Vision rehabilitation in children following brain injury

Brain injuries in children often lead to vision problems.Head trauma is common in childhood. Most head trauma in children is minor and does not result in brain injury or long term problems. However, a small number of children who appear to be at low risk may have a brain injury.

Accoding to the United States Centers for disease control, the rates of traumatic brain injury ("TBI") related visits to the emergency room increase the most for kids four years old and younger from 2001-2009. Emergency room visits for these young children increased by more than 50% from 1374.0 to 2193.8 per 100,000.  In fact, children four years old or younger had the highest rates of TBI-related emergencies of any other age group.

We evaluate children to idenitfy those who have suffered a traumatic brain injury (TBI) so that deterioration in the child's condition can be prevented and any associated problems, such as vision and eye movement dysfunctions, can be treated before they result in other injuries such as falls or academic and reading problems.

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Studies on vision therapy rehabilitation following brain injury

Scientific studies on vision, brain injury and vision therapy.Vision rehabilitation following a traumatic brain injury was been extensively studied.

Click here for over 110 references to scientific studies on visual dysfunction, brain injury and vision therapy rehabilitation.

 

Vision Related Literature on Acquired Brain Injury

Updated March 2013
Compiled by Lynn Fishman Hellerstein, OD, FCOVD, FAAO

  1. Aksionoff EB, Falk NS. The differential diagnosis of perceptual deficits in traumatic brain injury patients. J Am Optom Assoc 1992;63:554-8.
  2. Aksionoff EB, Falk NS. Optometric therapy for the left brain injured patient. J Am Optom Assoc 1992;63:564-8.
  3. Alesterlund L, Maino D. That the blind may see: A review: Blindsight and its implications for optometrists. J Optom Vis Dev 1999;30(2):86-93
  4. Anderson DC et al. The dizzy patient: a review of etiology, differential diagnosis, and management. J Am Optom Assoc 1995;66:545-558.
  5. Chokron, S., Perez, C., Obadia, M., Gaudry, I., Laloum, L., Gout, O., From blindsight to sight: cognitive rehabilitation of visual field defects, Restorative Neurology and Neuroscience 2008;26, 305.
  6. Ciuffreda KJ. The efficacy of and scientific basis for vision therapy in non-strabismic accommodative and convergence disorders. Optometry 2002;73:735-762.
  7. Ciuffreda KJ, Han Y, Kapoor, Ficarra AP. Oculomotor rehabilitation for reading in acquired brain injury. NeuroRehabilitation 2006;21(1):9-21.
  8. Ciuffreda KJ, Kapoor N, Han Y. Reading-related ocular motor deficits in traumatic brain injury. Brain Inj/Professional 2005;2:16-20.
  9. Ciuffreda KJ, Kapoor N, Rutner D, Suchoff IB, et al. Occurrence of oculomotor dysfunctions in acquired brain injury: A retrospective analysis. J Am Optom Assn 2007;78:155-161.
  10. Ciuffreda KJ, Ludlam, Kapoor N. Conceptual Model of Optometric Vision Care in Mild Traumatic Brain Injury. J Behav Optom 22;10-12.
  11. Ciuffreda KJ, Ludlam, Kapoor N. Clinical oculomotor training in traumatic brain injury. Optom Vis Dev 2009;40(1):16-23.
  12. Ciuffreda KJ, Rutner R, Kapoor N, Suchoff IB. Vision therapy for oculomotor dysfunctions in acquired brain injury. Optometry-J Am Optom Assn 2008;79:18-22.
  13. Ciuffreda KJ, Suchoff IB, Marrone MA, et al. Oculomotor rehabilitation in traumatic brain-injured patients. J Behav Optom 1996;7:31-8.
  14. Ciuffreda KJ, Suchoff IB, Kapoor N, et al. Normal vision function. In: Downey & Darling’s Physiological Basis of Rehabilitation Medicine, 3rd ed. Gonzalez EG, Myers SJ, Edelstein JE, et al., eds. Boston: Butterworth–Heinemann, 2001;241-61.
  15. Ciuffreda, K. J., and Tannen, B., Eye Movement Basics for the Clinician, Mosby, St. Louis, MO, 1995.
  16. Cohen AH. Optometric management of binocular dysfunctions secondary to head trauma: case reports. J Am Optom Assoc 1992;63:569-75.
  17. Cohen AH, Rein LD. The effect of head trauma on the visual system: the doctor of optometry as a member of the rehabilitation team. J Am Optom Assoc 1992:63;530-6.
  18. Cohen AH. Acquired visual information-processing disorders: Closed head trauma. In: Press LJ, ed. Applied Concepts in Vision Therapy. St. Louis: Mosby, 1997:154-67.
  19. Cohen AH. Optometric rehabilitative therapy. In: Press LJ, ed. Applied Concepts in Vision Therapy. St. Louis: Mosby. 1997:278-86.
  20. Cohen AH. The role of optometry in the management of vestibular disorders. Brain Injury/Professional 2005;2:8-10.
  21. Cohen AH. Management of patients with hemianopic visual field loss. J College of Optom in Vision Dev 2003;34: 111-18.
  22. Cooper J. Deflating the rubber duck. J Behav Opt 1998;9(5):115-119.
  23. Craig S, Kapoor N, et al. Profile of Selected Aspects of Visually Symptomatic Individuals With Acquired Brain Injury: A Retrospective Study. J Behav Optom 2008;19:1-10.
  24. Du T, Ciuffreda KJ, Kapoor N. Elevated dark adaptation in traumatic brain injury. Brain Injury 2005 ;19(13):1125-38.
  25. Falk, Naomi S. and Aksionoff, Elizabeth B. , The Primary Care Optometric Evaluation of theTraumatic Brain injury Patient J Am Optom Assoc 8/92;63(8),
  26. Fox RS. The rehabilitation of vergence and accommodative dysfunctions in traumatic brain injury. Brain Injury/Professional 2005;2:12-15.
  27. Gianutsos R, Ramsey G. Enabling rehabilitation optometrists to help survivors of acquired brain injury. J Vis Rehabil 1988;2(1):37-58.
  28. Gianutsos R, Suchoff IB. Neuropsychological consequences of mild brain injury and optometric implications. J Behav Optom 1998;9(1):3-6.
  29. Gianutsos R, Suchoff IB. Visual fields after brain injury: management issues for the occupational therapist. In: Scheiman M, ed. Understanding and Managing Vision Defects-A Guide for Occupation Therapists,2nd edition. Thorofare, N.J.: Slack, 2002:248-62.
  30. Goodrich L, Kirby J, et al. Visual Function in Patients of a Polytrauma Rehabilitation Center: A descriptive Study. J of Rehabilitation Research and Development November 2007: 44: 929-936.
  31. Gottlieb DD, Freeman P, Williams M. Clinical research and statistical analysis of a visual field awareness system. J Am Optom Assoc 1992;63:581-8.
  32. Gottleib DD, Fuhr A, Hatch WV, et al. Neuro-optometric facilitation of vision recovery after acquired brain injury. Neuro-rehab 1998;11:175-99.
  33. Han Y, Ciuffreda KJ, Kapoor N. Reading-related oculo-motor testing and training protocols for acquired brain injury in humans. Brain Res Protoc 2004;14(1):1-12.
  34. Han, M. H., Craig, S. B., Rutner, D., Kapoor, N., Ciuffreda, K. J., Suchoff, I. B., Medications prescribed to brain injury patients: a retrospective analysis, Optom 2008; 79, 252.
  35. Harrison RJ. Loss of fusional vergence with partial loss of accommodative convergence and accommodation following head injury. Binoc Vis 1987;2(2):93-100.
  36. Hellerstein LF. Visual problems associated with brain injury. In: Scheiman M, ed. Understanding and Managing Vision Defects-A Guide for Occupational Therapists, 2nd edition.Thorofare,N.J::2002:178-85.
  37. Hellerstein LF. Visual rehabilitation for patients with brain injury. In: Scheiman M, ed. Understanding and Managing Vision Defects-A Guide for Occupational Therapists, 2nd edition.Thorofare,N.J::2002.
  38. Hellerstein LF, Fishman BI. Vision therapy and occupational therapy: An integrated approach. J Behav Optom 1990;1(5):122-126.
  39. Hellerstein LF, Fishman BI. Collaboration between occupational therapists and optometrists. OT Pract 6/99;22-30.
  40. Hellerstein LF, Freed S. Rehabilitative optometric management of a traumatic brain injury patient. J Behav Optom 1994;5(6):143-8.
  41. Hellerstein LF, Freed S, Maples WC. Vision profile of patients with mild brain injury. J Am Optom Assoc 1995;66:634-9.
  42. Heitger MH et al. Eye movement and visuomotor arm movement deficits following mild closed head injury. Brain 2004;127(3):575-590.
  43. Herdman SJ. Patients with vestibular disorders, part II. Postgraduate advances in Physical Therapy, APTA 1987:1-16.
  44. Hillier CG. Vision rehabilitation following acquired brain injury: a case series. Brain Injury/Professional 2005; 2:30-32.
  45. Hinrichs CA. Vision rehabilitation for the multiply challenged child. J Optom Vis Devel 6/92;23(2): 9-13.
  46. Jackowski MM, Sturr JF, Taub HA, Turk MA. Photophobia in patients with traumatic brain injury: uses of light-filtering lenses to enhance contrast sensitivity and reading rate. Neuro-rehab 1996;6:193-202.
  47. Jackowski MM, Sturr JF, Turk MA, Friedman DI. Clinical indications of altered peripheral field function in patients with traumatic brain injury. Invest Ophthalmol Vis Sci 1999;40 (4):32 (supplement).
  48. Kapoor N, Ciuffreda KJ. Vision disturbances following traumatic brain injury. Current Treatm Options in Neurol 2002;4:271-280
  49. Kapoor N, Ciuffreda KJ, Suchoff IB. Egocentric localization in patients with visual neglect. In: Suchoff IB, Ciuffreda KJ, Kapoor N, eds. Visual and Vestibular Consequences of Acquired Brain Injury. Santa Ana, CA: Optometric Extension Program, 2001:131-144.
  50. Kapoor N, Ciuffreda KJ, Han,Y. Oculomotor rehabilitation in acquired brain injury: A case series. Arch Phys Med Rehab 2005;1667-78.
  51. Kapoor N, Ciuffreda KJ. Vision problems. In: Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of traumatic brain injury. Washington, DC: American Psychiatric Publishing,Inc,2005:405-15.
  52. Katz RT, Golden RS, Butter J, Tepper, Rothke S, Holmes J. Driving safety after brain damage: follow-up of twenty-two patients with matched controls. Arch Phys Med Rehabil 2/90;71:133-137.
  53. Lachapelle, J., Bolduc-Teasdale, J., Ptito, A., McKerral, M., Deficits in complex visual information processing after mild TBI: electrophysiological markers and vocational outcome prognosis, Brain Inj, 2008;22, 265.
  54. Leslie S. Myopia and accommodative insufficiency associated with moderate head trauma. Optom Vis Dev 2009;40(1):25-31.
  55. Ludlam WM. Rehabilitation of traumatic brain injury with associated visual dysfunction—a case report. Neuro-rehabilitation 1996;6:183-92.
  56. Maino DM. Diagnosis and management of special populations. Mosby, St. Louis 1995.
  57. Maino D. Neuroplasticity: Teaching an old brain new tricks. Rev Optom, 2009; 46(1):62-64,66-70.
  58. Mandese M. Oculo-visual evaluation of the patient with traumatic brain injury. Optom Vis Dev. 2009;40(1)L37-44.
  59. Margolis, N. W., and Suter, P. S., Visual field defects and unilateral spatial inattention: diagnosis and treatment, J Behav Optom 2006;(17) 31.
  60. McCabe, Patricia, M.P.N., P.T., and Bergman, Susan Biener, M. D., Vision Rehabilitation for Physiatry Residents: A Model Curriculum. Am J of Phys Med and Rehab, Vol. 78, No. 4, 389-391, July/August 1999.
  61. McKenna, K., Cooke, D.M., Fleming, J., Jefferson, A., and Ogden, S., The incidence of visual perceptual impairment in patients with severe traumatic brain injury, Brain In 2006;(20) 507.
  62. Mosimann UP, Muri RM, Felblinger J, Radanov BP. Saccadic eye movement disturbances in whiplash patients with persistent complaints. Brain 2000; 123(4):828-835.
  63. Nelms AC. New visions—collaboration between OTs and optometrists can make a difference in treating brain injury. OT Practice 7/17 & 31/2000;31:15-8.
  64. Padula WV. A Behavioral Vision Approach for Persons with Physical Disabilities. Optom Exten Prog. 1988.
  65. Padula WV. Neuro-optometric Rehabilitation for Persons with a TBI or CVA. J Optom Vis Develop. 6/92;(23)4-8.
  66. Padula W. Visual evoked potentials (VEP) evaluating treatment for post-trauma vision syndrome (PTVS) in patients with traumatic brain injuries (TBI). Brain Inj 1994;8:125-33.
  67. Padula WV, Argyris S, Ray J., Visual evoked potentials (VEP) evaluating treatment for post-trauma vision syndrome (PTVS) in patients with traumatic brain injuries (TBI), Brain Inj. 1994;(8)125.
  68. Padula WV, Politzer T, Simmons-Grab, etal. Visual Dysfunction Following a Neurological Event. J Rehab Prof 1-3/2001.
  69. Padula WV, Shapiro JB, Jasin P. Head injury causing post trauma vision syndrome. N Engl J Optom 1988;41(2):16-21.
  70. Padula WV, Shapiro JB, Jasin P. Head Injury Causing Post Trauma Vision Syndrome. N Engl J Optom, 12/88;17-20.
  71. Padula WV, Susan G. Post Trauma Vision Syndrome: Part I. Inside View Newsletter, The Centre for Neuro Skills, Issue 8.3, ISSN# 1065-7320, Summer 1999, 1-3.
  72. Padula WV, Susan G. Post Trauma Vision Syndrome: Part II. Inside View Newsletter, The Centre for Neuro Skills, Issue 8.4, ISSN# 1065-7320, Fall 1999. 1-3.
  73. Park E, Bell JD, Baker AJ. Traumatic brain injury; Can the consequences be stopped? Canadian Med Assoc J 2008; 178(9:1163-70.
  74. Peli, E., Vision multiplexing: An engineering approach to vision rehabilitation device development, Optom Vision Sci 2001;(78) 304.
  75. Politzer TA. Case studies of a new approach using partial and selective occlusion for the clinical treatment of diplopia. NeuroRehab 1996;6:213-217.
  76. Raymond MJ, Bennett TL, Malia KB, Bewick KC. Rehabilitation of visual processing deficits following brain injury. NeuroRehab 1996;6:229-240.
  77. Proctor A. Traumatic brain injury and binasal occlusion. OptVis Dev 2009;40(1):45-50.
  78. Reinhard, J., Schreiber, A., Schiefer, U;, Kasten, E., Sabel, B. A., Kenkel, S., Vonthein, R., Trauzettel-Klosinski, S., Does visual restitution training change homonymous visual field defects? A fundus controlled study, Brititsh Journal of Ophtalmology, 89, 30, 2005.
  79. Roberts S. Visual disorders of higher cortical function. J Am Optom Assoc 1992;63:723-32.
  80. Rosenthal, M.; Griffith, E.R.; Bond, R; Miller, J;.D., Rehabilitation Of The Adult & Child With Traumatic Brain Injury. Ed.#2 F.A.. Davis Company, Philadelphia Second Edition.
  81. Roy, Raymond R., The Role of Binocular Stress in the Post- Whiplash Syndrome. Amer. J. of Optom Arch Am Acad Optom. Nov 1961; 625-635.
  82. Rutner D, Kapoor N, Ciuffreda KJ, Craig S, et al.. Occurrence of ocular disease in traumatic brain injury in a selected sample: A retrospective analysis. Brain Inj 2006;20(10) 1079-86.
  83. Rutner D, Kapoor N, Ciuffreda KJ , Suchoff IB, et al. Frequency of occurrence of ocular disease in symptomatic individuals with acquired brain injury. A clinical management perspective. J Behav Optom 2007;18:31-36.
  84. Sabates, Nelson R., MD; Gonce, Mark A., MD; Farris, Bradley K., MD, Neuro-ophthalmological Findings in Closed Head Trauma. J Clin Neuro-Ophthal.11(4), 1991;273-277,
  85. Scheiman M, Gallaway M. Vision therapy to treat binocular vision disorders after acquired brain injury: factors affecting prognosis. In: Suchoff IB, Ciuffreda KJ, Kapoor N, eds. Visual and Vestibular Consequences of Acquired Brain Injury. Santa Ana, CA: Optom Ext Prog, 2001:89-113.
  86. Scheiman M, Wick B. Binocular and accommodative problems associated with acquired brain injury. In: Scheiman M, Wick B, eds. Clinical Management of Binocular Vision- Hetrophoric, Accommodative, and Eye Movement Disorders, 2nd edition.Philadelphia, PA: Lippincott Williams & Wilkins, 2002: 573-95.
  87. Shumway-Cook A, Horak FB. Rehabilitation strategies for patients with vestibular deficits. Neur Clin 5/90;8(2):441-457.
  88. Shumway-Cook A, Horak FB. Vestibular rehabilitation: an exercise approach to managing symptoms of vestibular dysfunction. Seminars in Hearing 5/89;10(2):196-209.
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  91. Suchoff IB. The diagnosis of visual unilateral spatial inattention. Brain Injury/Professional 2005;2:22-25.
  92. Suchoff IB, Ciuffreda KJ. A ;primer for the optometric management of unilateral spatial inattention. J Am Optom. 2004;75:305-19.
  93. Suchoff IB, Ciuffreda KJ, Kapoor N, eds. Visual and vestibular Consequences of Acquired Brain Injury. Santa Ana, CA: Optometric Extension Program Foundation, 2001.
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More information

To learn more about vision therapy and brain injuries, visit: www.braininjuries.org

Another excellent resource is the website of NORA, the Neuro-Optometric Rehabilitation Association.

NORA

 

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The US Army uses vision therapy for brain injuries

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Brain injury brochure

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At our Vancouver optometry clinic, we have the largest vision therapy practice in the city and we treat many patients who have vision problems as a result of traumatic brain injuries.  Most of the injuries resulted from car accidents or concussions sustained in sporting activities.  

 

Vision therapy and adults with convegence insufficiency

"Anomalies of accommodation, vergence, version, photosensitivity, and field of vision are amenable to noninvasive, rehabilitative interventions, such as vision therapy, which is rendered by optometrists and is described in this article. Further, vision therapy may be performed in isolation or in conjunction with the application of the following:

Kapoor and Ciuffreda, Vision Disturbances Following Traumatic Brain Injury,Current Treatment Options in Neurology 2002,4:271–280

 

"These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population"

In an 2008 study published in the journal, Optometry, that studied oculomotor dysfunctions in acquired brain injury, the researchers concluded that, "[n]early all patients in the current clinic sample exhibited either complete or marked reduction in their oculomotor-based symptoms and improvement in related clinical signs, with maintenance of the symptom reduction and sign improvements at the 2- to 3-month follow-up. These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population. Furthermore, it shows considerable residual neural plasticity despite the presence of documented brain injury."

 

King Devik test for concussion

Concussions and eye movements

The most popular medical test for
concussions is the King-Devick test, created by optometrists, Dr. Alan King and Dr. Steven
Devick. It diagnoses concussions by looking for vision dysfunctions in the way the eyes move.

Watch this video from the Today Show featuring the King-Devick test: