More than 80 percent of what we learn is processed visually. It is easy to understand why visual dysfunction from closed head injury/traumatic brain injury (TBI) can profoundly affect the speed and level of recovery.

Vision symptoms may be among the earliest observed following head trauma and injury. Double vision, visual
blur, headaches, eyestrain, dizziness, disorientation and reading difficulties present as some of the early changes
in visual status.

TRAUMATIC BRAIN INJURY

 
75% OF HEAD TRAUMA SURVIVORS NEED REHABILITATION.
90% NEED VISUAL CARE.

Neuro-optometry provides diagnosis and treatment for vision dysfunctions resulting from Acquired Brain Injury (ABI). With treatment, many visual symptoms can be managed or eliminated. Proper vision intervention encourages a faster and more successful recovery in other sensory and movement areas.

Neuro-optometric rehabilitation involves the use of special instruments and techniques to evaluate ocular motility (eye tracking), accommodation (eye focusing), vergence (eye alignment) and visual information processing/visual perception dysfunctions. 

Specialty lenses and prisms are then utilized to improve eye function and perception. A comparison is often made with physical therapy or occupational therapy in that both treatments involve the re-training of neurological signals from the brain to body systems.

Dr. Ashley is committed to providing comprehensive and caring vision evaluations to survivors of Acquired Brain Injury. Our mission is to help each person reach their highest visual abilities and goals.

 

The CDC reports that there are approximately 3.8 million concussions annually in the United States.  As the NFL and media have brought more light to the danger of mild traumatic brain injury (mTBI), research on concussion is at an all-time high.  The goal of this research is to better protect, detect, and treat concussion patients in the future.  The first step is to educate the public in order to dispel many of the myths we all grew up believing regarding concussion.  It is no longer getting your “bell rung.”  The current definition of concussion from the Zurich guidelines is a brain injury defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.

CONCUSSION

Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:

  • Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.

  • Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.

  • Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.

  • Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness (LOC). Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged.

Signs/symptoms generally show up soon after the injury. However, you may not know how serious the injury is at first and some symptoms may not show up for hours or days. For example, in the first few minutes you might be a little confused or dazed, but an hour later not be able to remember how you got hurt. You should continue to check for signs of concussion right after the injury and a few days after the injury. If your concussion signs or symptoms get worse, you should go to the emergency department right away.

Concussion Signs Observed
  • Can’t recall events prior to or after a hit or fall

  • Appears dazed or stunned

  • Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent

  • Moves clumsily

  • Answers questions slowly

  • Loses consciousness (even briefly)

  • Shows mood, behavior, or personality changes

Concussion Symptoms Reported
  • Headache or “pressure” in head (most common)

  • Nausea or vomiting

  • Balance problems or dizziness

  • Double or blurry vision

  • Bothered by light or noise

  • Feeling sluggish, hazy, foggy or groggy

  • Confusion, concentration or memory problems

  • Just "not feeling right” or “feeling down”

Statistics from the CDC

  • Adolescents are more at risk due to their “developing brain"

  • In similar sports, females have a higher rate of concussion than males

  • NFL Hit = 30 mph car accident

  • More neurons in your brain than stars in the sky

  • Fewer than 10% of sports related concussions involve loss of consciousness

  • Research suggests that if someone has already received one concussion, they are 1-2 times more likely to receive a second one. If they've had two concussions, then a third is 2-4 times more likely, and if they've had three concussions, then they are 3-9 times more likely to receive their fourth concussion

  • Football is the most common sport with concussion risk for males

    • 75% chance during football career

    • 20% chance each season

  • Soccer is the most common sport with concussion risk for females

    • 50% chance during soccer career

Why is an optometrist involved with concussions?

 

Dr. Ashley became involved with traumatic brain injury and concussion management due to patients continued visual struggles and symptoms after a brain injury. 50-90% of TBI patients suffer from visual dysfunctions. 70% of all sensory processing in the entire body is directly affected by information coming from the two eyes. The visual system is responsible for 44% of the brain’s energy consumption. With this kind of power, you can imagine how an injury to the brain can affect how the body processes visually.

Symptoms of Post-Trauma vision Syndrome (PTVS)
     

Constellation of visual problems after brain injury:

  • Eyes drifting outward

  • Eyes not working together

  • Double vision

  • Blurred vision

  • Light sensivity

  • Visual field loss

  • Concentration difficulties

  • Reading problems

  • Poor spatial judgement

  • Poor depth perception

  • Possible visual midline shift

Dr. Ashley is dedicated to increasing public awareness of all of the members of the post-concussive health care team. After a concussion, patients may need assessment and treatment in multiple disciplinary areas: cognitive function, vestibular and ocular abilities, post-traumatic migraine, cervical function, and anxiety/mood assessment. Dr. Ashley works as part of the multi-disciplinary team with many clinics/physicians in the Kansas City Metro area. 

STROKE

 

A stroke, or cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage. If the occipital lobe of the brain is affected, vision will be affected. Both central (straight ahead 20/20 vision) and peripheral vision are vulnerable, depending on the location of the CVA.

Most nerve fibers from the right eye cross to the left side of the brain and vice versa. A CVA/stroke on the left side of the brain may result in a loss of the right field of vision in both eyes – if the CVA/stroke is on the right side of the brain, the left field of vision may be affected. If the brain cells receiving high resolution data from the macula/fovea cells of the retina are intact, 20/20 or close acuity will still be present. If these brain cells are affected by the CVA, visual acuity may be markedly reduced.

A CVA/stroke in high brain centers may affect visual information processing and visual perception. Visual interpretation and judgments of

visual stimuli take place in higher

level cognitive (thinking) brain

regions – a CVA/stroke may disrupt

the inter-connections of brain neurological circuitry. Thought processes and logical reasoning may change from pre-CVA/stroke abilities.

Lenses, special prisms, and rehabilitation are often combined to restore visual motor guidance abilities, ocular motility (eye tracking), accommodation (eye focusing), vergence (eye alignment) and visual information processing/visual perception skills. Special prisms, call yoked prisms, may be prescribed to correct visual mid-line shift (a shifting of the awareness of the mid-line of the body) and other mal-adaptations of head and body posture. Prism lenses may allow better abilities in daily living activities with the loss of peripheral visual field.

MOVEMENT • VISION • PERFORMANCE

2301 10th Avenue | Leavenworth, KS 66048

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