TBI final

outcome of delaying therapy according to the CONCUSS study

delaying therapy for 6 weeks did not negatively impact the eventful effectiveness of OBVAM, it prolonged the period of symptoms and delayed the return to normal activities

seizure

temporary disruption of regular brain activity

Nonepileptic seizures

resemble epileptic seizures but lack abnormal brain electrical discharge. they don't respond to anti-seizure drugs and are treated with cognitive behavioral therapy

epilepsy

2+ unprovoked seizures

what lobe of the brain is most commonly associated with epilepsy

temporal lobe

a mild TBI has _____ the risk of epilepsy

double

which lobe are complex visual hallucination most commonly associated with

temporal

what treatment for epilepsy had a 90% average reduction in the group with long term implants

targeted thalamic stimulation treatment

TBI, CTE and acute enecphalopathy can lead to endocrine dysfunction and can therefor cause?

post-traumatic hypopituitarism --> GH deficiency

magnocellular pathway

unconscious information on motion, depth, and brightness and pre-conscious body preparation and posture for movement.

dorsal stream

layers 1 & 2 of LGN

parvocellular pathway

conscious awareness of color, recognition, perception and fine details

ventral stream

account for 80% of ganglion cells

koniocellular pathway

involved in reflexive eye and head movements

has one branch the splits into each parvo and mango pathway

egocentric localization requires?

visual components, vestibular components and postural/proprioceptive components

prosaccades

reflexive, stimulus-driven toward a target

anti-saccades

voluntary saccades away from a target, requiring suppression of reflexive prosaccade

memory-guided saccades

directed towards the location of a previously presented target

therapy for VMS, focal binding, and AEL patients

saccades

what is the most common type of saccadic intrusion and explain

Square Wave Jerks

they are small saccades from the target, followed by a short intersaccadic interval and then another saccade back to the target

what does base left yoked prisms do

corrects spatial disorientation/AEL and moves attention toward the right field of view

what does base right yoked prisms do

moves attention toward the left field of view

what does base down yoked prisms do

expands space, person leans back on their heals

what does base up yoked prisms do

grounding effect, person leans forward on their toes

what methods reduce the symptoms of focal binding

BI prism

bi-nasal occlusion

blue tint

what does low plus lenses do

reduced visual demand and stress

what is the primary marker and defining feature of CTE

accumulation of pTau protein

the localization of the protein is a critical factor between CTE and non-CTEtau

a single TBI with LOC is linked to an increase in what disease

parkinsonism

Direct Traumatic Optic Neuropathy (TON)

direct trauma to the head can cause damage to the optic nerve and dislocate it from the scleral canal.

most commonly from forehead trauma

signs of direct traumatic optic neuropathy

decreased VA, VF defect (arcuate), and normal fundus.

order a CT or MRI

indirect traumatic optic neuropathy

blunt trauma to orbit or cranium and the force damages the optic nerve.

this is the most common form and usually at the canalicular optic nerve

optic atrophy

irreversible loss of RGC axons within the optic nerve

signs: pallor or NFL wedge defects

optic nerve hypoplasia

incomplete development of the optic nerve

has a double ring sign

toxic optic neuropathy

bilateral retrobulbar optic neuropathy from meds or toxins

blue tints

good for calming, CI, accommodative spasm

increases parasympathetic

green

good for pain relief, migraine, vertigo and DAI

yellow

stimulating, increases sympathetic and decreases accommodation

pink

good for emotional fatigue, CE, accommodative excess

Rose/FL-41

good for photophobia

what is the most intense sensory depressant tint

violet

what tint triggers migraines

red

lyme disease

triad: BV dysfunction, visual processing deficits and asthenopia

visual snow syndrome

neurological disorder of central visual processing. can be associated with Lyme and COVID.

persistent visual static, floaters and after images

tx: violet tint, lamotrigine, low plus, prism

what is the outcome of a stroke in the right parietal lobe

left hemifield neglect

what % of TBI patients had strabismus

what % of cardiovascular accidents patients had strabismus

25%

35%

A pattern esotropia

more eso in upgaze

V pattern esotropia

more eso in downgaze

A pattern exotropia

more exo in downgaze

V pattern exotropia

more exo in upgaze

what should you expect if a TBI patient has a new-onset diplopia

a non-comitant deviation

post-concussion syndrome

lasts longer than 1 month after injury

30-50% of children with concussions

return to play/learn

rest: 1-2 days

return to learn: 1 week

return to play: 1-2 weeks

superior colliculus

initiates saccades

DLPFC

anti-saccades, inhibition of reflexive saccades

caudate nucleus

inhibits SNPR (allowing saccades) when FEF is active

SNPR

inhibits superior colliculus to prevent saccades

FEF

voluntary, memory guided saccades

PEF

reflexive saccades

abnormal egocentric localization

caused by neurological events disrupting the ambient process and leads to a spatial dysfunction. magno and parvo pathways don't align and therefore a midline shift is formed

focal binding

problem with the dynamic process of shifting attention between central and peripheral vision. its associated with VOR and saccadic suppression. it points to a dysfunction in control and smooth coordination of eye movements and visual attention

objective prism test

patient fixates at a distance target and high BO prism is placed in front of the "blind eye". if the patient is seeing: they should make an involuntary inward movement, while a blind eye will not

internuclear ophthalmoplegia

lesion of MLF causing ipsilateral adduction weakness and contralateral abducting nystagmus

Tolosa-Hunt syndrome

idiopathic granulomatous inflammation of the cavernous sinus causing painful ophthalmoplegia

Binasal occlusion

occludes bitemporal retina to reduce peripheral noise

van orden star test

behavioral test measuring spatial organization and identifying midline shifts

what is the purpose of the alpha omega pupil test

assess autonomic balance and sympathetic dominance

the alpha omega pupil sign is characterized by

a pupil that constricts then re-dilates or pulses

ipRGCs contain what photopigment

melanopsin

what wavelength region is melanopsin most sensitive to

480-blue

which tint is indicated for acute syndrome (post-TBI, CI)

blue or BG

which tint is best choice for chronic eso posture and low visual stamina

red/orange

FL-41 is helpful for

photophobia

fluorescent light sensitivity

blepharospasm

best tint for migraine photophobia

green

patients with visual snow respond best to

violet tint

key rule of the TBI tint tiral

subjective tint preference must align with objective phoria findings

parkinson's disease most common report increased comfort with?

blue tints

which type of patient most benefits from blue application tints that stimulate the parasympathetic system

post-concussive patients with headaches, photophobia or increased sympathetic drive