Neuro-Optometric Rehabilitation of Visual and Visual-Vestibular Symptoms Following Acquired Brain Injury

Abstract

Primary Objectives: To review the neurology of the vestibular and balance processing systems, the visual-vestibular symptoms experienced as a result of deficits in integrating visual and vestibular sensorimotor function, and to describe a neuro-optometric rehabilitation protocol for the management of those with visual and visual-vestibular symptoms. Background: Patients with acquired brain injury (ABI) often experience sensorimotor visual deficits and symptoms of disequilibrium affecting their activities of daily living and quality of life. Dizziness, vertigo and gait disturbance, and their effect on balance, are among the most common complaints in this population. The visual system is a major component of balance and although often overlooked, it contributes heavily when vestibular dysfunction is present. When patients are unable to compensate for deficits in vestibular function with vestibular rehabilitation alone, one of the more common reasons is impairment in one or both of the other sensory inputs necessary for balance (visual and proprioceptive). Conclusion: The visual system plays a crucial role in the overall sense of balance. Even minor oculomotor deficits and binocular vision dysfunction can have a negative effect on the vestibulo-ocular reflex (VOR) by creating mismatches between the visual and vestibular systems. This mismatch may exacerbate the sensation of disequilibrium, especially when patients are in multi-visually stimulating environments with motion, such as shopping in a grocery store, or without motion, such as watching TV or working on a computer monitor. As awareness of visual and visualvestibular dysfunctions following ABI increases, the demand for optometrists who offer neurooptometric rehabilitation will increase as well. Understanding the visual sequalae following ABI and coupling it with the current research on neuro-plasticity, optometrists who specialize in neuro-optometric rehabilitation can better aid in the rehabilitation of these individuals.