The Neuro-Optometric Rehabilitation Association International is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

BLOG: What does the neck have to do with vision?

June Chiang

by June Chiang, OD

It might seem surprising that an optometrist is interested in the biomechanics of the neck, shoulders and cervical spine — but these can be integral to solving problems related to the visual system, especially following a stroke, concussion or other form of brain injury.

Stroke patients often present with a visual field inattention or visual field loss to one side, which often leads to a head turn. The head turn can result in chronic tightness of certain muscle groups and weakness of others, eventually leading to chronic neck pain and cervical spine or disc damage.

In terms of concussion or blunt force trauma, a vertical deviation can occur if cranial nerve IV is affected. This can lead to a compensatory head tilt, which can also cause imbalance in the neck muscles and chronic neck pain and cervical tissue damage.

Neuro Vision treatment in the form of special lenses and vision therapy can bring pain relief and also help the patient become more visually aware of the neglected side. It can also improve proprioception of head centering. If your head is well centered, it makes sense that you’ll be able to pay better attention to visual stimuli from all directions and get the most benefit from other rehabilitation therapies (physical, occupational and speech).

Thus, addressing the untreated visual dysfunction can, by itself, make the head and shoulders straighter. Neuro Vision treatment may help the patient avoid or reduce other cervical treatments, such as pain medications (opioids), injections and surgery. It can facilitate better performance and learning in other rehab therapies. These are a couple good reasons for addressing head and neck biomechanics as Neuro Vision practitioners.

The impact of cervical mechanics works in the reverse direction as well. As the head is posturing and moving, there are a myriad of complicated feedback loops via the thalamus and basal ganglia, which help inform the sensory systems. The motor systems inform the sensory systems and vice versa. Improved head and neck control will help provide improved proprioceptive and spatial information for the visual system to process and interpret. Then the visual system can integrate and process the peripheral visual stimulus along with the central visual stimulus. This is the core issue for so many brain injury patients who lose the ability to process both peripheral and central visual stimuli simultaneously.