Visual Retraining


Will you explain how you start saccadic or smooth pursuit training?

Answer:

“I don’t do saccadic or pursuit training initially by itself. I keep everything, in the beginning, 18 inches and out. What happens is, at 18 inches and in, you begin to stimulate convergence. If you stimulate convergence, that can change how that system works. So, you want to keep that periphery open, whether you’re just getting them peripherally aware. Once again, either seated or you can put them down on the floor, you have to put them in a safe position to do that.”

Faculty:

DeAnn Fitzgerald, OD

Q: How do you use a TheraBand?


Answer:

“We take the TheraBand and wrap it around the patient’s arm, have them hang on to it, perhaps wrap it around their back (depends on if this patient is in a wheelchair), and this gives them pressure. It allows them to know where they are in space. You can do that with TheraBand or a weighted vest. The specifics can be found in a Canadian study. It’s actually a physiotherapist I worked with through NORA that was able to do the Canadian study with the weighted vest and had a lot of good results with that. So, when we incorporated it, we started out with getting eye movements to work better. If they’re in a wheelchair or seated in front of me, if I assess their eye movements and I find they have saccadic intrusions, nystagmus, I just merely ask them to press against my hand to initiate that movement and then I observe the pursuits and the saccades. So, that’s where getting into shoring up that parietal lobe or giving that information has been very helpful. Who else uses it is Craig Hospital in Colorado.”

Faculty:

DeAnn Fitzgerald, OD

Does a convergence insufficiency affects someone’s progress in VRT?


Answer:

“Does a convergence insufficiency affect someone’s progress in VRT? Absolutely. So what ends up happening is that, as I talked about before, we have two concepts that are probably behind NPC. So NPC is very much a spatial type of problem. So if we don’t know where we are in space, if we’re using more of the typical type of vestibular rehab, my humble opinion is that if we stay at that level, we’re not going to be able to get that patient better. And once again, I would suggest using dorsal parietal types of peripheral activities in order to help that.

One of the ways you can do that depending upon the age of your patient, but if you can have that patient lie down on the floor, and then you begin to do your vestibular types of trainings. We understand that in a supine position, it’s not going to be holding as you get up because of gravity, but there is some memory involved in there. So I would start with a lying down position if you can, and then have them seated. When you can’t use a lying down position, that’s where we’re looking at these weighted vests, a t-shirt one size too small, that sort of thing.”

Faculty:

DeAnn Fitzgerald, OD

Q: Can medications change your findings?


Answer:

“Well, absolutely medications will absolutely change all of your types of findings. That’s the number one thing I ask. I ask, “Are you taking any medications?” And so for those patients who present with dizziness or lightheadedness, and they’re on three different blood pressure medications. Once again, the first thing I want to find out is if they’re standing and they get lightheaded, that’s going to be pretty common. That’s what should happen. What you can try is having, get squared away at the end of your chair or at the end of their bed. What they want to do is if they stand up and they’re lightheaded, what I’d have them try is (it sounds interesting), I’d have them plug their nose, do a Valsalva type of technique, not real hard. That drives the blood pressure up to their brain, and then they take a few minutes and they stand, they may not have that type of lightheadedness.”

Faculty:

DeAnn Fitzgerald, OD

Q:How do you perform an anti-saccade task?


Answer:

“Getting back to the question of anti-saccades, that is one way to actually legitimately check out how is that frontal lobe working. And I think as we talked about how can we then drive that frontal lobe in order to be able to act more appropriately. Well, one way to check it would be the Stroop test, you could use looking at saccadic latencies, you could look at arm swing or lack thereof. You can look at anti-saccades. What do you do then to see if you can change that real estate? I would do then a contralateral cerebellum type of activity. So if I’m looking at a left frontal lobe decrease, then I’m going to do something to get that right cerebellum to see if I can get it to communicate better with that left frontal lobe.”

Faculty:

DeAnn Fitzgerald, OD



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FACULTY BIO:

DeAnn Fitzgerald, OD

DeAnn Fitzgerald, O.D. is Vice President of the Neuro-Optometric Rehabilitation Association (NORA), an inter-disciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life. Dr. Fitzgerald has been providing eye care to eastern Iowa since graduating from Pacific University School of Optometry in 1984. She runs a busy primary care clinic where she diagnoses and treats ocular disease and evaluates patients with brain injury. She recently launched her sports vision and concussion clinic, Active Evolution Studio. Dr. Fitzgerald has a special interest in sports vision performance and concussion.