Presentation at the 9th World Conference of the International Brain Injury Association meeting in Edinburgh, Scotland ABSTRACT Objectives: Few reports in the literature note how optometric vision therapy (OVT) can improve the quality of life for those with traumatic brain injury (TBI). This presentation discusses the significant improvements of signs and elimination of symptoms noted after a regimen of OVT that resulted in improved oculomotor skills, attention, reading and driving ability in a patient with TBI. Case Report: PA, a university professor, is a 53 y/o WF with a history of traumatic brain injury due to a car accident. Her symptoms included falling asleep while reading, avoidance of reading, decreased attention, and major problems parking her car. The TOVA (Test of Variables Attention) showed an ADHD Score of -4.00 while the Visagraph revealed significant problems in span of recognition, fixation, reading rate/comprehension, efficiency and fluency. She was diagnosed with convergence insufficiency, oculomotor dysfunction (pursuits/saccades), and attention deficit. Optometric vision therapy sessions followed a standard format that included monocular, biocular, binocular and an integration/stabilization therapy phase. Computer aided OVT included the use of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the EyePort. After 27, 45 min OVT sessions both the TOVA and Visagraph showed normal attention and oculomotor skills, convergence insufficiency resolved, reading ability improved and parking problems eliminated. All other symptoms were either improved or eliminated. PA currently successfully teaches at a major USA university. Conclusions: Individuals with TBI often exhibit marked problems in oculomotor skills, binocular vision dysfunction, attention, and other visual abilities that affect their quality of life. Primary eye care providers, in general, do not diagnosis or manage the many vision function, functional vision and vision information processing disorders associated with TBI. Primary eye care providers can utilize this case as a starting point to help them do so in the future or to motivate them to refer to those who have experience and expertise in this area. This case demonstrates that with OVT both symptoms and signs that adversely affect an individual’s quality of life after traumatic brain injury can be improved.

1. Improving Vision Function in the
Patient with Traumatic Brain Injury
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A;
Professor of Pediatrics/Binocular Vision, Illinois Eye Institute/Illinois College of
Optometry; Chicago, Il. USA
Darrell G. Schlange, OD, FAAO;
Associate Professor/Ocular Motility & Binocular Vision, Illinois Eye
Institute/Illinois College of Optometry; Chicago, Il. USA

2. ABSTRACT
Objectives: Few reports in the literature note how optometric vision therapy
(OVT) can improve the quality of life for those with traumatic brain injury
(TBI). This presentation discusses the significant improvements of signs and
elimination of symptoms noted after a regimen of OVT that resulted in
improved oculomotor skills, attention, reading and driving ability
in a patient with TBI.
Case Report: PA, a university professor, is a 53 y/o WF with a history of
traumatic brain injury due to a car accident. Her symptoms included falling
asleep while reading, avoidance of reading, decreased attention, and major
problems parking her car. The TOVA (Test of Variables Attention) showed an
ADHD Score of -4.00 while the Visagraph revealed significant problems in span
of recognition, fixation, reading rate/comprehension, efficiency and fluency.
She was diagnosed with convergence insufficiency, oculomotor dysfunction
(pursuits/saccades), and attention deficit. Optometric vision therapy sessions
followed a standard format that included monocular, biocular, binocular and an
integration/stabilization therapy phase. Computer aided OVT included the use
of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the
EyePort…...

3. …..After 27, 45 min OVT sessions both the TOVA and Visagraph
showed normal attention and oculomotor skills, convergence
insufficiency resolved, reading ability improved and parking problems
eliminated. All other symptoms were either improved or eliminated.
PA currently successfully teaches at a major USA university.
Conclusions: Individuals with TBI often exhibit marked problems in oculomotor
skills, binocular vision dysfunction, attention, and other visual abilities that
affect their quality of life. Primary eye care providers, in general, do not
diagnosis or manage the many vision function, functional vision and vision
information processing disorders associated with TBI. Primary eye care
providers can utilize this case as a starting point to help them do so in the
future or to motivate them to refer to those who have experience and
expertise in this area. This case demonstrates that with OVT both symptoms
and signs that adversely affect an individual’s quality of life after traumatic
brain injury can be improved.

12. Other Eye/Vision Presentations
Neuro-Optometric Rehabilitation of ABI/TBI
Induced Vision impairment
Steen Aalberg, FCOVD-I
Kraskin & Skeffington Institute, Slangerup, Denmark

13. Other Eye/Vision Presentations
A Retrospective Analysis of Vertical Heterophoria
Treatment and Amelioration of Post-concussive Disorder
Symptoms Via a Multifaceted Assessment Battery
Mark Rosner, Debby Feinberg, Jennifer Doble,
Arthur Rosner
University of Michigan, Ann Arbor, MI, USA, St Joseph Mercy Hospital, Ann Arbor, MI,
USA, William Beaumont Hospital, Royal Oak, MI, USA, Vision Specialists Institute,
Bloomfield Hills, MI, USA

14. A Retrospective Analysis of Vertical Heterophoria Treatment and
Amelioration of Post-concussive Disorder Symptoms Via a
Multifaceted Assessment Battery
Mark Rosner, Debby Feinberg, Jennifer Doble, Arthur Rosner
Conclusions: In the subset of patients with TBI simultaneously diagnosed with VH, treatment of VH
with prismatic lenses resulted in marked reduction of all metrics for headache, dizziness and
anxiety, which coincided with the patient’s perception of overall VH symptom reduction.
Identification of VH in patients with TBI with prolonged post-concussive symptoms should become
a high priority, as effective treatment is available for VH which significantly reduces post-
concussive symptoms. ….anecdotally, while there is significant improvement in gait, balance,
reading comprehension/speed and cognitive performance, further studies will be needed to
ascertain whether these types of functional improvements are to be routinely expected with
correction of VH.

15. How did the international
audience respond to this
information ?

16. ICO/IEI’s Brain Injury Team
Dr. Dominick Maino
Dr. Darrell Schlange
Dr. Len Messner
Dr. Tracy Machinski
Dr. Navjit K. Sanghera

17. What can you do?
Become a Student member
of the Neuro-Optometric
Rehabilitation Association.

18. References:
Ciuffreda KJ, Ludlam DP, Kapoor N. Clinical oculomotor training in traumatic
brain injury. Optom Vis Dev 2009;40(1):16-23.
Leslie S. Myopia and accommodative insufficiency associated with moderate
head trauma. Opt Vis Dev 2009;40(1):25-31.
Mandese M. Oculo-visual evaluation of the patient with traumatic brain
injury. Optom Vis Dev. 2009;40(1):37-44.
Proctor A. Traumatic brain injury and binasal occlusion. Optom Vis Dev
2009;40(1):45-50.

19. Shameless Plug Alert!
Visual Diagnosis and Care of the Patient with Special
Needs
Edited by Drs. Marc Taub, Mary Bartuccio, Dominick
Maino
Published by Lippincott, Williams & Wilkins May 2012
Acquired Brain Injury: Kenneth Ciuffreda, Neera
Kapoor
Cortical Visual Impairment (CVI): Barry Kran, Luisa
Mayer
Neuro-plasticity and the Patient with Special Needs:
Dominick M. Maino, Robert Donati, Yi Pang, Stephen
Viola, Susan Barry

20. Laddies, and Lassies….if you have questions, please feel free to ask:
Dominick “The Bruce” MacMaino
Lord of Scotchland; Duke of Haggis and 9th Earl of the MacMaino Clan

21. What is Neuro-Optometric
Rehabilitation?
• Rehabilitation of the neurologically
challenged patient
– TBI or ABI
– Lenses, prisms, low vision aids, special
activities
• Vision plays huge role patients’ quality of
life, but is usually neglected during
rehabilitation therapy

22. NORA
• Neuro-Optometric Rehabilitation Association
– Multidisciplinary
– Mission to serve physically and cognitively
disabled persons and provide quality visual
rehabilitation
– Educate professionals (including optometrists) and
develop INTER and INTRA-professional networks
that include Neuro-Optometric and Vision
Rehabilitation Services

23. NORA Student Group
• Raise awareness of neuro-optometric
rehabilitation, and its importance in the
care of TBI and ABI patients.
• Keep the ICO community informed about
news from NORA.
• Potentially help you differentiate yourself
from other optometrists and create a
demand

24. NORA Student Group
Possible Upcoming Meetings
• What you can expect from TBI and ABI patients
– Psychiatrists
– Neurologists
• Patient perspective of neuro-optometric rehabilitation
– Wounded Warriors
– Athletes
• Private Practice Management of patients with TBI and ABI
• And More:
– Chicago Concussion Coalition
– Sports Legacy Institute
– Speech and Language Therapists
– Occupational and Physical Therapists
– Neurosurgeons

25. NORA Student Group
• How to Get Involved in:
– Become a Student Member of NORA
– Class Representative
– Social Media Representative
– Treasurer

26. 21st Annual NORA Multi-Disciplinary
Conference
• April 19th-April 22nd
• University of Memphis Holiday Inn
• Topics include:
– Hospital Based Visual Neuro-rehabilitation
– Concussions – Overview of Current Knowledge
and Treatment
– Neurotransmitters in Rehabilitation
– Nutritional Considerations in Neuro-rehabilitation

27. Questions? Suggestions? Ideas?
• Lisa Wong
– Lwong@eyedoc.ico.edu
• Jennifer Tai
– Jtai@eyedoc.ico.edu
• Hanna Froehlich
– Hfroehlich@eyedoc.ico.edu
• Dr. Dominick Maino (Faculty Advisor)
– Dmaino@ico.edu