Traumatic Brain Injury Research

Aksionoff EB, Falk NS. The differential diagnosis of perceptual deficits in traumatic brain injury patients. Am Optom Assoc 1992;63:554-8.


Aksionoff EB, Falk NS. Optometric therapy for the left brain injured patient. J Am Optom Assoc 1992;63:564-8.


Alesterlund L, Maino D. That the blind may see: A review: Blindsight and its implications for optometrists. J Optom Vis Dev 1999;30(2):86-93.

Anderson DC et al. The dizzy patient: a review of etiology, differential diagnosis, and management. J Am Optom Assoc 1995;66:545-558.
Calvanio R, Williams R, Burke DT, Mello J, et al. "Acquired brain injury, visual attention, and the useful field of view test: A pilot study."  Arch. Phys. Med. Rehabil. 2004; 85(3): 474-8.  
   Objective: To compare the findings of the Useful Field of View (UFOV) test with those of conventional neuropsychologic tests to determine the utility of the UFOV test as a measure of attention in a population with brain injury. 

   Design: Cohort study.

   Setting: Freestanding rehabilitation hospital.

   Participants: Fifteen inpatients with severe brain injury.

   Interventions: Not applicable. 

   Main Outcome Measures: UFOV test, FIM/T instrument, lengh of stay (LOS), and standard neuropsychologic testing. 

   Results: The UFOV subtest UF2 correlated strongly with the other 2 subtests, UF1 and UF3.  The UF2 subtest correlated most strongly with paper and pencil tests of visual attention.  The UF2 predicted 52% of the FIM change and 60% of the LOS variance, second only to admission FIM score, which predicted 75% and 80% of FIM change and LOS variance, respectively. 

   Conclusions: Among the patients in our study, the UFOV test can be used to determine the visual divided attention of patients with acquired brain injury.  The results also showed that the UFOV test correlated with LOS and FIM change in patients with acquired brain injury recovering in a rehabilitation facility.  Because the UFOV test is much more quickly administered and scored than other measures of attention and divided attention, these results suggest that the UFOV test may provide an easy means to measure a critical variable in the population with head injury. 
Chokron, S., Perez, C., Obadia, M., Gaudry, I., Laloum, L., Gout, O., From blindsight to sight: cognitive rehabilitation of visual field defects, Restorative Neurology and Neuroscience 2008;26, 305.

Ciuffreda KJ. The efficacy of and scientific basis for vision therapy in non-strabismic accommodative and convergence disorders. Optometry 2002;73:735-762.

Ciuffreda KJ, Han Y, Kapoor, Ficarra AP. Oculomotor rehabilitation for reading in acquired brain injury. NeuroRehabil 2006;21(1):9-21.

Ciuffreda KJ, Kapoor N, Han Y. Reading-related ocular motor deficits in traumatic brain injury. Brain Inj/Professional 2005;2:16-20.

Ciuffreda KJ, Kapoor N, Rutner D, Suchoff IB, et al. Occurrence of oculomotor dysfunctions in acquired brain injury: A retrospective analysis. J Am Optom Assn 2007;78:155-161.

Ciuffreda KJ, Ludlam, Kapoor N. Clinical oculomotor training in traumatic brain injury. Optom Vis Dev 2009;40(1):16-23.

Ciuffreda KJ, Rutner R, Kapoor N, Suchoff IB. Vision therapy for oculomotor dysfunctions in acquired brain injury. Optometry-J Am Optom Assn 2008;79:18-22.

Ciuffreda KJ, Suchoff IB, Marrone MA, et al. Oculomotor rehabilitation in traumatic braininjured patients. J Behav Optom 1996;7:31-8.

Ciuffreda KJ, Suchoff IB, Kapoor N, et al. Normal vision function. In: Downey & Darling's Physiological Basis of Rehabilitation Medicine, 3
rd ed. Gonzalez EG, Myers SJ, Edelstein JE, et al., eds. Boston: Butterworth/Heinemann, 2001;241-61.

Ciuffreda, K. J., and Tannen, B., Eye Movement Basics for the Clinician, Mosby, St. Louis, MO, 1995.
Cockerham GC, Goodrich GL, Weichel ED, et al. Eye and visual function in traumatic brain injury. Journal of Rehabilitation Research and Development 2009; 46:818-18.

Cohen AH. Optometric management of binocular dysfunctions secondary to head trauma: case reports. J Am Optom Assoc 1992;63:569-75.

Cohen AH, Rein LD. The effect of head trauma on the visual system: the doctor of optometry as a member of the rehabilitation team. J Am Optom Assoc 1992:63;530-6.

Cohen AH. Acquired visual information-processing disorders: Closed head trauma. In: Press LJ, ed. Applied Concepts in Vision Therapy. St. Louis: Mosby, 1997:154-67.

Cohen AH. Optometric rehabilitative therapy. In: Press LJ, ed. Applied Concepts in Vision Therapy. St. Louis: Mosby. 1997:278-86.

Cohen AH. The role of optometry in the management of vestibular disorders. Brain Injury/Professional 2005;2:8-10.

Cohen AH. Management of patients with hemianopic visual field loss. J College of Optom in Vision Dev 2003;34: 111-18.

Cooper J. Deflating the rubber duck. J Behav Opt 1998;9(5):115-119.

Craig S, Kapoor N, et al. Profile of Selected Aspects of Visually Symptomatic Individuals With Acquired Brain Injury: A Retrospective Study. J Behav Optom 2008;19:1-10.

Du T, Ciuffreda KJ, Kapoor N. Elevated dark adaptation in traumatic brain injury. Brain Injury 2005 ;19(13):1125-38.

Doble JE, Feinberg DL, Rosner MS, Rosner AJ., Identification of binocular dysfunction (vertical heterophobia) in traumatic brain injury patients and effects of individualized prismatic spectacle lenses in treatment of postconcussive symptoms: a retrospective analysis.  American Academy of Physical Medicine and Rehabilitation 2010; 2(4): 244-253

Falk, Naomi S. and Aksionoff, Elizabeth B. , The Primary Care Optometric Evaluation of theTraumatic Brain injury Patient J Am Optom Assoc 8/92;63(8).

Fisk GD, Novack T, Mennemeier M, Roenker D.  "Useful field of view after traumatic brain injury."  Journal Head Trauma Rehabil. 2002, 17(1): 16-25.
   Background:  Traumatic Brain Injury (TBI) survivors often have sensory and cognitive impaitments that may interfere with driving ability.  The Useful Field of View (UFOV) is a measure of visual information processing that is a good predictor of vehicle crash risk in older adults.

   Objective:  The objective of this study was to explore the possibility that UFOV is comprompised afte TBI. 

   Design:  UFOV performance of 23 TBI survivors and 18 young adults without neurological impairment were compared. 

   Conclusion:  TBI survivors had higher UFOV scores that young adults, which indicated a greated functional loss of peripheral vision.  The results suggest that the UFOV may be a valuable instrument for assessing driving readiness in TBI survivors. 
Fox RS. The rehabilitation of vergence and accommodative dysfunctions in traumatic brain injury. Brain Injury/Professional 2005;2:12-15.

Gianutsos R, Ramsey G. Enabling rehabilitation optometrists to help survivors of acquired brain injury. J Vis Rehabil 1988;2(1):37-58.

Gianutsos R, Suchoff IB. Neuropsychological consequences of mild brain injury and optometric implications. J Behav Optom 1998;9(1):3-6.

Gianutsos R, Suchoff IB. Visual fields after brain injury: management issues for the occupational therapist. In: Scheiman M, ed. Understanding and Managing Vision Defects-A Guide for Occupation Therapists,2nd edition.
Thorofare, N.J.: Slack, 2002:248-62.

Goodrich L, Kirby J, et al. Visual Function in Patients of a Polytrauma Rehabilitation Center: A descriptive Study. J of Rehabilitation Research and Development November 2007: 44: 929-936.

Gottlieb DD, Freeman P, Williams M. Clinical research and statistical analysis of a visual field awareness system. J Am Optom Assoc 1992;63:581-8.

Gottleib DD, Fuhr A, Hatch WV, et al. Neuro-optometric facilitation of vision recovery after acquired brain injury. Neuro-rehab 1998;11:175-99.

Han Y, Ciuffreda KJ, Kapoor N. Reading-related oculo-motor testing and training protocols for acquired brain injury in humans. Brain Res Protoc 2004;14(1):1-12.

Han, M. H., Craig, S. B., Rutner, D., Kapoor, N., Ciuffreda, K. J., Suchoff, I. B., Medications prescribed to brain injury patients: a retrospective analysis, Optom 2008; 79, 252.

RJ. Loss of fusional vergence with partial loss of accommodative convergence and accommodation following head injury. Binoc Vis 1987;2(2):93-100.

Hellerstein LF. Visual problems associated with brain injury. In: Scheiman M, ed. Understanding and Managing Vision Defects-A Guide for Occupational Therapists, 2
nd edition.Thorofare,N.J::2002:178-85.

Hellerstein LF. Visual rehabilitation for patients with brain injury. In: Scheiman M, ed. Understanding and Managing Vision Defects-A Guide for Occupational Therapists, 2
nd edition.Thorofare,N.J::2002.

Hellerstein LF, Fishman BI. Vision therapy and occupational therapy: An integrated approach. J Behav Optom 1990;1(5):122-126.

Hellerstein LF, Fishman BI. Collaboration between occupational therapists and optometrists. OT Pract 6/99;22-30.

Hellerstein LF, Freed S. Rehabilitative optometric management of a traumatic brain injury patient. J Behav Optom 1994;5(6):143-8.

Hellerstein LF, Freed S, Maples WC. Vision profile of patients with mild brain injury. J Am Optom Assoc 1995;66:634-9.

Heitger MH et al. Eye movement and visuomotor arm movement deficits following mild closed head injury. Brain 2004;127(3):575-590.

Herdman SJ. Patients with vestibular disorders, part II. Postgraduate advances in Physical Therapy, APTA 1987:1-16.

Hillier CG. Vision rehabilitation following acquired brain injury: a case series. Brain Injury/Professional 2005; 2:30-32.

Hinrichs CA. Vision rehabilitation for the multiply challenged child. J Optom Vis Devel 6/92;23(2): 9-13.

Jackowski MM, Sturr JF, Taub HA, Turk MA. Photophobia in patients with traumatic brain injury: uses of light-filtering lenses to enhance contrast sensitivity and reading rate. Neurorehab 1996;6:193-202.

Jackowski MM, Sturr JF, Turk MA, Friedman DI. Clinical indications of altered peripheral field function in patients with traumatic brain injury. Invest Ophthalmol Vis Sci 1999;40 (4):32 (supplement).

Kapoor N, Ciuffreda KJ. Vision disturbances following traumatic brain injury. Current Treatm Options in Neurol 2002;4:271-280.

Kapoor N, Ciuffreda KJ, Suchoff IB. Egocentric localization in patients with visual neglect. In: Suchoff IB, Ciuffreda KJ, Kapoor N, eds. Visual and Vestibular Consequences of Acquired Brain Injury. Santa Ana, CA: Optometric Extension Program, 2001:131-144.

Kapoor N, Ciuffreda KJ, Han,Y. Oculomotor rehabilitation in acquired brain injury: A case series. Arch Phys Med Rehab 2005;1667-78.

Kapoor N, Ciuffreda KJ. Vision problems. In: Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of traumatic brain injury. Washington, DC: American Psychiatric Publishing,Inc,2005:405-15.

Katz RT, Golden RS, Butter J, Tepper, Rothke S, Holmes J. Driving safety after brain damage: follow-up of twenty-two patients with matched controls. Arch Phys Med Rehabil 2/90;71:133-137.

Lachapelle, J., Bolduc-Teasdale, J., Ptito, A., McKerral, M., Deficits in complex visual information processing after mild TBI: electrophysiological markers and vocational outcome prognosis, Brain Inj, 2008;22, 265.

Leslie S. Myopia and accommodative insufficiency associated with moderate head trauma. Optom Vis Dev 2009;40(1):25-31.

London R, Wick B, Kirschen D., Post-traumatic pseudomyopia.  Optometry 2003; Feb;74(2):111-20.

Massucci, Maura E.  "Prism adaptation in the rehabilitation of patients with unilateral spatial inattention."  Journal of Behavioral Optometry,  2009; 20(4), 101-105.  
   Abstract:  Unilateral spatial inattention (USI), also known as neglect, can occur subsequent to acquired brain injury, including traumatic brain injury or stroke.  USI can be present with or without a visual field defect, as determined by standard clinical methods.  Patients with USI can show varying degrees of spontaneous recovery within the first three months post-brian injury, but for many patients, USI symptoms remain severe.  Yoked prism has long been used in optometric management of visual field defects, including USI.  In this regard recent research shows that prism adaptation (PA) to a rightward displacment of the visual field improves USI symptoms.  Not only does PA ameliorate neglect on a sensorimotor level, it also influences higher spatial representation and cognition.  Its effects continue for up to six months with two weeks of twenty minute per day PA training.  Though PA's mechanism is not fully understood, the posterior parietal cortex and cerebellum are implicated in the process.  PA has huge implications for USI rehabilitation; its non-invasive nature makes it an effective rehabilitation tool to ameliorate both visuo-motor responses and higher levels of spatial representation and cognition in USI patients. 
Novack TA, Banos JH, Alderson AL, Schneider JJ, et al.  "UFOV performance and driving ability following traumatic brain injury."  Brain Inj. 2006; 20(5), 455-61. 
  Primary Objective:  To investigate the relationship between performance on the Useful Field of View Test (UFOV) and driving performance following traumatic brain injury (TBI).

   Participants:  Sixty people with TBI referred for drivintg evaluation.

   Measures:  Useful Field of View Test, Global Rating Scale and Driver Assessment Scale.

   Results:  Subject performance diminished as the complexity of the UFOV sub-tests increased.  There was a significant relationship between UFOV performance, particularly on the second sub-test, and on-road driving performance.  Subject age and Trail Making Test, Part B were also predictive of driving performance. 

   Conclusions:  The UFOV can be used as a screening measure to determine readiness to participate in an on-road driving assessment. 
Tinius TP, Tinius KA:  "Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder."  Journal of Neurotherapy, 2001; 4(2), 27-44.

Weissberg E, Lyons SA, Richman JE  "Fixation Dysfunction With Intermittent Saccadic Intrusions Managed by Yoked Prisms: A Case Report."  Optometry 2000 (71) #3 183-188.
   Background: A 44-year-old woman came to us with a cheif symptom of "jumping letters side-to-side, which is most noticeable while reading".  The onset occurred after she had experienced a closed head traumatic brain injury 3 years earlier.  Several neuro-opthalmologists diagnosed a fixation instability secondary to saccadic intrustions and prescribed Gabapentin, which provided minimal relief.  
   Methods:  The term saccadic intrusion referes to an inappropriate saccade witha  disruption effect on fixation.  Our examination revealed a myopic anisometropia.  Motility testing confirmed saccadic intrusions that lessened on occlusion of either eye and superior gaze.  A plano spectacle with six prism diopter yoked base down was used to position the eyes in the superior null poitn.  Electrooculography, using the Visagraph II, demonstrated pre and post changes with the prism.  The uncorrected anisometropia allowed the patient to be monocular under binocular viewing conditions. 

   Case Report:  The case report focuses on fixational problems that may occur secondary to traumatic brain injuries.  There is evidence that the origin of the problem may be from uninhibited brain stem circuits.  Pharmacological treatment may only offer transient improvement.  The responsibility of a functional cure is often placed on the optometrist. 

   Conclusion: This case demonstrates how an alternative use of prism and prescription application can play an important role in the management of fixation dysfunctions.