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Home » Vision+ Performance and Rehab » Concussion and Brain Injury Visual Neuro-Rehabilitation


It is one of the most common sports and recreation-related injuries affecting as many as 1.6 to 3.8 million people annually, but concussions don’t just come from sports alone. These injuries can be the result of any hard impact to the head or body that generates a sudden jolt of movement to the brain. Concussion often happen from twisting and rotational forces, and it’s not only possible, but common, to get a concussion without even hitting your head directly.

Nearly 50 percent of patients with concussions experience symptoms related to vision and visual processing, even worse for adolescents, where the number rises to a staggering 69 percent! Luckily, about 85-90% of patients will spontaneously recover.  That means, unfortunately, that 10-15% of patients will not recover with rest alone and will need some rehabilitation to help recover.  Addressing any compromised visual processing after a brain injury can enhance your rehabilitation, and we’re happy to contribute to your rehabilitation team to help you meet your goals.

Upwards of 50% of the brain is involved in visual processing, so it’s no wonder that a concussion (or any brain injury) can have such a devastating impact on vision, visual function, and visual comfort. Even if central 20/20 vision seems untouched, there can be devastating damage done to numerous areas that contribute to daily visual function.  Many times, these problems from brain injury go unnoticed during the early treatment phase, and unidentified or unaddressed visual problems can slow rehabilitation in all areas.

Common Visual Symptoms of a Concussion

Unfortunately, the symptoms of a concussion do not always show up immediately after an injury. In fact, it can take several days in some cases for notable symptoms of the injury to emerge, according to the Mayo Clinic.

Brian injury, including concussion, are associated with many issues affecting vision and visual perception. Every individual with brain injury has a unique story with individual needs and varying symptoms. Symptoms can evolve and change over time, and they may include:

  • Focusing Problems – A reduction in eye focusing ability results in blurry vision at near, even in young athletes. Near vision may be constantly blurry or may pulse in and out of clarity during near activities.
  • Blurry Vision – Blurred vision following a concussion is common and sometimes unpredictable. It can affect distance vision, near vision, the transition between ranges, and may come and go.
  • Convergence Insufficiency – This inability to use the eyes comfortably at near can result in a number of additional symptoms including headaches, eyestrain, fatigue, and double vision during near activities.
  • Double Vision – Anyone who sees double (even intermittently) should be evaluated by an optometrist with advanced training in neuro-optometry, binocular vision, and visual neurorehab.
  • Light Sensitivity – Photophobia, or light sensitivity, can result from various types of ABI and TBI, including concussions.
  • Ocular-motor Dysfunction – Deficiencies in eye movement abilities are quite common following concussions and other forms of mild traumatic brain injuries. These eye movement deficits can pose challenges with many activities of daily life, including reading and driving.
  • Reduced Cognitive Abilities with Visual Tasks – Visual perceptual deficits can be caused by concussions and have dramatic effects on academic, occupational and even athletic success.
  • Visual Discrimination – Seeing small detailed differences between objects.
  • Visual Memory – Keeping a visual image in your head in order to retain information better.
  • Visual Sequential Memory – Remembering a sequence of information, like a phone number, or several items on a to-do list.
  • Visual Figure Ground – Important for finding objects in a crowded area (like working with spreadsheets on a computer). If poor, crowded stores and restaurants can be overwhelming.
  • Reduced Visual Processing Speed or Reaction Time – Prolonged visual processing speed can slow down an athlete both on and off the field. The speed with which an athlete processes visual information affects many aspects of athletic competition, including reading the field of play, judging the speed of a moving ball or puck, and judging the speed of other players on the field.

In 2014, the visual system was added to the Concussion Trajectory as a critical piece of concussion management.  Research is showing that visual neurorehabilitation and optometric vision therapy is helpful in the recovery process for mTBI patients.

A good rehabilitation process must include an evaluation of the visual system and treatment of all related visual problems. The old adage for brain rehab recovery of ‘give it time’ is outdated and does not apply any more. Dr. Dovie and Dr. Hempelmann, at Vision+ Performance and Rehab, will work as an integral part of the rehabilitation team to help the brain-injured patient. The vision problems related to brain injury can be significantly reduced, if not eliminated, in most cases.  Addressing the visual system can also help other rehabilitation go much smoother. It is estimated 80% of what we learn comes through the visual system, it may be hard to learn (and relearn) skills of daily living if the visual system is impaired.

Contact us today to inquire about scheduling an evaluation regarding concussion recovery.

Some research supporting vision neurorehabilitation following head injury:

  • Vision Therapy for Post-Concussion Vision Disorders. Gallaway, M, et al. Optometry & Vision Science: Jan 2017 – Vol 94 – Issue 1 – p. 68-73.
  • A Review of the Current Practice in Diagnosis and Management of Visual Complaints Associated with Concussion and Postconcussion Syndrome. Heinmiller, L and Gunton, K. Curr Opin Ophthalmol 2016; 27(5): 407-412.
  • Current and Emerging Rehabilitation for Concussion: A Review of the Evidence. Broglio, S, et al. Clin Sports Med 2015 April; 34 (2): 213-231.

Concurrent Vision Dysfunctions in Convergence Insufficiency with Traumatic Brain Injury. Alvarez, T, et al. Optom Vis Sci. 2012 December: 89 (12).