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The Connection Between Vision and Acquired Brain Injuries 

March is Brain Injury Awareness month in the United States, so we thought this would be a good opportunity to explore the connection between vision and acquired brain injuries. 

The World Health Organization defines acquired brain injury as an injury to the brain that is not hereditary, congenital or degenerative. Some brain injuries have traumatic causes, such as a blow to the head, whiplash, concussion, a motor vehicle collision or a sports related injury, while others, including stroke, brain hemorrhage, and exposure of neurotoxins, are non-traumatic. Over 160,000 Canadians sustain brain injuries each year, 30% of which are suffered by children while participating in sports and recreational activities. Over a million Canadians live with the effects of an acquired brain injury, and with these effects ranging from headaches, visual field loss, dizziness, and blurry/double vision, to depression, irritability and memory problems, it is clear to see how an untreated brain injury can be devastating to the individual and their family members. 
Nearly 70% of the neural connections within the brain are involved with some aspect of vision (visual input, perception or integration), so visual dysfunction is very common following a brain injury. A 2016 study found that 80% of post-concussion patients suffered from an oculomotor problem, the most common being convergence insufficiency (reduced eye teaming ability) and accommodative insufficiency (reduced eye focusing ability). Some other common effects on the visual system following a brain injury include:
-blurry vision at distance and/or near
-double vision
-visual field loss
-light sensitivity
-oculomotor dysfunction (eye movement deficiency)
-reduced visual perception
-reduced visual processing speed

Although all of these vision problems can have detrimental effects to the patient, two of the above are exceptionally devastating and impairing: visual field loss and double vision.
Visual Field Loss - Following a brain injury, visual field loss can range from complete loss of peripheral vision, to small areas of partial loss. Hemianopsia (loss of half of the field) and quadranopsia (loss of quarter of the field) are common. Theses individuals are at an increased risk of further injury from bumping into objects, being struck by approaching objects, and falls. Optometrists specializing in neuro-optometric rehabilitation are able to employ techniques to teach these individuals how to scan into their area of field loss. Scanning therapy, optical field awareness, field enhancing prisms and other adaptive strategies are employed to aid in the functional rehabilitation of the visual field loss. 
Double Vision (diplopia) - This is another common visual finding after an acquired brain injury and can be very debilitating. The patient's ability to read, walk, and perform other activities of daily living suddenly become disrupted or nearly impossible when living with sudden onset diplopia. A combination of therapies including prisms, fusion training and selective occlusion can be employed by a trained optometrist and/or vision therapist with the goal of re-establishing single, clear, binocular vision. Selective occlusion ("spot patching") is preferred over full occlusion when treating diplopia in brain injury patients. The spot patch eliminates diplopia by blurring central vision but without compromising peripheral vision. This ensures the patient does not lose peripheral fusion, visual field or the visual components contributing to orientation, balance, and mobility.

As mentioned above, neuro-optometric rehabilitation is a specialized area of optometry that addresses the specific ocular and neurological symptoms associated with acquired brain injuries. Patients of all ages who have experienced neurological deficits may benefit from a neuro-optometric assessment and treatment. Modalities such as corrective lenses, prisms, tints, selective occlusion and vision therapy may be used in the treatment of brain injury patients. However, a comprehensive, multi-disciplinary rehabilitation regimen involving occupational therapy, physiotherapy etc, is advised in conjunction with neuro-optometric rehabilitation to help elicit a full recovery. 
Two of our own vision therapy optometrists, Dr. Patricia Fink and Dr. Shirley Ha, both have extensive training in neuro-optometric rehabilitation and are members of the Neuro-Optometric Rehabilitation Association (NORA). They are both able to assess and treat individuals with acquired brain injuries (including both traumatic and non-traumatic causes). 

For more information, be sure to check out: 
Neuro-Optometric Rehabilitation Association (NORA)

There are nearly 1000 substances which have been identified as having neurotoxic effects. Both acute and chronic exposure to these toxins can cause neurological and brain problems leading to memory loss, an altered mental status, and vision problems (including strabismus and nystagmus). 
The four major categories of toxins that can have a negative effect on the brain are:
Metals - lead, mercury and manganese primarily.
Solvents and Fuels - such as those found in glues, paints and paint thinners. 
Pesticides - either through inhalation or absorption through the skin. 
Carbon Monoxide.
Clark Elliott, Ph.D., author of "The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get It Back," speaks about how he suffered a head injury and was told by doctors that he would never recover or improve. After eight years of sometimes being unable to read, to walk or to make decisions, he received neuro-optometric treatment based on brain-plasticity principles—and is fully recovered today.
Please visit Dr. Elliott's website for more information on his book. 
We are so fortunate to have hosted a series of complimentary seminars at HVTC by Dr. Carissa Doherty and Dr. Danielle O'Connor, naturopaths from Natural Care Clinic, over the past several months. We have had attendees enjoy all of the seminars, as well as broadcast them live on our Facebook page (be sure to Like our page so you can have access to them too!).
We encourage all parents of our vision therapy patients to come join us for these lectures, as the overall health of your child is closely linked to the health of his/her visual function.
We look forward to learning with you! 

Tuesday, March 21, 2017 (6:30 – 8:00 pm) - 
Balanced Hormones

Copyright © 2017 Halton Vision Therapy Center, All rights reserved.

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