I want to thank Dr. Doug Major for emailing about the Stanford Sports Concussion Summit held last year at which he presented a poster, and the fact that its continuing education presentations are now available online. This program was arranged by the Stanford Brain Performance Center of the Department of Neurosurgery and Stanford Athletics at the Stanford University School of Medicine.
The first video in the online presentation is Concussion Subtypes for Targeting Treatments by Jamshid Ghajar, MD, PhD, FACS. It is notable for including Ocular-Motor as one of the subtypes, which Dr. Ghajar introduces at the 9 minute mark.
Dr. Ghajar also references a paper in press in the journal Neurosurgery, which has now been published, Concussion Guidelines Step 2: Evidence of Subtype Classification. Here is the paragraph from that paper, citing the Ocular-Motor Subtype:
“The ocular-motor subtype involves dysfunction of the visual system (eyesight, eye focusing, eye teaming, and visual perception skills) following injury. Ocular-motor and visual dysfunction can cause difficulty obtaining, understanding, and processing visual stimuli. Dysfunction can trigger or exacerbate symptoms and impair a patient’s ability to integrate and process information. Ocular-motor and visual impairments may be detected by saccades, smooth pursuit, conjugate gaze, convergence, accommodation, and fixation assessments. Deficits in the ocular-motor system may mimic cognitive impairment functionally and are frequently found in conjunction with the vestibular symptoms. Patients diagnosed with this subtype have the following: difficulty with visual activities (screen time, reading, near work, driving, etc); asthenopia (eye strain) and eye fatigue; problems with visual focus including changing focus from near to far and back (assessed for as convergence distance, accommodation, and reading issues); photophobia; blurred vision or double vision; frontal headaches or eye pain/pressure behind the eyes; vision-derived nausea; difficulty judging distances; difficulty tolerating complex visual environments; and significant exacerbation of premorbid visual impairment. Hence, these symptoms may contribute to problems concentrating or difficulty in completing written work.“
Another informative video is the presentation on Physical Therapy for Concussion Recovery, by Erin Isanhart, PT, DPT, NCS. There are many helpful videos embedded within Dr. Isanhart’s presentation.
There is a nice slide that Dr. Isanhart puts up at the 8:32 mark, citing that vision therapy has been shown to alleviate symptoms of concussion, followed by an even nicer statement that she makes as a vestibular therapist.
“So as a vestibular therapist I have some of that in my repertoire, which you’ll see with the Brock String and the Smile Push-Ups here, but reality is if this isn’t working, we need to send them to somebody that only does vision therapy.”
During her superb presentation, Dr. Isanhart also references something they have at Stanford called the BIT (Bioness Integrated Therapy) System which looks intriguing. It is pictured on your left in this slide (at the 16:30 mark), an looks something like the Sanet Vision Integrator.
The BITS has six main therapy categories with a total of 24 Therapy Programs and four Standardized Assessments. Each program has different levels of difficulty. Variables can be customized to each individual’s needs and paced to be progressively challenging. The standardized assessments are 1) Trail Making, 2) Bell Cancellation, 3) Maze, and 4) Visual Scan & Motor Reaction.
Therapy programs include Visual Scanning (single target and complete array), Visual Pursuit (smooth pursuit and rotator), Cognitive (memory and rhythm), Visual Motor (geoboards and drawing), and Charts (central and peripheral).