Functional Vision Problems After Concussion [Title Page] OUTLINE

Functional Vision Problems after Concussion [Title Page] OUTLINE

• Objectives • Anatomy of the eye • Brain • Visual Acuity Loss • Visual field Loss • With Neglect • Without Neglect • Common Eye Problems • Treatment • Take-away Tips • Resources • References OBJECTIVES

• Following this presentation, participants will be able to:

• Name the 2 most common kinds of visual problems and describe the difference between them.

• Name 3-5 symptoms commonly seen in concussions.

• Name/describe 3 interventions to reduce symptoms seen in concussions. For those who have experienced any type of head trauma that results in a concussion or post-concussive syndrome, you probably are well aware that there can be numerous eye-related problems that result. [Title Page] Eye symptoms are a frequent side effect of a concussion, and as reported by research, the prevalence of vision problems may be as low as 69% or as high as 90% according to The Neuro-Optometric Rehabilitation Association (NORA).

For Brain injury in general, the literature says 20-40% of people with BI experience related vision disorders. However the exact prevalence is not known as it is often overlooked or undiagnosed. Anatomy of the Eye

This Photo by Unknown Author is licensed under CC BY-NC-ND A Little more Anatomy

2 Most Common Visual Problems

Visual Acuity Loss

Visual Field Loss

This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-NC

Visual Field Loss

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This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY-SA

Visual Field Loss without neglect

This Photo by Unknown Author is licensed under CC BY-SA-NC Treatment Strategies

Without Neglect With Neglect

• Encourage visual scanning in a • Stand on neglected side systematic search pattern • Include neglected side in all activities

• Bring neglected side across the body

• Head and eye movement • Use perceptual anchors • Awareness training • Patching • Use Pusher syndrome strategies • Reduce visual stimuli • Lighthouse strategy Break Other eye problems that result from Concussions

• Blurred or double vision • Light sensitivity

• Partial Vision Loss • Eye Pain

• Abnormal eye movements • Headaches

• Fatigue • Poor tracking/gaze shifting Page 7

Blurry or double vision is a common complaint after a concussion and may result from damage to the muscles and/or nerves around the eyes.

This can stem from what is known as convergence insufficiency; in effect, the alignment of the eyes diverge when trying to focus on nearby objects. Page 8

Photophobia, or sensitivity to light, is also a residual effect of a concussion and can be exacerbated by specific light sources such as bright sunlight, fluorescent lighting and LCD screens (computers/cell phones). Page 9

Partial or complete loss of vision can also occur post head trauma, often taking on different forms depending on the patient.

He or she might experience blind spots in the periphery or have reduced vision in one half of the visual field.

This can be caused by several factors: in some cases direct eye injury, bruising, lacerations, broken blood vessels or swelling in the area.

. Page 10

Sometimes the eyes just hurt, whether it is a stabbing pain, a dull ache in or around the eye, or even redness, burning and itchiness. The trauma that caused the concussion can sometimes create what is known as an accommodation spasm which can make the eye hurt. This is when one of the muscles around the eye contracts and stays contracted for an extended period of time. Page 11

Weakened, delayed or otherwise abnormal eye movements are also frequently present for patients and are particularly noticeable for those with persistent post-concussive syndrome. Headaches after a concussion ( or TBI) are one of the most common side effects of a head injury. However, for some individuals they can become a significant complication that persists long after the initial injury has occurred, developing into potentially chronic post-concussive headaches. Although post-concussive issues arise in about 10-20% of patients after a injury, studies have shown that these enduring headaches may affect anywhere between 59% to more than 90% of individuals.

This Photo by Unknown Author is licensed under CC BY-NC- ND It is important to distinguish between headaches that arise immediately after an injury and those that persist for weeks and months after the concussion. Generally, immediate head pain can manifest within a few hours or days after hitting your head and will resolve itself shortly after proper rest and treatment. However, post-concussion HA’s begin within 7 days of the injury and generally last for at least 3 to 6 months. It has even been suggested that nearly a quarter of all HA’s after a concussion persist for a year or more. Concussion Fatigue is different. There are 3 general types of fatigue that people refer to: they are Physical, Cognitive and Concussion. Physical is the plain everyday fatigue that we all know, it is that tired feeling if you stayed up to late, or done too much physical activity. Cognitive is also referred to as “mental fatigue”. It could be due to studying, taking a test, or working at your desk. Generally these two types are intermittent and can be resolved with This Photo by Unknown Author is licensed under CC BY-NC- rest and taking a break, but you can ND work thru these types of fatigue. Factors can include: Lack of restorative and regular sleep Psychiatric issues like anxiety or depression Chronic pain Chronic stress Other less common factors can include: Seizure related fatigue Hydrocephalus

Hormonal abnormalities This Photo by Unknown Author is licensed under CC BY-ND Nutritional deficiencies Renal failure Hepatitis Page 12

Concussion patients often report that they feel disoriented with poor tracking or gaze shifting and/or have other symptoms (vertigo) triggered by busy or disorienting environments. Treatment for post-concussive vision problems

The treatment for functional vision problems resulting from a concussion will be different for every person.

For some – and this is ideal, of course – problems like hemianopsia resolve themselves. For others, it doesn't and the length of time for learning compensatory strategies depends on a person’s cognitive level post injury.

? So who helps a person learn strategies and compensations?

An interdisciplinary team can include Nursing, Physical and Occupational therapists, Speech-Language Pathologists, Physical and Rehabilitation physicians, Neurologists, Psychologists, Audiologists, Ophthalmologists and Counselors/Social Workers. Each and everyone of these professionals play an important role in a persons recovery. Take-away Tips

Environmental Modifications • Reduce clutter • Use of contrast • Use of lighting • Reduce glare • Noise reduction

Sleep Hygiene • Rest when needed • Sleep in a cooler, darker, quieter room • Avoid electronics an hour before, exercise 2 hours before, caffeine 4 hours before • Have a routine with the same time up and bed daily Energy Conservation • Pace yourself • Schedule activity and rest throughout the day • Self check yourself for fatigue level • Ask for help

Diet • Balanced • Nutritious • Consider 4-5 smaller meals vs 3 larger ones

Medications • Review with physician any interactions or side effects • Be aware of “rebound effect” This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-NC-ND References

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