MANAGEMENT OF ACQUIRED BRAIN INJURY IN A CHILD

Melnick Auditorium

Introduction. Transient ischemic attacks (TIA) can be detrimental to the body as well as the visual system. This case will focus on the effects of TIAs on the visual system of a child. The presentation will include a description of how to use both Fresnel prisms and vision therapy to successfully treat children with acquired brain injury. Case presentation. A nine-year-old female presented with neck pain from a left head turn which developed following a series of transient ischemic attacks due to a ventriculoperitoneal (VP) shunt malfunction. The transient ischemic attacks lead to a comitant strabismus, oculomotor dysfunction, pendular nystagmus, and bilateral left hemianopia. Her goals for vision therapy include regaining comfort and efficiency in reading books and music. Deviation From the Expected. Typically a person with a bilateral left hemianopia will use yolked prisms in order to help them appreciate their left peripheral field; thus, yolked Fresnel prisms were used on the patient. She was able to appreciate the increase in her left field, but became diplopic after a few weeks of using the yolked prism. During vision therapy different prisms and visual techniques will be used to train the patient to function efficiently and comfortably. Discussion. VP shunt malfunctions can occur due to obstructions, disconnections, or infections. Optometrists like any other health care professional, need to be aware of what to look for in a child that is having a ventriculoperitoneal shunt malfunction. Some visual problems during a VP shunt malfunction are blurry vision, double vision, or loss of vision. These patients need to be immediately referred to the emergency room. If the VP malfunction has caused an acquired brain injury, vision therapy should become part of the treatment plan, along with OT and PT. Conclusion. The patient is currently going through vision therapy. The nine-yearold female patient has been working on using yolked prism, fixation, oculomotor, peripheral awareness, and visual scanning activities during the vision therapy sessions. We anticipate vision therapy will allow her, and other children with acquired brain injuries, to increase her comfort and efficiency in reading. Grants. None.