seeing is believing: the healing potentials of optometric ... conference/ac2019/ac2019...seeing is...
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Seeing is Believing: The Healing Potential of Optometric Vision
Therapy for a TBI Survivor
38th Annual Brain Injury ConferenceMarch 28, 2019
Eileen Lawlor, LICSW, LADC, BCD, SurvivorTheresa J Ruggiero, OD, FCOVDBoard Certified in Optometric Vision Therapy
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Theresa J. Ruggiero, OD, FCOVDElizabeth B. Hannigan, OD, FCOVD
Naomi G. Clay, OD
86 Masonic StreetNorthampton, MA 01060
(413) 586-5002northamptonvision.com
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“It is a terrible thing to see and yet have no vision”
Helen Keller1880 - 1968
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What Does it Mean to See?
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What Does it Mean to Have Vision?
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Visual Input/Efficiency
• Ocular Motility• Accommodation• Binocularity
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Visual Information Processing/Integration
• Group of visual cognitive skills• Selectively extract visual information from
environment• Integrate visual information with other
sensory systems• Assign meaning/understanding
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What is it?
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Vestibular Ocular Reflex
• VOR• Stabilize gaze• Balance• Spatial awareness• Navigate space safely
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Let’s Stand . . .
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Eileen Before TBI
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Q E 2
Dr. Ruth
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Visual Pathways
• Primary– Optic nerve Visual Cortex (occipital lobe)
• Via lateral geniculate nucleus (LGN)
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Neural Substrates of Vision
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Auxiliary
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Common Visual SymptomsPost TBI
• Blur• Photophobia• Dry eyes• Diplopia (double vision)/Eyes out of sync• Loss of place when reading• Headaches
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Common Vision Related Consequences of TBI
• Dizziness• Mental Confusion• Fatigue
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Common Vision Related Consequences Related to Persistent Symptoms
• Anxiety• Depression• Hyper-vigilance• Sleep Disturbances
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If vision is not functioning well , it interferes. If functioning well it enhances and stabilizes!
- Dr. John Streff
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Remember Vision-Brain Connection
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Pathophysiology of TBI• Closed head injury (vs open): typically causes a more
diffuse or global insultCoup (acceleration) insultContre-coup (deceleration) insultPercussive blast (more with returning veterans)
Results: shearing forces which may lead to:1. Breakage of blood vessels2. Diffuse axonal injury (DAI)
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Common Visual Consequences of Acquired Brain Injury
• Blurred Vision• Diplopia• Photophobia• Headache• Visual Field Loss
Ropper & Gorson (2007) NEJM 356: 166-172
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•National Hospital Ambulatory Medical Care Survey — United States, 2001–2010 (Emergency Depart Visits)
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Neuro-Ophthalmologist: assess visual substrate health
vsNeuro-Optometrist:
restoration of visual function
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Role of the Neuro-Optometrist• To diagnose and/or treat vision disturbances to
optimize functional vision for use in a patient’s:- activities of daily living (ADL’s) thereby impacting overall quality of life (QOL) - overall rehabilitation (make your job easier )
Finding a neuro-optometrist:- noravisionrehab.org -covd.org
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Visual/Ocular Assessment
• Ocular health• Refractive status
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The Neuro-Optometric Evaluation
• Visual Efficiency Assessment• Visual information processing• Visual spatial organization• Visual motor integration• Visual vestibular integration• Posture/gait assessment
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Vision Rehabilitation
• Lenses• Prisms• Optometric Vision Therapy• Optometric Phototherapy (Syntonics)• Phototherapy-based Multi-Sensory Training
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Lenses
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Prisms
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Optometric Vision Therapy
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Patient Specific Goals
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Establish FeedbackMechanisms
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Basic – InvolvingVision and Movement
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Complex – InvolvingMultiple Systems
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Neuroplasticity at Any Age
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Virtual Reality
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Optometric Phototherapy
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Multi-Sensory Training
• Optometric phototherapy• Vestibular• Auditory• Proprioception
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Signs and Symptoms of Visual Dysfunction
• Blur• Eyes out of sync/double vision• Headaches• Confusion• Dizziness• Symptoms made worse in busy visual
environment
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Brain Injury Vision Symptom Survey
• Overview• Specificity
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Professional’s Referral Guide Vision Disturbances and Associated Symptoms Following ABI
Ocular Motility and Vergence Deficits
Limited reading endurance, eye fatigue, HA’s, loss of place, has given up reading
Visual-Vestibular Dysfunction Dizziness, imbalance, motion sensitivity, “shaky” vision, overwhelmed by visually busy environments, “heavy-headedness”
Photophobia Hypersensitive to lights, especially fluorescents; wearing sunglasses indoors
Visual Processing Deficits Concentration difficulties; confusion, unable to multi-task, word retrieval issues
Visual Field Neglect and/or Cut Bumping into doorways, knocking over things; leaning or drifting
Visual-Motor coordination dysfunction
Dropping things, driving difficulties, writing issues
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Resources
Neuro-Optometric Rehabilitation Association - noravisionrehab.org
College of Optometrists in Vision Development:- covd.org
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Thank You!
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Theresa J. Ruggiero, OD, FCOVDElizabeth B. Hannigan, OD, FCOVD
Naomi G. Clay, OD
86 Masonic StreetNorthampton, MA 01060
(413) 586-5002northamptonvision.com