May 22, 2020
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BLOG: Harness neuroplasticity to aid TBI recovery

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Tina Dang Aldana, OD, FAAO
Tina Dang Aldana

by Tina Dang Aldana, OD, FAAO

Neuroplasticity is the brain’s ability to adapt to change and rewire itself. This rewiring happens throughout life but is particularly important after a traumatic brain injury.

As a civilian neuro-optometrist at the Lansduhl Regional Medical Hospital in Germany, I have the privilege of treating Army service members and their families from across Europe and Africa. Although some cases involve mission-related blast injuries, many of the people I treat have sustained a concussion or TBI from the same types of causes one might see anywhere: falls, sports, assaults and car accidents.

Although each patient’s presentation and symptoms may be unique, what they all have in common is the need to retrain damaged synaptic connections in their brains. This requires neuroplasticity and, more importantly, activity-dependent plasticity.

Consider that if you are right-handed, it is theoretically possible to promote the development of brain synapses for left-handed tasks, but it will happen much faster if you train your brain by using your left hand. The activity is what drives synaptic strength and repair, helping to improve motor function, learning and memory retention. After a TBI, we can use these principles of activity-dependent plasticity to associate vision therapy with an activity that provides feedback. So, for example, we might incorporate a balance board into visual attention or visual focus exercises to help patients relearn efficient eye tracking while in motion.

One of the most important things I do is educate my patients that vision is much more than acuity, or the ability to see 20/20 on the eye chart. “Vision” also encompasses the brain’s ability to use visual input to learn, read and move. Many of my post-TBI patients will sheepishly say, “You probably think I’m crazy, but ...” They go on to describe a troubling symptom; perhaps their focus fades in and out when reading, or when they scan their environment, they feel like point A and B are clear but the space between is blurry. It is so reassuring for patients when I can tell them they aren’t crazy, that I understand their symptoms and that I can help them fix the problem.

You all have patients just like this sitting in your chair, but they may never describe their symptoms if you don’t ask questions about visual function. When you encounter common visual disturbances related to poor eye tracking or accommodative dysfunction, suspect a TBI, even if the patient hasn’t mentioned it. You can treat these problems and help patients dramatically improve their visual function and comfort.

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In my experience, this is the low-hanging fruit of TBI care. Unlike vision therapy for binocular vision problems in childhood, addressing mild TBI symptoms doesn’t necessarily require specialization in vision therapy or rehabilitation. You can use your knowledge of the visual system and neuroplasticity to help patients learn how to control their focusing system and improve their visual function.

For more information:

Tina Dang Aldana, OD, FAAO, currently serves as the neuro-optometrist for the U.S. Army, Regional Health Command Europe, at the Landstuhl Regional Medical Center in Landstuhl, Germany, where she is a member of an interdisciplinary team at the Traumatic Brain Injury and Rehabilitation Clinic. She also consults internationally on the topics of TBI, vision rehabilitation and neuroplasticity.

Aldana will be a presenting a talk on neuroplasticity as the key to vision rehabilitation after TBI at the NORA virtual annual conference, Sept. 11-13, 2020. Information will be posted soon on the NORA website.

Disclosure: Aldana reports no relevant financial disclosures.

Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.