Reply-To: "Merilee Kern" From: "Merilee Kern" To: Subject: Therapy Times Date: Thu, 21 Apr 2011 15:03:49 -0700 Organization: Kern Communications MIME-Version: 1.0 Content-Type: multipart/related; type="multipart/alternative"; boundary="----=_NextPart_000_0CE6_01CC0035.51B90B50" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 6.00.2900.5931 X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.6090 This is a multi-part message in MIME format. ------=_NextPart_000_0CE6_01CC0035.51B90B50 Content-Type: multipart/alternative; boundary="----=_NextPart_001_0CE7_01CC0035.51B90B50" ------=_NextPart_001_0CE7_01CC0035.51B90B50 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Article available for preview = nowhttp://www.therapytimes.com/content=3D1402J84C487E5886408040441 home :: features=20 Getting the Whole Picture Vision rehabilitation for hemianopsia By Errol Rummel, OD, FAAO, FCOVD, FNORA=20 04.26.11 Article available online at: http://www.therapytimes.com/042611Vision=20 =20 As Director of the Neuro-Optometric Rehabilitation Clinic at a leading = N.J. rehabilitation hospital, with years of consulting at New Jersey = rehabilitation hospitals, and over 30 years of private clinical = experience working with people who have suffered stroke or brain injury, = I am in the unique position to have worked with over a thousand patients = with hemianopsia. With additional training and certification in vision therapy, and = neuro-optometric rehabilitation, I have treated multitudes of patients = with hemianopsias and have seen improvement in their activities of daily = living, as they receive rehabilitative treatment for their hemianopsia. = I have also seen many patients achieve reduction in the size and/or = density of the affected hemispatial field loss as a result of a new = therapy. Millions of people worldwide suffer, often needlessly, without hope from = vision loss due to neurological injuries like stroke, trauma, or = resection of tumors in the brain. In the U.S. alone, 20-30 percent of a = prevalent population of 10 million TBI and stroke survivors may suffer = visual field deficits - most erroneously believing their condition can = only be compensated for. Patients' who have had a stroke or traumatic brain injury, may lose one = half of their side vision. This is called "hemianopsia". Patients who = have a hemianopsia are usually aware of the side vision loss. Hemispatial neglect is the inattention to, or lack of awareness of, one = half of their side vision, and is usually associated with a hemianopsia. = The lesion in the brain causing hemianopsia and/or hemispatial neglect = usually occurs in the right frontal-parietal lobe, resulting in left = side hemianopsia and/or left side hemispatial inattention. The symptoms and signs of hemispatial field dysfunction include, but are = not limited to the following:=20 a.. The patient can not or does not, readily or spontaneously scan = into the area of the hemianopsia.=20 b.. The patient has no awareness of the field loss.=20 c.. The patient bumps into things on the side of the hemianopsia, but = doesn't learn to compensate for the problem.=20 d.. When reading, the patient misses parts of words on the side of the = neglect, and/or misses parts of the eye chart line on the side of the = neglect.=20 e.. There is a tendency for the patient to have a head or body = orientation turned away from the neglected side, and when ambulating, = the patient may drift away from the neglected side.=20 Effective treatment of hemianopsia involves skilled input from = rehabilitation specialists including optometric physicians skilled in = neuro-optometric rehabilitation, physiatrists, occupational therapists, = optometric vision therapists, and physical therapists. The best opportunity for a patient to reach maximum medical, and = functional levels of improvement requires a three prong approach: A = rehabilitation protocol for reducing hemispatial neglect, which includes = training eye movement scanning compensation in the direction of the = field loss; a program of Vision Restoration Therapy (of Boca Raton, = Fla.-based NovaVision Inc.); and the prescription of Side Vision = Awareness Glasses. Hemianopsia and/or neglect related therapies start when the person is a = rehabilitation hospital in-patient and continues on an out-patient basis = when the patient has been released from in-patient care. The training is done by my prescription either in a rehabilitation = facility out-patient OT/PT clinic, and/or as in-office care with an = optometric vision therapist in my office under my supervision. Vision = Restoration Therapy (VRT) is a home based program performed twice a day = for 6 months.=20 The hemianopsia therapy protocol I have written, used by the OT's, PT's, = and vision therapists under my supervision, includes but is not limited = to the following training:=20 a.. Encourage eye and head movements to the effected side, including = scan board exercises.=20 b.. Teach the patient to use closed eye scanning movements as well as = open eye scanning movements toward the effected side.=20 c.. Have the patient walk around the room in the direction of the = effected side in order to reinforce the lack of a visual map of space on = the neglected side.=20 d.. Have the patient use a flashlight aimed alternately toward each = foot while walking, to enhance vision with visual-motor reinforcement on = the effected side.=20 e.. Encourage the playing of games like crossword puzzles and real = (hard copy) card playing (not computer games), because non-computer = games involve tactile/sensory input.=20 f.. Increase sensory awareness on the effected side. Have the patient = squeeze a ball using their hand on the side of neglect; have the patient = trace a line that extends into the side of the defect; place the = patients finger in the area of neglect, with the therapist rubbing the = patients finger to stimulate sensory awareness on that side.=20 g.. Tell the patient to forcibly/rapidly move their eyes as far toward = the neglect as possible while sensing the feeling of their eyes at the = extreme gaze. Encourage the patient to become aware of the "feel" of = their eyes when gazing as far toward the neglected side as possible.=20 h.. To encourage scanning toward the hemianopsia have the patient wear = a "beeper-timer" wristwatch set to beep at intervals, as a reminder to = scan regularly toward the field deficit.=20 i.. When the patient begins to have awareness of their hemi-field = loss, teach the patient to visually scan about 20 degrees toward the = field loss, and then to turn the head in the direction of the field loss = once they have scanned 20 degrees in that direction.=20 j.. Use therapies to stimulate physical movement into the area of = neglect, like balloon catching/tossing, and also searching for = predictive (and later non-predictive) stimuli in the neglected field.=20 k.. Turning a page at a 45 degrees angle will improve reading ability = for some patients with neglect who do not respond to other treatments.=20 l.. Enhancing the "blindsight" aspects of a hemianopsia will allow a = patient more spatial awareness (at a subconscious level) within their = hemianopic field defect. Studies have shown that some patients can = detect orientation of a vertical or horizontal line, the color of a = green or red object, and/or can point to the approximate location of a = moving object held within the area of the field loss.=20 Once a patient has learned compensatory scanning in the direction of the = hemianopsia, I will custom design and prescribe "Side Vision Awareness = Glasses". This is a spectacle mounted custom made prism device which = enhances the patient's awareness of objects in direction of the lost = field, by about 15 degrees to 20 degrees.=20 As the patient scans into the prism portion of the glasses, the = environment in the direction of the field loss is moved toward the = patients midline, which improves awareness of objects located in visual = space toward the side of the missing field. Although the use of prism lenses to enhance awareness of the environment = within the area of the field loss is a known optical principle, I have = been able to design "Side Vision Awareness Glasses" in a way that = maximizes the treatment effectiveness, by using a step by step = examination protocol to determine the exact power and placement of the = eyeglass mounted prism device, and by using a specific training program = that insures the patient will get the maximum rehabilitative benefit of = "Side Vision Awareness Glasses". As part of that training, "Vision Restoration Therapy" is indicated = prior to or simultaneously prescribed with the special glasses. VRT can = permanently reduce the width of the hemianopsia, making the patient more = capable of performing activities of daily living. When I have prescribed = "Side Vision Awareness Glasses", VRT makes the use of the glasses even = more effective. NovaVision's VRT is an FDA-cleared, patented, non invasive medical = therapy which has been proven through numerous studies to provide = significant functional improvement to patients suffering from = hemianopsia resulting from such injuring. VRT can improve and restore the hemianopic field loss by about 3-5 = degrees at the crucial vertical field midline along with obvious and = more than expected improvement in the patients' functional abilities. = When added to the 15 to 20 degrees of side vision awareness from the = special glasses I prescribe, most patients can function extremely well, = with many now driving safely.=20 The time lapse between a patient's injury or the patient's age of = initiation of VRT treatment is not relevant, and in fact the therapy has = delivered successful outcomes for patients who suffered vision loss = years before receiving VRT. In one such case, a veteran who acquired = brain damage during World War II benefited from VRT, giving hope to = survivors unduly suffering from neurological vision loss due to stroke, = tumors, or trauma. Scientist's and physicians have long believed that once a person = experiences a brain injury, the resulting vision deficit effects are = irreversible. Research over the last 15 years has demonstrated that the = cortex doesn't have a fixed functional architecture. The brain's ability = to modify its structural and functional organization to compensate and = overcome injuries is called "neuroplasticity".=20 NovaVision's management team believes that the non-invasive computer = based neuro-stimulation leads to visual improvement through = neuroplasticity. While this hasn't been categorically proven to be the = driver behind the unequivocal functional improvements, continued studies = such as the fMRI and other ongoing studies should substantiate the = company's beliefs. Regardless, NovaVision has shown the functional = results for the patients are real and can be demonstrated through a = combination of both objective and subjective results, which I have = observed myself, regarding those patients for whom I prescribed Vision = Restoration Therapy.=20 In the past, the emphasis of rehabilitation for hemianopsia was just = compensation or adaptation, however, no longer does a patient with = hemianopsia have to be told nothing more can be done. However, a = combined clinical approach of compensatory scanning and field awareness = training, along with prescription of "Side Vision Awareness Glasses", = and treatment with NovaVision's Vision Restoration Therapy, gives the = patient the best chance for maximum achievement in real world activities = of daily living.=20 - Errol Rummel, OD, FAAO, FCOVD, FNORA is Director of the Low Vision = Care Center, serving the general New Jersey and Philadelphia area. In = addition to family eye care, Dr. Rummel's expertise is in the care of = patients with difficult/unusual vision problems, including adult and = pediatric eye muscle problems, amblyopia (lazy eye), = neurologically-related vision problems (due to stroke, head injury or = multiple sclerosis) and low vision care for visually impaired patients = (due to macula degeneration, diabetic retinopathy). ------=_NextPart_001_0CE7_01CC0035.51B90B50 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Article available for preview now
= http://www.therapytimes.com/content=3D1402J84C487E5886408040441
 
3D""=20
 

3D"Getting
3D""=20
3D""=20
home :: = features

Getting the Whole = Picture
Vision rehabilitation for=20 hemianopsia
By Errol Rummel, OD, FAAO, FCOVD, FNORA =
04.26.11

Article available online at:=20 http://www.therapytimes.com/042611Vision

3D""=20
3D""=20
As Director of the=20 Neuro-Optometric Rehabilitation Clinic at a leading N.J. rehabilitation=20 hospital, with years of consulting at New Jersey rehabilitation = hospitals, and=20 over 30 years of private clinical experience working with people who = have=20 suffered stroke or brain injury, I am in the unique position to have = worked with=20 over a thousand patients with hemianopsia.

With additional = training and=20 certification in vision therapy, and neuro-optometric rehabilitation, I = have=20 treated multitudes of patients with hemianopsias and have seen = improvement in=20 their activities of daily living, as they receive rehabilitative = treatment for=20 their hemianopsia. I have also seen many patients achieve reduction in = the size=20 and/or density of the affected hemispatial field loss as a result of a = new=20 therapy.

Millions of people worldwide suffer, often needlessly, = without=20 hope from vision loss due to neurological injuries like stroke, trauma, = or=20 resection of tumors in the brain. In the U.S. alone, 20-30 percent of a=20 prevalent population of 10 million TBI and stroke survivors may suffer = visual=20 field deficits =96 most erroneously believing their condition can only = be=20 compensated for.

Patients=92 who have had a stroke or traumatic = brain=20 injury, may lose one half of their side vision. This is called = =93hemianopsia=94.=20 Patients who have a hemianopsia are usually aware of the side vision=20 loss.

Hemispatial neglect is the inattention to, or lack of = awareness of,=20 one half of their side vision, and is usually associated with a = hemianopsia. The=20 lesion in the brain causing hemianopsia and/or hemispatial neglect = usually=20 occurs in the right frontal-parietal lobe, resulting in left side = hemianopsia=20 and/or left side hemispatial inattention.

The symptoms and signs = of=20 hemispatial field dysfunction include, but are not limited to the = following:=20
  • The patient can not or does not, readily or spontaneously scan = into the=20 area of the hemianopsia.=20
  • The patient has no awareness of the field loss.=20
  • The patient bumps into things on the side of the hemianopsia, but = doesn=92t=20 learn to compensate for the problem.=20
  • When reading, the patient misses parts of words on the side of the = neglect, and/or misses parts of the eye chart line on the side of the = neglect.=20
  • There is a tendency for the patient to have a head or body = orientation=20 turned away from the neglected side, and when ambulating, the patient = may=20 drift away from the neglected side.
Effective treatment of = hemianopsia=20 involves skilled input from rehabilitation specialists including = optometric=20 physicians skilled in neuro-optometric rehabilitation, physiatrists,=20 occupational therapists, optometric vision therapists, and physical=20 therapists.

The best opportunity for a patient to reach maximum = medical,=20 and functional levels of improvement requires a three prong approach: A=20 rehabilitation protocol for reducing hemispatial neglect, which includes = training eye movement scanning compensation in the direction of the = field loss;=20 a program of Vision Restoration Therapy (of Boca Raton, Fla.-based NovaVision=20 Inc.); and the prescription of Side Vision Awareness = Glasses.
3D""

Hemianopsia and/or neglect related therapies = start when the=20 person is a rehabilitation hospital in-patient and continues on an = out-patient=20 basis when the patient has been released from in-patient = care.

The=20 training is done by my prescription either in a rehabilitation facility=20 out-patient OT/PT clinic, and/or as in-office care with an optometric = vision=20 therapist in my office under my supervision. Vision Restoration Therapy = (VRT) is=20 a home based program performed twice a day for 6 months.

The = hemianopsia=20 therapy protocol I have written, used by the OT=92s, PT=92s, and vision = therapists=20 under my supervision, includes but is not limited to the following = training:=20
  • Encourage eye and head movements to the effected side, including = scan=20 board exercises.=20
  • Teach the patient to use closed eye scanning movements as well as = open eye=20 scanning movements toward the effected side.=20
  • Have the patient walk around the room in the direction of the = effected=20 side in order to reinforce the lack of a visual map of space on the = neglected=20 side.=20
  • Have the patient use a flashlight aimed alternately toward each = foot while=20 walking, to enhance vision with visual-motor reinforcement on the = effected=20 side.=20
  • Encourage the playing of games like crossword puzzles and real = (hard copy)=20 card playing (not computer games), because non-computer games involve=20 tactile/sensory input.=20
  • Increase sensory awareness on the effected side. Have the patient = squeeze=20 a ball using their hand on the side of neglect; have the patient trace = a line=20 that extends into the side of the defect; place the patients finger in = the=20 area of neglect, with the therapist rubbing the patients finger to = stimulate=20 sensory awareness on that side.=20
  • Tell the patient to forcibly/rapidly move their eyes as far toward = the=20 neglect as possible while sensing the feeling of their eyes at the = extreme=20 gaze. Encourage the patient to become aware of the =93feel=94 of their = eyes when=20 gazing as far toward the neglected side as possible.=20
  • To encourage scanning toward the hemianopsia have the patient wear = a=20 =93beeper-timer=94 wristwatch set to beep at intervals, as a reminder = to scan=20 regularly toward the field deficit.=20
  •  When the patient begins to have awareness of their = hemi-field loss,=20 teach the patient to visually scan about 20 degrees toward the field = loss, and=20 then to turn the head in the direction of the field loss once they = have=20 scanned 20 degrees in that direction.=20
  • Use therapies to stimulate physical movement into the area of = neglect,=20 like balloon catching/tossing, and also searching for predictive (and = later=20 non-predictive) stimuli in the neglected field.=20
  • Turning a page at a 45 degrees angle will improve reading ability = for some=20 patients with neglect who do not respond to other treatments.=20
  • Enhancing the =93blindsight=94 aspects of a hemianopsia will allow = a patient=20 more spatial awareness (at a subconscious level) within their = hemianopic=20 field defect. Studies have shown that some patients can detect = orientation of=20 a vertical or horizontal line, the color of a green or red = object, and/or=20 can point to the approximate location of a moving object held = within the=20 area of the field loss.
Once a patient has learned = compensatory=20 scanning in the direction of the hemianopsia, I will custom design and = prescribe=20 =93Side Vision Awareness Glasses=94. This is a spectacle mounted custom = made prism=20 device which enhances the patient=92s awareness of objects in direction = of the=20 lost field, by about 15 degrees to 20 degrees.

As the patient = scans into=20 the prism portion of the glasses, the environment in the direction of = the field=20 loss is moved toward the patients midline, which improves awareness of = objects=20 located in visual space toward the side of the missing = field.

Although=20 the use of prism lenses to enhance awareness of the environment within = the area=20 of the field loss is a known optical principle, I have been able to = design =93Side=20 Vision Awareness Glasses=94 in a way that maximizes the treatment = effectiveness,=20 by using a step by step examination protocol to determine the exact = power and=20 placement of the eyeglass mounted prism device, and by using a specific = training=20 program that insures the patient will get the maximum rehabilitative = benefit of=20 =93Side Vision Awareness Glasses=94.

As part of that training, = =93Vision=20 Restoration Therapy=94 is indicated prior to or simultaneously = prescribed with the=20 special glasses. VRT can permanently reduce the width of the = hemianopsia, making=20 the patient more capable of performing activities of daily living. When = I have=20 prescribed =93Side Vision Awareness Glasses=94, VRT makes the use of the = glasses=20 even more effective.

NovaVision=92s VRT is = an FDA-cleared,=20 patented, non invasive medical therapy which has been proven through = numerous=20 studies to provide significant functional improvement to patients = suffering from=20 hemianopsia resulting from such injuring.
VRT can improve and restore = the=20 hemianopic field loss by about 3-5 degrees at the crucial vertical field = midline=20 along with obvious and more than expected improvement in the patients=92 = functional abilities. When added to the 15 to 20 degrees of side vision=20 awareness from the special glasses I prescribe, most patients can = function=20 extremely well, with many now driving safely.

The time lapse = between a=20 patient=92s injury or the patient=92s age of initiation of VRT treatment = is not=20 relevant, and in fact the therapy has delivered successful outcomes for = patients=20 who suffered vision loss years before receiving VRT. In one such case, a = veteran=20 who acquired brain damage during World War II benefited from VRT, giving = hope to=20 survivors unduly suffering from neurological vision loss due to stroke, = tumors,=20 or trauma.

Scientist=92s and physicians have long believed that = once a=20 person experiences a brain injury, the resulting vision deficit effects = are=20 irreversible. Research over the last 15 years has demonstrated that the = cortex=20 doesn=92t have a fixed functional architecture. The brain=92s ability to = modify its=20 structural and functional organization to compensate and overcome = injuries is=20 called =93neuroplasticity=94.

NovaVision=92s management team = believes that the=20 non-invasive computer based neuro-stimulation leads to visual = improvement=20 through neuroplasticity. While this hasn=92t been categorically proven = to be the=20 driver behind the unequivocal functional improvements, continued studies = such as=20 the fMRI and other ongoing studies should substantiate the company=92s = beliefs.=20 Regardless, NovaVision has shown the functional results for the patients = are=20 real and can be demonstrated through a combination of both objective and = subjective results, which I have observed myself, regarding those = patients for=20 whom I prescribed Vision Restoration Therapy.

In the past, the = emphasis=20 of rehabilitation for hemianopsia was just compensation or adaptation, = however,=20 no longer does a patient with hemianopsia have to be told nothing more = can be=20 done. However, a combined clinical approach of compensatory scanning and = field=20 awareness training, along with prescription of =93Side Vision Awareness = Glasses=94,=20 and treatment with NovaVision=92s Vision Restoration Therapy, gives the = patient=20 the best chance for maximum achievement in real world activities of = daily=20 living.

=97 Errol Rummel, OD, FAAO, FCOVD, FNORA is = Director=20 of the Low Vision Care=20 Center, serving the general New = Jersey and=20 Philadelphia area. In addition to family eye care, Dr. Rummel's = expertise is in=20 the care of patients with difficult/unusual vision problems, including = adult and=20 pediatric eye muscle problems, amblyopia (lazy eye), = neurologically-related=20 vision problems (due to stroke, head injury or multiple sclerosis) and = low=20 vision care for visually impaired patients (due to macula degeneration, = diabetic=20 retinopathy).
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