VISION TRAINING TO IMPROVE CLASSROOM ENDURANCE POST-TBI: A CASE STUDY WITH A 26-YEAR-OLD FEMALE

Abstract

Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including students when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training has been found to be successful in improving oculomotor endurance, giving patients the ability to maintain focus for long periods of time and to mitigate against suppression. Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including those of students, when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training successfully improves oculomotor endurance, allowing patients to maintain focus for long periods andmitigate against suppression. Case Report: This report describes a 26-year-old female presenting with activity-induced sensory overload, specifically in the setting of her college classroom lectures. The patient described symptoms appearing as headache, fatigue, and blurred vision. Upon initial examination, she was determined to have a left eye exophoria with fatigue-induced left eye suppression and left eye lateral abduction deficiencies. A personalized action plan was designed to improve left-right oculomotor symmetry and endurance and mitigate against suppression through a weekly structured vision training program. In this 7-week program, individual and dual eye saccadic exercises improved, with both eye horizontal saccades improving from 26 characters read aloud per minute to 36 characters read out loud per minute. With these regular vision training sessions, the patient displayed improved oculomotor endurance, decreased suppression with prolonged activity, and better dual-eye coordination. After the post-vision training program, the patient could attend her college lectures without invoking symptoms.