How 2 Visual Problems after Concussion Affect Academics and Athletics

To convince you of the importance of healthy visual function after a concussion (and to get you to read this entire blog), let me ask those who have had a concussion to answer a few simple questions.

• Does even reading a few pages lead to heavy feeling of the eyes or headaches?
• Do you cringe at the prospect of hours of note-taking due to blurry vision, losing track of words, and again, onset of headaches?
• Does trying to follow ball movement when you watch practice or a game lead to dizziness, double vision, and a strong sense of futile frustration and a desire to vomit?

Now, while there are other potential causes for all the above issues, one very common post-concussion denominator is indeed visual dysfunction, also known as oculomotor dysfunction.

With formal names like Convergence Insufficiency and Saccadic Dysfunction you might indeed think that this stuff is far too technical to grasp,  but in reality, these issues strike at the very heart of some basic life functions.

Now, without further delay, I will describe the two most common types of oculomotor dysfunction and how they can affect school and sports.

1) CONVERGENCE INSUFFICIENCY

Convergence insufficiency occurs when your eyes don't work together while you're trying to focus on a nearby object. When you read or look at a close object, your eyes need to turn inward together (converge) to focus. This gives you binocular vision, enabling you to see a single image.  (courtesy of Mayo Clinic)

Real world consequences

• Blurry vision, headaches, and dizziness when trying to change focus from more distant objects (screen, smart board, white board) to closer objects (note pad, lap top, worksheet)
• Similar symptoms while trying to track and object coming closer to the face, such as catching a ball

2) SACCADIC DYSFUNCTION

Saccades – the ability to jump your eyes from one target to another accurately.Saccades are necessary for tracking skills while reading or copying information. In order to process visual information properly, the eyes must move smoothly and quickly from one object to another. Saccades are crucial to the ability of the visual system to perceive and interpret images. When smoothly tracking with the eyes, the eyes must also be able to cross the midline of the body without hesitation; (courtesy of NorthShore Pediatric Therapy)

There are 2 flavors of Saccadic Dysfunction- horizontal (side to side)  and vertical (up and down)

Real World Consequences

HORIZONTAL

• Fatigue, blurry vision  and headaches with reading (both screen and book/paper) as eyes loose track of words and lines due to inability to smoothly move from side to side
• Double vision, headaches and even nausea when trying to follow back and forth ball movement, such as at a tennis match

VERTICAL

• Similar symptoms of distress when repeatedly looking up at a board or speaker, then looking down at a piece of paper or a computer screen
• Worsening symptoms if trying to look up at a target (basketball hoop) or tracking a ball coming down from the sky

How can I get help with these problems?

Practical in-office testing strategies have been developed to better identify these issues, so do not hesitate to contact a sports medicine or concussion specialist for evaluation.

Depending on symptoms and evaluation findings, potential treatment strategies could include:

• Classroom modifications
  • Assistance with note-taking
  • Listening to lectures or reading assignments rather in place of actual reading
  • Reduction in reading assignments
  • Oral testing
• Oculomotor exercises
  • Options include home-based versus formal office-based programs
  • On-going research efforts are attempting to study ideal time frame after concussion to start visual exercises, and how to determine length of programs

Wonderful PlayPositive Article on Coaches Helping Injured Players Stay Engaged

Wanted to share an excellent article by PlayPositive written for coaches to emphasize two basic tenets of Sports Medicine: focus on what one CAN do, rather than what one CAN'T do and always try to make positive learning experiences even out of the most difficult injury situations.

Very happy that our coaching colleagues can benefit from these recommendations, but the truth is that all of us involved in the recovery process (yes, that includes parents) need to read and heed this advice.

Injured athletes and performers who are unable to participate in usual training and competitive activities routinely report feeling strong senses of isolation and loss of self-identity. The formal diagnosis of an injury provides a particular set of challenges, but often the aftermath requires keeping the athlete "in the game" by continually communicating acceptable activities, cross training options, and criteria for safe advancement to advanced level of participation.

As emphasized in the PlayPositive piece, finding creative learning experiences will enable injured athletes to make important contributions not only to their long-term growth but also encourage team-based development.

An optimal response to any injury includes regular and open discussion that must be encouraged between athletes, families, sports medicine providers, coaches and other instructors. I often find that the time investment in exchanging messages, notes, and even cell phone numbers can make a huge impact and is greatly appreciated by all parties.

Do you have any particular recommendations to help keep injured athletes "stay in the game" during their recovery process? What are the most efficient ways to encourage communication between athletes, coaches, medical providers and families?