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Behavioral Optometry
BOAF
Volume1 Number1 2012
plete visual field recovery. I’ve had several patients who have discontinued the use of such prism systems. Typically the gains in visual field decrease (shrink) back to baseline after 2- 3 months. These treatment op- tions are used in conjunction with typical orientation and mo- bility therapy for improving safety during mobility.
USI patients generally im- prove, but some are quite se- vere and may take more time to recover. Visual orientation and localization activities are the foundation of treatment. Some simple activities are spatial judgment activities such as blindsight training. Other signifi- cant improvements can be gained using both rotational vestibular input and vibration of the cervical muscles on the side of the deficit.
These gains may disappear shortly after the discontinuance of the sensory input. Typically improvement is faster when we follow the stimulation activity with spatial awareness and lo- calization activities.
Documentation of im- provements of USI may be made by repeating visual field testing including dual presenta- tion both sitting and while standing. A patient may dem- onstrate USI while standing but may not while sitting. This sug- gests that testing should be made during standing and con- cerns communicated to the re- habilitation therapist regarding a fall risk while walking. It is also easy to repeat the draw a clock
test during each therapy ses- sion looking for changes in per- formance.
Summary
The rehabilitative process is critical to help patients to return quickly and fully back to their work and recreational activities. Vision is one of the most inte- grated sensory motor systems in the brain and thus is involved in most everything we do. Thus the visual process can be a critical component of the reha- bilitation process and should always be addressed in the pa- tient. If any concerns present, the patient should always be evaluated and recommenda- tions made so that the rest of the rehabilitation process can progress quickly and fully. This can significantly help the rest of the rehabilitation team to reach their goals for the patient.
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Curtis R. Baxstrom
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