Acquired Brain Injury can come in many forms. Below are some common diagnoses:

• Traumatic Brain Injury
• Mild Acquired Brain Injury
• Mild Closed Head Injury
• Post-Concussive Syndrome
• Cervical Trauma Syndrome
• Post Traumatic Vision Syndrome
• Stroke
• Cerebral Palsy
• Cerebral Vascular Accident

Essentially, Acquired Brain Injury is an insult to the brain. It can result from a blow to the head, stroke, or neurological dysfunction. This can produce a diminished or altered state of consciousness, and may result in impairment of cognitive abilities, sensory processing and/or physical function. Impairments may be mild or severe; most are amenable to rehabilitation. Specific effects can be:

• Disturbance of behavioral or emotional functioning
• Partial or total functional disability
• Physiological maladjustment
• Visual dysfunction

Hidden Visual Problems

Often, visual problems resulting from Acquired Brain Injury are overlooked during initial treatment of the injury. Frequently these problems are hidden and neglected, lengthening and impairing rehabilitation.

Vision is the most important source of sensory information. Consisting of a sophisticated complex of subsystems, the visual process involves the flow and processing of information to the brain. Because there is a close relationship between vision and the brain, Acquired Brain Injury can disrupt the visual process, interfering with the flow and processing of information. The result is a vision problem. Symptoms indicating a vision problem are:

• Blurred vision
• Sensitivity to light
• Reading difficulties; words appear to move
• Comprehension difficulty
• Attention and concentration difficulty
• Memory difficulty
• Double vision
• Aching eyes
• Headaches with visual tasks

Good Visual Skills - Good Vision

Good visual skills are necessary for efficient information processing. When processing visual information is difficult, one may "try harder," straining without even knowing it because the effort is subconscious. If the visual system is inefficient, every task can seem difficult, using more energy than required. Visual skills affected by Acquired Brain Injury include:

• Tracking - the ability of the eyes to move smoothly across a printed page or while following a moving object.
• Fixation - quickly and accurately locating and inspecting a series of stationary objects such as words while reading.
• Focus change - looking quickly from far to near and back without blur.

• Depth perception - judging relative distances of objects-how far or near they are.
• Peripheral vision - monitoring and interpreting what is happening in the surrounding field of vision.
• Binocularity - using both eyes together as a team-smoothly, equally and accurately.
• Maintaining attention - keeping focused on a particular activity while interference, such as noise, is present.
• Visualization - accurately picturing images in the "mind's eye," retaining and storing them for future recall.
• Near vision acuity - clearly seeing, inspecting, identifying and understanding objects viewed within arm's length.
• Distance acuity - clearly seeing, inspecting, identifying and understanding objects viewed at a distance.
• Vision perception - understanding what is seen.

Optometry and Rehabilitation

Very few in the health care professions, including head trauma rehabilitation centers, are adequately aware of visual problems resulting from Acquired Brain Injury and the visual-perceptual consequences. Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team.

The vision care professional can play an important role in the rehabilitation effort. Through vision therapy and the proper use of lenses, a behavioral optometrist specifically trained to work with Acquired Brain Injury patients can help improve the flow and processing of information between the eyes and the brain.

Vision therapy can be very practical and effective. After evaluation, examination and consultation, the optometrist determines how a person processes information after an injury and where that person's strenghts and weaknesses lie. The optometrist then prescribes a treatment regimen incorporating lenses, prisms, low vision aides and specific activities designed to improve control of a person's visual system and increase vision efficiency. This in turn can help support many other activities in daily living.

Often, visual problems resulting from Acquired Brain Injury are overlooked during initial treatment of the injury.

What is Behavioral Optometry?

Behavioral optometry is based upon the core principle that vision is a learned process and can be developed or enhanced at any age. Optometrists practicing this method have continued their education beyond the basic Doctor of Optometry (O.D.) degree. This continuing education emphasizes the use of lenses, prisms and vision therapy to enhance a patient's visual capabilities, reduce visual stress, prevent and rehabilitate vision problems. As a member of the rehabilitative team, behavioral optometrists have extensive experience treating the vision problems stemming from Acquired Brain Injury.

Not all optometrists practice behavioral optometry. To find out how you can contact a behavioral optometrist in your area, call or write the Optometric Extension Program Foundation.