shift, at will, where they are looking from one place to another, preferably by just moving their eyes. Following this, we then begin to work on the higher level perceptual processing of the visual information that comes into the system. This includes understanding what is being seen, seeing the spatial relationships in things, short and long-term visual memory, figure-ground discrimination, and many more things that so many people just take for granted. It is exciting to work to help people recover their lives. Many who have lost hope have had that hope restored as a by-product of vision therapy. ---Here is some additional content from a pamphlet I wrote on this condition---

What do I actually do?

Unfortunately, ABI/TBI is the fastest growing part of my practice. The unfortunate part is that so many people are suffering head injury, strokes, or other brain injury. The good part is that as a result of modern medicine so many survive who in the past who have succumbed. It is very rewarding to be a part of the recovery efforts of our patients with ABI/TBI helping them to get back as many skills and abilities as is possible.

It is nearly impossible to sustain a head injury and to not affect some aspect of the visual process. Vision is so pervasive in our thought and in the sensory input the brain receives from the outside world (70% of all input to the brain from all sources is from the optic nerves and therefore enters through the eyes!) that almost any brain injury will affect our visual abilities.  Those things most affected include but are not limited to:

  • Visual concentration and attention and a general slowing down of responses
  • Visual field disturbances: strokes often cause one whole side of sight to be missing
  • Visual motor disturbances where the control of the muscles of the eyes is affected and there can be tracking and/or alignment problems causing double vision and worse.
  • Visual perception and visual memory problem where so many of the abilities we take for granted are compromised

Fortunately, vision therapy can address many of these acquired problems. Vision therapy is complementary to many of the other therapies needed by this population including physical therapy, occupational therapy, speech and language therapy and many other services.

An excellent resource is the Neuro Optometric Rehabilitation Association (NORA).