Vision Rehabilitation in Brain Injury
Until recently vision rehabilitation has frequently been neglected after brain injury. It is natural that the most serious often life threatening problems were treat first.
Vision problems were often left until after other more serious problems were resolved or these vision problems were never treated. The hospital model was traditionally more oriented to occupational, physical and speech therapy. Occupational therapists play an important role in the initial visual rehabilitation of conditions such as hemianopsia and visual neglect.
However, many aspects of a patient’s recovery may hinge on the rehabilitation of the vision disorders. Further vision rehabilitation needs the expertise of optometrists or ophthalmologist who specialize in vision rehabilitation.
Today we understand the high incidence of vision problems in brain injury. Research has shown that visual disorders occur in 30% to 85% of brain injury patients. Early identification and treatment can help speed the recovery of many patients.
Survival is no longer the only goal of most brain injury patients. Returning to a normal life, to driving if possible and to work or school are their expectations. To meet these high expectations we must continually raise the level of care we provide especially in solving the vision problems of brain injury patients. The literature list below show some of the important papers dealing with visual problems after brain injury
Literature List: Vision and Brain Injury
Adapted from Neera Kapoor, OD, MS*Kenneth J. Ciuffreda, OD, PhD
Vision Disturbances Following Traumatic Brain Injury
Baker RS, Epstein AV: Ocular motor abnormalities from head trauma. Surv Ophthalmol 1991, 35:245–267.
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Bohnen S, Twijnstra A, Wijnen G, et al.: Tolerance for light and sound of patients with persistent post–concussional symptoms 6 months after mild head injury. Neurology 1991, 238:443–446.
Hellerstein LF, Freed S, Maples WC: Vision profile of patients with mild brain injury. J Am Optom Assn 1995, 66:634–639.
Sabates NR, Gonce MA, Farris BK: Neuro–opthalmological findings in closed head trauma. J Clin Neurol Ophthalmol 1991, 11 :273–277.
Schlageter K, Gray K, Shaw R, Sammet R: Incidence and treatment of visual dysfunction in traumatic brain injury. Brain Inj 1993, 7:439–448.
Suchoff IB, Kapoor N, Waxman R, Ference W: The occurrence of visual and ocular conditions in a non-selected acquired brain-injured patient sample. J Am Optom Assoc 1999, 70:301–308. Supporting evidence, including a brief literature review, for the occurrence of various vision problems in patients with acquired brain injury.
Harrison RJ: Loss of fusional vergence with partial loss of accommodative convergence and accommodation following head injury. Binoc Vis 1987, 2:93–100.
Lepore FE: Disorders of ocular motility following head trauma. Arch Neurol 1995, 52:924–926.
Waddell PA, Gronwall DM: Sensitivity to light and sound following minor head injury. Acta Neurol Scand 1984, 69:270–276.
Suter PS: Rehabilitation and management of visual dysfunction following traumatic brain injury. In Traumatic Brain Injury Rehabilitation. Edited by Ashley MJ, Krych DK. Boca Raton: CRC Press; 1995:198–220.
Gianutsos R, Ramsey G, Perlin R: Rehabilitative optometric services for survivors of brain injury. Arch Phys Med Rehabil 1988, 69:573–578.
Jackowski MM, Sturr JF, Taub HA, Turk MA: Photophobia in patients with traumatic brain injury: uses of light–filtering lenses to enhance contrast sensitivity and reading rate. Neurorehab 1996, 6:193–201.
Zihl J, Kerkhoff G: Foveal photopic and scotopic adaptation in patients with brain damage. Clin Vis Sci 1990, 5:185–195.
Ciuffreda KJ, Suchoff IB, Marrone MA, Ahmann E: Oculomotor rehabilitation in traumatic brain–injured patients. J Behav Optom 1996, 7:31–38.280Neurologic Ophthalmology and Otology
Padula WV: Neuro–optometric rehabilitation for persons with TBI or CVA. J Opt Vis Dev 1992, 23:4–8
Diller L, Weinberg J: Hemi–inattention and rehabilitation: the evolution of a rational treatment program. In: Advances in Neurology, vol 18. Edited by Weinstein EA, Freidland RP. New York: Raven Press; 1977.
Gianutsos R, Suchoff IB: Visual fields after brain injury: management issues for the occupational therapist. In Understanding and Managing Vision Deficits: A Guide for Occupational Therapists. Edited by Scheiman M. Thorofare: Slack; 1998.
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Rossetti Y, Rode G, Pisella L, et al.: Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature 1998, 395:166–169.Supporting evidence for the prescription of yoked prisms for a temporary period in patien ts with clinical signs of neglect with or withoutvisual field defects.
Rossi PW, Kheyfets S, Reding MJ: Fresnel prisms improve visual perception in stroke patients with homonymous hemianopia or unilateral visual neglect. Neurology 1990, 40:1597–1599.
Webster JS, Jones S, Blanton P, et al.; Visual scanning training with stroke patients. Behav Ther 1984, 15: 129–143.
Weinberg J, Diller L, Gordon W, et al.: Training sensory awareness and spatial organization in people with right brain damage. Arch Phys Med Rehabil 1979, 60:491–496.
Welch RB, Goldstein G: Prism adaptation and brain damage. Neuropsychologia 1972, 10:387–394.
Gianutsos R: Visual field deficits after brain injury: computerized screening. J Behav Optom 1991, 2:143–150.
Kerkhoff G, MunBinger U, Haaf E, et al.: Rehabilitation of homonymous scotomata in patients with post-geniculate damage of the visual system: saccadic compensation training. Restorative Neurol Neurosci 1992, 4:245–254.
Kapoor N, Ciuffreda KJ, Suchoff IB: Egocentric localization in patients with visual neglect. In: Visual and Vestibular Consequences of Acquired Brain Injury.
Edited by Suchoff IB, Ciuffreda KJ, Kapoor N. Santa Ana: Optometric Extension Program Foundation; 2001.
Stein JF: Representation of egocentric space in the posterior parietal cortex. Q J Exp Physiol 1989, 74:583–606.
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Karnath HO: Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation. Brain 1994, 117:10 01 – 101 2 .
Snyder LH, Batista AP, Andersen RA: Coding of intention in the posterior parietal cortex. Nature 1993, 386:167–70.
Snyder LH, Grieve KL, Brotchie P, Andersen RA: Separate body–and world referenced representations of visual space in parietal cortex. Nature 1998, 24:887–890.
Jackowski MM: Altered visual adaptation in patients with traumatic brain injury: photophobia, abnormal dark adaptation, and reduced peripheral visual field sensitivity. In Visual and Vestibular Consequences of Acquired Brain Injury.
Edited by Suchoff IB, Ciuffreda KJ, Kapoor N. Santa Ana: Optometric Extension Program Foundation; 2001.
Suchoff IB, Gianutsos R, Ciuffreda KJ, Groffman S: Vision impairment due toacquired brain injury. In The Lighthouse Handbook on Vision Impairment and Rehabilitation. Edited by Silverstone B. New York: Oxford University Press; 2000. Supporting evidence reviewing the various vision problems following acquired brain injuryand the associated ocular anatomy and physiology, where appropriate.
Ciuffreda KJ, Tannen B: Eye movement basics for the clinician. St. Louis: Mosby Year Book; 1995.
Fayos B, Ciuffreda KJ: Oculomotor auditory biofeedback training to improve reading efficiency. J Behav Optom 1998, 9:1–10.
Ciuffreda KJ: Visual vertigo syndrome: a clinical demonstration and diagnostic tool. Clin Eye Vis Care 1999, 11 :41–42.
Ciuffreda KJ, Levi DM, Selenow A: Amblyopia: basic and clinical aspects. Boston: Butterworth; 1991.
Press LJ: Applied Concepts in Vision Therapy. St. Louis: Mosby; 1997.
Gianutsos R: Functional and subjective visual fields: practical methods for the assessment of vision and promotion of metavision in brain injury survivors with visual field loss. In Visual and Vestibular Consequences of Acquired Brain Injury.
Edited by Suchoff IB, Ciuffreda KJ, Kapoor N. Santa Ana: Optometric Extension Program Foundation; 2001.