NeuroRehabilitation

Following a neurological event such as a traumatic brain injury (TBI), cerebrovascular accident (CVA), multiple sclerosis (MS), etc. Vision imbalances can occur between affecting the focal and ambient visual process that can affect balance, posture, ambulation, reading, attention, concentration and cognitive function in general. Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS) can be the cause of these difficulties. This paper discusses the symptoms and characteristics of these syndromes as well as methods of treatment.

When an individual experiences a head injury, trauma shatters the patient's environment as well as affecting her/his body and physiology. Visual neuro-motor functions serve as a major link between self control and the perception of the environment. Information about the visual neurological pathways and their specialized functions serve to guide visual rehabilitative therapy. The visual system proves to be a useful avenue to help the head trauma patient interact with her/his environment and more competently deal with her/his world. An individual's ability to regain stability and improved environmental perception are positively influenced by the development of visual neuro-motor control. Two patients' case summaries illustrate rehabilitation success for patients who manifest field deficit or hemianopsia.

A step-by-step case report describes the rehabilitation program for visual dysfunction of a 52-year-old woman, beginning 2 years post-trauma. Methods to ameliorate such symptoms as diplopia, ocular discomfort, dry eye, inefficient saccadic movement, spasms of accommodation, poor reading comprehension and very limited stamina for near visual tasks are presented. Specific procedures are discussed and results are described and tabulated.

Patients who have sustained traumatic brain injury (TBI) often experience a new, intense and chronic photophobia. Photophobia, an intolerance to light, is an incompletely understood, subjective symptom, which has been divided into ocular and central types. Various commercial sources of light-filtering lenses have been developed, which have proven to be successful in diminishing visual symptoms expressed by patients who are photophobic. However, despite the many subjective reports of improved visual performance and comfort with use of these filters, there has been little documentation of actual enhanced visual sensitivity/efficiency. Letter contrast sensitivity (CS) and reading rate were measured in patients with TBI, who, despite good ocular health, experienced significant light intolerance. These patients exhibited up to two fold increases (0.3 log units) in binocular letter contrast sensitivity, as measured with the Pelli-Robson Letter CS Chart, in the presence of selected Corning Photochromic Filters (CPF), as compared to performance in the absence of CPF filters, or to that of similarly treated normal observers. These same patients demonstrated reading rates enhanced up to 39% above that measured in the presence of nearpoint optical correction alone. Reading performance of normal observers was unaffected by similar light filtration. These data provide objective evidence for improvement of visual function provided by light-filtering lenses in patients who become photophobic after TBI. Contrast sensitivity testing and assessment of reading rate add objective criteria for the clinical selection of light-filtering lenses in the treatment of TBI-induced photophobia.

Vision loss is often a complication of a traumatic brain injury (TBI). To maximize rehabilitation of a person with a TBI, the professionals who coordinate and carry out therapeutic activities should be aware of the impact impaired vision can have on over all processing. This article will address how the low vision examination and treatment process can be an invaluable adjunct to a rehabilitative therapy program.

Diplopia is a serious and intolerable sequelae to the problems of strabismus, ophthalmoplegia, gaze palsy, and decompensated binocular skills that occur in patients with head injury, stroke and other neurologically compromising conditions. A variety of treatment measures are available for diplopia, but they are not always successful. When treatment is either not used, or fails, patching has been used to occlude the vision of one eye. Although patching is effective in eliminating diplopia, it creates problems by rendering the patient monocular. Monocular vision causes a loss of stereopsis and reduction of peripheral visual field which in turn causes problems in eye hand coordination, depth judgments, orientation, balance, and mobility. A new method of treating diplopia, the ‘spot patch’, has been successfully evaluated. It is a procedure that eliminates diplopia without the limitations and side effects of traditional patching.

The purpose of this study was to establish national point prevalence rates for traumatic brain injury, resulting in recognizable disability among adults living in institutions or in the community. The report is based on the Canadian Health and Activity Limitation Surveys (1986–1987), conducted in households and in institutions by Statistics Canada. These surveys used multi-stage cluster design with stratification, unequal probabilities of selection and computer linkage to the 1986 census of the population (households only). A combined representative sample of 632 adults with disabilities resulting from an injury to the brain provides a total population estimate of 15 000 adults. Participation rate by potential respondents was 90% in the household survey, and 97% for the institutional survey. The overall national prevalence rate of traumatic brain injury is 74.3 per 100 000 (95% CI 66.3–82.4) adults. Prevalence rates are highest in the 45–64 age range. Gender specific rates are 96.9 per 100 000 males and 52.9 per 100 000 females, with a 1.8:1 male to female ratio. The vast majority (84%) of adults with traumatic brain injury reside in household, rather than institutional settings. Prevalence rates allow estimates of the national public health burden of traumatic brain injury. Findings point to the health care burden of middle aged individuals living primarily in community settings.

Visual processing deficits are a common sequelae in individuals who have sustained a brain injury, Visual processing includes the acquisition of visual information and the appropriate use and manipulation of that information based upon task or environmental demands, Following brain injury, visual processing deficits can manifest in various ways, and will likely interfere with the patient's progress and rehabilitation outcome, This article describes the importance of understanding and accurately identifying visual processing deficits and implementing specific rehabilitation strategies to maximize functional independence.