More than meets the eye
A 17-year-old student and lifeguard came to our program after having backstroked into a wall in April. He first presented with neck pain and stiffness, headache, difficulty falling asleep and difficulty with problem solving, attention, school work and memory but never complained of any eye difficulty. He initially tried some therapy at a clinic that does physiotherapy in Aurora, Ontario and another one that does sports physiotherapy in Vaughan but found he wasn’t getting better so sought out a post-concussion syndrome specialist in Toronto and found our Aurora rehabilitation center conveniently located.
His neurocognitive assessment revealed average functioning except for the domain in reaction time where he was significantly reduced vs. his age-matched peers. Blood work was done and showed no abnormality. He was then initiated in cognitive behavioral therapy for insomnia by our medical and occupational therapy team with a successful outcome. Our chiropractor taught him biofeedback strategies to improve his energy level and his core neuromuscular recruitment to offload his tired neck muscles.
His school had allowed him a pass on his exams and he had already been granted acceptance to University so he was fortunate that there was no pressure in this regard. He still had difficulty reintegrating back to work so accommodations were prescribed by our team.
Our team assessed that he had accommodative excess, convergence excess and anisometropia – visual disorders that are best treated by vision therapy, stress management, energy management, CBT-i and prescription lenses. He had unwittingly already treated much of this. He then recalled that in fact he had a pair of glasses when he was 5 years-old but that was told he no longer needed them. It is true that since then, prior to this injury, he was functioning very well with anisometropia. His mother also has the same condition – anisometropia. But in the context of this injury it was important for him to get glasses to correct it to better facilitate recovery.
Our physiotherapist at our Thornhill physiotherapy clinic started him on vision therapy exercises prescribed and overseen by our optometrist with specialized training in binocular vision disorders post-concussion. He showed remarkable ability in becoming aware of functions of the visual assessment most of us take for granted and to improve it as assessed by our training drills. Once his visual performance has normalized, he should be able to resume work with no restrictions and be ready for University with no cause for hindrance in his academic performance from this injury.
Written by: Dr. Taher Chugh
Last update: July 2018