Do You Know How I See? Traumatic Brain Injury and Visual Impairments MAER Presentation April 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 Responses Verbal Responses Eye OpeningTOTAL SCORE Mild GCS ModerateGCS 9-12 SevereGCS 3-8 Vegetative 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 Infants Toddlers School Age Teenagers Young Adults Military Personnel Elderly

Infants Shaken Baby Syndrome Falls Repeated injuries Abuse Research Findings – Plasticity – Recovery

Shaken Baby Syndrome You Tube video RealCare Shaken Baby from The Doctors TV Show May 10,

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 Publicationswww.lapublishing.comwww.lapublishing.com – Behaviors – School – Communication – Teaching Strategies – Families Websites – Professional Organizations – Educational – Informational – Personal Experiences