Visual guidance and optometric vision therapy can play an important role in helping a child return to learn effectively after mTBI and even more severe TBI. The Concussion Project initiative provides significant information to the public about this subject. Optometric collaboration with the concussion specialty center at Children’s Hospital of Philadelphia (CHOP) has resulted in an important new article in Optometry & Vision Science on Nearpoint of Convergence After Concussion in Children.
From the article’s conclusion:
Concussion questionnaires may not be sensitive to detect vision symptoms in children, making an accurate assessment for convergence important in the evaluation of concussion. Some children with abnormal NPC will recover without any formal intervention after concussion; however, a subset of patients with persistent abnormal NPC after concussion may benefit from interventions including vestibular and/or vision therapy.
The Return to Learn Plan from CHOP is a very good one, and to that we can add consideration of visual factors in the recovery process.
Return to Learn Plan: Children’s Hospital of Philadelphia (CHOP)
Immediately after a concussion, it is beneficial to take a break from cognitive (thinking, processing) activities for up to a few days.
This may mean no school, no homework, no computer, no texting, no video games and maybe no TV if it makes symptoms worse. In general, it is beneficial to minimize screen time. As symptoms improve, slowly reintroduce light cognitive activity. Initial activities may include watching TV, listening to audio books, drawing and cooking, as long as they do not increase symptoms.
Light cognitive activity is resumed once your child has had significant improvement in symptoms at rest. Your child may do activities that do not cause symptoms to get worse.
Initially, your child may only tolerate five to 15 minutes of work at a time. Stop the activity when moderate symptoms develop. Your child may increase the length of cognitive activity as long as symptoms do not worsen significantly or as long as symptoms improve within 30 minutes of taking a break.
School-specific activity should be increased gradually: When feeling better, your child should try to do some schoolwork at home, increasing the duration as tolerated. Your child should continue to participate in this activity in short bursts of time (up to 30 minutes) as tolerated and then work up to longer time periods.
Follow these guidelines to determine when your child is ready to return to school: When your child is able to do one hour of homework at home for one to two days, she may try to return to a modified school schedule. Examples of a modified schedule: A decreased number of classes, adjustments to decrease reading and note taking, and extra time to complete assignments and tests. If symptoms develop while your child is at school, she should take a break in a quiet, supervised area until symptoms improve. When symptoms improve, she may return to class. Your child may increase her time in school as tolerated.
The guidelines appear reasonable and sound, but the question comes to mind, what about the children who, because of a painful and concentration-sapping convergence insufficiency, could not do one hour of homework before the concussion? Are they now free not to return to school indefinitely?