Contributed by: Juliet Machado, COVT

“Don’t compare your life to others. You have no idea what they have been through.” – Sam Cawthorn

Today was to be the day. I was going to be presenting at the 50th annual COVD meeting, internationally, in the year 2020!!

Inspiration struck following last year’s annual COVD meeting in Kansas City. On my flight home I drafted the first outline of a presentation about the complexities of working with people who have suffered a brain injury; tips on how Vision Therapists can guide survivors to thrive after enduring a loss like no other – a loss of identity.

My approved proposal from the COVD Education Committee to join the prestigious group of presenters that have come before me, led me to a year of thinking, planning, collaborating, researching, creating, editing and breathing.

The meeting was in sight. My schedule was jam packed, my nerves were barely in check and I was getting more excited by the day. I was anticipating all the amazing experiences planned for this year’s meeting and I was excited to be with my VT family (and my real family too; my dad and first cousin, both FCOVD, were going to be there!).

Then the world changed….in what seemed like an instant.

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There was confusion, and panic.
The medical community was giving me information I didn’t fully understand.
Events and travel were cancelled.
My job was put on hold, and I struggled with what to do with myself.
I was isolated, not able to be in areas with crowds of people.
I had lost my purpose.
I had to evaluate my financial situation.
I was getting headaches.
My anxiety was high and I didn’t want to eat.
I felt exhausted but couldn’t sleep.
I was frustrated as I set goals I somehow couldn’t accomplish.
All I wanted was to have my normal back.
And it was unknown when it was going to get better.
And I was afraid.

With an unsettling sense of familiarity to these occurrences, I paused, took a moment to reflect, and had a sudden, overwhelming awareness that the “new normal” we are all experiencing with COVID-19 is a glimpse into life after brain injury. I was overcome with emotion as I realized the similarities with our current situation while simultaneously humbled to remember that although we will overcome this pandemic, brain injury survivors will need to continue the ongoing work of discovering their personal “new normal”.

I found a new purpose. I reminded myself of the tools I use as an ABI Vision Rehabilitation Therapist and began the necessary work to thrive during this challenging time. I began to breathe, and eat, and sleep and walk. I found space to think in a new way, to research, and to create.

My work brought me to the realization that I still have something to share today. The same theme as my original presentation, guiding survivors to thrive, and the same goal, that you find a tool to “take back to your office on Monday morning” to share with and help someone else.

Given the current circumstances, we have all become survivors. We all need to practice tools to keep our mind and body safe during unsettling times. Find what works for you, too, and practice your favorites. Use your personal experience to connect on a deeper level with the brain injury survivors you work with optimizing their vision therapy program.

Create a positive mindset. Discover what you can do instead of dwelling on what you cannot control. Practice looking for the positive while getting rid of the noise of negative thoughts.

  •  Make a daily plan or schedule. Set realistic goals
    ○ Give yourself permission to check off only one thing a day. Build from there.
  • Use a Journal.
    ○ Write down something you are Grateful for.
  • Pick up an old hobby or try something new. Listen to a new genre of music. Go through old pictures. Make a mask!

Recognize that the sympathetic nervous system is in overdrive, attending to the problem and how we are going to survive, not allowing the parasympathetic system to process, think, and solve. We must work to create balance.

  • Practice Belly Breathing. Slow, deep breathes. Work to get out of your head and into your body.
  • Start the day with a cross lateral “hook up” activity.
    ○ Something simple – March In Place with opposite arm/leg movement.
  • Stimulate the vagus nerve by humming and gargling throughout the day.

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Practice good Visual Hygiene. Especially now that we are reading more, and on our devices extended periods of time. Following brain injury visual hygiene is necessary for the overall success of vision rehabilitation.

  • 20-20-20 Rule. Every 20 minutes, look 20 feet away, for 20 seconds. Visualize. Set a timer to remind you.
  • Use your glasses, and keep them clean. Keep your screens clean too.
  • Practice good posture, hold the book at 16”, use good lighting, avoid glare and reflections.
  • Set your computer/laptop screen 20-30 inches from your eyes with the top of the screen just below eye level. Tilt the top of the screen away from you at 10- to 20-degree angle.

Nutrition and exercise are necessary for good body regulation. Our bodies rely on the fuel we provide and the energy we put out.

  • Eat mindfully to allow your body and brain to process the meal. Eat without distraction, stop, sit, savor your food. Talk yourself away from negative thoughts associated with comfort eating – eat in moderation. Stay hydrated.
    ○ Eat regularly, every 4-6 hours. If needed, schedule meals so they become one less thing to have to think about.
    ○ Start the day with a good source of protein to set you up with energy for the day.
    ○ Eat whole foods, eat meals with protein and produce.
    ○ Remove inflammatory food sources.
  • Move your body during the day. Aim for 30 minutes.
    ○ For survivors:
    ■ Exercise safely.
    ■ Do not provoke symptoms. Recovery should be achievable within 5-minutes of activity cessation.
    ○ Go for a walk.
    ■ Walk with a visual purpose. Pay attention to how vision supports or interferes. Can you comfortably integrate central/peripheral information? Practice moving your eyes, head, body to navigate space and obtain visual information.  Talk while you walk.  Dribble a ball.  Bop a balloon.

Find Support. As a human species it is our nature to stay connected to others, it brings us relief to know we are not alone. In this difficult time of physical distancing, technology allows us to safely reach out to family and friends to find comfort in others who are sharing our experience. Brain injury survivors need this connection now more than ever.

The community of providers dedicated to the development, rehabilitation, and enhancement of vision performance thrive on the power of potential. It is our mission to improve the quality of life of those we serve, and we pour our heart and soul into our work.  Keep going – no matter how bad things are now, no matter how many days you’ve spent wishing things were different – keep going. Take care of yourself, and those around you.  There is light at the end of the tunnel, stay focused.

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Cheers to the 50th Annual COVD meeting in 2021, may we find peace until we join together to celebrate our health, our VT family and our triumph.


Juliet Machado, COVT works at Lifetime Eye Care in Eugene, OR and has been a member of COVD since 2005.   Through COVD, she serves on the Vision Therapist Education Subcommittee and is an active therapist certification mentor. Juliet has lectured on the connection between vision and learning, vision and special populations, vision rehabilitation following brain injury; has presented for the COVD Therapist Webinar Program, regularly lectures through Pacific University’s Graduate Program to students completing their Masters degree in education and has presented a 3-day comprehensive course on vision therapy practice and management.  She thanks her husband and daughter for their patience and love while she found her path to thrive.