Homonymous Hemianopsia and Visual Neglect following a TBI
Following an injury to the right side of the brain, an individual’s visual field might be affected.
Some vision problems after TBI include:
- Blurred vision
- Sensitivity to light
- Double vision
- Achy eyes
- Headaches with visual tasks
- Words appear to move when reading
- Loss of visual field
The loss of part of one’s visual field can refer to Homonymous Hemianopsia. The resultant consequence is losing one half of their side vision on the same side in both eyes. “Homonymous” refers to having the same, “Hemi” refers to half and “Anopsia” refers to blindness.
“Neglect” is the inattention to or lack of awareness of visual space to the right or left, which can occur following damage to the processing areas of the brain. It should not be confused with hemianopsia, which is damage to the primary visual pathways cutting off input to the cerebral hemispheres. In other words, neglect is a “perceptual deficit”, whereas hemianopsia is a “visual deficit”.
Some individuals who have neglect may also have hemianopsia; however, this does not have to be the case.
The resultant symptoms of neglect include:
- Bumping into objects on the right or left
- Missing parts of words on the right or left when reading
- Hemispatial neglect – When one may only eat food off half the plate, only apply make up on half the side of their face
Treatment for both visual neglect and hemianopsia concentrates on awareness training of the neglected/damaged side. This includes the following:
- Encouraging eye and head movement to the neglected side by using scanning exercises
- Increase the client’s sensory awareness in the area of neglect. This may include squeezing a ball on the side of neglect.
- The client may wear a “timer” to beep at intervals in order to remind them to scan toward the neglected field.
- Use tactile reinforcement to help the client find the neglected side when reading, such as a Velcro or sandpaper strip.
- Place bright stickers on the neglected side on doorways and walls throughout the home to help make the client aware of this side and prevent bumping into it
The occupational therapists at GLA incorporate these strategies into the client’s activities of daily living.
Our Success Story this month comes from a client who was diagnosed with Homonymous Hemianopsia following her TBI. In addition to the hemianopsia, she was displaying symptoms of left neglect.
She began to notice this when she started bumping into objects on her left side. She was bumping into doorways and furniture to her left. She missed parts of her meal as she was not paying attention to the whole plate. She could not read as she was missing parts of the lines on the left. Her family also noted that she was not looking to her left when crossing the street and they were concerned for her safety.
In occupational therapy sessions, we began incorporating “awareness training” into treatment. The family was educated on the awareness training so that they could continue to cue her when the therapists were not present.
The OT was working closely with the Rehabilitation Support Worker who was able to incorporate the training into daily functions and community activities. The client even found a love of Badminton, which forced her to follow the birdy with her eyes when hit to the left of her.
The client has been able to integrate the strategies learned into her daily routine and is continually improving with becoming more aware of her left side. For example, she is now able to cue herself to look to the left with an alarm set in her cell phone. The phone will beep several times per day and a message will be displayed to look to her left. She also learned to screen the plate when she eats. She moves her head to the left when she reads so she does not miss parts of the line. Her family was taught to try to sit to the left of her and place objects, such as ingredients when cooking, to the left, in order to “force” the client to scan this way.
Although she may not regain her left sided vision loss, she has learned techniques and strategies of how to compensate for this loss and has become more functional in her daily activities because of this.
If you would like to find out more information about how we work with clients with Homonymous Hemianopsia, please visit our website.