Acquired Brain Injuries or Traumatic Brain Injuries
Optometrists are a pivotal part of the rehabilitation of a patient who has suffered from an Acquired Brain Injury (ABI) or Traumatic Brain Injury (TBI). Post Concussion Syndrome also falls into the category of brain injuries.
Acquired brain injuries (ABI) are caused when the axons within the brain are “sheared” by a blow to the head either by an accelerated force (baseball), decelerated force (whiplash type of injury) or percussion (explosion-likely with soldiers) type of force. This type of shearing or swelling of the brain cells may not be seen by an MRI. Another type of ABI is due to bleeding within the brain caused by a stroke or cerebral vascular accident (CVA).
The damage that an optometrist sees may not be present initially. In fact, it may not reveal itself for weeks after the injury. The Mayo Clinic estimates that 15% of patients with post concussion syndrome may have symptoms that persist a year or more. The most common visual symptoms observed are:
- Blurred Vision
- Double Vision
- Sensitivity to light
- Reading difficulties, words appear to move
- Loss of visual field
- Misalignment of eye
- Memory difficulty
- Frequent loss of place while reading
It is interesting to note that the Veterans Administration is becoming increasingly more aware of ABI with the Iraq war veterans. More than 16 percent of all casualties evacuated from Iraq sustained eye injuries, according to data compiled between 2003 and 2005. The Walter Reed hospital in the last five years has surgically treated about 700 soldiers with blindness or moderate-to-severe visual injuries. The Bethesda National Naval Medical Center lists more than 450 eye injuries that have required surgery.
Such numbers reflect injuries requiring immediate optical surgery and care, but mild-to-severe head injuries can fail to get appropriate attention until it is too late to correct them. Visual disorders associated with traumatic brain injury (TBI) include diplopia (double vision), convergence disorder (an eye-muscle disorder affecting near vision), photophobia (light sensitivity), ocular-motor dysfunction (also an eye-muscle disorder) and an inability to interpret print. Losing depth perception can be one of the most devastating long-term effects of eye injuries.
Because of the high-tech body armor issued to soldiers in Iraq and Afghanistan, doctors now confront profoundly injured troops who once would have died of thoracic and abdominal wounds before non-fatal injuries to eyes and extremities received medical attention. The injured may experience low reading speeds, inability to concentrate and an inability to process visual information. Many patients could exhibit sound ocular health following a TBI, but it is important to perform neuro-optometric exams.
Patients with these types of symptoms benefit greatly with the addition of Behavioral Optometry and Vision Therapy (Rehabilitation Vision Therapy) to their rehabilitation program. Working with patients with convergence problems, focusing problems and visual perceptual issues are who Dr. Diane deals with on a daily basis. Individuals who have suffered from an ABI or concussion are unique however as their brain has suffered trauma. The brain has “neuroplasticity.” This means that areas in the brain next to the injured site can reorganize itself to do the activities once done by the injured area. New brain wiring occurs though changes in brain structure and is enhanced by experience. Vision Therapy provides that experience. Dr. Diane knows many procedures that repeat a similar concept. By repetition and using a multisensory approach (looking, touching, listening and balance), cortical (brain) involvement where neuroplasticity takes place occurs.