Skipping steps can set you back
Skipping steps can sometimes take you longer as seen in this case of a 17-year-old competitive basketball player who sustained a concussion while jet-skiing in August 2017. She had many symptoms after her head injury, most notably: Headache, balance problems, dizziness, light sensitivity, noise sensitivity, irritability, sadness, nervousness, feeling “slow”, and difficulty remembering. She had been spending weeks in a dark room under the advice of another practitioner although we now know that this is not a good strategy to employ in recovering from a concussion. She also had seen her routine optometrist who dispensed her glasses that made her feel worse. We asked her to return them and in the ensuing weeks/assessments we identified a more complete visual diagnosis that mandated a different optical prescription and that did provide her immediate relief.
Her post-traumatic tension-type headaches were managed naturally through lifestyle changes, school accommodations, medical management of her sinusitis, management of her whiplash and management of her mood.
She had been on Cipralex prior to this injury for anxiety but it was felt that Cipralex was making her ability to accommodate (visually) on objects worse so this was changed to Cymbalta. Cymbalta proved to be helpful also in improving her neck pain in addition to chiropractic therapy. She was given/taught many other strategies to cope with anxiety: performing therapeutic activities, relaxation strategies and was gradually reintroduced to cardiovascular exercise. Helping her manage her activities and energy helped her feel more in control of her day.
To help her with her cognitive ability, she was given compensatory cognitive strategies, therapeutic activities and school accommodations. She was able to catch up with her school work and finished the year with marks in the 90s. We also advocated for her with the university admissions committee which in hindsight proved to be unnecessary as her marks were very high. She did end up getting into her preferred university program.
Her binocular vision exam revealed convergence insufficiency and accommodative excess. This is traditionally managed with lenses, stress/energy management and vision therapy. Before embarking on vision therapy, she was advised to do some vestibular therapy to help restore her spatial awareness/orientation and improve her visuo-vestibular awareness and coordination. She decided to skip this and sought therapy from a clinic that does sports physiotherapy in Vaughan and left our program. She did improve in her ability to do the exercises she trained in but whenever one does therapy, one must ask if the skills learned are transferrable to the unpredictability and variability of everyday life. For example, does just doing bicep curls make one physically strong at doing any form of labour work? Unfortunately, this proved to be the case for this patient and after having done very well in visual tasks in her classroom environment she had what is referred to as binocular vision collapse after playing a leisure game of basketball for 25 minutes. She experienced persistent dizziness, imbalance, light sensitivity, intolerance to brisk motions and visually rich environments. She then sought us again at our aurora physiotherapy & rehabilitation centre to help her with this.
She is now undergoing vestibular therapy to help restore the ability of her brain to integrate the information coming from her visual system and vestibular system in a more healthy and effective fashion. She was offered to integrate vestibular therapy with vision therapy in our specialized suite for this sort of physiotherapy in Markham but she passed having prepaid her entire vision therapy care with another provider, about $4000. We recommend that patients don’t do this as there is a chance you will not need so many vision therapy sessions. We are having excellent results in just 10 sessions of vision therapy for many patients. Since patients pay per session at our clinic, there is no chance of overpaying or feeling locked in for more therapy than you need. This is more economical, efficient and transparent.
Written by: Dr. Taher Chugh
Last update: June 2018