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Rehabilitation of Balint's syndrome

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Jeff Cara

on 29 July 2014

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Transcript of Rehabilitation of Balint's syndrome

78 yo FM
S/P ascending aortic aneurysm repair
Suffered cerebral anoxia
Bilateral dorsolateral Parieto-occipital lesions
Somatosensory association cortex (BA 7)
Visual association cortex (BA 19)
Adverse prognosis for comorbidities (1)
Impaired vocational rehabilitation (1)
Delays rehabilitation progress (2,3)
Leads to complications due to accidents
write a walk
Polymyalgia rheumatica
Hx of SVT s/p ablation
Balint's Syndrome
Rehabilitation of
Past Medical History
Visual Rehabilitation
Take Home message
+Limited Evidence-Based Research
+Successful rehabilitation has been reported
+Use your judgement- Customize treatment based
upon the 3 principles
1. Case
2. Pathophysiology
3. Implications for the patient
4. Visual Rehabilitation

Lifestyle Implications
Therapies used in the Rehabilitation of Balint’s Syndrome
The eyes focus mostly on the title, then the first bullet point. From there the focus diminishes as the viewer reads their way through the bullet point list.
Concluding with an overview (or final reveal) can be a great way to bring the context of your story together.
Lando Calrissian
Darth Vadar
Han Solo
The Intergalactic Empire
Imperial ground forces
Emperor Palpatine
Calamari Cruiser
Blow up Death Star (again)
Save Galaxy (again)
The Rebel Alliance
Admiral Ackbar
Characters :
Millenium Falcon
Luke Skywalker
Tie Fighters
AT-ST Walkers
Super Star Destroyer
Death Star
The overview structure implies the tension
between the two sides
- it can be conveyed even at a distance where we can't see the details
Rehabilitative Implications of Visual Deficits
Social History
Lives alone
Denies alcohol, tobacco, or recreational drug use
Functional History
Drives independently
Independent with all ADLs
Significant level of family & social support
5 steps to enter home w/o railings
No grab bars in the shower at this time
What is Balint's Syndrome?
1. Ocular apraxia
2. Optic ataxia
1. Mobility
2. Binocular vision-->depth perception
3. Reading & Subsequent language processing.
4. Visual memory
3 Treatment Principles of Visual (or neuro) Rehabilitation
1. Compensation
2. Substitution
3. Restitution
1. Eye movement training
Goal: Increase self-control of visual scanning
5. Exercises of visual search
2. Convergence exercises
Goal: Acquire greater control of eye movements
3. Word reading
Goal: To teach the patient to scan and read words by spelling them out
4. Visuokinetic functioning
Goal: Develop kinesthetic learning of words
6. Trail-making exercises
7. Writing exercises
8. Functional adaptation
1. Reding MJ, Potes E. Rehabilitaton outcome following initial unilateral hemispheric stroke: life table analysis approach. Stroke 1990;19:1354–8.
2. Bruell JH, Peszczynski M. Perception of verticality in hemiplegic patients in relation to rehabilitation. Clin Ophthal 1958;12:124–30.
3. Denes G, Semenza C, Stoppa E, et al. Unilateral spatial neglect and recovery from hemiplegia. A follow up study. Brain 1982;105:543–52.
4. Diller L, Weinberg J. Evidence for accident-prone behavior in hemiplegic patients. Arch Phys Med Rehabil 1970;51: 358–63.
5. Baum B, Hall KM. Relationship between constructional praxis and dressing in the head-injured adult. Am J Occup Ther 1981;35:438–42.
6. Neurovisual rehabilitation: recent developments and future directions. Georg Kerkhoff. J Neurol Neurosurg Psychiatry 2000;68:691–706
6. Neurovisual rehabilitation: recent developments and future directions. Georg Kerkhoff. J Neurol Neurosurg Psychiatry 2000;68:691–706
Finally, to share the wisdom of Dr. Giacino “clinicians and researchers should remain ever-mindful of the trappings of ‘therapeutic nihilism.’ …In other words, nothing can be done, so nothing should be done. No prophecy was ever more self-fulfilling.”
Thank you
Dr. Herman
John Soloman
Dr. Colbert
Dr. Lee
Goal: Improve visual scanning
and recognition of words
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