Reading problems may occur from various problems after a stroke or head injury. It is crucial that the type of reading problem be diagnosed. The list below contains some of the more common causes of reading problems after brain injury with introduction to how they may be treated. The problems may occur individually or be part of a constellation of problems related to Post Trauma Vision Syndrome. Treatment of PTVS through various neuro-optometric rehabilitative interventions may resolve many of the problems below.
Post Trauma Vision Syndrome
Essentially, individuals with PTVS begin to look at paragraphs of print almost as isolated letters on a page and have great difficulty organizing their reading ability. It has been found that the use of prisms and bi-nasal occlusion can effectively demonstrate functional improvement, while also being documented on brain wave studies by increasing the amplitude (this is like turning up the volume on your radio).
Reading Problems Due to Visual Field Loss Field loss patients often lose their place in reading. Simple techniques, like boundary marking, sticking a Post-it note along the side of a column of print, can mark the beginning or end of the column and reduce confusion. A right hemianopsia patient may lose his or her place at the end of a line. The right hemianopsia patient may leave off words at the end of a line. A left hemianopsia patient may have difficulty at the start of each line and may not return to the very beginning of the line. Convergence Disorders Affecting Reading Patients may experience reduced convergence after stroke or head injury. Our eyes must turn in together accurately as a team to prevent double vision and eye fatigue in reading. Prisms may aid some patients. Orthoptic therapy may aid some, but not all patients with convergence insufficiency will respond fully to therapy due to the variation in the extent of trauma which may be present.
Loss of Accommodation (Focusing) Affecting Reading
Young head injury patients may experience decreased focusing ability. It is often missed because at an early age doctors don't expect loss of accommodation. It happens naturally at about age 42. Individual with reduced accommodation may benefit from bifocals. Alexias /Word Blindness Affecting the Ability to Read If the patient is unable to read due to damage to areas which process reading, but can understand verbal reading, electronic machines are available such as the Kurzweil Omni 1000 and 3000 and the Zerox Expert Reader. These machines scan all typed print, interpret it and read it aloud to the patient. Talking books and reading radio are also very helpful. Loss of Cognitive Skills May Affect Reading and Comprehension Patients may need to relearn their reading skills developed in childhood or the damage may online pokies be so severe as to preclude reading. Therapists may be able to re-establish reading over time. Low Vision Causing Reading Problems When visual acuity is significantly impaired, high add bifocals or low vision devices may be indicated. Magnifiers, Electronic Magnification CCTVs, special and microscopic eye wear may help the patient read again. Diplopia Causing Disruptions to Reading If the binocular vision problem can be treated, therapy, surgery or prisms may be used to re-establish binocular vision. If the double vision is not curable, then occlusion may be required. Partialsemi-opaque occlusion may reduce diplopia while minimizing the disruption to to ambient vision caused by total opaque. Eye Gaze Disorders Patients with inferior gaze paresis may not be able to look down into the bifocal, but may read with single vision reading eyewear. Clip on reading lenses or single vision reading lenses may also employed. Eye Movement /Tracking Disorders Affecting Reading Eye movement disorders may also interfere with reading. As we read down a line of words, we must make a series of accurate saccades or jumps from one group of words to another. As our head or the paper moves, we must make rapid adjustments of our eye position called pursuit movements. These rapid eye movements are mediated by the vestibular system. Failure of these movements to work smoothly may impair smooth comfortable and may cause vertigo effects.
Unstable Ambient Vision Brain injury patients may present with vertigo, sensitivity to light and extreme sensitivity to motion around them. Trying to sustain reading becomes very difficult. The patient may experience nausea, loss of attention, difficulty fixating on the words and fatigue. Unstable ambient vision is a hallmark of Post Trauma Vision Syndrome.