Andrew R. Adamich, OD
Carol E. Marusich, OD, MS, FCOVD
Board Certified in Vision Therapy
Lifetime Eye Care Inc.
4765 Village Plaza Loop Suite 100
Eugene Oregon 97401
Phone 541.342.3100 Fax 541.342.6153
www.lifetimeeyecare.net
Vision Rehabilitation Following Brain Injury
Carol E. Marusich, OD, MS, FCOVD
In addition to the traumatic event involved in head injury and stroke, there are at times lingering symptoms which can delay recovery. Each brain injury patient may present very differently. In some cases, these symptoms can be subtle, confusing and difficult to relate to the injury directly. Some can affect performance of every day tasks which had been automatic.
Vision rehabilitation evaluation should be completed simultaneously with other therapeutic (OT, PT, speech & language, etc.) evaluations. Frequently, an undetected visual problem interferes with the patient's progress in those therapies. Think of a patient with a midline shift, intermittent double vision or visual field loss being asked to perform activities that require balance, work on language activities which require reading, or cognitive rehabilitation that involves extended time reading, working at a computer or on a memory device. It is important to appreciate how a vision problem can significantly interfere with other functional assessments and treatment.
Rehabilitation programs sometimes suggest waiting to evaluate or treat visual symptoms because they might become less prevalent over time. This would be like keeping a wheelchair or a cane from a patient whose mobility might improve in a few months! The brain injured patient's condition is dynamic and requires appropriate intervention as early in the rehabilitation process as possible and at every step along the way. Vision rehabilitation can and often does enhance rehabilitation in other sensory-motor and cognitive areas.
Injuries which affect sight, visual efficiency, and visual perception are significant because they impact performance on many levels. The following list includes some of the common visual symptoms which can be associated with brain injury.
Decreased blink rate and dry eyes.
Blurred vision at distance and / or near.
Difficulty tracking or following moving objects with your eyes.
Inability to understand what is seen
Inability to recognize written words
Inability to see or to recognize colors
Inability to recognize faces
Inability to recognize multiple stimuli
Poor visual-motor coordination or mobility
Poor balance
Difficulty following moving objects
Tendency to stare
Memory Problems
Difficulty reading: skips; rereads; words or letters jump around on the page.
Objects and print can appear to be unstable.
Headache or visual discomfort.
Difficulty focusing with one or both eyes.
Frequent squinting or excessive blinking to make vision clearer.
Double vision or overlapping / shadow images.
Need to close one eye to see clearly.
Unusual head tilt or head turn.
Difficulty judging depth or location of objects
bumps into objects, under or over reaches for objects.
Portions of a page or objects appear to be missing.
People or things suddenly appear from one side that you didn't see approaching.
Difficulty seeing at night.
Tunnel Vision.
Difficulty concentrating on visual tasks.
Sensitivity to light.
Discomfort in crowded areas with a lot of movement such as shopping.
Vision appears unstable or shifts from eye to eye.
Difficulty maintaining eye contact; appears to look past the observer.
Poor visual memory; difficulty remembering where you put things.
When brain injury occurs, early diagnosis and treatment are important for successful recovery. Vision, as one of our primary senses, plays a vital role in the rehabilitation process. Untreated vision problems and visual perceptual processing conditions can delay or interfere with that process. Good communication between patient and doctor concerning visual symptoms will promote early diagnosis and treatment of underlying vision conditions, and will enhance the rehabilitation program. Even years after brain injury has occurred, persistent underlying vision problems can continue to interfere with comfort and performance and should be treated to allow optimal long term recovery.