Vision

A concussion can change your vision and how the brain processes what you see. Research shows fifty to ninety per cent of people with post-concussion syndrome have vision issues. This can make it difficult to read, watch TV, ride in a car and/or use a computer or tablet. Your vision can affect your balance, your ability to pay attention and concentrate and how you see your surroundings.

If your vision has been affected by your brain injury, you may:

  • have blurred vision
  • be sensitive to light
  • find it hard to navigate busy environments
  • have double vision
  • have issues with depth perception
  • find your eyes drifting outward

If you are having vision problems, see an optometrist to make sure your eyes are healthy. Your optometrist may find nothing wrong with your eyes, but there may be problems with how your eyes work together.

When you look straight ahead, your eyes focus on objects in front of you. Your eyes work together to send the images to your brain. After a concussion your eyes may not be able to work together properly. Your brain will focus on parts of the image your eyes see that overlap.

What can help your vision after a brain injury?

Using cloudy tape and your own glasses or a pair from the dollar store with the lenses popped out you can use a trick called bi-nasal occlusion to improve your visual processing.

Watch the above video on how to tape your glasses on YouTube.

Taping your glasses

Why? Putting tape on the outside of your glasses helps your eyes focus by blocking the part of your vision where the images overlap. This helps our eyes work on their own instead fighting to work together.

Taping your glasses can help reduce symptoms for activities such as reading, watching TV, using the computer and in busy environments.

How? You will need:

  • your glasses or sunglasses. If you do not wear glasses, you can buy reading glasses from a dollar store, department store or grocery store.
  • tape. Not clear tape. Cloudy works best.

Put the tape on your lenses about one centimetre away from your nose. The tape may be angled slightly and wider at the top. You can tape the inside of your lenses to make it less noticeable.

Eye tracking exercise

Purpose: To practice eye movements and following a target to improve efficiency of eye movements

Starting Position: Sitting comfortably in a chair with back supported.

Exercise: Hold onto a pen or a popsicle stick or just use your finger as a visual target. Hold it out at arm’s length and move it right and left and up and down in an ‘H’ pattern.  Do this as slowly as you need to in order to keep your eyes on the target and the target in focus. 

How to make it easier: Perform this task lying flat on your back. Start training with one eye covered and progress to using both eyes at once. Make sure the visual environment in front of you is as minimal as possible – like a blank wall. Wear a weighted compression vest.

How to make it harder:

  • move the target more quickly
  • add diagonal movements and circular movements (both directions)
  • add a balance task such as standing on one leg, in tandem stance (standing with one foot in front of the other), standing on a cushion
  • add noise distractions in the background

Near far accommodation

Purpose: To improve how fast and how efficiently you can focus on objects, both near and far, with your eyes at the same time as you are processing sound.

Starting position: This exercise can be done while sitting or standing. 

What you will need: Two blank pieces of paper, a marker, a metronome (“a device that produces an audible beat—a click or other sound—at regular intervals that the user can set in beats per minute (BPM)” source – Wikipedia)

Set up: Make a vertical line of letters down each page. Use the same letters.

Hold one page in one hand in front of your face (about arm's length away). 

Place the second page on the wall about 12 to 20 feet away from you at eye level. 

Exercise: Set the metronome to between 50 to 60 bpm with 2/4 timing and try to complete this task to the beat of the metronome. Keeping your head still, shift your eyes down to the paper in your hand and say the first letter at top of page. Then shift your eyes to paper on the wall and find and say the same letter.  Move your eyes (not your head) back down to the page in your hand and say the next letter below and then back up to the wall.  Continue repeating this task to the beat of the metronome moving vertically down the page.

Make it harder: Increase the speed of the metronome up to 120 bpm, increase the amount of letters on the page, stand on one leg or in tandem stance (with one foot in front of the other) or stand on unstable surfaces.

Wall clock eye exercise

wall clock

Purpose: To practice quick movements of the eyes in all directions.

Materials required: Post-it notes, marker, blank wall space.

Starting position: Stand in front of a wall.  Place 12 visual targets (Post-it notes work well) in a circle like a clock.  Place an X in the middle of the clock.

Exercise: Move your eyes as quickly as you can from each Post-it note to the centre X moving in a clockwise and then counter clockwise direction.

How to make it easier: 

  1. Perform the exercise while sitting in a chair with your back supported.
  2. Wear a weighted compression vest.

How to make it harder:

a) add a balance task such as standing on one leg, in tandem stance (standing with one foot in front of the other) or standing on a cushion. 

b) replace the X in the centre with the numbers in the circle worksheet. Move your eyes around the clock again but when you bring your eyes to the centre find the numbers in order from 1 to 12 with each eye shift.  Do this counter-clockwise from 12 to 1.

c) change the numbers on the wall clock so they are not in order and repeat b)

Dishwasher exercise

Purpose: To improve your balance when moving your head and neck

Starting position: Stand comfortably with your feet hip-width apart. Position yourself facing the coloured numbers worksheet on the wall and have the coloured letters worksheet positioned to the right or left of your body on the seat of a chair.-

Exercise: Find and touch the letters and numbers in order (A -1, B-2, C-3 etc...) on the coloured worksheets reaching across your body. Move your head and neck together quickly as you turn and bend down to touch the letter or number on the seat. Then return your head and neck to the starting position quickly and find the next letter/number on the coloured sheet on the wall. Repeat this on both the right and left sides of your body. Do as many repetitions as you are able to tolerate and let your symptoms be your guide.

How to make it easier: Place the coloured numbers worksheet on the backrest of the seat to decrease the distance you have to move your head and neck. Or, start with the same worksheet on the floor and on the wall. You can also move slower.

How to make it harder: Place the coloured worksheet on the floor to increase the change in head and neck position. You can also increase the speed of movements or try standing on one leg.  Add a brain challenge task. Think of a word that starts with each letter or go backwards through the letters and numbers.

Walking and looking

Purpose:  To be able to walk and move your head and eyes without symptoms of dizziness or unsteadiness. 

Starting position:  Stand in a space where you can walk in a straight line without bumping into anything.  

Exercise:  Start walking across the room at a comfortable pace. While walking, move your eyes from right to left or up and down (at your own pace). Maintain your walking speed while moving your eyes. Next, move your head and eyes together to look right to left or up and down.

Ways to make it easier: If task is too difficult, try wearing a TheraBand compression or walk slower.

Ways to make it harder: 

  • have someone walk beside you and throw and catch a ball with them. Look in the direction you are throwing and catching from.
  • count backwards by threes while doing the exercise
  • walk faster
  • do the exercise on a treadmill
  • move your head diagonally (e.g., up and to the left/down and to the right).'

Blind spot check

Purpose:  To increase your ability to turn your head and body easily and efficiently. It also helps you move your eyes, head and neck separately.

Starting position:  This exercise can be done while sitting (supported on a chair or unsupported on the floor or any flat surface) or standing. 

Exercise:  Keep your head still and facing forward. Turn your eyes to the left; then turn your head to look over your left shoulder. Keep your eyes looking left. Then return your head and eyes to face forward in one smooth motion. Ask someone to watch your eyes to ensure they return forward without stopping along the way. Repeat the same activity looking to the right.

Make it harder:  Add a 180 degree turn of your whole body after turning your head.  If you tried the exercise while sitting, try standing. To make it even more difficult, try the exercise on an unstable surface like sitting on an exercise ball.

Reading

When reading, many patients who have had a concussion find it hard to keep their place on the page or remember what they have read. Using a blinder and/or coloured overlays, can make reading easier. Also, reading aloud can help you remember what you have read. Other tricks for reading:

  • don’t try to read when you are tired
  • stop for rest breaks
  • write key words in margins
  • choose something short and easy to read
  • try bigger text versions or use a magnifier

Blinder

What is it? A blank piece of paper folded in half.

Why? When reading a book or magazine, our eyes see the whole page at once. But our brain has to focus on processing a single line of text or picture. After a concussion, your eyes and brain can have difficulty focusing on one line at a time. This can cause symptoms such as headaches, dizziness, fatigue, and blurry vision. Using a blinder can make reading easier by covering the words and pictures on a page you don’t need to see.

How? You will need: 

  • a book or magazine
  • a blank piece of paper

Fold the piece of paper in half to make a blinder. Move the blinder slowly down the page you are reading in your book or magazine. Read one line at a time. You can also use the blinder as a bookmark!

If the text you have read at the top of the page is distracting cover it with a second blinder.

Watch this video on YouTube for how to use a blinder.

Coloured overlays

What is it? Thin, coloured, clear sheets of plastic; also known as dividers.

Why? When there is too much contrast between paper and text it can be difficult to read. It will feel uncomfortable and too much for the brain to process. By putting a coloured overlay over a page while you are reading it decreases the contrast between the white page and the black text.

How? You will need:

  • clear dividers in different colours. You can buy them at most office supply stores.

Put a coloured overlay over a page you are reading. Try the different colours one at a time and see which one works for you. You may also derive benefit from placing a colour overlay over your computer screen.

Watch the above video on YouTube for how to use coloured overlays.

Using a tablet or e-reader

If you like to read on a tablet or e-reader but the contrast is too bright try:

  • Turning down the screen brightness
  • Changing the colour of the background and letters
  • Find directions for IOS devices and for Android devices 

Vision clinic for patients

Patients referred to the ABI outpatient team, at St. Joseph's Parkwood Institute, are screened and treated for post-trauma vision syndrome. Those with complex vision issues are referred onto Dr. Cheryl Letheren, an optometrist with special training in neuro-optometric rehabilitation. Dr. Letheren offers a clinic once a month to further assess and identify the need for ongoing treatment with vision therapists and/or provides guidance to physiotherapy or occupational therapy as follow up. To find an optometrist with this training in your area, please see https://nora.cc/

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