Can the Mystery of Persistent Symptoms of Post-Concussion Disorder be Solved?

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 Persistent post-concussion symptoms are often posited as a mystery by some healthcare providers. And in the context of litigation, the familiar refrain from defense “so-called” experts is that the typical period of spontaneous recovery for mild traumatic brain is three months, and that to the extent that symptoms linger beyond that, it is often attributable to some psychosocial problem. This conclusion may be pre-ordained by the expectation bias of professionals retained by insurance companies to defeat and/or minimize a damages claim. But it also can be fostered by healthcare providers with limited awareness of problems that reflect actual physical injury.

Head injury victims frequently complain of a constellation of symptoms that can include headache, double vision, dizziness, sensitivity to light and/or sound, decreased attention, confusion in busy visual environments, losing place when reading, and/or visual memory problems. Some of these symptoms may improve over time; other may remain fairly constant. A thorough physical examination by a neurologist, physiatrist (physical medicine & rehabilitation), or even an conventional optometrist or ophthalmologist might reveal a deficit in refraction or eye alignment, demonstrating how the eyes operate together. However most of these specialists do not perform the type of exacting examination performed by specialists in the fields of neuro-optometry, rehabilitation optometry, integrative optometry or developmental optometry. In many cases, a patient will have a routine eye examination for eye glasses or contact lenses, figuring that some vision difficulties are attributable normal changes in vision without connecting the head injury to vision changes. This type of visual disturbance may in reality be what has been classified as a “post trauma vision syndrome” or a “visual mid-line shift syndrome”.

In a situation involving the type of persistent post–concussion disorder symptoms referenced above, a specialized assessment should be sought. A head injury that causes these symptoms may be the result of the disruption of white matter fibers in the brain. Some of the brain injury related symptoms are susceptible to improvement with vision therapy including a home exercise program or the use of prism lenses with eye-wear. While a permanent cure of a vision problem related to brain injury is unlikely, vision therapy and prism lenses can often improve the level of function and make living with a traumatic brain injury more tolerable.

By Stewart M. Casper. Posted October 7, 2015

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