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Many of our Stonebridge exercise classes focus on Falls Prevention. There is a good reason for that.     According to the Centers for Disease and Control and Prevention, one in five falls result in serious injury such as broken bones or head injuries. The CDC goes on to say that each year 3 million older adults are treated in emergency departments for fall injuries, 95 percent of hip fractures are caused by falling, and that falls are the most common cause of traumatic brain injury.

Another term you may encounter for traumatic brain injury is TBI or concussion.       The brain is surrounded by fluid inside the skull which cushions and protects it from daily bumps. With severe impact, the fluid sometimes isn’t enough to protect the brain from a sudden stop or a blow to the head. In those situations, your brain may crash against your skull, resulting in an interruption of brain function.

The risk of having a serious bump on the noggin doesn’t end when we step out on the sidewalk or climb a ladder to change a light bulb. Although falls are a common cause of head injuries, every time we get into our car we are at risk as well. Motor vehicle accidents are listed just below falls as a common cause of TBI. I know this fact only too well as my car was rear ended resulting in a concussion last fall. Most head injuries heal shortly after they occur. Unfortunately, some can result in persistent medical issues such as frequent headaches, dizziness, nausea, decreased balance, light and/or noise sensitivity, blurry vision, double vision, abnormal eye movements, confusion, memory loss, the inability to organize thoughts or schedules, impaired judgment, poor impulse control, anxiety, fatigue, irritability and depression. It’s a very big list!

Today I want to talk about visual disturbances that may occur because of a concussion.       If you have suffered a concussion, you may lose your ability to track and focus on moving objects or scan and shift visual focus from one object to another. You may notice that it is more difficult to read and follow lines without a bookmark. I wear reading glasses and have found it helpful to place cloudy scotch tape on the inner aspect of the lens to help with that problem.


Gaze stability is another issue affecting individuals post head injury. This refers to the eye’s ability to maintain focus while the head is moving. Light sensitivity can also be a major roadblock. Its summer, the sun is bright, and many buildings offer fluorescent lighting which can be especially

problematic too. Fluorescent bulbs emit an invisible flicker which seems to be picked up by the brain. This visual disturbance creates the perfect storm for increased vertigo, nausea, and headache symptoms. Sunglasses may be needed for months or even years after a head injury. I have a condition called pinpoint pupils from my concussion which makes my pupils very small and they never dilate. This condition is often permanent causing light sensitivity and headaches. I also have floaters which create the illusion of little dots and spider web like lines floating around in my visual field, especially in a bright room. According to Steve Rauchman M.D. who specializes in Ophthalmological care, after a head trauma, the eyeball can be shaken up, dislodging these little particles. Floaters are common complaints after whiplash and head trauma in motor vehicle accidents.

These same patients may also complain of flashing lights. Floaters can indicate hidden retinal tears which can lead to retinal detachment and permanent loss of vision. An ophthalmologist can perform a detailed exam of the edge of the retina to look for small tears. It is very important to go to the hospital or an eye doctor that specializes in post concussion eye exams

if you have any of the above symptoms to confirm that there isn’t damage to

the retina.

When dealing with complicated eye related vision problems post concussion you will have to undergo an eye examination. This exam should be performed by a neuro-optometrist at a vision training centre. The

neuro-optometrist is an optometrist who has special training in the neurological aspects of the visual system. The neuro-optometrist not only diagnoses general eye health problems and corrects refractive errors to improve visual acuity but also carefully assesses functional binocularity, spatial vision, and visual processing abilities. Neuro-optometrists diagnose injury-related gross ocular and perception impairments, provide education regarding functional implications of visual diagnoses, and recommend treatment and compensatory strategies to speed rehabilitation. Treatment often includes prescription of specialty lenses and prisms for improved


performance in rehabilitation activities and reduced symptoms in daily living. I am finally being approved for blue lenses which should help with bright lights and have had to undergo a lot of vision training.

Another common side effect of a concussion is the loss of smell. Remember the brain is the epicenter of our senses so an injury to the brain can affect multiple daily activities, tasks and experiences.

Head injuries must be taken seriously. Some research has linked moderate and severe traumatic brain injury to a greater risk of developing Alzheimers, Dementia and Parkinsons. After a head injury, clinicians will tell you the brain needs rest. Get as much rest as possible. And be certain to see a physician before starting any type of post concussion exercise program. If you find any of your symptoms getting worse during exercise be certain to take a break. I am ten months post concussion and still experiencing all my original symptoms, almost daily headaches and the bed spins when I lie down. I’ve always used exercise to “fix” my problems, but my concussion has been my greatest exercise challenge yet.

Balance issues have been reported to last for years post-concussion. Therefore, it is important to incorporate balance exercises into your daily routine. You will probably find that balance is much more difficult with your eyes closed. I had very good balance before my accident and was astounded by the changes. This is something we must be very aware of when going back to class.             It is very important to SLOW DOWN!!!                              I also discovered that it is very important to make certain you are in a safe supported environment and really pay attention when performing balance related exercises.

Everybody can benefit from eye tracking exercises. Eye tracking exercises help strengthen eye muscles and improve visual acuity. Training your vision helps to balance the rest of the body, most importantly the vestibular system which is the balance system located in the inner ear. Below are a few visual exercises that have been recommended to me during my rehabilitation process.


Focus: While sitting comfortably, stretch out one arm and hold a pencil. Focus on the pencil at arm’s length, and then gradually bring the pencil closer until the pencil appears double.                                                        As we look at objects up close, we pull both eyes together. This is called convergence. Convergence insufficiency is a common cause of eye discomfort resulting in eye fatigue, eye strain, headaches, and blurred vision.

Another great focus exercise is to return the pencil to its starting position at about arms length. Next focus on the pencil and then an object further

away in the room…say a clock….and then back to the pencil. Shifting focus

is great for the eyes.


Pencil Pushups: Start with one pencil six to eight inches in front of your nose. Hold the other pencil directly behind at arm’s length so it disappears from your vision. Stare at the first pencil until you see the second pencil start to rise above the front pencil (without moving your arms)


Following: Move the pencil up and down and follow the pencil with your eyes. Next move the pencil side to side and follow the pencil with your eyes.

Shifting: Stretch out your arms in front of you and hold two pencils so the tips are at eye level, about 12 inches apart. Keep your head still as you look at the target to your right. Then quickly move your gaze to the left target


and then back and forth from target to target. Repeat for one minute. Shifting works by engaging the macula, the central part of the retina, which is responsible for clear, detailed vision. By moving the eyes frequently, more information comes through this part of the retina, thus providing the eyes with more in-focus visual information. Next try one pencil up above eye level and then one lower shifting your gaze back and forth. Try making the targets wider and wider to really work your peripheral vision.

Gaze Stabilization: Start the exercise by holding the target steady and turning your head from right to left while keeping your eyes on the target. Repeat the back-and-forth motion for one minute.

Seeing originates in the brain. A billion images are produced in the retina every minute. When we have a brain injury sometimes the brain can’t assimilate all these images. The exercises above are a great way to teach your eyes and brain to work together as a team. Visual training may feel uncomfortable at first or even increase headaches. When you have a concussion, the brain needs a break several times during the day. Make certain to only perform exercises as tolerated and at the end of the day so that you can rest afterward and don’t have to worry about driving.

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