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Behavioral Optometry
BOAF
Volume1 Number1 2012
rehabilitation process is the development of spontaneous and volitional movement. When I see this occur, I know the pa- tient is emerging and is heading in the direction of recovery. Of- ten visual processing can be a trigger such as the initiation of eye movements that can trigger motor control lower down. An example of the critical link of eyes to body is driving. Have you ever noticed that your gaze looking to one side or the other draws your body and steering wheel toward the same direc- tion? The second aspect of movement that is critical is that any movement of the head in- cludes stimulation of the vesti- bular system. As the vestibular system receives input, there is generally increased arousal and attention, thus the patient is better prepared to be cortically involved in the rehabilitation process. An example of this is while driving you may become tired. Have you ever noticed shaking your head to try to be- come more alert and put off that sleepy feeling?
The second reference that is important is information com- ing from Coyle in his book, The Talent Code. In his book he reviews how small groups of people have become sensations in their areas of endeavor. An example is the sudden onset of many Korean women on the professional golf circuit or how a small town in Russia develops some of the best tennis players in the world. His key is about myelination and how it develops
and is maintained. We know that water intake and appropri- ate nutrition are critical. But we must also include motivation and “deep” practice according to Coyle. Deep practice is to take the task, and learn it in a variety of different and more complex ways. It is interesting because Sue Barry also empha- sizes that “novelty” is one of the critical aspects for her to de- velop stereopsis. This aspect is critical for visual rehabilitation. An example of this may be seen during the rehabilitation of a cranial nerve 6 paresis/palsy. One consideration is to simply tell the patient to practice mov- ing their eyes to the side to try to recover function. But the above research would suggest we should improve all the sec- ondary and tertiary movements as well. Thus instead of working just “eye movements to the side”, we should ask our pa- tients to move them to the di- rection we want to improve and include many variations such as up and over and down and over. Ciuffreda and others summa- rized the work by Ron, et al. that suggests we should also include pursuits, saccades, doll’s eye and motion (OKN) processing in all these direc- tions during EOM rehabilitation. This is an example of ocular motor subsystem transfer. This is where if you train saccades in a patient with an ABI they re- cover function faster and to a fuller degree. Not only this, but they also make better improve- ments in the other types of eye
movements. The best overall recovery was found when mul- tiple systems were treated. This concept of varying therapy from many aspects can also include the concepts of both monocular and binocular activities.
Treatment of ABI
The overall treatment plan for a patient suffering an ABI should be for rehabilitation with the addition of compensatory strategies for support. During the rehabilitative process, some patients may recover quickly and others are slower. The use of compensatory strategies can be supportive during the initial phases of rehabilitation. This might include touching the wall to decrease disequilibrium or the use of occlusion to eliminate diplopia while walking. This would decrease the concern for safety while walking. If possi- ble, selective occlusion can be used so the patient may not experience diplopia and also have a full visual field available for maintenance of balance. Each case is different and should be looked at individually. In some cases it may not be possible to fully recover or re- habilitate the visual sequelae and the compensatory strate- gies may end up being used on a more permanent basis.
The important factor to re- member in rehabilitation is to look at the patient as a whole. We need to make sure we’re aware of all the different con- cerns. It is important to deter- mine what goals are to be met.
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