Page 36 - BOAF Journal 1 2012:2707

Behavioral Optometry BOAF Volume1 Number1 2012
Article - Curtis R.Baxstrom, MA,OD,FCOVD,FNORA.
...Acquired Brain Injuries (Original English)
Optometry and Acquired Brain Injuries.
Introduction
What is an Acquired Brain Injury?
An acquired brain injury (ABI) includes multiple different types of insults to brain proc- essing. Suter and Harvey sug- gest it can include traumatic brain injuries-open, closed, vascular and nonvascular, cere- brovascular accidents, spinal injuries including neck injuries, neurological conditions and even developmental disabilities secondary to a variety of differ- ent causes. ABI’s can be more complex when several condi- tions overlap. An example would be a patient with Down’s syndrome who suffers a trau- matic brain injury from a motor vehicle accident.
Automaticity and Resil- ience
Throughout our daily lives, we come across situations where we are challenged with the demands of auditory, visual and other sensory motor expe- riences. An example of automa- ticity might be attempting to talk on a cell phone while driv- ing your vehicle. Brooks and Goldstein, “The Power of Resil- ience” discusses resilience in their book. It is best described regarding ABI as how much you can handle before the threshold is reached and you are no
longer able to efficiently deal with your sensory motor experi- ences. Because of our automa- ticity and resilience of brain function, we are able to pay attention to what we are doing and filter other information that might otherwise distract us.
An example of automaticity in a traumatic brain injury could be a patient who has lost the ability to walk following a head injury. The visual system was not directly affected, but is af- fected based on automaticity. In this example, the patient main- tains single vision while in a prone or supine position. But when the patient begins to deal with gravity by trying to sit up or stand, he immediately loses control of his binocular vision and demonstrates a strabismic condition. His brain processing for moving no longer has auto- maticity. He has moved towards survival and preventing a fall against gravity takes prece- dence in brain processing. In this case, it is likely that either improving fragile visual process- ing or treatment toward his re- covery to deal with gravity will decrease the likelihood of di- plopia returning. Preferably one would work in both areas, thus further enhancing one’s auto- maticity and resilience.
Patients with acquired brain injuries are a population that can benefit from the services of optometric evaluation and man- agement including but not lim- ited to: visual guidance and the prescribing of lenses, prisms, selective occlusion and visual rehabilitation. Many patients who suffer an acquired brain injury may be limited in recovery due to the visual sequelae of their acquired brain injury. In many cases, appropriate visual evaluation and management can provide the missing piece to a successful outcome during the rehabilitation process. This can be measured by a faster and fuller rehabilitation and re- covery of function.
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