Binasal Occlusion (BNO), Visual Motion Sensitivity (VMS), and the Visually-Evoked Potential (VEP) in mild Traumatic Brain Injury and Traumatic Brain Injury (mTBI/TBI)

Analysis of the Clinical Effect of Visual Electrophysiological Examination Combined with Targeted Health Education Nursing in Children

Objective

To analyze the clinical effect of visual electrophysiological examination combined with targeted health education nursing in children.

Methods

A total of 100 children who underwent visual electrophysiological examinations in the Ophthalmology Department of our hospital from March 2019 to March 2021 were selected as the study subjects. The children were randomly divided into two groups, the control group and the observation group, with 50 children in each group. Children in the control group received routine nursing, while those in the observation group received a combination of routine nursing and targeted health education nursing. The nursing satisfaction, degree of cooperation with examination, examination time, changes in the psychological state, and the stress response of the children and their families were then compared and analyzed.

Results

The nursing satisfaction of the observation group was higher than that of the control group (94.0% vs. 80.0%) (P < 0.05). The degree to which children in the observation group cooperated with examination was higher than that of children in the control group (96.0% vs. 78.0%) (P < 0.05). The average time spent on VEP and ERG examinations by children in the observation group was 6.33 ± 1.37 hours and 55.25 ± 4.92 hours, respectively, significantly lower than that of 12.45 ± 1.02 hours and 70.36 ± 5.31 hours, respectively, spent by children in the control group (P < 0.05). After intervention, the depression, hostility, anxiety, and obsession scores of children in the observation group were all significantly lower than those of children in the control group (P < 0.05). There was an increase in the heart rate, respiratory rate, and mean arterial pressure in children from both groups, but the magnitude of increase in the observation group was much smaller than that in the control group (P < 0.05).

Conclusion

The combination of visual electrophysiological examination and targeted health education nursing in children has a remarkable clinical effect. It improves the children's degree of comfort as well as the parents' degree of satisfaction. It also reduces the time spent on examinations, facilitates the smooth completion of examinations, and improves the efficiency of examinations. This nursing method is one that merits more widespread promotion and clinical application.

Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.

Vision therapy: Occlusion, prisms, filters, and vestibular exercises for mild traumatic brain injury

A number of treatment approaches have been advocated for persistent visual complaints following mild traumatic brain injury. These include devices such as binasal occlusion, yoked prisms, vertical prisms, and filters, as well as vestibular training. We discuss the rationale and the evidence for each of these approaches. Binasal occlusion has been advocated for visual motion sensitivity, but it is not clear why this should help, and there is no good evidence for its symptomatic efficacy. Base-in prisms can help manage convergence insufficiency, but there are few data on their efficacy. Midline shift is an unproven concept, and while the yoked prisms advocated for its treatment may have some effect on egocentric neglect, their use in mild traumatic brain injury is more questionable. A wide variety of posttraumatic symptoms have been attributed to vertical heterophoria, but this is an unproven concept and there are no controlled data on the use of vertical prisms for mild traumatic brain injury symptoms. Filters could plausibly ameliorate light intolerance but studies are lacking. Better evidence is emerging for the effects of vestibular therapy, with a few randomized controlled trials that included blinded assessments and appropriate statistical analyses. Without more substantial evidence, the use of many of these techniques cannot be recommended and should be regarded as unproven and in some cases implausible.

Concussion part II: Rehabilitation - The need for a multifaceted approach

INTRODUCTION

While most individuals recover in the initial days to weeks following a concussion, in up to 30% of cases symptoms and functional limitations may persist beyond the initial four weeks. There is emerging evidence that multifaceted physiotherapy techniques for individuals who have ongoing symptoms following concussion may be of benefit.

PURPOSE

The purpose of this masterclass article is to summarize the evidence for rehabilitation, describe treatment techniques and multifaceted interventions following concussion.

IMPLICATIONS

Concussion is a heterogenous injury and multiple types of rehabilitation may be required to address ongoing alterations in function. A greater understanding of evidence based rehabilitative techniques will enable the clinician to direct treatment and facilitate recovery for individuals who have ongoing symptoms following concussion.