Traumatic and Acquired Brain Injury TBI in San Gabriel

What is Acquired Brain Injury (ABI) or Concussion?

Acquired Brain Injury (ABI)/concussion is an all-encompassing/umbrella term for damage to the brain that occurs after birth. Typically this damage is sudden, non-progressive, non-degenerative, and leads to abnormalities in neurological processing. These neurological changes can adversely affect the way a person functions in their activities of daily living, i.e., thought process, emotional behavior, speech ability, and physical changes such as impaired motor function, problems with a person’s visual system including, but not limited to:

Eye tracking problems
Eye teaming problems
Eye focusing problems
Visual field problems
Visual information processing problems

An ABI can be from an external traumatic injury (where the brain encountered physical trauma from such incidents as a motor vehicle or bicycle accident, a fall, an assault, contact sports, or neuro-surgery, etc.) or it can be from an internal cause (a stroke, an aneurysm, a brain tumor, a viral infection or inflammation such as meningitis, a vestibular dysfunction such as Ménière’s disease, or any post-surgical complications leading to an anoxic or hypoxic event in the brain).

For more information on brain injury please visit https://www.sportsvision.pro/athletes/sports-vision-testing/

How can this affect my vision?

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(Image provided by NORA – https://noravisionrehab.org/patients-caregivers/about-brain-injuries-vision)

The majority of the hardwiring of the brain involves the visual pathway, so it is common to experience a visual problem after a brain injury. The most common visual symptoms/visual problems associated with acquired brain injury (ABI) are:

Blurred vision at distance viewing
Blurred vision at near viewing
Slow shift of focus from near-to-far or far-to-near
Difficulty copying or taking notes
Double vision
Pulling or tugging sensation around eyes
Unable to sustain near work or reading for periods of time
Loss of place while reading
Eyes get tired while reading
Headaches while reading
Covering/closing one eye
Easily distracted when reading

Decreased attention span
Reduced concentration ability
Difficulty remembering what has been read
Loss of balance
Face/head turn or head tilt
Bothered by movement in environment and/or by crowded environments
Light sensitivity
A sensation of the floor, ceiling, or walls tilting
Dizziness
A sensation of the room spinning
A sensation of not feeling grounded
Postural shifts/veering off when walking

Neuro Optometric Vision Rehabilitation (Brain Injuries & Vision)

How vision affects learning and concussion recovery

Other visual conditions that can develop at birth or due to a brain injury:

Nystagmus- a vision condition in which the eyes make repetitive, uncontrolled movements. These movements often result in reduced vision and depth perception and can affect balance and coordination. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern (aoa.org).
Oscillopsia– a phenomenon where images are perceived as unstable and moving, and is the result of ocular instability. This condition is usually associated with acquired nystagmus, or lesions in the oculomotor, cerebellar, and vestibular systems. Patients with oscillopsia usually report blurred vision, images go in and out of focus, double , nausea, dizziness and challenges with activities of daily living.
Visual Snow Syndrome (VSS) – is a rare condition where patients complain of visual snow or dots appearing in their field of vision or appearances of static like in a poorly tuned television. Some patients also report palinopsia (images at times superimposed on the new image, and frequently with trailing), entopic imagery (persistence of an image), light sensitivity, hyperacusis, impaired night vision, phonophobia, imbalance, and/or tinnitus.

Here are some visual symptoms to look out for:

Post-Trauma Vision Symptoms

Double vision
Headaches
Blurry vision
Dizziness or nausea
Attention or concentration difficulties
Staring behavior (low blink rate)
Spatial disorientation

Loses place when reading
Can’t find beginning of next line when reading
Comprehension problems when reading
Visual memory problems
Pulls away from objects when they are brought close to him/her

Visual Midline Shift Syndrome

Dizziness or nausea
Spatial disorientation
Consistently stays to one side of hallway or room

Bumps into objects when walking
Poor balance or posture: leans back on heels, forward, or to one side when walking. standing or seated in a wheelchair

Insults to the cortex produced by a traumatic brain injury cause stress in central and autonomic nervous systems. The effect on vision causes an interference with the ambient visual process which is part of the sensory-motor feedback loop. This disruption occurs at the level of mid-brain where vision is matched with kinesthetic, proprioceptive, and vestibular processes. As a result, a head injured person may experience diplopia (double vision), binocular dysfunction, or concentration difficulties.

In the past, these symptoms were diagnosed as individual eye problems or muscle imbalances. However, the visual system is really a relationship of sensory-motor functions which are controlled and organized in the brain. The eye alignment imbalances and other reported difficulties that result from a head injury often occur because of dysfunction of the ambient visual process affecting sensory-motor spatial disorganization. This causes an eye to turn out (exotropia) or a strong tendency to both eyes to diverge (exophoria).

The resulting binocular problems are characteristics of a syndrome – Post Trauma Vision Syndrome (PTVS).

What treatments are available?

Lens – a specifically prescribed optical device that focuses light onto the retina to obtain a clear image; at times, lenses are used at near to help the eye focus more easily and efficiently with increased comfort.

Prism – a specialized optical device that deviates/’bends’ light; prisms are frequently prescribed as a component of the treatment for binocular vision problems and to eliminate double vision, as well as to provide comfort for near visual tasks such as reading.

Tint/coating – an optical component that alters the amount of light to the eyes; at times, it may also alter the color of the object; they are used to help those with light sensitivity/glare problems.

Selective occlusion and/or Binasal Occlusion – the use of specially graded filters to help patients who are experiencing double vision or visual confusion, to provide visual comfort and improve central-peripheral awareness.

Neuro-Optometric Rehabilitation (Vision Therapy) – is a series of vision therapy sessions, similar to physical therapy, to train the brain and eyes to work together as a team and to improve visual skills, visual spatial awareness and reduce visual symptoms.

For more information on brain injury please visit https://www.sportsvision.pro/athletes/sports-vision-testing/

Further Readings from NORA Regarding Concussions and Brain Injuries:

Common Vision Problems & Symptoms Following a Concussion
Neuro-optometric Rehabilitation – A Vital Part of Your Overall Recovery
The Vestibular Vision Connection
Women and Concussions

For more information visit noravisionrehab.org