9th World Congress International Brain Injury Vision Abstracts
A Retrospective Analysis of Vertical Heterophoria Treatment and Amelioration of Post-concussive Disorder Symptoms Via a Multifaceted Assessment Battery
Mark Rosner, Debby Feinberg, Jennifer Doble, Arthur Rosner
University of Michigan, Ann Arbor, MI, USA, St Joseph Mercy Hospital, Ann Arbor, MI, USA, William Beaumont Hospital, Royal Oak, MI, USA, Vision
Specialists Institute, Bloomfield Hills, MI, USA
Objectives: Traumatic brain injury (TBI) appears to precipitate vertical heterophoria (VH) (a form of binocular vision misalignment) in a subset of patients after TBI, and the VH appears to be causing post-concussive headache, dizziness, anxiety, neck pain and reading difficulties in this group. We hypothesized that treatment of the VH utilizing realigning prismatic spectacle lenses would significantly reduce these post-concussive symptoms. Our original study demonstrated a 71.8% subjective reduction of overall VH symptom burden with prismatic lens treatment, which correlated with a 48.1% reduction of a self-administered VH symptom assessment instrument developed by the authors currently undergoing validation (Vertical Heterophoria Symptom Questionnaire (VHSQ)). The objective of this study is to utilize validated survey instruments and other metrics to quantify the reduction of headache, dizziness and anxiety resulting from prismatic lens treatment.
Methods: Thirty eight patients with a history of TBI, who presented to an optometric binocular vision subspecialist with persistent post-concussive symptoms and who were simultaneously diagnosed with VH, had completed data sets and were included in
this retrospective analysis. Data was collected prior to and at the conclusion of VH intervention from validated survey instruments (Headache Disability Index (HDI), Dizziness Handicap Inventory (DHI), Zung Self-Rating Anxiety Scale (SAS); from the
VHSQ; from a subjective rating (0-10 scale) of headache, dizziness and anxiety severity; and from a sub-analysis of VHSQ questions that pertain specifically to headache, dizziness and anxiety. Upon conclusion of treatment, subjective assessment of overall improvement of VH symptoms was obtained utilizing a 10 cm visual analog scale (VAS). Effect of treatment was analyzed using paired t-test.
Results: When compared with pre-intervention baseline, there was an 80.2% decrease in subjective overall VH symptom burden (p¼0.00001). There was a relative reduction in the VHSQ (50.5%; p¼0.0001); HDI (29.9%; p¼0.028); DHI (40.7%;p¼0.002); Zung SAS (19.1%; p¼0.0001); 0-10 scores for headache (55.4%), anxiety (33.9%) and dizziness (60.8%); two VHSQ headache questions (49.6%); six VHSQ dizziness questions (51.2%); and the three VHSQ anxiety questions (42.1%).
Conclusions: In the subset of patients with TBI simultaneously diagnosed with VH, treatment of VH with prismatic lenses resulted in marked reduction of all metrics for headache, dizziness and anxiety, which coincided with the patient’s perception of overall VH symptom reduction. Identification of VH in patients with TBI with prolonged postconcussive symptoms should become a high priority, as effective treatment is available for VH which significantly reduces post-concussive symptoms. While anecdotally VH is common in this cohort, further studies will be required to determine true VH prevalence. Also anecdotally, while there is significant improvement in gait, balance, reading comprehension / speed and cognitive performance, further studies will be needed to ascertain whether these types of functional improvements are to be routinely expected with correction of VH.
Comments: It's interesting to note that Dr. Debby Feinberg is a former student of mine at the Illinois College of Optometry. She is married to Dr. Mark Ross, an emergency room physician who is the brother to Dr. Arthur Ross who is an ENT physician. They published a previous paper that I commented on (Identification of Binocular Vision Dysfunction Vertical
Heterophoria in Traumatic Brain Injury Patients and Effects of Prismatic
Glasses) in one of my MainosMemos postings.
Improving Vision Function In The Patient With Traumatic Brain Injury
Dominick Maino, Darrell Schlange
Illinois College of Optometry/Illinois Eye Institute, Chicago, Il, USA
Objectives: Few reports in the literature note how vision therapy (VT) can improve the quality of life for those with traumatic brain injury (TBI). This presentation discusses the significant improvements of signs and elimination of symptoms noted after a regimen of VT in oculomotor skills, attention, reading and driving ability in a patient with TBI.
Case Report: PA, a university professor, is a 53 y/o WF with a history of traumatic brain injury due to a car accident. Her symptoms included falling asleep while reading, avoidance of reading, decreased attention, and exhibited major problems parking
her car. The TOVA showed an ADHD Score of -4.00 while the Visagraph revealed significant problems in span of recognition, fixation, reading rate/comprehension, efficiency and fluency. She was diagnosed with convergence insufficiency, oculomotor
dysfunction, and attention deficit. VT sessions followed a standard format that included monocular, biocular, binocular and an integration/stabilization therapy phase. Computer aided VT included the use of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the EyePort. After 27, 45 min VT sessions both the TOVA and Visagraph showed normal attention and oculomotor skills, convergence insufficiency resolved, reading ability improved and parking problems eliminated. All other symptoms were either improved or were eliminated. PA currently successfully teaches at a major USA university.
Conclusions: Individuals with TBI often exhibit marked problems in oculomotor skills, binocular vision dysfunction, attention, and other visual abilities that affect their quality of life. Primary eye care providers, in general, do not diagnosis or manage the many vision and vision information processing problems associated with TBI can utilize this case as a starting point to help them do so in the future or to motivate them to refer to those who have experience and expertise in this area. This case demonstrates that with VT both symptoms and signs that adversely affect an individual’s quality of life after traumatic brain injury can be improved.
Neuro-Optometric Rehabilitation of ABI/TBI Induced Vision impairment
Steen Aalberg
Kraskin & Skeffington Institute, Slangerup, Denmark, OEPF, Santa Ana CA, USA
Educational goal is to make the participant aware of the presence of some of the vision problems occurring from ABI/TBI, their potential impact on the rehab process, and to provide a few simple tools to verify their presence. The optometric definition of vision as ‘‘The deriving of Meaning and Direction of Action as Triggered by Light’’ reveals that acuity and visual fields are only two parts of vision, reminding us we should be more
careful when judging and quantifying vision problems. Vision is developed through and for movement, thus in the adult becoming responsible for the planning of movement and guiding of our motor system, as well as playing the main role in perceiving and understanding of the visual world we live in. Vision impairments in various forms exist with high frequency occurrence in brain injured patients. While the more obvious types of vision problems, like hemianopsia and major eye turns, are likely to be identified, a lot of less visible vision problems may go undetected throughout rehabilitation, thus potentially
impairing the outcome. Binocular problems of almost any kind will influence the ability to read, orient oneself in space and maintain concentration. Fixation problems and eye motor problems due to neural damage can cause mild or severe diplopia, loss of 3D-vision, create major proceptional disturbances and impair balance and cognition. Very often these problems, at least in their milder forms, does not surface through direct complaints from the patient, but are left to be revealed by professionals within eye care. This paper will adress the topic through examples of common vision problems following brain injury, as well as a series of visual symptoms all health care professions working with the brain injured patient should be aware of. Some simple ways of observing or determining if a vision problem might be present will be discussed as a help to decide when to refer, and some of the tools
Saturday, March 31, 2012
Friday, March 30, 2012
Improving vision function in the patient with Traumatic Brain Injury
I am giving this presentation today (03-30-12) to Illinois College of Optometry students and faculty for the newly formed SNORA (Student Neuro-Optometric Rehabilitation Association). As this student's organization faculty adviser, I am very proud that ICO students are interested in helping those with brain injury. DM
Improving vision function in the patient with Traumatic Brain Injury
View more PowerPoint from Dominick Maino
Tuesday, March 27, 2012
The Illinois College of Optometry is Where You Want to Be!
Illinois College of Optometry Primary Care Grand Rounds CE
The last Primary Care Grand Rounds CE event for the Spring Quarter is scheduled for Thursday, March 29.
When: 5:30-7:30 PM
Where: Adams Center
Topics: Disseminated RPE Hyperplasia, Toxic Optic Neuropathy, Acute Corneal Edema
Presenters: Melissa Siragusa, Rob Sun, Natalie McKee
This is an excellent opportunity to enjoy two hours of
non-tested CE & intellectual discussion with your colleagues.
Sponsored in part by an Alcon - Partners in Education Grant
Hors d'oeuvres & beverages will be provided.
Monday, March 26, 2012
Visual Diagnosis and Care of the Patient with Special Needs
Visual Diagnosis and Care of the Patient with Special Needs
Marc Taub, Mary Bartuccio, Dominick M. Maino
Marc Taub, Mary Bartuccio, Dominick M. Maino
Tentative Chapters and Authors
1. The Life Cycle Approach to Care for Patients with Special Needs
Glenn Steele, Dominick M. Maino
2. Genetics
Charles Connor
3. Cerebral Palsy
Ashley Reddell, Marc B. Taub
4. Down syndrome
Margaret Woodhouse, Dominick M. Maino
5. Fragile X syndrome
Elizabeth Berry-Kravis, Dominick M. Maino
6. Intellectual Disabilities of Unknown Etiology
Karen Kehbein, Marc B. Taub
7. Oculo-Visual Abnormalities Associated with Rare Neurodevelopmental Disorders
Daniel Smith
8. Autism
Rachel A. Coulter
9. Acquired Brain Injury
Kenneth Ciuffreda, Neera Kapoor
10. Attention Deficit Hyperactivity Disorder (ADHD)
Terry Browning, Mary Bartuccio
11. Learning Disabilities
Garth Christianson, Eric Borsting
12. Mental Illness and Dual Diagnosis (MR/MI)
Pam Schnell, Dominick M. Maino, Robert C. Jespersen
13. Neurodegenerative Diseases
Denise A. Valenti
14. Cortical Visual Impairment (CVI)
Barry Kran, Luisa Mayer
15. Vision Screening and Patients with Special Needs
Mary Bartuccio, Nadine Girgis
16. Comprehensive Examination Procedures
Marc B. Taub
17. Diagnosis and Treatment of Refractive Error
James Newman
18. Diagnosis and Treatment of Oculomotor Dysfunction
Paul Harris
19. Diagnosis and Treatment of Binocular Vision and Accommodative Dysfunction
Erin Jenewein, Kelley Meehan
20. Diagnosis and Treatment of Strabismus and Amblyopia
Jackie Rodena, Yin Tea
21. Diagnosis and Treatment of Vision Information Processing Disorders
Deborah Amster
22. Diagnosis and Treatment of Commonly Diagnosed Ocular Health Anomalies
William Kress, Jon Neal, Andrew Rixon
23. Special Assessment Procedures
Scott Steinman, Maryke Neiberg
24. Neuro-plasticity and the Patient with Special Needs
Dominick M. Maino, Robert Donati, Yi Pang, Stephen Viola, Susan Barry
25. Optometric Management of Functional Vision Disorders
Samantha Slotnick, Curt Baxstrom, Jason Clopton
26. Complentary and Alternative Approaches
Patricia S. Lemer
27-Technology for Rehabilitation, Treatment and Enhancement
Jeffrey Cooper, Sidney Groffman, Paul Harris, Marc B. Taub
28. The Multidisciplinary Approach
Robert Hohendorf, Robin Lewis, Orli Weisser-Pike, Monika Kolwaite, Julie L. Marshall, Deborah Schrager-Hoffnung, Pamela Compart, Danielle L. Hinton, Elizabeth Bishop, Fred Hidagii, Marc B. Taub
29. Disabilities and the Education System
David A. Damari
30. The Optometric Practice and Patients with Special Needs
Jason Clopton, Dan Fortenbacher, Bradley Habermehl
31. The Process of Communication
Len Press, Nancy Torgerson
Sunday, March 25, 2012
Neuroplasticity and the Patient with Special Needs
...in the new book from Lippincott, Williams & Wilkins...
Visual Diagnosis and
Care
of the Patient with
Special Needs
Edited by:
Marc B. Taub, OD, MS, FAAO, FCOVD,
Mary Bartuccio, OD,
FAAO, FCOVD,
Dominick M. Maino,
OD, MEd, FAAO, FCOVD-A
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