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Behavioral Optometry
BOAF
Volume1 Number1 2012
This also points out to the clear importance of vision in overall processing. The visual system is so pervasive in brain processing that there are not many conditions where it isn’t involved to at least some de- gree. Other acquired brain in- jury examples include a sudden difficulty with prepresbyopia secondary to loss of accommo- dative ability. This can influence near point activities, thus affect- ing one’s ability to perform in the rehabilitation of speech and written language. Walking can be affected by the shifting of the visual egocentric localiza- tion, making walking more diffi- cult. A vestibular concussion may not be recoverable with standard gaze stabilization ac- tivities, but may improve once visual strategies are included. One other important area is the visual fields of a patient that could be constricted or the loss of one’s visual field secondary to hemianopsia and/or unilateral spatial inattention (visual ne- glect). In this case, most activi- ties of daily living such as showering and putting on your clothes can be severely af- fected. Looking at these condi- tions and evaluating and treat- ing them from a visual perspec- tive should provide the patient with a better opportunity for a faster and fuller recovery from their injury.
How Does One Recover Neurologically?
Recovery from an acquired brain injury occurs through
many avenues. It should first be noted that some symptoms might spontaneously improve and recover, although their can still be other processing deficits that may not be observed. An- other important consideration is that most symptoms and condi- tions are overt. That is, we can observe the hemiplegia and the speech deficits. But most vis- ual sequelae are covert and thus not readily observed. Ex- amples include visual field loss that could affect walking into things. A rehabilitation therapist may believe it is secondary to a hemiplegia and not be aware of a concurrent vision deficit. The patient may reach and knock something over and believe it is ataxia, where it could also be related to a compromised bin- ocular system and affecting the ability to visually localize.
It should be noted that re- covery may be spontaneous or it might occur secondary to de- creased swelling and/or blood reabsorption. The important factor is to work toward ad- dressing visual function as quickly as possible. Often it is asked how long should I wait until I refer them to an optome- trist for an evaluation. I recom- mend that any question regard- ing a visual sequelae should lead to a vision consultation. This may eliminate roadblocks to the recovery process and expedite a faster and more full recovery of the patient.
Neurogenesis and Neuro- plasticity
The area of neurogenesis and neuroplasticity is a fast and ever increasing area of re- search. We know that there is neurogenesis throughout our lifespan and this can be an im- portant factor in the recovery of acquired brain injuries. Neuro- plasticity is a continual process and intricately involved in visual rehabilitation. You can use a search engine using “vision and neuroplasticity” to find a tre- mendous amount of research on the topics.
There are two other re- sources that could prove bene- ficial to the better understand- ing of this area. The first is a book titled, “Spark” by Ratey who discusses the importance of exercise and psychological/ neurological conditions. His emphasis is that exercise can reduce many of the symptoms of a variety of concerns includ- ing memory, confidence, atten- tion and psychological condi- tions. He discusses and shares research that exercise may eliminate or reduce the need for medications. I believe this is a critical point as many drugs that are used following acquired brain injury have many detri- mental side effects. These side effects may be reduced or eliminated when exercise is combined with the modification or possible elimination of medi- cations.
The most critical point of exercise is the inclusion of movement in a rehabilitation program. Probably the greatest indicator of recovery during the
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