riding the wave…

Anyone who has been around Vision Therapy for a decent period of time may be familiar with the idea of offering rehabilitative care to patients with Traumatic Brain Injuries.  Helping patients to re-organize their visual inputs and balance their visual stimuli a lot of times can improve their quality of life post-injury. Just as every patient we treat is unique, my sense is every patient suffering a brain injury is equally as unique and challenged.  To quote an old adage, “when you’ve seen one brain injury, you’ve seen one brain injury”.  Among other aspects, the mechanism of injury and applications of rehabilitative care all play a role in a patient’s recovery, while the patient themselves dictate how far and how fast treatment and recovery may travel.  In my experience, patients with brain injuries lack nothing in “want  to”, only to see their progress slowed by their brains needing time and grace to heal. When this idea crosses my mind, flashes of my friend Abby Asaad COVT come to mind.

Working with patients who have been diagnosed with a traumatic brain injury used to scare and intimidate me.  I would worry that something would be missed, or somehow, I would harm them further. Looking back it seems silly, but at the time, the fear was real. As my comfort and experience level grew, it’s been amazing to have watched and helped many survivors put their lives back together, even if my part in their recovery was small.  Over time I’ve discovered these patients to be an area of great challenge on my ever expanding therapy skills. The truth is, these days my patients who have suffered a brain injury tend to offer the greatest sense of satisfaction.  As much as we are trained in Vision Therapy to expect the unexpected, sometimes these patients will challenge our sense of the unexpected and move us into a world of creativity and adaptability which would cause even the most seasoned therapist discomfort.  We need to be flexible, and we need to make it work.

Recently, our office began working with a patient who has challenged every skill I’ve ever learned, borrowed, stole, or inherited during my time as a Vision Therapist.  His mechanism of injury was uncommon considering the population patients I’ve treated, yet the impacts of his injury are far reaching. Sadly, his life has become a series of doctor visits, therapy sessions and pain management. When he’s not occupied with one of those chores, he reports being asleep. There is no fun, there is no enjoyment, and there’s only limited interaction with his wife and children in between migraine triggers. We have been working together for 8 weeks now, and mostly the goal has been achieving some semblance of visual comfort. He is extremely light sensitive, motion sensitive, experiences intermittent vertical diplopia, and reports nausea and a headache with every slight adjustment to his world.  Obviously, he unable to drive and his lack of independence has taken a toll on his emotional state and his home life. His road has been rough, to say the least.

Generally speaking patients offer us a “way in”, or an opportunity to expand visual capacities and abilities, no matter how narrow the opening.  Once we have a proverbial foot in the door, we look to find ways to broaden their visual world. Sadly, with this patient, my “way in” has not yet presented itself. We have made minuscule (perhaps an over-estimation) amounts of progress and continue to work to help make the world a bit easier to manage. Every time this patient arrives I’m hopeful in offering him a small bit of comfort, and every time he walks out I beat myself up for a few hours after making him feel more nauseous and generally ill than when he walked in. Finding a path between helping and hurting seems to be a fine line and a very delicate balance.  Regardless of past ideas, this one is going to be tough.

A very wise therapist once told me some patients will offer more to me than I will ever be able to offer to them.  I feel a wave of learning coming on…


Posted on June 25, 2018, in From My Perspective.... Bookmark the permalink. 1 Comment.

  1. GWilliamsFamilyEye

    Robert, I love your statement “time and grace to heal”. In addition to your experience and ability to communicate, your blogs are valuable due to your balance and honesty. We all have patients who do not progress as we would like and that, also, is important to share. Your positive attitude, when you could be frustrated, is priceless.
    Gary J. Williams


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