1. Do You See What I See? How vision and perception are affected by ABI
Leah Bell, OTR/L, CLVT, CBIS
Trena Duckworth, OTR/L

2. Objectives Define the anatomy and complexities of the visual system.
Identify the difference between vision and perception and how the 2 work together to facilitate our sensory experience within the environment.
Analyze how deficits with vision and perception can affect our daily function.
Analyze how deficits with vision and perception can affect our ability to learn and recover from injury.
Learn and practice basic assessments to identify visual and perceptual deficits.
Identify strategies and therapies that can help patients overcome or adapt to deficits related to visual and perceptual disorders.

3. We are all visual learners
Our Visual Brain
We are all visual learners
Visual deficits are present in the majority of individuals with brain injury
80% of TBI patients (Bessler & Craig, n.d.)
66% of CVA patients (National Stroke Association)
80-85% of our perception, learning, cognition, and activities are mediated through vision (Politzer, n.d.)
With more than half of our cerebral cortex devoted to processing vision, acquired brain injury can devastate our ability to sense and interact with our world through vision

4. Frontal Lobe Parietal Lobe Occipital Lobe Temporal Lobe
Brain Regions
Frontal Lobe
Parietal Lobe
Occipital Lobe
Temporal Lobe

5. Limbic System/Lobe Amygdala Hippocampus

6. Basal Ganglia Visual motor reactions Reflexive responses
Interactions with your environment

7. Vision: The act or power of sensing with the eyes

8. How the Eye Sees Saccadic movements
Information travels to the occipital lobe
Putting the pieces together
Filling in the blank spots (Video)

10. Optic Tract Occipital lobe Midbrain - LGN
From Eye to Brain
Optic Tract
Occipital lobe
Midbrain - LGN

11. Perception: Physical sensation interpreted in the light of experience

12. Optical Illusions

13. What do YOU see?

14. Why do we perceive differently?

15. Deficits with Vision Hemianopsia and quadrantopsia
Visual field cuts
Hemianopsia and quadrantopsia
Homonymous hemianopsia
Acuity
Strabismus
Double Vision
Saccades/Occulomotor Dysfunction

16. Visual Field Cuts
KUMedical Center

17. Evaluation and Treatment
Confrontation Testing
Damato Campimeter
Standard Automated Perimetry – Humphery Perimeter
Amsler Grids
Treatment
Scan Scan Scan
Cancellation tasks
Anchoring lines
Prisms
Typoscopes

18. Acuity How clearly do you see? Deficit with the lens of the eye
Speed at which impulse
reaches the occipital lobes

19. Evaluation and Treatment
Snellen Chart
Warren Text Card
Behaviors: squinting, distance of reading material, etc.
Treatment
Enlarge font
Glasses
Magnifyers

20. Strabismus Misalignment of the eyes Causes double vision
Suppression of one eye for compensation
Cranial Nerve Palsies
-tropia vs -phoria

21. Evaluation and Treatment
Corneal Reflection
Cover/uncover test
Gross observation
Presence of diplopia
Maddox Rod (resting –phoria)
Treatment
Patching/occluding
Eye exercises (monocularly)
Prisms
Binocular fusion activities
Red/green glasses
Vectograms
Brock’s String
Surgery

22. Small snapshots of a scene Need for motion to stimulate vision
Saccades
Small snapshots of a scene
Need for motion to stimulate vision

23. Evaluation and Treatment
Observation
Spaced out targets
Slowed reading speed
Treatment
Hidden objects games, papers, etc.
Word searches
Timed cancellation tasks
Scavenger hunts

24. Deficits with Perception
Visuospatial deficits
Diplopia (Double Vision)
Neglect/Hemispatial Inattention
Cortical Visual Impairment

25. Visuospatial Deficits
Difficulty with how 2 or more parts relate to each other.
Difficulty with pattern completion, building from a blue print, etc.
Constructional
Apraxia

26. Real Life

27. Simple Table

28. Completed

29. Evaluation and Treatment
Pipe constructions/building tasks
Other similar visuospatial activities; pattern completion, puzzles, object alignment, etc.
Behavioral observation
Treatment
Color coded materials and blueprint
Strategies using stereognosis
Blocking out unnecessary visual information
Practice with geoboards, grids, sequential strategies
Working with our horses on obstacle courses

30. Deficits with Perception
Diplopia
2 Images
Breakdown in the brain when processing
Can happen monocularly
Visual Perseveration
Cerebral polyopia
Palinopsia (reference)

31. Evaluation and Treatment
Missing object when reaching
Winking behaviors
Occasional diplopia with monocular viewing
Reports of “tracers” or “shadows”
Treatment
Possibly patching/occluding
Point accuracy activities
Track and target

32. Deficits with Perception
Neglect/Hemispatial Inattention
Often present with R MCA CVA
A lack of awareness of one side (usually left)
Body
Environment
Mild, moderate, severe

33. Evaluation and Treatment
Behaviors
Missing written info on one side
Poor performance on written work
Injury to one side
Difficulty navigating
Scanning patterns
Treatment
Scan Scan Scan
Positioning and environmental set-up
Auditory and tactile cues
Anchoring and typoscopes
Finger guiding
Mirrors

34. Deficits with Perception
Cortical Visual Impairment
Loss of vision in spite of perfectly functioning eyes and optic nerve
Bilateral occipital lobe damage
Anoxia, multiple CVA, gunshot wounds, etc

35. Evaluation and Treatment
Response to movement in periphery
Inconsistent visual deficits
Officially diagnosed by VEP
Treatment
Light
Color identification
Stimulate what they have
More research on children than adults

36. Post Trauma Vision Syndrome
Inaccurate ambient information processing
Difficulty maintaining eye contact
Difficulty with eye/head separation
Visual Hallucinations
Dizziness
Deficits with convergence, pursuits, saccades
Midbrain damage
Diagnosed with VEP

37. Post Trauma Vision Syndrome
Treatment
Binasal Occlusion
Prism
Eye/head separation activities
Tracking
Brock’s string
Binocular fusion activities (red/green glasses)

38. Functional Implications
Because of deficits, learning and creating new memories can be inaccurate.
Visual
How many people are here?
Cover your right eye – Now how many?
Add neglect
Add strabismus
Think about how this can affect rehab.
Cognitive deficits versus visual deficits??

39. What can we do? Concept of neuroplasticity Rewire around damage
New neural pathways
Repetition
Make it meaningful
Novel activities
Compensation with strategies

40. Conclusion
Deficits with vision and perception can negatively effect learning and life following an acquired brain injury.
However, with therapy and learned strategies, these deficits can be overcome or minimized to allow for a functional and successful life.

41. Contact Information
Leah Bell, OTR, CLVT, CBIS
Pate Rehabilitation, Brinlee Creek Ranch
Trena Duckworth, OTR

42. References
Chabris, Christopher, Simons, Daniel. The Monkey Business Illusion. (2010). Retrieved from
Farrald, Robert R., Shamber, Richard G., A Diagnostic and Prescriptive Technique: A Mainstream Approach to Identification, Assessment and Amelioration of Learning Disabilities. Sioux Falls, South Dakota, Adapt Press 1973.
Scheiman, Mitchell, Scheiman, Maxine, Whittaker, Stephen G. Low Vision Rehabilitation. A Practical Guide for Occupational Therapists. Thorofare, New Jersey, SLACK Inc
Zoltan, Barbara. Vision, Perception and Cognition. A Manual for the Evaluation and Treatment of the Neurologically Impaired Adult. Thorofare, New Jersey, SLACK Inc
Memory. (n.d.). In Merriam-Webster Dictionary online. Retrieved from
Bessler, M., OD, FCOVD, & Craig, S., OD. (n.d.). Vision Problems After Traumatic and Acquired Brain Injury. Retrieved October 10, 2017, from