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Post Trauma Vision Syndrome

adapted by Kate Moss from text by Millie Smith and Nancy Levack

Editor's Note: In the preceding article by Marnee Loftin, she gives a firsthand account of the effects of Traumatic Brain Injury and talks about the problems she experienced in her vision, cognitive and emotional functioning. I thought that it would be good to share some more information about the visual issues related to TBI with you. What follows is adapted from Teaching Students with Visual and Multiple Impairments: A Resource Guide, by Millie Smith and Nancy Levack.

Sensory problems are common after traumatic brain injury. The problems these children have with their vision is referred to as Post Trauma Vision Syndrome or PTVS. Over half of the children who have experienced brain injury have vision problems, such as blurred or double vision and visual field defects. Blurred or double vision may improve during the first six months after the trauma event, but the field abnormalities are more likely to persist (Mira, Tucker, & Tyler, 1992).

Binocular vision is what allows us to blend the two images seen by each of the eyes into only one perceived image. Long-term difficulties with binocular vision are common. These include:

When these conditions are present from birth, the brain adapts by suppressing the vision in one eye. In post trauma vision syndrome the condition occurs abruptly. The brain does not have a chance to adapt gradually and abnormal vision persists. It is important that any child who suffers traumatic brain injury receive a comprehensive ophthalmologic exam (Mira, Tucker, & Tyler, 1992). Double vision in particular interferes with depth perception, locating objects, and the ability to match visual information with kinesthetic, proprioceptive, and vestibular experiences. These terms are explained below:

Because of double vision which occurs with PTVS, balance, coordination, and movement become impaired (Padula, Shapiro, & Jasin, 1988).

Many individuals with a post trauma brain injury experience a variety of visual-perceptual abnormalities. Students with post trauma vision syndrome (PTVS) have a difficult time transferring the visual information they learned prior to injury to present situations. Problems with spatial organization are common. They may also develop abnormal head posture along with high tone in muscle tissues in other parts of the body, particularly about the head, neck, and shoulder areas. This happens because the child will try to correct or improve his visual functioning by tilting or holding his head in an unnatural position (Padula, Shapiro, & Jasin, 1988).

Children with traumatic brain injury may also have damage to their ears. Mira, Tucker, and Tyler (1992) also describe the types of ear damage that frequently occurs with a traumatic brain injury. There may be damage to the middle ear which can cause a conductive type of hearing loss. There may be damage to the inner ear or the auditory pathways into the brain which can cause a sensorineural hearing loss. Children with visual impairments generally rely on their hearing to compensate for the loss of visual functioning. For this reason, it is critical that children with PTVS have a complete audiological evaluation.

Characteristics of PTVS

The characteristics of post trauma vision syndrome include:

(Adapted from Padula, Shaprio, & Jasin, 1988)

Suggestions and Interventions

The following is a list of suggestions and interventions that can be tried with students who have PTVS. Some of the items are interventions which should be prescribed by eye specialists or require input from motor specialists.

Spatial disorganization

Abnormal posture

Double vision

Poor fixations and pursuits (difficulty scanning for a specific object or following a progression)

Poor concentration and attention

Poor visual memory

Movement abnormalities---Objects/words appear to move around the page

Inability to take in all but a fragment of a visual scene or the disappearance of visual objects due to abnormal perception

Inability to read despite the ability to write

Failure to attend to objects in affected hemisphere

Inability to distinguish colors

Inability to visually guide limbs

Field abnormalities

Editor's Note: Children with Traumatic Brain Injury typically face additional problems in the areas of communication, acquiring new information, spatial orientation, attention and concentration, task completion, impulse control, dealing with anger, social integration, and social conversation. For information and suggestions to address these concerns the following resources are suggested:

Blosser, J. L. & de Pompei, R., (1994). Pediatric traumatic brain injury: proactive intervention, Singular Publishing Group, San Diego, CA.

Mira, M.P., Tucker, B.F., & Tyler, J.S. (1992). Traumatic brain injury in children and adolescents: sourcebook for teachers and other school personnel, Pro•Ed, Austin, TX.

Smith, Millie and Levack, Nancy, (1996). Teaching students with visual and multiple impairments: resource guide, Texas School for the Blind and Visually Impaired, Austin, TX, p. 215-238.

Brain Injury Association
1776 Massachusetts Avenue NW, Suite 100
Washington, D.C. 20036-1904
(800)444-6443 - toll free or (202)296-6443

Contact for newsletter, information, referrals, national conferences and advocacy efforts.

REFERENCES

Mira, M.P., Tucker, B.F., & Tyler, J.S. (1992). Traumatic brain injury in children and adolescents: sourcebook for teachers and other school personnel, Pro•Ed, Austin, TX.

Padula, W.V., Shapiro, J. B., & Jasin, P. (1988). Head injury causing post trauma vision syndrome. New England Journal of Optometry, 41(2), 16-20.


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