VISION TRAINING TO IMPROVE CLASSROOM ENDURANCE POST-TBI: A CASE STUDY WITH A 26-YEAR-OLD FEMALE NVT in the classroom
Main Article Content
Abstract
Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including students when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training has been found to be successful in improving oculomotor endurance, giving patients the ability to maintain focus for long periods of time and to mitigate against suppression.
Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including those of students, when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training successfully improves oculomotor endurance, allowing patients to maintain focus for long periods and
mitigate against suppression.
Case Report: This report describes a 26-year-old female presenting with activity-induced sensory overload, specifically in the setting of her college classroom lectures. The patient described symptoms appearing as headache, fatigue, and blurred vision. Upon initial examination, she was determined to have a left eye exophoria with fatigue-induced left eye suppression and left eye lateral abduction deficiencies. A personalized action plan was designed to improve left-right oculomotor symmetry and endurance and mitigate against suppression through a weekly structured vision training program. In this 7-week program, individual and dual eye saccadic exercises improved, with both eye horizontal saccades improving from 26 characters read aloud per minute to 36 characters read out loud per minute. With these regular vision training sessions, the patient displayed improved oculomotor endurance, decreased suppression with prolonged activity, and better dual-eye coordination. After the post-vision training program, the patient could attend her college lectures without invoking symptoms.
Downloads
Article Details
References
Giza C, Greco T, Prins ML. Concussion: pathophysiology and clinical translation. Handb Clin Neurol 2018;158:51–61. https://doi.org/10.1016/ b978-0-444-63954-7.00006-9
Dwyer B, Katz DI. Postconcussion syndrome. Handb Clin Neurol 2018;158:163–178. https://doi.org/10.1016/b978-0-444-63954-7.00017-3
Leddy JJ, Baker JG, Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Rehabil Clin N Am 2016;27(2):437–454. https://doi.org/10.1016/j.pmr.2015.12.003
Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc 2008;14(1):1–22. https://doi.org/10.1017/s135561770808017x
Helveston EM. Visual training: current status in ophthalmology. Am J Ophthalmol 2005;140(5):903–910. https://doi.org/10.1016/j.ajo.2005.06.003
Covassin, T, Moran R, Wilhelm K. Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions. Am J Sports Med 2013;41(12):2885–2889. https://doi.org/10.1177/0363546513499230
Tsushima WT, Jordan A, Tsushima VG, et al. Effects of a Single Concussion During the School Year on the Academic Performance and Neuropsychological Functioning of High School Athletes. Hawaii J Health Soc Welf 2020;79(7):212–216.
Clark JF, Colosimo A, Ellis JK, et al. Vision training methods for sports concussion mitigation and management. J Vis Exp 2015;(99):e52648. https://doi.org/10.3791/52648
Stine CD, Arterburn MR, Stern NS. Vision and sports: a review of the literature. J Am Optom Assoc 1982;53(8):627–633.
Abernethy B. Training the visual-perceptual skills of athletes. Insights from the Study of Motor Expertise. Am J Sports Med 1996;24(6 Suppl):S89–92.
Fleet A, Che M, Mackay-Lyons M, et al. Examining the use of constraint-induced movement therapy in Canadian neurological occupational and physical therapy. Physiother Can 2014;66(1):60–71. https://doi.org/10.3138/ptc.2012-61
Page S, Boe S, Levine P. What are the ‘ingredients’ of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations. Restorative Neurology & Neuroscience [serial online] 2013;31(3):299–309. Available from: Academic Search Complete, Ipswich, MA. Accessed November 24, 2014.
Collins CC, Carlson MR, Scott AB, Jampolsky A. Extraocular muscle forces in normal human subjects. Invest Ophthalmol Vis Sci 1981;20(5):652–664. https://www.ncbi.nlm.nih.gov/pubmed/7216678
Enderle JD. (2012). Chapter 13 - Physiological Modeling. In J. D. Enderle & J. D. Bronzino (Eds.), Introduction to Biomedical Engineering (Third Edition) (pp. 817–936). Academic Press. https://doi.org/https://doi.org/10.1016/ B978-0-12-374979-6.00013-7
Debski EA. Fixing my gaze: A scientist’s journey into seeing in three dimensions. J Clin Invest 2009;119:3188. Copyright © 2009, American Society for Clinical Investigation. https://doi.org/10.1172/jci41156
Serna A, Rogers DL, McGregor ML, et al. Treatment of symptomatic convergence insufficiency with a home-based computer orthoptic exercise program. J aapos 2011;15(2):140–143. https://doi.org/10.1016/j.jaapos.2010.11.023
Zupan M, Wile A. Eye on the Prize. Training & Conditioning 2015.
Scheiman M, Wick B. Clinical Management of Binocular Vision. New York: Lippincott 1994:188–192.
Barry SR. Fixing My Gaze: A Scientist’s Journey into Seeing in Three Dimensions. New York: Basic, 2009.
Wakayama A, Nakada K, Abe K, et al. Effect of suppression during tropia and phoria on phoria maintenance in intermittent exotropia. Graefes Arch Clin Exp Ophthalmol 2013;251(10):2463– 2469. https://doi.org/10.1007/s00417-013-2410-8. Epub 2013 Jul 3.
Grooms D, Appelbaum G, Onate J. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation. J Orthop Sports Phys Ther 2015;45(5):381–93.
Clark JF, Holloway GM, Elgendy-Peerman HT, et al. Vision training to improve a consecutive exotropia: A case study with a 14-year old female athlete. Optom Vis Perf 2016;4(3).