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Posted on 03-23-2015
Here is another, more typical, story for Brain Injury Awareness Month. Jayne was referred by her acupuncturist and came to me for the first time only after she had suffered a mild traumatic brain injury. Vision therapy and proper lenses are usually very potent in treating visual symptoms resulting from concussions and other brain injuries. Vision therapy should be considered for anyone who has suffered a concussion/brain injury. It can be critical for improving quality of life after suffering a traumatic brain injury.
I first saw Jayne in August 2010. She had suffered a traumatic brain injury in August 2009 by hitting the top of her head and stunning herself. Jayne reviewed proposals for a living and complained of difficulty reading, light sensitivity, discomfort at the computer, fluctuating focus at all distances and balance issues. She worked in a busy office, which regularly presented visual triggers that would cause her great discomfort. All busy environments seemed to trigger balance problems and disorientation. She did not want to show how much trouble she was having and just persevered at work as best she could. She was able to keep up the pace, but with constant, fairly severe discomfort.
We were unable to complete the initial evaluation because Jayne reported feeling dizzy and nauseated. She said she felt almost like vomiting and blacking out. Jayne said she started having a hard time fairly early on during the exam, but did not want to say anything too early or stop because it is her nature to push through hardship. Finally, she could not take anymore and had to stop. Luckily there is a sofa in my waiting room, because Jayne needed to lie down for the better part of an hour before she felt like she could walk to her car, let alone drive it.
Jayne’s initial evaluation findings were relatively unremarkable, other than the history of acquired brain injury. Her compensating lenses for nearsightedness and astigmatism provided almost 20/20 distance acuity. Her reading prescription provided what Jayne described as “not comfortable anywhere” acuity at near, though the acuity was measured as 20/20 at near with her current near lenses. She was alternately losing input from each eye at distance and near on an intermittent basis. Overall, her findings did not paint as poor a visual picture as I might have expected given the severity of her discomfort. Nonetheless, based on her presenting complaints, I definitely felt it was imperative to attempt vision therapy.
Several weeks later, with unsurprising trepidation, Jayne made an appointment to begin a vision therapy program with me. She ended up cancelling that appointment and that was the last I heard from her. That is, until she made an appointment for a progress evaluation in August 2012.
Jayne reported that she continued to hide her discomfort at work, determined to push through; she was anything but comfortable. Jayne was being treated for what she thought was anxiety with some interesting techniques. These techniques seemed to recognize that her visual issues were a big part of the problem for Jayne. And she had obtained some intermittent relief thanks to these techniques. Nonetheless her visual difficulty continued. Jayne had trouble in certain environments that, to my mind, provide triggers provoke uncomfortable visual reactions, including nausea, loss of balance and disorientation. All of her triggers were visual in nature.
In comparing this evaluation with our first encounter, Jayne showed some slight improvement in several findings. She continued to alternately lose input from each eye at distance and near on an intermittent basis, but had a much easier time making it through the evaluation this time; she had no complaints of discomfort and managed to leave the office without having to lie down first.
After the evaluation we decided that Jayne would begin a vision therapy program immediately in an effort to desensitize her to the visual triggers that were making her miserable. I decided to try one more thing before she left the office – narrow binasal occlusion.
I placed the narrow binasal occlusion on her current glasses and Jayne immediately felt a significant difference. She was hesitant to admit what she was feeling for fear of it not being real. She said that she instantly felt 80% better. The following week, Jayne reported that she was maintaining the 80% improvement in her symptoms. She was much better able to handle busy public places, including her workplace. Jayne did very little vision therapy as it turned out, but was committed to wearing the binasal occlusion. I did give her an updated prescription for use at the computer, which seemed to give some relief as well.
I last saw Jayne in September 2014. She continues to wear the narrow binasal occlusion on her glasses and insists that she is not ready to discontinue that part of her treatment. She still prefers her new computer glasses as well. The improvement she experienced immediately upon wearing the narrow binasal occlusion has remained intact. She’s talking about starting vision therapy again.
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