The devil is in the details
A 75 year-old female patient came to our program with persistent post-concussion symptoms of 1 year duration after she had had a slip on ice resulting on a fall backwards onto the back of her head. She struggled with her symptoms and was eventually seen by a behavioural optometrist and a visual therapist at another center. She did 26 sessions (expense amounting to nearly 6 months of work and $5000) and was not feeling any better. She then reached out to our program. Over the course of the first few assessments she was found to have several fundamental problems that would have, or did, preclude her success with vision therapy.
To review briefly, she had developed Benign Paroxysmal Positional Vertigo and Persistent Postural-Perceptual Dizziness somewhere along the way post-concussion, during her time at vision therapy perhaps. To put it simply, she had poor appreciation of her peripheral field of view which lent poor context to her impression of where she felt she physically was. She also was over-reliant on her visual system, which was betraying her. In this context, her doing visual therapy could be likened to trying to focus a camera in a shaky hand. She unwittingly tried to stabilize her perception of what she was seeing by reflexively stiffening her neck, a process that was challenging to get her to relax. Her neck was already susceptible to pain due to arthritis and so this added insult to injury. Our assessment revealed many neck diagnoses that were amenable to getting better with therapy. The first time we had her stand in front of an obnoxious table cloth – see below – she nearly fell and had to be caught. She identified her orientation with that of the tablecloth. No wonder she had avoided Costco, grocery stores, busy areas, etc. Other diagnosis that she had developed in the context of the above were headaches, fatigue, insomnia, anxiety/depression, cognitive complaints, isolated from activities she enjoyed in addition to the visual issues she had – double vision when she looked off to her left.