Introduction
Vision, as a multifaceted processing system, extends beyond mere visual acuity. A structured approach to evaluating and addressing visual deficits is essential for effective treatment. Such a systematic methodology aids in determining treatment priorities, ensuring that interventions are sequenced optimally for maximum efficacy. In this case Neuro-optometry is a specialized optometry field focusing on visual and neurological condition management, particularly in cases of traumatic brain injury (TBI), stroke, and neurodegenerative diseases.[1] Traumatic Brain Injury (TBI) occurs when an external force impacts the head, causing brain dysfunction. Symptoms range from mild, such as headaches and confusion, to severe, including cognitive deficits and motor impairments.[2] The diagnosis typically involves clinical evaluations, imaging studies like CT and MRI scans, and neuropsychological assessments. Treatment includes immediate care, possible surgery, and long-term rehabilitation.[2] The aim of this blog is to show how the efficacy of a visual therapy program with the purpose of improving the functional skills involved in visual efficacy to reduce the symptoms cased by TBI.[2]
Philosophy Of Vision Rehabilitation Vision rehabilitation for TBI patients aims to improve functional vision, enhancing daily activities and quality of life. This involves not just correcting visual acuity
but also addressing binocular vision, ocular motility, and visual perception.[3] Vision rehabilitation can be approached from two perspectives: top-down and bottom-up. The top-down approach focuses on higher cognitive functions and visual processing, while the bottom-up approach emphasizes basic visual skills and sensory input. Top-down vision therapy primarily uses the frontal cortex and bottom-up utilizes the visual, vestibular, auditory, and somatosensory system to rehabilitate visual deficits.
Figure 1. Visual Hierarchy and Therapy Sequencing
Patients with mild symptoms typically benefit most from the top-down vision therapy approach, while those experiencing more severe symptoms generally find the bottom-up vision therapy approach more effective.[4][2]
Visual Problems in Traumatic Brain Injury
The visual problem associated with TBI, categorizing them similarly to dementia- related vision impairments. Although each visual aspect is discussed individually, many patients experience multiple visual issues concurrently.[2][5] The visual
problems reported in TBI are summarized in table 1.
Table 1. summary of visual signs and symptoms associated with traumatic brain injury (TBI)
Optometric Evaluation in TBI Patients
Patients with mild traumatic brain injury (mTBI) often experience visual
symptoms despite good visual acuity. Thus, through assessments of binocular
vision, accommodation, and ocular motility are crucial to detect post-trauma
sequelae.[6][7] According to some authors multidisciplinary approach is
recommended for persistent symptoms lasting over month. In children, mTBI
related visual symtoms can significantly hinder near-related tasks, such as reading,
impacting school performance.
Table 2. components of optometric examinations and analyzing data
Components Of Effective Vision Therapy
To effectively treat patients with traumatic brain injury (TBI), vision therapy must
leverage top-down visual processing and neuroplasticity.[7] Cohen highlights five
essential components: motivation, feedback, repetition, sensorimotor mismatch,
and intermodal integration, all involving top-down processing. Incorporating these
elements enhances neuroplastic changes, leading to more effective treatment
outcomes.[7][8]
Table 3. Therapeutic Activities and Goals in TBI Patients
Conclusion
Neuro-optometry plays a vital role in the rehabilitation of TBI patients, addressing
a wide range of vision-related issues that can impact recovery and quality of
life.[9][10] A multidisciplinary approach, incorporating both top-down and
bottom-up strategies, is essential for effective vision rehabilitation. By focusing on
individualized therapy plans and regular assessments, neuro-optometrists can help
TBI patients achieve significant improvements in visual function and overall well-
being.[9][10]
References
1. Greenwald, B. D., Kapoor, N., & Singh, A. D. (2012). Visual impairments in the first
year after traumatic brain injury. Brain Injury, 26(11), 1338-1359.
https://doi.org/10.3109/02699052.2012.706356
2. Cohen, A. H. (1998). Optometric management of patients with brain injury. Santa Ana,
CA: Optometric Extension Program Foundation.
3. Ciuffreda, K. J., Rutner, D., Kapoor, N., Suchoff, I. B., Craig, S., & Han, M. E. (2007).
Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective
analysis. Optometry-Journal of the American Optometric Association, 78(4), 155-161.
https://doi.org/10.1016/j.optm.2006.10.011
4. Brahm, K. D., Wilgenburg, H. M., Kirby, J., Ingalla, S. P., Chang, C. Y., & Goodrich, G.
L. (2009). Visual impairment and dysfunction in combat-injured servicemembers with
traumatic brain injury. Optometry and Vision Science, 86(7), 817-825.
https://doi.org/10.1097/OPX.0b013e3181ae5e2b
5. Master, C. L., Scheiman, M., Gallaway, M., Goodman, A., Robinson, R. L., Master, S.
R., & Grady, M. F. (2016). Vision diagnoses are common after concussion in
adolescents. Clinical Pediatrics, 55(3), 260-267.
6. Goodrich, G. L., Kirby, J., Cockerham, G., Ingalla, S., Lew, H. L., & Bramley, L. (2007).
Visual function in patients of a polytrauma rehabilitation center: A descriptive study.
Journal of Rehabilitation Research and Development, 44(7), 929-936.
https://doi.org/10.1682/JRRD.2007.02.0034
7. Suter, P. S., & Harvey, L. H. (2011). Vision Rehabilitation: Multidisciplinary Care of the
Patient Following Brain Injury. CRC Press. https://doi.org/10.1201/b10647
8. Thiagarajan, P., & Ciuffreda, K. J. (2013). Short-term persistence of oculomotor
rehabilitative changes in mild traumatic brain injury (mTBI): A pilot study. Journal of
Rehabilitation Research and Development, 50(8), 1223-1230.
https://doi.org/10.1682/JRRD.2012.11.0201
9. Nouraeinejad, A. (2018). Neuro-Optometry, Neuro-Optometrist, and Neuro-Optometric
Rehabilitative Implications. Journal of Modern Rehabilitation, 12(2), 89-133.
10. Han, M. H. E. (2019). The Role of Neuro-Optometric Rehabilitation. In Acquired Brain
Injury (pp. 89-133).
