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Neurology residents

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Shannon McGuire

on 9 February 2014

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Transcript of Neurology residents


A dynamic, interactive process of motor and sensory function mediated by the eyes for the purpose of simultaneous organization of posture, movement, spatial orientation, manipulation of the environment and to its highest degree perception and thought.
More specific
Secondary to Focal
Lightning fast
Diverse in brain
Larger impact on balance/posture & function
Spatial vs Focal Systems
Let's see what happens when I
take away your spatial vision!
Eye is not like a camera
Vision is not a passive system
recording images
The Brain Behind
the Eyeballs!
Vision is our dominant sense
70% of all sensory fibers
6 of 12 cranial nerves
80% of everything we learn
How successful we are depends on our previous experience and intact pathways within the brain
Brain is actively working to process stim
to make sense of our world
Information comes in fragmented
& the brain smooths it out
The brain can be fooled!
It all depends on your
Dr. William Padula OD
More than 32 visual area in the cerebral cortex
More than 300 pathways between these areas
Visual processing is highly distributed and
Areas of Integration
Superior colliculus in the midbrain
involved in spatial orientation,
eye movement control and
integration of spatial information
with vestibular, tactile and
auditory information
20% of retinal information takes a dorsal
pathway to posterior parietal cortex Involved in “where is it?” and “how to”
aspects of visual process
maintain spatial coordinates that allow for the determination of the position and localization
of objects in space and are used as a guide to
direct ourselves through space.
Center of multisensory convergence where visual, proprioceptive and vestibular information are combined
~1 million retinal ganglion fibers in the eye that are involved in processing light
80% travel to visual cortex to be used in eyesight
20% from the peripheral retina go to non-visual structures
These fibers affect balance, posture, reflexes, emotions, muscles, sleep & auditory processing.
Focal = What? = Parvocellular
Visual Retinal Pathway
Spatial = Where? = Magnocellular
Non-Visual Retinal Pathway
Binasal Occlusion
use transparent tape on glasses,
sunglasses or empty glass frame
Compression & Weight
Hudac et al 2012
Case study with BNO & prism
Why does it work?
The overlap in this portion of the visual field causes an
increase demand on binocular integration to be efficient and comfortable
Breaks up focalization,
reengages spatial vision
Appropriate part of the brain is
used for the visual task
Increases speed of
visual processing
Increases the dependence on peripheral cues
constellation of problems after TBI
exophoria blurred vision
photophobia double vision
convergence insufficiency
reading difficulty
issues with spatial/depth perception
trouble in busy environments
Post Trauma Vision Syndrome
Now it is your turn...
Think about a
real life example
One diagnostic
Spatial system not working effectively
Resulting in over focalization
trouble releasing from fixation
Movements in periphery become detail
Process detail first & spatial second
Inability to filter out excessive visual info
Visual Midline Shift Syndrome/
Abnormal Egocentric Localization
Effect of Yoked Prism
Visual Midline Shift Test
Right Visual Midline Shift
Anterior Midline Shift
Role of Optometry
specialized training
Dr. Cheryl Letheren - London
prescription of glasses with
Vision Therapy
Improves visual efficiency
Brain is not working as hard
fMRI Finger Sequencing Task
fMRI Mental Subtraction Task
Vision therapy - What to work on
ability to hold an object on the fovea
able to follow a moving target
start monocular build to binocular
be aware of background visual stim
a jump movement of the eyes to align with a target of interest
Percon saccade training
20 line reading races
Wall clock
Near Far Accommodation - monocular
important for driving
Brock String
Visual Attention
& Processing
up & down
left & right
stationary versus moving target
iPad/iPhone Apps
Vision Worksheets
I Spy books
need lots of repetition (10,000)
Fish Crackers
Why does this work?
increases proprioceptive input
give patients a sense of where their body is in space
ups the signal - allows them to dampen the noise
increased balance
decreased anxiety
decreased fatigue
What effect does the vest have:
pilot study done - still analyzing data
One more magic trick for mTBI
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