On February 26, 2017, Dr. Penelope Suter, OD, gave a lecture on Post Brain-Injury Vision Rehabilitation — Enhancing the Future of Functional/Behavioral Optometry. The focus was on neuro vision rehabilitation for patients who may present with common oculomotor/binocular dysfunctions due to:
- Stroke (adult and pediatric)
- Traumatic brain injury (TBI) related to auto accidents, work, etc.
- Sports related concussion
- Veterans
- Children with vision and reading problems
- Patients with learning disabilities, ie: Austim spectrum
A few concepts stood out during the lecture:
- Concussion: The symptoms of mild concussion, expected to spontaneously resolve within weeks of occurrence, can persist for years after, as reported by veterans.
- Among 262 athletes, 43% of those with a history of concussion reported they had knowingly hidden symptoms …to stay in a game, and 22% of athletes overall indicated that they would be unlikely to report concussion symptoms to a coach in the future. (1) Meanwhile, a retrospective review of 159 student records from elementary through college aged students showed that in 43.5% of sports related concussion cases, the patient returned to the sport too soon, and 44.7% returned to school too soon when “too soon” was defined by regression. (2)
- Besides numerous vision deficits, visual spatial neglect is extremely common. In one study, patients hospitalized with stroke reported visual spatial neglect in up to 82% of assessable right hemisphere stroke patients and 65% of assessable left hemisphere stroke. (3)
- Huber and Weisel’s experimental results that lead to the conclusion of a critical period for vision was “over-interpreted”. The partial reorganization of receptive fields for sensory stimuli can change in minutes of a lesioned cortex. Plasticity is the basis of therapy and learning.
- Neuro and developmental optometrists are well equipped to test and treat these patients to drastically improve their functional vision, with specific rehabilitation techniques and optical treatment methods.
- Dr. Suter’s take home: Vision deficits are generally COVERT, thus dysfunction in the visual system is most often demonstrated in motor, balance, attentional, cognitive, and behavioral deficits.
Dr. Penelope Suter, OD, FCOVD, offers decades of professional experience, while showing humility for the complexity of this subject, inviting other specialists to contribute to the conversation. She has a private practice in Bakersfield and is the first editor of the textbook Vision Rehabilitation: multidisciplinary care of the patient following brain injury, (Suter & Harvey, CRC Press, 2011).
BRAIN HQ: Brain training to improve perceptual speed
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