NORA
Neuro-Optometric Rehabilitation Association International, INC
This guide and checklist has been prepared to assist rehabilitation professionals (doctors, therapists, counselors, etc) in determining the appropriateness of referring clients for neuro-optometric rehabilitation and treatment. Reliable observations skills provide valuable information to professionals regarding clients who have sustained a traumatic brain injury, CVA or other neurological impairments. This information may be a first step in determining if visual difficulties are interfering with the rehabilitation progress of the individual.
Insults to the cortex produced by a traumatic brain injury cause stress in the central and autonomic nervous systems. The effect on vision seems to be an interference with the ambient visual process, which is part of the sensory-motor feedback loop. This disruption occurs at the level of the midbrain where vision is matched with kinesthetic, proprioceptive and vestibular processes. As a result, a head-injured person may experience diplopia (double vision), binocular dysfunction, or concentration difficulties.
In the past, these symptoms were diagnosed as individual eye problems or muscle imbalance. However, the visual system is really a relationship of sensory-motor functions, which are controlled and organized in the brain. The eye alignment imbalances and other reported difficulties that result from head injury often occur because dysfunction of the ambient visual process affecting sensory-motor spatial disorganization. This causes an eye to turn our (exotropia) or a strong tendency for both eyes to diverge (exophoria). The resulting binocular problems are characteristic of a syndrome- the Post Trauma Vision Syndrome.
| The Characteristics of the PTVS include: |
The Symptoms of the PTVS include: |
| • Extropia or High Exophoria |
• Possible Diplopia |
| • Accommodative Insufficiency |
• Objects Appear to Move |
| • Convergence Insufficiency |
• Poor Concentration and Attention |
| • Low Blink Rate |
• Staring Behavior |
| • Spatial Disorientation |
• Asthenopic Symptoms |
| • Poor Fixations and Pursuits |
|
| • Unstable Peripheral Vision |
|
After a neurological impairment such as TBI or CVA, mismatches in neuro-motor and ambient vision processing can occur, causing shifts in concept of a person's visual and neuro-motor midline. This shift in midline can cause a person to shift his body laterally or anteriorally/posteriorally, affecting balance, posture and gait. This shift in visual midline has been termed the Visual Midline Shift Syndrome.
The Characteristics and Symptoms of the VMSS include:
- Associated Neuromotor Difficulties with Balance, Coordination, and Posture
- Leaning Forward/Backward
- Leaning to one Side
- Seeing the Floor Tilted
Due to the major impact of the visual system on cognitive and motor function, the visual rehabilitative needs of the head injured, stroke, or neurologically impaired patient must be addressed as early as possible. Neuro-optometric rehabilitation is an individualized treatment regimen for patients with visual deficits as a result of such injuries. The treatment plan improves specific acquired vision dysfunctions determined by standardized diagnostic criteria. Treatment regimens encompass medically necessary non-compensatory lenses and prisms with and without occlusion and other appropriate rehabilitation.
Behavioral observations during therapy sessions or medical examination, in-depth interviews and screening will provide information to rehabilitation professionals about potential visual and neuro-motor dysfunction, Following is a list of client symptoms and/or behaviors that may be reported or observed. If these symptoms are present, the client may be in the Post Trauma Vision Syndrome and/or the Visual Midline Shift Syndrome and should be referred for neuro-optometric rehabilitation.
Rehabilitation Professional's Checklist
(PTVS/VMSS)
Name__________________
Date___________________
1. Post Trauma Vision Syndrome
___ Double vision
___ Headaches
___ Blurry vision
___ Dizziness or nausea
___ Attention or concentration difficulties
___ Staring behavior (low blink rate)
___ Spatial disorientation
___ Loses place when reading
___ Can't find beginning of next line when reading
___ Comprehension problems when reading
___ Visual memory problems
___ Pulls away from objects when they are brought to close to him/her
2. Visual Midline Shift Syndrome
___ Dizziness or nausea
___ Spatial disorientation
___ Consistently stays to one side of hallway or room
___ Bumps into objects when walking
___ Poor balance or posture: leans back on heels, forward, or to one side when walking, standing or seated in a wheelchair
