Vision Therapy for Oculomotor Dysfunction or Vision Deficits Following Acquired Brain Injury

Cassidy Holland, SPT, LAT, ATC1; Lisa Shirafuji, SPT1; Kara N. Keegan, SPT1; Sierra Muir, SPT1; Kara G. Kalinski, SPT1; Jeffrey Hoder PT, DPT1

1Doctor of Physical Therapy Division, Duke University, Durham, NC

Background

Purpose

Methods

• Visual impairments include vision, eye movement dysfunction, and visual perception1

• Visual impairments occur in approximately 60% of stroke cases in the acute stage following stroke and 69% in traumatic brain injuries (TBI)1, 2

• Examine literature on interventions used to treat oculomotor dysfunction and hemispatial neglect caused by acquired brain injury (ABI)

• Provide clinical recommendations to physical therapists (PTs) treating these populations

• Determine if oculomotor intervention improves functional ability in patients post ABI

• Subjects with oculomotor dysfunction or visual field neglect caused by ABI

• Oculomotor specific interventions

Inclusion Criteria

• Over 25% of study's population age ≥ 18• Non-English studies• Case series and case reports• History of previous ABI, oculomotor dysfunction,

comorbid diagnosis of neurodegenerative conditions, tumors, or alexia/dyslexia

• Interventions that were exclusively pharmacological, substitutive, motor exercises, or higher-level visual skill interventions

Exclusion Criteria

• Modified Downs and Black Checklist

Risk of Bias

• PubMed• Embase• CINAHL Complete

Databases Reviewed• Scopus• PsycINFO

Clinical Relevance

Acknowledgements / References

• Oculomotor interventions appear to have significant treatment effects following ABI

• Effects are seen across the ICF model and include improvements in activities of daily living, neglect, reading, mobility, and improving quality of life and functional capacity

• Most interventions were computer-based programs administered by vision specialists

• Access to current interventions is limited across rehabilitation specialists, including PTs

• Treatment effects lack generalizability due to small sample sizes and poor study designs

• Current evidence does not allow clinical recommendations to be made for practitioners other than vision specialists

• Future research should focus on oculomotor interventions accessible to physical therapists for more complete clinical recommendations

• It may be beneficial for physical therapists to perform oculomotor interventions, as they typically encounter patients earlier in the treatment process

We would like to thank Leila Ledbetter, MLIS, for assisting us with our literary search.

1. Hanna, K., Hepworth, L. and Rowe, F. (2017). The treatment methods for post-stroke visual impairment: A systematic review. Brain and Behavior, 7(5), e00682. doi:10.1002/brb3.682.

2. Armstrong, R. A. (2018). Visual problems associated with traumatic brain injury. Clinical and Experimental Optometry, 101(6), 716-726. doi:https://doi.org/10.1111/cxo.1267

Conclusions

https://www.reviewofoptometry.com/article/computer-based-vision-therapy-sets-sights-on-ushttps://visionhelp.wordpress.com/2011/05/22/sensorimotor-dynamics-and-two-visual-systems-shades-of-skeffington-brock-part-1/brock-string-3-beads-near-space-2/

Resultshttps://st2.depositphotos.com/1909187/5873/i/450/depositphotos_58732733-stock-photo-female-opticla-nerve-anatomy-brain.jpg

Demographics

Number of studies 27

Total participants 1108

Time since injury 6 days to 20.17 years

Age range 9.6 to 84 years

Risk of Bias – Methodological Quality

0 Excellent

4 Good 29 interventions117 outcomes16 Fair

7 Poor

Interventions

Body Functions and Structures Activities Participation

Outcomes

ICF Distribution