Consequences of Neuro-Visual q Processing Dysfunction Affecting - - PowerPoint PPT Presentation

Consequences of Neuro-Visual q Processing Dysfunction Affecting Balance Posture Balance, Posture & Spatial Orientation (Visual Midline Shift Syndrome) (Visual Midline Shift Syndrome)

Willi V P d l OD FAAO William V. Padula, OD, FAAO, FNORA, FNAP ICBO / NORA A il 8 2010 April 8, 2010

Padula Institute Vi i R h bili i

• f Vision Rehabilitation

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Neuro - Visual Processing Neuro Visual Processing Dysfunction Affects

• Posture
• Balance

Balance

• Spatial orientation

Att ti d t ti

• Attention and concentration
• Binocularity

Balance Posture Movement Balance, Posture, Movement and Spatial Orientation

• Affected by:

Affected by:

• mismatch between vision and

sensorimotor information sensorimotor information

Neuro-Visual Processing: A Model for Visual Rehabilitation

Need for Neuro Optometric Need for Neuro Optometric Rehabilitation

• Visual Processing Problems
• Binocular Function Problems
• Balance/Posture
• Cognitive Rehabilitation through

Lens/Prism/Sect

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e s/ s /Sect

• Hemianopsia

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Neuro-Visual Processing Rehabilitation Rehabilitation

A li d i i l f t d

• Applied principles of movement and

posture to understanding of vision i processing

• Use of prescribed therapeutic lenses

and prisms to affect posture and movement through visual processing

Ganglion Cells from Retina

Magnocellular—shape and movement (rapid) Magnocellular shape and movement (rapid) Parvocelluular—detail information contained in shape (much slower) shape (much slower) Konicocellular

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Retinal Cells Transverse Retinal Cells Transverse Through

R ti i l t ti th P

• Retino-geniculate cortico pathway—P

and M cells

• Retino-tectal pathway—M cells for

spatial orientation prior to focalization

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(posture and balance)

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Neurological Visual Pathway Neurological Visual Pathway to Superior Colliculus

O ti T t i S i B hi

• Optic Tract via Superior Brachium
• Occipital Cortex via Optic Radiations

(through Lateral Geniculate)

• Spinotectal Tract (from Spinal Cord and

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p ( p Medulla)

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Lateral Geniculate

• Dorsal Ganglion – relay and distribution
• f visual information to portions of brain

p

• ther than occipital cortex
• Ambient Vision – 20% peripheral fibers

match and relay with axons delivered to

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match and relay with axons delivered to superior colliculus

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Motion Perception

• Retinal sensory (ambient vision)
• Ganglion cells

Ganglion cells

• Lateral Geniculate

Th l

• Thalamus
• Occipital cortex

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Coordinated Movement Requires Interaction Between Requires Interaction Between

• Sensory afferents from vision (ambient)

S t

• Somato-sensory
• Vestibular

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Information from Superior Colliculus (Ambient Vision) (Ambient Vision)

• Integrates with head and body postural

information flowing through g g

• Vestibulo-spinal tract

Vestibulo cerebellar tract

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• Vestibulo-cerebellar tract

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Multi-Sensory Integration and Multi Sensory Integration and Conscious Perception

• Projected into secondary and

associational cortices of Frontal, , Parietal, and Temporal Lobes

• Produces awareness of:

Produces awareness of:

• Dizziness

V ti

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• Vertigo
• Imbalance

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Vi l Midli Shift Visual Midline Shift Syndrome Syndrome

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Modifying Postural Adaptation Following a CVA Through Prismatic Shift of Visuo-Spatial s at c S t o suo Spat a Egocenter

• W. Padula OD,
• C. Nelson PhD OTR,
• W. Padula MS,
• R. Benabib MS,

T Yil MPH

• T. Yilmaz MPH,
• S. Krevisky MS
• Brain Injury (2009) 23:6,

566-576

Lean or Ambulatory Drift

• Is it neurological?

g

• Is it visual?
• Is it both? (Eubank and Ool 2001)
• Is it both? (Eubank and Ool, 2001)

(Nelson and Benabib, 1993)

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Postural Adaptation Following Postural Adaptation Following a CVA

L T d th H i ti Sid

• Lean Toward the Hemiparetic Side

(uncompensated state)

• Lean Away from the Hemiparetic Side

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y p (compensated state)

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Postural Adaptation Following Postural Adaptation Following a CVA

• Lean Toward the Hemiparetic Side

p (uncompensated state)

• Lean Away from the Hemiparetic Side

(compensated state)

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(compensated state)

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Case Studies (Videos)

VMSS Affects

• Spatial orientation for

p

– Posture – Balance a a ce – Ambulation – Driving Driving – Spatial localization

Conclusion

• Neuro-Optometric Rehabilitation is and

Emerging Specialty N O t P t l Th i i li d

• NeurOpto-Postural Therapy is a specialized

approach within NOR

• Following a Neurological Event the Majority
• Following a Neurological Event the Majority

will have Visual Dysfunction

• Post Trauma Vision Syndrome and Visual

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y Midline Shift Syndrome

• The Interdisciplinary Challenge

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Neuro-Visual Processing Neuro Visual Processing Treatment Approaches

• Lens
• Prism

Yoked Prism

• Yoked Prism
• Enhanced Field Prism

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• Sectoral Occlusion
• Visual-Postural Therapy

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py

Padula Institute of Vision Rehabilitation Rehabilitation

PO Box 1408 Guilford, CT. USA 06437 203-453-2222 Web: padulainstitute com Web: padulainstitute.com Email: pad la@pad lainstit te com

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wpadula@padulainstitute.com