I was very excited to attend the COVD Annual Meeting this year in Bellevue, WA.  As a neuro-optometrist, there were many educational courses this year that were geared toward my practice and one in particular was the Pre-Meeting Course “Optometric Management of Patients with Acquired Brain Injury and Brain Filtering Problems,” taught by Dr. Allen Cohen and Dr. Neera Kapoor.  I was mentored by both of these presenters during my residency and their knowledge and experience are truly amazing.

Dr. Neera Kapoor is the recipient of this year’s Skeffington Award, of which she is most deserving, as she has written and co-authored numerous papers in the area of neuro-optometric rehabilitation.  Below is a review of a recent article she co-authored in COVD’s journal, Visual Development and Rehabilitation.

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OT-OD synergy during management of the Concussed: A Case report illustrating seamless care ‘handoffs’

I truly enjoyed reading this article because of the multidisciplinary aspect of this patient’s care.  The multidisciplinary team in this case included physiatry (PM&R physicians), neuro-optometry, occupational therapy (OT), and vestibular therapy.  Such a model of rehabilitation that includes neuro-optometry is rarely found in rehab hospitals, which is unfortunate, as visual deficits are so prevalent in the concussion and traumatic brain injury (TBI) population.   I appreciated the details pertaining to OT intervention, as OTs do focus on patient education, symptom management, and functional skills that are unique to their profession.  Some thoughts and questions:

  1. The patient did not see the neuro-optometrist during the first course of OT, which consisted of 39 sessions over 11 months. The authors stated that a recommendation was made to integrate neuro-optometry into the care team, but the patient did not follow through due to scheduling conflicts.  In my experience, patients benefit from neuro-optometry evaluations earlier-on in their treatment.
  2. It was noted repeatedly by the care team that the patient was experiencing an extreme amount of work-related pressure, and that this may have influenced the reported subjective impressions of her recovery. This statement really resonated with me. I encounter many patients who also experience life stressors during their recoveries, and those stressors do affect their perception of symptoms.  My question is: Did this patient receive a psychological evaluation?  I have found that these patients often benefit from psychological counseling that addresses the irritability, mood changes, and sleep disturbances brought on by brain injury.
  3. I wonder if neuro-optometric rehabilitation therapy and occupational therapy need to be two separate entities if there is a neuro-optometrist on staff. In our multidisciplinary clinic, we have the neuro-optometrist perform the evaluation and follow-up, and the occupational therapist performs the neuro-optometric rehabilitation therapy.  This does require the neuro-optometrist to provide additional education and training on neuro-optometric rehabilitation procedures, including the use of prisms and accommodative lenses, both of which an OT cannot use unless working directly with a neuro-optometrist.  But if the neuro optometrist and OT can build a trusting relationship and open dialogue in such a situation, this arrangement could deliver the same care more efficiently.

This article shined a light on how neuro-optometrist and OTs can work together in a multidisciplinary practice.  It would be a benefit to all concussion and TBI practices to have a neuro-optometrist on staff, allowing better patient access and better multidisciplinary communication and treatment of the TBI patient.

 

Rizzo JR, Waskiewicz M, Kapoor N. OT-OD synergy during management of the concussed: A case report illustrating seamless care “handoffs’. Vision Dev & Rehab 2017;3(3):131-46.