Optometry And Brain Injury Flashcards
As an optometrist what do I stand to gain by knowing more about brain injury?
will be able to change a life in a way no other provider can
What are TBIs?
concussion: sports, motor vehicle accident, falls, assault
What non-traumatic acquired brain injuries?
stroke, anoxia (overdose), infection (herpetic encephalitis), arteriovenous malformation (AVM), metabolic
How can you inquire about brain injuries?
Have you every had a motor vehicle accident, sports head injury, fall, workplace injury?
What is the brain injury vision symptom survery?
2016, validated by comparing mTBI and nonTBI population, good test-test reliability; >31 predictive of mild to moderate TBI
What is the scale of the brain injury symptom survey?
0-112, >31 is predictive of mild to moderate TBI
What is a good question that may uncover a brain injury?
Do you have any problems when you go to the grocery store or deal with large crowds of people?
What is visual extinction?
with simultaneous presentation of similar stimuli in each visual field, the phenomenon that the person is incapable of attending to one of the stimuli
What are two other names for visual extinction?
hemispatial neglect and unilateral spatial inattention
What side strokes predominately cause visual extinction?
right sided strokes to the posterior parietal area (in charge of visuo-spatial maps)
Right sided damage –>
left sided inattention
T/F neglect is a more severe form
true; patient unaware of left side of self and world, patient unable to interact with left space, can mimic homonymous hemianopsia
What is prism adaptation?
purposefully creating a visuo-motor mismatch, so that the patient must activate areas of the brain responsible for recalibrating spatial maps
What is an indirect result of prism adaptation?
the patient will now be aware of areas of space they previously ignored
How is yoked prism generally prescribed in traumatic concussion patients?
small amounts (<5) in any direction, worn more often and long term
What is concussion yoked prism used for?
space compression or expansion (abnormal egocentric localization)
What is non-traumatic yoked prism used for?
image shifting (visual neglect/inattention)
How is yoked prism generally prescribed in non-traumatic stroke patients?
larger amounts (10-30), opposite the field defect (typically BL>BR), work intermittently/in office
What is the normal relationship between VOR and COR?
VOR > COR
If there is damage to VOR what is the relationship between VOR and COR?
COR>VOR
What is COR?
cervico-ocular reflex
What is VOR?
vestibulo-ocular reflex
How does space compression work?
at the apex of the prism space is compressed and at the base it is expanded
T/F concussion patients are hypersensitive to space compression/expansion
true
What are post trauma vision syndrome signs?
oculomotor dysfunction, ocular misalignment, accommodative dysfunction, CI, visual motion hypersensitivity, anomalous egocentric localization, photosensitivity, low blink rate/dry eye
What are post trauma vision syndrome symptoms?
diplopia, blurred vision, objects appear to move, poor concentration and attention, staring behavior, asthenopia, dizziness or nausea, spatial disorientation
What are accommodative therapies?
N/F Hart chart, monocular accommodative rock, monocular fixation/binocular field
What are binocular VT therapies?
eye control, coin circles, brock string
What are oculomotor therapies?
wall saccades, SVI saccades, reflexion/binovi
What are visual spatial therapies?
greenwald eye movements, SVI rotator, CP saccades
What are multisensory integration therapies?
flashlight pointing, balance board + column jumping + metronome, myers flying rings + bozu ball
What basic technique could dramatically improve your patient’s success?
look hard look soft
Is how we interact with our world more dependent on central vision or peripheral?
peripheral
