About Amanda Zeller Manley, O.D., F.C.O.V.D.

Developmental Optometrist based in Bethesda/Chevy Chase, Maryland (greater Washington DC metro area).

Traumatic Brain Injuries and Their Effect on Mental Health

Dr. Mehrnaz Green

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Do you or someone you know experience a concussion or other traumatic brain injury?

For many who have suffered a TBI, they look “normal” or “the same” on the outside, but their ability to physically function, see, think and behave have been affected.

Many of you know that we specialize in treating vision problems after a brain injury.  https://noravisionrehab.org/patients-caregivers/about-brain-injuries-vision/common-vision-problems-symptoms-following-a-brain-injury

Vision problems after a TBI are well documented and often discussed with health care providers.  What many TBI patients have a hard time discussing is changes in their mental health.  Due to the nature of how the brain functions, mental health changes after TBI is common and well researched.

https://www.psychologytoday.com/us/blog/the-truisms-wellness/201604/traumatic-brain-injury-the-invisible-illness

Many TBI patients show signs of depression, mood disorders, anxiety, PTSD and have also developed sleep disorders not present before their injury, even with a mild TBI. https://www.nih.gov/news-events/news-releases/mental-health-disorders-common-following-mild-head-injury

A recent study was released that showed soldiers who suffer moderate or severe TBI were more likely to suffer other mental health conditions than those with other serious injuries https://academic.oup.com/milmed/advance-article/doi/10.1093/milmed/usz440/5688870

Too many times, patients keep their mental health changes to themselves and do not reach out for help.  If you or someone you know is suffering from mental health problems, it’s not your fault.  Biological and chemical changes to your brain are occurring due to the injury. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2536546/

Talk to your doctors about what you are experiencing to get you started to the road to recovery. https://msktc.org/tbi/factsheets/emotional-problems-after-traumatic-brain-injury

Vision Rehabilitation Effective for Stroke and Injury Related Blindness

By Dr. Mehrnaz Green

man in green parka jacket holding white book

Photo by Andrea Piacquadio on Pexels.com

At VCDC, we work with patients with visual field loss due to strokes and other brain and eye injuries.  For some, visual rehabilitation helps them coordinate their reduced vision to other motor and cognitive pathways so that they can function again at home and at work.  For many patients, vision rehabilitation reduces their visual field loss.

A new study from the University of Miami Miller School of Medicine found that visual rehabilitation is effective for patients who have suffered vision loss related to stroke or traumatic brain injury.

https://www.sciencedirect.com/science/article/pii/S0010945219304101?via%3Dihub

To learn if vision rehabilitation would help you or a family member, please visit our website: www.visiontherapydc.com or

Neuro-Optometric Rehabilitation Association: https://noravisionrehab.org/

Where you can find out more about this effective treatment for challenges after a stroke or brain/eye injury.

What is Visual Thinking?

Visual thinking, visual perception, visual processing…. all different names for a set of skills that don’t take place in your eyeballs. brain clear background

It may be a strange concept, but all vision takes place in your brain. Your eyeballs are really just bits of brain that grow out on the optic stalk to become sensors. Yep, eyeballs are just sensors. Light energy creates chemical and electrical signals in the retina, at the back of the eye. A series of neural circuits sends those signals to various points throughout the brain. Then signals go back to the eyeball, to tell it where to look, and what to look for. Those signals create the visual image, plus all the information about that image.

apple

Photo by Pixabay on Pexels.com

For example: imagine looking at an apple– a red roundish thing. The visual signal may give you information about the color, shape, size. But I want you to imagine picking it up. How heavy is it? What temperature is it? Imagine giving it a sniff. Can you imagine the fragrance? Now take a bite. How does it feel as your teeth sink in? What sound does it make? How does it taste? Also, where did you pick it up from? Was it on your kitchen counter, or plucked from a tree? Was it day, or night?

How did you know all of that from seeing a red roundish thing? What if you picked the red roundish thing up, but found yourself biting into a rubber ball? Not the same experience at all!

Visual perception is not just creating that visual image, but all of the sensory information that goes with it. It’s remembering the location of that apple. It’s creating the anticipation of what interacting with that apple will be like. Now that your apple, with a

sliced apple

Photo by John Finkelstein on Pexels.com

bite missing, is on the kitchen counter, what would it look like from a different vantage point in your kitchen? Would you still be able to see the bite mark? How do you know this is still an apple?

There are many other aspects of visual perception that we use in daily life, such as:

  • Spelling sight words
  • Understanding directional labels, such as right, left, over, under
  • Developing the concept that the word “four”=”4″= ♥♥♥♥
  • Remembering how much milk was left in the jug after breakfast
  • Remembering where we left our keys
  • Remembering which drawers the shirts go in
  • Finding that favorite stuffy from the pile in the toy box
  • Searching out the answers in the SAT comprehension testconfused guy
  • Parallel parking
  • Safely making a left turn across traffic
  • Assembling furniture
  • Academic stuff, like reading comprehension, word problems, geometry, advanced math and science, art; understanding maps, graphs, charts
  • Plus a whole bunch more

Why does visual perception come more easily for some than for others?

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What is this? It’s not your eyes that will tell you, but your brain.

All aspects of vision are learned. That’s something most of us never think of, because we learned it at such a young age. It seems to just happen on its own. Some of us do a better job at learning vision, and some of us don’t.

Walking is a learned skill, too. You can take a look at any large group of people and observe that there are variations in the acquisition of that skill, too.

Fortunately, just as physical skills such as running, walking, kicking a ball, and touch-typing can be learned with appropriate instruction, visual perceptual skills can as well.

If you’d like to improve your visual skills, we can help.

VCDC closing for in-person visits; Virtual VT appointments available

In order to keep patients, family members, and the VCDC team safe, we have decided to close doors to in-person office visits for the next two weeks. Virtual VT appointments will be available by Zoom or Skype.

If you would like to keep your scheduled appointment time, it will remain available. Our administrative team is reaching out to all scheduled patients to confirm virtual appointments. If you would not prefer to have your regular VT session virtually, Dr. Green and I do still recommend scheduling weekly 25-minute sessions to review and update home vision therapy activities so progress you have already made is not lost.

As the virus situation evolves, we will be providing regular updates.

Wishing you all good health,

Dr. Zeller

Headaches and Traumatic Brain Injuries

By Dr. Mehrnaz Green

Headaches are one of the most common complaints that we hear about from our TBI patients.  Medical Xpress (2/19) reported in a preclinical study to assess “persistent post-traumatic headaches” in a mouse model, investigators “concluded that CGRP [calcitonin

woman in gray tank top lying on bed

Photo by Andrea Piacquadio on Pexels.com

gene-related peptide] may be the link between traumatic brain injuries and post-injury headaches.” According to the lead author of the research, which was published in Cephalgia, “The sustained prevention of the actions of CGRP with an antibody treatment administered early after a mild traumatic brain injury prevents post-traumatic headache in our preclinical model, as well as the vulnerability for development of persistent post-traumatic headache. … The encouraging aspect is that we do have a mechanism which seems to be driving some aspect of the pain, and if treated at the right time in this preclinical model, it seems to be effective.”

We will stay tuned for more updates on this exciting research and hope that it protects patients who just experienced a TBI from experiencing headaches.  For people who have been suffering from persistent post-traumatic headaches, we have good news.  Headaches, eye strain and nausea can be due to a vision problem that can be treated! At VCDC we provide vision rehabilitation, syntonics light therapy, specialty lenses and filters.  For many, one or a combination of the above treatments help reduce or eliminate headaches after a TBI.  To learn more, visit our website: www.vision therapydc.com or NORA (Neuro-Optometric Rehabilitation Association: https://noravisionrehab.org/

Microfluidic Chip May Be Able To Quickly Tell Whether Someone Has TBI From Finger-Prick Blood Sample, Researchers Say

Physics World (UK) (2/20) reported “researchers in the UK claim to have developed a microfluidic chip that can rapidly tell whether someone has suffered a traumatic brain injury from a finger-prick blood sample.” According to the article, “the optofluidic device detects a biomarker linked to brain injury, based on the way that it scatters light.” The researchers “claim that by testing for elevated N-acetylasparate levels, they were able to identify patients with traumatic brain injury with an accuracy of almost 99% immediately after injury, and around 91% at eight and 48 hours after injury.” The findings were published in Nature Biomechanical Engineering.