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Page 1: Improving vision function in the patient with Traumatic Brain Injury

Improving Vision Function in the Patient with Traumatic Brain Injury

Dominick M. Maino, OD, MEd, FAAO, FCOVD-A; Professor of Pediatrics/Binocular Vision, Illinois Eye Institute/Illinois

College of Optometry; Chicago, Il. USA

Darrell G. Schlange, OD, FAAO; Associate Professor/Ocular Motility & Binocular Vision, Illinois Eye

Institute/Illinois College of Optometry; Chicago, Il. USA

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ABSTRACTObjectives: Few reports in the literature note how optometric vision therapy (OVT) 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 OVT that resulted in improved oculomotor skills, attention, reading and driving abilityin 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 major problems parking her car. The TOVA (Test of Variables Attention) 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 (pursuits/saccades), and attention deficit. Optometric vision therapy sessions followed a standard format that included monocular, biocular, binocular and an integration/stabilization therapy phase. Computer aided OVT included the use of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the EyePort…...

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…..After 27, 45 min OVT 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 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 thataffect their quality of life. Primary eye care providers, in general, do not diagnosis or manage the many vision function, functional vision and vision information processing disorders associated with TBI. Primary eye care providers 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 OVT both symptoms and signs that adversely affect an individual’s quality of life after traumatic brain injury can be improved.

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Other Eye/Vision Presentations

Neuro-Optometric Rehabilitation of ABI/TBI Induced Vision impairment

Steen Aalberg, FCOVD-IKraskin & Skeffington Institute, Slangerup, Denmark

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Other Eye/Vision PresentationsA 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 RosnerUniversity 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

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A Retrospective Analysis of Vertical Heterophoria Treatment and Amelioration of Post-concussive Disorder Symptoms Via a Multifaceted Assessment BatteryMark Rosner, Debby Feinberg, Jennifer Doble, Arthur Rosner

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 post-concussive symptoms should become a high priority, as effective treatment is available for VH which significantly reduces post-concussive symptoms. ….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.

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How did the international audience respond to this information ?

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ICO/IEI’s Brain Injury TeamDr. Dominick MainoDr. Darrell Schlange

Dr. Len MessnerDr. Tracy Machinski

Dr. Navjit K. Sanghera

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What can you do?Become a Student member of the Neuro-Optometric Rehabilitation Association.

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References: Ciuffreda KJ, Ludlam DP, Kapoor N. Clinical oculomotor training in traumatic brain injury. Optom Vis Dev 2009;40(1):16-23.

Leslie S. Myopia and accommodative insufficiency associated with moderate head trauma. Opt Vis Dev 2009;40(1):25-31.

Mandese M. Oculo-visual evaluation of the patient with traumatic brain injury. Optom Vis Dev. 2009;40(1):37-44.

Proctor A. Traumatic brain injury and binasal occlusion. Optom Vis Dev 2009;40(1):45-50.

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Shameless Plug Alert!

Visual Diagnosis and Care of the Patient with Special Needs

Edited by Drs. Marc Taub, Mary Bartuccio, Dominick MainoPublished by Lippincott, Williams & Wilkins May 2012

Acquired Brain Injury: Kenneth Ciuffreda, Neera Kapoor

Cortical Visual Impairment (CVI): Barry Kran, Luisa Mayer

Neuro-plasticity and the Patient with Special Needs: Dominick M. Maino, Robert Donati, Yi Pang, Stephen Viola, Susan Barry

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Laddies, and Lassies….if you have questions, please feel free to ask:

Dominick “The Bruce” MacMainoLord of Scotchland; Duke of Haggis and 9th Earl of the MacMaino Clan

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What is Neuro-Optometric Rehabilitation?

• Rehabilitation of the neurologically challenged patient – TBI or ABI– Lenses, prisms, low vision aids, special

activities• Vision plays huge role patients’ quality of

life, but is usually neglected during rehabilitation therapy

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NORA

• Neuro-Optometric Rehabilitation Association– Multidisciplinary – Mission to serve physically and cognitively

disabled persons and provide quality visual rehabilitation

– Educate professionals (including optometrists) and develop INTER and INTRA-professional networks that include Neuro-Optometric and Vision Rehabilitation Services

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NORA Student Group

• Raise awareness of neuro-optometric rehabilitation, and its importance in the care of TBI and ABI patients.

• Keep the ICO community informed about news from NORA.

• Potentially help you differentiate yourself from other optometrists and create a demand

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NORA Student GroupPossible Upcoming Meetings• What you can expect from TBI and ABI patients

– Psychiatrists– Neurologists

• Patient perspective of neuro-optometric rehabilitation– Wounded Warriors– Athletes

• Private Practice Management of patients with TBI and ABI• And More:

– Chicago Concussion Coalition– Sports Legacy Institute– Speech and Language Therapists– Occupational and Physical Therapists– Neurosurgeons

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NORA Student Group

• How to Get Involved in:–Become a Student Member of NORA–Class Representative– Social Media Representative– Treasurer

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21st Annual NORA Multi-Disciplinary Conference

• April 19th-April 22nd

• University of Memphis Holiday Inn• Topics include:– Hospital Based Visual Neuro-rehabilitation– Concussions – Overview of Current Knowledge

and Treatment– Neurotransmitters in Rehabilitation– Nutritional Considerations in Neuro-rehabilitation

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Questions? Suggestions? Ideas?

• Lisa Wong– [email protected]

• Jennifer Tai– [email protected]

• Hanna Froehlich– [email protected]

• Dr. Dominick Maino (Faculty Advisor)– [email protected]


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