Consequences of Neuro-Visual Processing Dysfunction Affecting. & Spatial Orientation

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1 Consequences of Neuro-Visual Processing Dysfunction Affecting Balance, Posture & Spatial Orientation (Visual Midline Shift Syndrome) William V. Padula, OD, FAAO, FNORA, FNAP ICBO / NORA April 8, 2010

2 Padula Institute of Vision i Rehabilitation i 2

3 Neuro - Visual Processing Dysfunction Affects Posture Balance Spatial orientation Attention ti and concentration ti Binocularity

4 Balance, Posture, Movement and Spatial Orientation Affected by: -mismatch between vision and sensorimotor information

5 Neuro-Visual Processing: A Model for Visual Rehabilitation

6 Need for Neuro Optometric Rehabilitation Visual Processing Problems Binocular Function Problems Balance/Posture Cognitive Rehabilitation through Lens/Prism/Sect s /Sect Hemianopsia 6

7 Neuro-Visual Processing Rehabilitation Applied principles i of movement and posture to understanding of vision processing Use of prescribed therapeutic lenses and prisms to affect posture and movement through visual processing

8 Ganglion Cells from Retina Magnocellular shape and movement (rapid) Parvocelluular detail information contained in shape (much slower) Konicocellular 8

9 Retinal Cells Transverse Through Retino-geniculate i t cortico pathway P and M cells Retino-tectal pathway M cells for spatial orientation prior to focalization (posture and balance) 9

10 Neurological Visual Pathway to Superior Colliculus Optic Tract via Superior Brachium Occipital Cortex via Optic Radiations (through Lateral Geniculate) Spinotectal Tract (from Spinal Cord and Medulla) 10

11 Lateral Geniculate Dorsal Ganglion relay and distribution of visual information to portions of brain other than occipital cortex Ambient Vision 20% peripheral fibers match and relay with axons delivered to superior colliculus 11

12 Motion Perception Retinal sensory (ambient vision) Ganglion cells Lateral Geniculate Thalamus Occipital cortex 12

13 Coordinated Movement Requires Interaction Between Sensory afferents from vision (ambient) Somato-sensory Vestibular 13

14 Information from Superior Colliculus (Ambient Vision) Integrates with head and body postural information flowing through - Vestibulo-spinal tract - Vestibulo-cerebellar tract 14

15 Multi-Sensory Integration and Conscious Perception Projected into secondary and associational cortices of Frontal, Parietal, and Temporal Lobes Produces awareness of: - Dizziness - Vertigo - Imbalance 15 15

16 Visual Midline Shift Syndrome 16

17 Modifying Postural Adaptation Following a CVA Through Prismatic atc Shift of Visuo-Spatial a Egocenter W. Padula OD, C. Nelson PhD OTR, W. Padula MS, R. Benabib MS, T. Yilmaz MPH, S. Krevisky MS Brain Injury (2009) 23:6,

18 Lean or Ambulatory Drift Is it neurological? Is it visual? Is it both? (Eubank and Ool, 2001) (Nelson and Benabib, 1993) 18

19 Postural Adaptation Following a CVA Lean Toward the Hemiparetic Side (uncompensated state) Lean Away from the Hemiparetic Side (compensated state) 19

20 Postural Adaptation Following a CVA Lean Toward the Hemiparetic Side (uncompensated state) Lean Away from the Hemiparetic Side (compensated state) 20

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26 Case Studies (Videos)

27 VMSS Affects Spatial orientation for Posture Balance aa Ambulation Driving Spatial localization

28 Conclusion Neuro-Optometric Rehabilitation is and Emerging Specialty NeurOpto-Postural t Therapy is a specialized approach within NOR Following a Neurological Event the Majority will have Visual Dysfunction Post Trauma Vision Syndrome and Visual Midline Shift Syndrome The Interdisciplinary Challenge 28

29 Neuro-Visual Processing Treatment Approaches Lens Prism -Yoked Prism -Enhanced Field Prism Sectoral Occlusion Visual-Postural Therapy 29

30 Padula Institute of Vision Rehabilitation PO Box 1408 Guilford, CT. USA Web: padulainstitute.com lainstit te 30

CRITICALLY APPRAISED PAPER (CAP)

CRITICALLY APPRAISED PAPER (CAP) Padula, W. V., Nelson, C. A., Padula, W. V., Benabib, R., Yilmaz, T., & Krevisky, S. (2009). Modifying postural adaptation following a CVA through prismatic shift of visuo-spatial