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: The order of things after concussion

Patrick Quaid

by Patrick Quaid, MCOptom, FCOVD, PhD

I believe that the difference between a good health care practitioner and an excellent one is that an excellent one knows when to get others involved.

The reality is that none of us is an expert on everything, so we need to find like-minded colleagues with different areas of expertise to benefit our patients, particularly when it comes to the complexities of concussion care. However, it can be difficult to figure out not only who should do what, but in what order.

Steps for treating concussion

After years of working collaboratively with other professionals, here is my take on how to best treat concussion patients:

Rest. For most concussion patients, there should be a period of rest immediately following an acute head injury. However, this “rest” should be a week or two, not several months, as has been previously espoused.

Start with the neck and back. When symptoms persist beyond that initial rest period, I like to first ensure that we stabilize the larger muscles in the body so they can “teach” smaller muscles how to move. Therapy of any kind will be more effective if patients are sleeping well and can ambulate with relative ease. At this stage, one might consider involving chiropractic, physical therapy/physiotherapy, neuromuscular specialists or even a dentist who specializes in treating temporomandibular joint disorder.

Neuro-optometric assessment. Within 3 to 4 weeks of the injury, the patient should have a neuro-optometric assessment to diagnose any visual problems contributing to their symptoms. Vision is by far the dominant sense. Consider this: There are 1.2 million ganglion cells (a type of neuron) in each optic nerve, but only about 30,000 ganglion cells for each ear. Call me biased, but the anatomy is telling us something here.

Once diagnosed, patients can be treated as needed with tints, yoked prism, binasal occlusion and vision therapy as needed by the neuro-optometrist.

Vestibular assessment. The vestibular system develops at just 48 days gestation and is extremely important for human development and healthy function. Most concussion patients with dizziness or balance issues actually don’t have otic (ear) or vestibular problems. Vertigo, on the other hand of course, is indeed a vestibular issue. In dizziness, rather, there is essentially an underlying issue or a basic mismatch between vision and vestibular inputs.