Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Vision Problems Hiding in Plain Sight Vision and ABI/TBI Dan Bowersox, OD, FCOVD Bowersox Vision Center, Shelbyville, KY Post doctorate residency supervisor and adjunct faculty for Southern College of Optometry External rotation supervisor and adjunct faculty for Indiana University – School of Optometry No financial disclosures on this topic "Herein lies the paradox of coherence. The pattern of raw data sent to the brain is a shaky, fragmented picture . The brain processes the data, combining input from both eyes, and filling in the gaps in spatial vision with parallel streams of multisensory information. The result is a happy and competent human being living under the compelling illusion that vision is clear, single, simultaneous and stable. Compelling, that is, until brain injury shatters the illusion" (Mlodinow 2008) What is this about? 1. The brain / vision link 2. Post Trauma Vision Syndrome 3. Vision Therapy in Rehab 4. Visual Midline Shift Syndrome 5. Veteran’s Vision Program 6. Questions Why Do Visual Deficits Occur After ABI/TBI? There are over 1,900,000 nerve fibers that exit each eye. This represents 70% of the sensory nerve fibers in the body. 80% of everything we learn is visual. 90% of people with ABI that are symptomatic after 1 month have an ABI/TBI related visual issue. The Brain / Vision Link ֎ System Theory of Motor Control ֎ Bernstien (1967) Shumway-Cook and Woollacott (2007) ֎Movement results from interplay between ֎ Cognition ֎ Action systems ֎ Perception! The Brain / Vision Link Perception Vestibular, Proprioceptive & Vision! Need intact pathways to: Superior Colliculus Posterior Parietal Lobe Lateral Geniculate Nuc. (LGN) What do they do? The Brain / Vision Link Superior Colliculus Spatial Orientation (maps), Ocular Orientation (eye movement) Input also from auditory and somatosensory systems. (hearing and body input) The Brain / Vision Link Posterior Parietal Cortex Attention Conscious & Ambient Awareness and direction of movement Localizing objects in space rel. to ourselves This is where “Neglect” comes from The Brain / Vision Link Lateral Geniculate Nucleus (LGN) 90% of Visual information Separates roughly into peripheral and central Peripheral: Hard lines, positions, movement Central: Detail, texture, color Has direct connections to most of the brain. !! Decreases input to Visual cortex by 90%!! The Brain / Vision Link For normal vision all pathways must be in tact. The Brain / Vision Link The normal flow of information works well. The Brain / Vision Link But what happens when there is a neuro insult? Visual Deficits After TBI 35 areas of the brain are totally involved with the processing of visual information There are a least 305 intra-cortical pathways linking the 35 areas This Leads us to…. Post Trauma Vision Syndrome (PTVS) Visual Midline Shift Syndrome (VMSS) (Not to be confused with Midline Shift Syndrome) Post Traumatic Vision Syndrome (PTVS) Characteristics – To identify the bi-modal visual processing dysfunction affecting posture, balance and movement. – To understand the organization of the bi-modal visual process in development affecting posture and balance. – To understand the interaction of the spatial visual process and organization with the proprioceptive base of support (BOS) affecting the development of binocularity and visual skills. – To understand the use of yoked prisms prescribed for rehabilitation and appropriate therapeutic rehabilitative prism systems into the therapy regimen. Post Trauma Vision Syndrome Characteristics and symptoms of Post-Trauma Vision Syndrome Common Characteristics Common Symptoms Exotropia Diplopia (Double vision) Exophoria Blurred near vision (Problems reading) Convergence Insufficiency Perceived movement of print or stationary objects (Aliasing) Accommodative Insufficiency Asthenopia (Eye strain, fatigue, eye pain) Oculomotor Dysfunction Headaches Increased Myopia Photophobia (Light sensitivity) William V. Padula, Stephanie Argyris (1996) Post Trauma Vision Syndrome & Visual Midline Shift Syndrome. NeuroRehabilitation (6), pp. 165-171. Warning!! The next 2 slides will may make some people motion sick, give an instant headache or have the sensation of movement! If you are susceptible to these problems please look away! Bowen Aliasing 30% of normals and 70%+ ABI/TBI patients have some positive response. “Everything looks like its moving, but I know its not!” Post Trauma Vision Syndrome Often treated with: – Small amounts of prism (Base in) – Changes in refractive power – Bi-nasal occlusion Naveen K Yadav; Kenneth J Ciuffreda. (2014) Effect of Binasal Occlusion and Base-In Prisms on the Visual-Evoked Potential (VEP) in the VisuallyNormal and Mild Traumatic Brain Injury Populations. Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3498. Post Trauma Vision Syndrome – Vision therapy Effective refractive correction Convergence Saccadic movement Visual information processing – (Next 4 slides warning!) Effect of oculomotor vision rehabilitation on the visual-evoked potential and visual attention in mild traumatic brain injury Naveen K. Yadav, Preethi Thiagarajan, and Kenneth J. Ciuffreda Brain Injury Vol. 28 , Iss. 7,2014 Versional eye tracking in mild traumatic brain injury (mTBI): Effects of oculomotor training (OMT) Preethi Thiagarajan and Kenneth J. Ciuffreda Brain Injury Vol. 28 , Iss. 7,2014 Eyes Have to Point to the Same Place Once upon a time, there was a very ugly duckling. One day a beautiful princess came along and rescued him from a horrible fate. She picked him up into her hands and was ready to kiss him when…. Post Trauma Vision Syndrome Visual Midline Shift Syndrome Post Trauma change in placement of perceived midline Padula WV1,2, Subramanian P3, Spurling A1, Jenness J1. Risk of fall (RoF) intervention by affecting visual egocenter through gait analysis and yoked prisms. NeuroRehabilitation. 2015;37(2):305-14. An example of normal Visual Midline Shift Syndrome Changes in ambient visual system causes flexion away from affected side in 85% of cases. Anterior or posterior changes are common. Increases frustration from OT and PT with good posture during therapy and loss of posture during rest of day. Resulting in lack of progress and discharge. Visual Midline Shift Syndrome What does that look like? Right shift. Visual Midline Shift Syndrome Anterior / posterior (Lean forward or back) Proximity issues Visual midline shift on the Z axis – Increased anxiety crowds – Increased anxiety in big box stores – Grocery store isles closing in – Driver braking too late – Depth issues – Also treated with prism The Use of Prisms > What do they do? >Prisms move an image toward the apex and away from the base. The Use of Prisms Which change where objects appear. Example of Yoked Prism “You know, I have this patient and I have been scratching my head trying to figure him/her out.” Untreated vision disorders can slow down the rehabilitation process. THE VETERANS VISION PROGRAM AT BVC Any military veteran with post 9/11 service related TBI will be treated for that TBI at my office for FREE until s/he has reached their full capability. We reserve 4 slots per week for these heroes. Feel free to refer these vets to my office. GREAT BOOK! The Ghost in My Brain Clark Elliott, Ph.D. Thank you! Questions? Dan Bowersox, OD, FCOVD Cell 502 544 1600 Stuart Young, OD Cell 502 780 2815 [email protected] Bowersox Vision Center 403 Washington St. Shelbyville, KY 40065 This is Skeffington, the therapy dog at our office. Different type of lecture! 1. Participatory – Please text DANBOWERSOX841 to 22333 to join the polls – PollEv.com/DANBOWERSO X841 TEXT to 22333