How To Treat Visual Issues After A Concussion: A Case Study

Did you know Physical Therapists treat concussions? Recovering from a concussion can be a confusing and scary time. A Physical Therapist trained in concussion management can guide you through concussion rehab from start to finish. At Wagner PT & Performance, we are specially trained in concussion and vestibular rehabilitation. We can help with all the symptoms of a concussion, from neck and shoulder pain to headaches, visual issues, and more.

So, if you or someone you know needs concussion care, keep reading, and please reach out with any questions.

One caveat before we proceed: concussions are serious and need to be assessed ASAP. If you or a loved one have had a concussion, be sure to get evaluated.

The Visual System and Concussions

We use our visual system to orient ourselves in the world, help maintain balance, and participate in life. Luckily, most of us never have to think about our vision (other than wearing glasses or contact lenses). The mechanisms that keep our vision clear and functional are mainly automatic but can be interrupted after a concussion.

Up to 90% of patients have visual issues after concussions. These symptoms can include things like:

• Double vision

• Difficulty tracking objects

• Difficulty shifting gaze from one object to another

• Difficulty reading

• Eye strain

• Light sensitivity

Visual issues can also be a major driver of symptoms, such as:

• Headaches

• Fatigue

• Difficulty concentrating

• Brain fog

• Difficulty at school or work

If patients have trouble with their visual system, their brain must work much harder to function normally. When you combine this with other issues after a concussion, it can be easy to see why patients have so much trouble with concentration, brain fog, energy levels, irritability, and much more.

Every concussion is unique, but visual issues are one of the most common things we treat in post-concussion patients. This is true whether a patient is a couple of days post-concussion or multiple months out.

Here are some other resources and reading on this topic:

Concussions: American Optometric Association

Choose PT: Physical Therapy Guide to Concussion

How To Treat Concussions: A Case Study

As mentioned above, getting evaluated by a qualified healthcare provider after a concussion is essential. This is a mild traumatic brain injury, so don’t mess around with it.

We’re going to share a case study of a recent patient to illustrate how concussions with visual issues as a primary driver of symptoms are assessed and treated. This is an actual patient case shared with permission.

This patient is a high school football athlete who sustained a concussion after a hit to the head during a game. He did not lose consciousness but had some abnormal arm movements and disorientation.

Other initial symptoms included:

• Balance issues

• Nausea

• Dizziness

• Depth perception issues

• Reading difficulty

• Trouble driving at night

• Concentration issues

• Fatigue

• Neck pain

By the time he came into PT, it was about 10 weeks post-injury, and he was still having most of the above symptoms. Specifically, he was struggling with dizziness, nausea, and headaches, as well as difficulty completing full days at school.

The symptoms above may not seem related, but the visual system is a common thread. Let’s go through each symptom and briefly explain some potential mechanisms:

• The visual system is heavily used for balance. If visual information is inaccurate, balance will be affected.

• Altered vision can lead to feelings of motion sickness, which can cause nausea.

• Altered vision and balance mean orienting to your environment is difficult, and dizziness can result.

• Depth perception issues, reading difficulty, and problems driving at night are obviously related to vision challenges.

• Concentration difficulty and fatigue result from the brain working extra hard to function when visual issues are present.

• Neck pain affects mechanics that move and stabilize the eyes, worsening visual issues.

This is a quick overview of some possible ways visual symptoms can interact after a concussion, but you get the point. If we can treat the visual issues, most (if not all) of this patient’s symptoms should improve.

Treating Visual Issues After A Concussion

In some cases, patients need to be referred to Optometry or Ophthalmology in addition to PT. That was not the case with this patient, so we could dive right in and focus on re-training his visual, vestibular, and cardiovascular systems.

For this patient, initial treatment focused on the following five categories:

• Convergence training

• Vestibulo-ocular reflex training

• Sensory integration

• Posture and soft tissue work

• Cardiovascular work

I won’t dive into much detail for each of these treatments, but I’ll give a brief overview to contextualize everything.

Here is how Physical Therapy for a concussion can look:

• We retrained the eyes and vestibular system to track and focus on objects more effectively while improving balance and coordination.

• In addition, we ensured this patient’s nervous system got practice integrating multiple kinds of information (visual, vestibular, body sense, etc.) to get a clear picture of the environment and act appropriately.

• We improved neck range of motion, stability, and posture to reduce pain and improve concentration.

• On top of all this, we integrated cardiovascular and strength training to ensure this patient could control symptoms while under stress.

Here are some videos to give you a basic idea of the components of his treatment:

Convergence Training (Pen Push Ups)

Gaze Stability Training (x1 viewing)

Gaze Stability Training (x2 viewing)

Sensory Integration Training (vestibular and balance)

This patient improved very quickly (within a few days), and within about a month, we could progress to very challenging versions of balance and coordination drills, visual exercises, reaction time, and more.

The above is a brief overview, but it shows how treatment can be structured and how the nervous system can be retrained after a concussion. After a concussion, symptoms can be improved with the proper assessment and treatment, even if they have been present for weeks, like with this patient.

In addition to these treatments, we coordinated with this patient’s school administrators, teachers, and athletic trainers to ensure he had appropriate accommodations at school during his recovery. This allowed him to gradually increase his physical and cognitive activities to get a proper challenge without overdoing things.

Physical Therapy Can Help With Concussions

Physical Therapists with the proper training are ideally placed to help concussion patients deal with their symptoms and get back to life. We can spend the time necessary to assess and treat symptoms adequately, coordinate with family, teachers, work, and other healthcare providers, and help troubleshoot any issues.

Every concussion is unique and should be individually assessed. No standardized program will work for everyone because each case affects the brain differently.

Treatments only work if they are applied in the right way. More serious issues will present differently and must be referred in many cases. A good PT will know what can be treated and what needs to be referred for further evaluation.

The above treatments worked because a correct diagnosis was made, and we knew what to look for regarding treatment response, etc.

If you or someone you know needs help recovering after a concussion, please click the button below to reach out to us. We specialize in helping patients with post-concussion issues get back to their lives with confidence.