Occupational Therapy for Neurological Vision Deficits

 

What are neurological vision deficits?

Any vision problem caused by damage to the brain or nervous system rather than the eyes. 

 

What types of diagnoses commonly have neurological vision deficits?

Here are examples of some diagnosis that may have neurological vision problems:

·         Parkinsons

·         CVA

·         Multiple Sclerosis

·         Concussion

·         Multi system atrophy

·         Bells Palsy

·         Brain Tumors

·         Optic Neuritis

·         Alzheimer's 

 

What kinds of vision deficits can be treated with vision therapy?

·         Double vision

·         Impaired visual acuity/blurred vision

·         Slow/impaired visual scanning

·         Spatial disorientation

·         Eye strain/fatigue

·         Abnormal eye tracking/ocular motor dysfunction

·         Decreased color vision

·         Peripheral vision loss

·         Visual field cuts/hemianopsias

·         Visual spatial neglect

·         Visual midline shift symptoms (VMSS)

·         Difficulty reading/loss of concentration

·         Decreased visual processing speed 

 

How do I know if my client needs OT vision therapy?

You may consider an OT referral to vision therapy if your patient or client tells you that they are having:

·         Post stroke changes to vision.

·         Decreased ability to enjoy leisure reading.

·         Onset of double vision or blurriness.

·         Difficulty following moving objects such as watching a sports game or observing passing cars while driving.

·         Decreased sensitivity to color contrast (colors seem dimmer, difficulty reading black on white font).

·         Complaints of eye strain/pain with reading/watching TV/driving/using computer.

·         Difficulty gauging curbs and stairs when stepping off.

A referral to an occupational therapy can then be made to address the determined deficit areas either by providing neurological retraining or providing education on compensatory strategies. 

 

What are neurological vision techniques used in occupational therapy?

·        Eye exercises for tracking, saccades, near point convergence and gaze stabilization to improve speed and accuracy of eye movements

·        Fusion and anti-suppression training to improve binocular vision and decrease double vision

·         Visual motor integration for improve eye-hand coordination

·         Visual-vestibular/balance challenges

·         Adapting to prescription prism lenses 

 

What are examples of NON neurological vision deficits?

OT for these types of deficits include low vision and compensatory strategies only, as the client works w/ their vision specialist. 

·      Age-related macular degeneration

·      Cataracts

·      Glaucoma

·      Diabetic retinopathy

·      Migraine headaches

·      Retinal detachment

·      Vision loss/blindness  

 

What is low-vision training?

Low-vision training helps people with vision loss use their remaining vision to improve their quality of life. It can include: 

·       Assistive devices such as magnification, text readers, talking watches or colored filters.

·       Orientation and mobility to learn how to navigate safely, including using a cane or monocular telescope.

·       Adaptive techniques to perform daily tasks, such as driving assessments, meal preparation, and bill paying.  

 

What are some examples of compensatory strategies?

·       Using an anchor, such as a colored piece of tape, in the direction of the limited visual field can be helpful to increase recognition. Example: tape on the edges of steps or stairs.

·       Utilizing increase in visual contrast throughout the day. Example: use of bright colored placement underneath your plate to increase contrast

·        Avoid visual over-stimulation in the house.

·       Understanding when to give eyes a break to decrease over stimulation. Example: self-monitoring with timers to avoid excess time on computer.

·       Utilize a line tracker for reading if needed to increase the ease with tracking across a page. 

 

What should I do for a client who has both vision and vestibular concerns?

While it can be common for patients or clients to have both vision and vestibular deficits at the same time (dizziness and double vision), it is often best for them to manage their vestibular symptoms first before completing vision therapy, as the vision exercises can be overwhelming if compounded by a vestibular problem. Vestibular Physical Therapy can address some co-existing vision issues identified in conditions causing dizziness/vertigo/imbalance such as TBI/concussion, vestibular migraine, PPPD, and CVA.