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Assessment and Training for people with

Neurological Vision Deficits

NVT: Developed by Clinicians, for Clinicians

Acquired Brain Injury (ABI) is damage to the brain by a variety of causes; hypoxia, infection, tumour, substance abuse, degenerative neurological diseases, strokes or head trauma (TBI).

Traumatic Brain Injury (TBI) implies trauma to the head

and brain caused by an external force.

ABI can cause physical, cognitive, psychosocial and sensory impairments which may lead to restrictions in various areas of a person’s life and lifestyle.

Acquired Brain Injury

2.2 Million People in the US Acquired Brain Injury

Every Year

1.5 million Traumatic Brain Injury: every 21 seconds

700,000 will have a Stroke: one every 45 seconds

Stroke is the number 3 killer and leading cause of severe, long-term disability

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Neurological Vision Impairment

Neurological Vision Impairment occurs in 30 – 35% of all people who suffer a

Stroke or Traumatic Brain Injury.

“50% of the patients in a head trauma rehabilitation centre show visual system disorders not assessed before, although most of the patients were chronic and had been treated in other hospitals previously.” (Gianutsos)

ABI Per year NVD Per year

Accumlative - 4 years

USA 2.2 million 733,000 3 million

California 269,000 90,000

358,000

Neurological Vision Deficits

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Neurological Vision Impairment will affect all aspects of a persons daily life.

It would be standard care to receive: Physiotherapy – for improvement in loss of body functions or

reduced movement. Occupational Therapy – to increase upper body strength and

activities of daily living. Speech Therapy - swallowing, word pronunciation,

comprehension etc

In many instances there is no minimum clinical standard of care that covers Vision Screening for people with ABI

Therefore vision deficits can go undiagnosed and untreated.

Vision Therapy

7FOUNDATION TRIAD

OCULAR MOTOR

VISUAL FIELDVISUAL ACUITY

AROUSAL & ATTENTION

SCANNING

COGNITIONINTEGRATION INTERPRETATION RECOGNITION

VISUAL MEMORY

ADAPTATION

Assessment of Visual Function

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NVT Protocol Functional Vision Assessment

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Visual Perceptual Deficits

Visual Neglect/Visual Inattention - patients can be unaware of the extent of vision loss – causes difficulty with ALL activities of daily living (reading, eating, dressing, mobility in busy or unfamiliar areas).

Visual processing speed Visual Memory Visual Spatial deficits

Homonymous Hemianopia is the most common cause of visual field loss, quadrantanopia, relative field loss.

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NVT Standardized Scanning Assessment

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Motor Vehicle Accident TBI: Damage to:

frontal lobe, bi-temporal, bi-parietal and occipital craniotomy

Left Homonymous Quadrantanopia

Left Neglect

Visuo-spatial deficits

Visual processing deficits

Left Hemiparesis & Balance

Memory

Case Study - Angela

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Static Scanning Sitting Standing

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Pen and Paper Tasks

Transfer of scanning skills to table top tasks.

Systematic scanning pattern

Smooth scanning across a line in preparation for reading

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Step by step methodology in the transfer of scanning skills to mobility tasks in a graded fashion in a client’s local community.

Transfer to Walking and Scanning

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Progression - Scanning Skills Outdoors

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Transferring scanning skills intoeveryday community settings.Preparation for independent living.

SupermarketShopping

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Transfer from walking frameto support cane.Ensuring balance, gait and Scanning skills are not compromised.

Street Crossings,Car Parks

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Residential Area - Driveways

Transfer of scanning skills into residential settings.

Scanning into driveways for potential hazards

Good head turn,chin over shoulder for self monitoring

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The NVT Vision Rehabilitation System

1. NVT Scanning Device - Standardised Assessment and Treatment protocols

2. Vision 2000 Software - rehabilitation and patient management system

3. Comprehensive Training program for rehabilitation therapists.

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International Programs US - Veterans Affairs

VA Palo Alto, California – Oct 2006, 08, 10 VA Tampa, Florida – Oct/Nov 2007

UK Blindness Agencies Fife Society for the Blind – Jan 2006 Visibility Glasgow – Nov 2007

Denmark – IBOS June 2010

Exeter – WESC School Oct 2010

Australia – (20 yrs service delivery) Royal Society for the Blind – May 2007, 08 Guide Dogs Assoc. Nov 2009

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Training courses

On Line Theory Training Module 1 - Structure and function of the

brain in relation to Visual Processing. Module 2 – Neurological Vision Deficits

On site training Practical use of NVT Scanning device

and Vision 2000 software

Supervision of client training programs

Transfer of skills to mobility exercises.

strategies for dealing with the additional cognitive and physical deficits

Competency measures for attainment of skills

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Future Directions

Applicability to Education sector

Development of vocational training and services to young people with ABI

Home based rehabilitation programs for Stroke and ABI

International collaborative Research

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Allison Hayes

www.nvtsytems.com.au

PO Box 141, Torrensville. SA 5031

Australia

ahayes@nvtsystems.com.au

NVT: Developed by clinicians for clinicans.