In addition to a thorough neuro-visual work-up, an assessment by a functionally oriented ear, nose and throat specialist or a doctor of audiology who is American Institute of Balance-certified can complement very well work that is being done on the neuro-optometric front.
Remember, diagnosis before prognosis is key here. Ultimately, formal diagnosis of visual system issues is the domain of the neuro-optometrist, and diagnosis of vestibular issues is the domain of the doctor of audiology/ENT specialist at the end of the day. This is the first step.
In working with colleagues from other specialties, it is essential that we all collaborate, but at the same time learn how to stay in our own “lanes.” In other words, each practitioner should know where his or her role ends and not try to do everything, essentially. It can take some time to find the sort of colleagues who excel both at concussion care and at the collaboration and communication necessary to make it work seamlessly. But it’s worth the effort. Ultimately, we all need to become experts in our own fields but also an expert referral mechanism to other disciplines that complement our treatments when required. If the patient is not getting better, put your thinking cap on; you likely need to get someone else involved.
I have seen many patients who have been “spinning their wheels” for literally months (sometimes years), bouncing from one practitioner to another, without relief from their post-concussion symptoms. I firmly believe that if we do the right thing, in the right sequence, the vast majority of patients will get significantly better. In addition, your practice will grow faster as more allied professionals will get to know what you do also. It is a win-win!
How do you work with your concussion patients and colleagues from other specialties? Please share your thoughts and experiences in the comments section.
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Patrick Quaid, MCOptom, FCOVD, PhD, is the founder and CEO of VUE3 Vision Therapy, with two clinics, in Toronto and Guelph, Ontario. He is also an adjunct professor at the University of Waterloo School of Optometry & Vision Science. He has co-authored a book chapter on visual dysfunction in brain injury with Eric Singman, MD, PhD (head of Neuro-Ophthalmology, Johns Hopkins) in the medical textbook, Neurosensory Disorders in Mild Traumatic Brain Injury. Quaid is also chair of the Ontario College of Optometrists Registration Committee and has given more than 500 lectures on topics including visual dysfunction in concussion, visual dysfunction in reading-based learning issues, and glaucoma and low blood pressure. Quaid can be reached at www.vuetherapy.ca.