Do You Know How I See? Traumatic Brain Injury and Visual Impairments

MAER PresentationApril 26, 2012

Marquita Andion

Traumatic Brain Injury Defined

Department of Veterans Affairs and Department of Defense (VA/DoD 2009)

Traumatic Brain Injury is defined as a traumatically induced structural injury and/or physiological disruption of brain function as a result of and external force that is indicated by a new onset of at least one of the following clinical signs immediately following the event;

TBI Defined (Cont’d.)

• Any period of loss or decreased level of consciousness;

• Any loss of memory for events immediately before or after the injury;

• Any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, also known as [AOL]);

• Neurological deficits (weakness, loss of balance, change in vision, praxis, paresis/paraplegia, sensory loss, aphasia, etc. that may or may not be transient;

• Intracranial lesion.

Traumatic Brain Injury Association of America

Definition differs as follows;

Traumatic Brain Injury is an alteration in brain function, or other evidence of brain pathology, caused by an external force.

Adopted by the Brain Injury Association Board of Directors in 2011.

External Forces

• The head being struck by an object• The head striking an object• The brain undergoing an acceleration or

deceleration movement without any direct external trauma to the head

• A foreign body penetrating the brain • Forces generated from events such as a blast

or explosion or other force yet to be defined

Causes of TBI from Brain Injury Association of America 2006

Falls: 35.2%Unknown/Other: 21%Motor Vehicle: 17.3%Struck by/Against: 16.5%Assault: 10%

Acquired is NOT Traumatic

Not hereditary, congenital, degenerative, and/or birth trauma

Acquired may be:– Stroke– Near drowning– Hypoxia, anoxia – Tumor neurotoxins– Electric shock or lightning strike

Measures of Injury• Glasgow Coma Scale

Motor ResponsesVerbal ResponsesEye Opening TOTAL SCOREMild GCS 13-15

Moderate GCS 9-12Severe GCS 3-8Vegetative GCS <3

• Rancho Los Amigos Scale Levels I - VIII• MACE Military Acute Concussion Evaluation

Brain Reaction to Trauma

• Coup and Contracoup• Concussion• Contusion• Stretching• Shearing• Tearing• Swelling• Chemical Reactions• Induced Coma

Visual Implications

• Direct hits to visual organs• Retinal damage• Swelling• Chemical reactions• Affected centers of the brain• Other causal factors

Vision and the Brain

• Visual Organs• Visual Pathway• Lobes of the Brain that Translate Vision • Secondary Conditions• Medications

Lobes of the Brain and Their Functions from buzzle.com

Areas of the Brain Related to Vision

• Frontal Lobe

• Parietal Lobe

• Temporal Lobe

• Occipital Lobe

Neuro-Optometric Tests

• Yoked Prism Walk

• Padula Visual Midline Shift

• Super Fixation Disparity

• Z-Bell

TBI POPULATIONS

InfantsToddlersSchool AgeTeenagers Young AdultsMilitary PersonnelElderly

Infants

• Shaken Baby Syndrome• Falls • Repeated injuries• Abuse

• Research Findings–Plasticity–Recovery

Shaken Baby Syndrome

You Tube videoRealCare Shaken Baby

from

The Doctors TV ShowMay 10, 2010

http://www.youtube.com/watch?v=8bx_X8GmOY4

• Lag in Maturity• Flat affect/Listless• Unresponsive to stimuli• Refusal to nurse or eat• Lack of tracking• Not exploring physical environment• Poor response to verbal and/or visual cues

Infants & Toddlers

Suggestions

• Safe Environment• Nurturing• Touch/Movement• Stimulation for all Senses• Teach How to See• Manipulatives• Daily Routines• Toys and Games

School Age Children

• Falls• Bike Accidents • Sports Injuries• Car Accidents• Abuse• Other

School Age Children & Teens

• Physical Functioning– School Environment– Home Environment

• Classroom Structure• Treatment Modalities• Social Milieu• Behaviors

Cognition After TBI

• Attention• Memory– Encoding– Storage short term & long term– Retrieval

• Learning• Organization• Executive Functions

Relationship of Vision and Cognition

• All Environments• Activities of Daily Living• Societal Issues• Higher Learning• Employment • Families’ Futures

Teenagers and Young Adults

• Car Accidents• Falls• Sports Injuries• Motorized Vehicles • Dare Devil Incidents• Assaults• Gun Shots• Combat Related Injuries

Strategies for TBI Recovery

• Daily Routine• Order & Organization• Planning• Manipulating the Environment• Memory Aids• Low Tech Tools• Medium Tech Tools

Learning Strategies

• Teaching in chunks• Highlighting• Mental pictures• Mental practice• Verbal cues • Visual cues• Goal oriented• Utilize all resources

Social Implications for TBI

• Impervious to Nonverbal Clues• Impetuousness• Memory Deficits• Disregard for Safety • Poor Perceptual Skills• Compromised Reasoning• Disinhibition• Destructive Tendencies

Behavioral Implications

• Hyperactivity• Aggression• Anger Issues• Extreme Risk-taking• Heavy Partying• Alcohol & Drug Use• Hypersexuality/Hyposexuality• Irresponsibility• Undependable

Emotional Issues

• Emotional Outbursts• Anxiety• Depression• Paranoia• Self-Abusive Tendencies• Suicidal Thoughts

Elderly and TBI

• Slip & Falls• Home Accidents• Underlying Factors• Abuse• Secondary Conditions• Isolation

Suggestions for Elderly

• Rest• Safety • Overcoming “Fear of Falling”• Daily Routines• Schedules• Aids & Aides• Community Services

Publications & Websites • Lash Publications www.lapublishing.com

– Behaviors– School – Communication– Teaching Strategies– Families

• Websites– Professional Organizations– Educational – Informational– Personal Experiences