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

1. Do You Know How I See? Traumatic Brain Injury and Visual Impairments MAER Presentation April 26, 2012 Marquita Andion

2. 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;

3. 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.

4. 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.

5. 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

6. 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%

7. 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

8. Measures of Injury • Glasgow Coma Scale Motor Responses Verbal Responses Eye Opening TOTAL SCORE Mild GCS 13-15 Moderate GCS 9-12 Severe GCS 3-8 Vegetative GCS <3 • Rancho Los Amigos Scale Levels I - VIII • MACE Military Acute Concussion Evaluation

9. Brain Reaction to Trauma • Coup and Contracoup • Concussion • Contusion • Stretching • Shearing • Tearing • Swelling • Chemical Reactions • Induced Coma

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

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

12. Lobes of the Brain and Their Functions from buzzle.com

13. Areas of the Brain Related to Vision • Frontal Lobe • Parietal Lobe • Temporal Lobe • Occipital Lobe

15. Neuro-Optometric Tests • Yoked Prism Walk • Padula Visual Midline Shift • Super Fixation Disparity • Z-Bell

16. TBI POPULATIONS Infants Toddlers School Age Teenagers Young Adults Military Personnel Elderly

17. Infants • Shaken Baby Syndrome • Falls • Repeated injuries • Abuse • Research Findings • Plasticity • Recovery

18. Shaken Baby Syndrome You Tube video RealCare Shaken Baby from The Doctors TV Show May 10, 2010 http://www.youtube.com/watch?v=8bx_X8GmOY4

19. Infants & Toddlers • 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

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

21. School Age Children • Falls • Bike Accidents • Sports Injuries • Car Accidents • Abuse • Other

22. School Age Children & Teens • Physical Functioning • School Environment • Home Environment • Classroom Structure • Treatment Modalities • Social Milieu • Behaviors

23. Cognition After TBI • Attention • Memory • Encoding • Storage short term & long term • Retrieval • Learning • Organization • Executive Functions

24. Relationship of Vision and Cognition • All Environments • Activities of Daily Living • Societal Issues • Higher Learning • Employment • Families’ Futures

25. Teenagers and Young Adults • Car Accidents • Falls • Sports Injuries • Motorized Vehicles • Dare Devil Incidents • Assaults • Gun Shots • Combat Related Injuries

26. Strategies for TBI Recovery • Daily Routine • Order & Organization • Planning • Manipulating the Environment • Memory Aids • Low Tech Tools • Medium Tech Tools

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

28. Social Implications for TBI • Impervious to Nonverbal Clues • Impetuousness • Memory Deficits • Disregard for Safety • Poor Perceptual Skills • Compromised Reasoning • Disinhibition • Destructive Tendencies

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

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

31. Elderly and TBI • Slip & Falls • Home Accidents • Underlying Factors • Abuse • Secondary Conditions • Isolation

32. Suggestions for Elderly • Rest • Safety • Overcoming “Fear of Falling” • Daily Routines • Schedules • Aids & Aides • Community Services

33. Publications & Websites • Lash Publications www.lapublishing.com • Behaviors • School • Communication • Teaching Strategies • Families • Websites • Professional Organizations • Educational • Informational • Personal Experiences