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1.
Optom Vis Sci ; 94(1): 7-15, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-26889821

RESUMO

PURPOSE: To assess the prevalence of visual dysfunctions and associated symptoms in war fighters at different stages after non-blast- or blast-induced mild traumatic brain injury (mTBI). METHODS: A comprehensive retrospective review of the electronic health records of 500 U.S. military personnel with a diagnosis of deployment-related mTBI who received eye care at the Landstuhl Regional Medical Center. For analysis, the data were grouped by mechanism of injury, and each group was further divided in three subgroups based on the number of days between injury and initial eye examination. RESULTS: The data showed a high frequency of visual symptoms and visual dysfunctions. However, the prevalence of visual symptoms and visual dysfunctions did not differ significantly between mechanism of injury and postinjury stage, except for eye pain and diplopia. Among visual symptoms, binocular dysfunctions were more common, including higher near vertical phoria, reduced negative fusional vergence break at near, receded near point of convergence, decreased stereoacuity, and reduced positive relative accommodation. CONCLUSIONS: The lack of difference in terms of visual sequelae between subgroups (blast vs. nonblast) suggests that research addressing the assessment and management of mTBI visual sequelae resulting from civilian nonblast events is relevant to military personnel where combat injury results primarily from a blast event.


Assuntos
Traumatismos por Explosões/epidemiologia , Concussão Encefálica/epidemiologia , Militares , Transtornos da Visão/epidemiologia , Acomodação Ocular , Adulto , Traumatismos por Explosões/fisiopatologia , Concussão Encefálica/fisiopatologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Prevalência , Estudos Retrospectivos , Estados Unidos , Transtornos da Visão/fisiopatologia , Acuidade Visual
2.
Optom Vis Sci ; 94(1): 16-19, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27668633

RESUMO

In this article, we explore the roles of media, research, and advocacy in education and research funding. All three have played critical roles in advancing our understanding of eye, vision, and brain injuries in sports and in the military.


Assuntos
Pesquisa Biomédica/economia , Lesões Encefálicas/complicações , Defesa do Consumidor , Traumatismos Oculares/complicações , Necessidades e Demandas de Serviços de Saúde , Apoio à Pesquisa como Assunto , Transtornos da Visão/etiologia , Traumatismos em Atletas/etiologia , Educação em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Militares
3.
J Rehabil Res Dev ; 51(4): 547-58, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25144168

RESUMO

Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are signature injuries of the Iraq and Afghanistan conflicts. The conditions can be comorbid and have overlapping signs and symptoms, making it difficult to diagnose and treat each. TBI is associated with numerous changes in vision function, but vision problems secondary to PTSD have not been documented. To address this shortcoming, we reviewed the medical records of 100 patients with a history of TBI, noting PTSD diagnoses, visual symptoms, vision function abnormalities, and medications with visual side effects. Forty-one patients had PTSD and 59 did not. High rates of binocular vision and oculomotor function deficits were measured in patients with a history of TBI, but no significant differences between patients with or without PTSD were evident. However, compared to patients without PTSD, patients with PTSD had more self-reported visual symptoms in all four assessments and the complaint rates were significantly higher for light sensitivity and reading problems. Together, these findings may be beneficial in understanding vision problems in patients with TBI and PTSD as comorbid conditions compared with those with TBI alone.


Assuntos
Lesões Encefálicas/complicações , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos da Visão/etiologia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Traumatismos por Explosões/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Índices de Gravidade do Trauma , Violência , Transtornos da Visão/diagnóstico , Testes Visuais , Acuidade Visual , Adulto Jovem
4.
J Rehabil Res Dev ; 50(6): 757-68, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24203539

RESUMO

Although traumatic brain injury (TBI) can happen to anyone at any time, the wars in Iraq and Afghanistan have brought it renewed attention. Fortunately, most cases of TBI from the recent conflicts are mild TBI (mTBI). Still, many physical, psychological, and social problems are associated with mTBI. Among the difficulties encountered are oculomotor and vision problems, many of which can impede daily activities such as reading. Therefore, correct diagnosis and treatment of these mTBI-related vision problems is an important part of patient recovery. Numerous eye care providers in the Department of Veterans Affairs, in military settings, and in civilian practices specialize and are proficient in examining patients who have a history of TBI. However, many do not have this level of experience working with and treating patients with mTBI. Recognizing this, we used a modified Delphi method to derive expert opinions from a panel of 16 optometrists concerning visual examination of the patient with mTBI. This process resulted in a clinical tool containing 17 history questions and 7 examination procedures. This tool provides a set of clinical guidelines that can be used as desired by any eye care provider either as a screening tool or adjunct to a full eye examination when seeing a patient with a history of mTBI. The goal of this process was to provide optimal and uniform vision care for the patient with mTBI.


Assuntos
Lesões Encefálicas/complicações , Anamnese , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Testes Visuais , Técnica Delfos , Humanos
5.
Optom Vis Sci ; 90(2): 105-12, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23314131

RESUMO

PURPOSE: Blast-related (BR) traumatic brain injuries (TBIs) occur secondary to explosive blasts. Blast-related TBIs can be caused by the blast wave itself or by direct head trauma caused by events surrounding the blast. Non-blast-related (NBR) TBIs are caused by direct head trauma. Recent evidence shows that TBIs are associated with vision problems, particularly binocular system problems. The purpose of this study was to determine if similar types and amounts of vision problems are present in patients with BR TBIs and NBR TBIs. METHODS: A retrospective analysis of eye examination records of 50 NBR TBI and 50 BR TBI patients was conducted. Frequencies of visual symptoms and abnormal vision function measurements were computed and compared for the two patient groups. RESULTS: More than 65% of NRB TBI and BR TBI patients reported vision problems. Reading complaints were found in approximately 50% of the patients. Light sensitivity was reported significantly more often in BR TBI patients (67%) than in NBR TBI patients (33%) (p < 0.01). Saccadic dysfunction was measured more often in NBR TBI patients (85%) than in BR TBI patients (58%) (p < 0.01). High rates of accommodative dysfunction and convergence insufficiency were also found, but the group differences were not significant. Strabismus, pursuit abnormalities, fixation defects, and visual field defects were also common in both groups. CONCLUSIONS: For most findings, the mechanism of injury (NBR vs. BR) did not result in different frequencies or types of visual dysfunction. The reasons for finding higher frequencies of light sensitivity in the BR TBI group and saccadic dysfunction in the NBR TBI group are unknown, and further research is needed. Overall, the rates of vision complaints and oculomotor defects were high in both groups, indicating a need for a thorough eye examination for any patient with a history of TBI.


Assuntos
Lesões Encefálicas/complicações , Militares , Transtornos da Motilidade Ocular/etiologia , Veteranos , Baixa Visão/etiologia , Acuidade Visual , Adulto , Lesões Encefálicas/diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/epidemiologia , Transtornos da Motilidade Ocular/fisiopatologia , Estudos Retrospectivos , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia , Baixa Visão/epidemiologia , Baixa Visão/fisiopatologia , Adulto Jovem
6.
NeuroRehabilitation ; 26(3): 213-22, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20448311

RESUMO

The present review characterizes dual sensory impairment (DSI) as co-existing auditory and visual deficits in TBI that can be peripherally or centrally based. Current research investigating DSI in the military population, along with applicable research which focuses on unimodal deficits, is considered. Due to the heterogenous nature of TBI lesions, an important challenge that the clinician faces is ruling out the influence of multiple sensory deficits and/or the influence of cognitive processes on diagnosis and rehabilitation of the patient. Treatment options for DSI involve remediation of the sensory deficits via existing sensory aids or training exercises.


Assuntos
Lesões Encefálicas/complicações , Transtornos da Surdocegueira/etiologia , Transtornos da Percepção/etiologia , Lesões Encefálicas/reabilitação , Transtornos da Surdocegueira/reabilitação , Humanos , Militares/estatística & dados numéricos , Transtornos da Percepção/reabilitação
7.
Eye Brain ; 2: 47-55, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-28539762

RESUMO

The purpose of this paper is to describe the response of a Department of Veterans Affairs medical center's development of a rehabilitation program for patients with hemianopsia. Hemianopsia affects significant numbers of troops returning from Afghanistan and Iraq and their neurological vision loss presented unique challenges in developing an appropriate and effective rehabilitation program. A literature review indicated that existing therapies lacked supporting scientific evidence and that traumatic brain injury (TBI)-related vision loss affects large numbers of civilians. The increasing number of patients with TBI-related vision loss necessitated the development of an innovative program which combined elements of therapies that the literature suggested were most promising. In this paper we briefly review the literature, describe the rehabilitation program developed, and present case studies of two patients who incurred vision loss as a result of a motor vehicle accident and a gunshot wound. The intent of the article is to begin the documentation of our ongoing, evidence-based neurological vision loss rehabilitation program. We also encourage others who do not currently do so to assess the need for implementing vision rehabilitation programs for patients with TBI-related vision loss.

8.
Optom Vis Sci ; 86(7): 817-25, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19521270

RESUMO

PURPOSE: The purpose of this study was to determine the frequencies of visual impairment and dysfunction among combat-injured Polytrauma Rehabilitation Center (PRC) inpatient and Polytrauma Network Site (PNS) outpatient military personnel with traumatic brain injury (TBI). METHODS: A retrospective analysis of data from vision screenings of 68 PRC-inpatients with moderate to severe levels of TBI and 124 PNS-outpatients with mild TBI at the VA Palo Alto Health Care System was conducted. RESULTS: Eighty-four percent of PRC-inpatients and 90% of PNS-outpatients had TBIs associated with a blast event. The majority of patients in both the PRC and PNS populations had visual acuities of 20/60 or better (77.8% PRC, 98.4% PNS). Visual dysfunctions (e.g., convergence, accommodative, and oculomotor dysfunction) were common in both PRC and PNS populations. In the PRC-inpatient population, acuity loss of 20/100 to no light perception (13%) and visual field defects (32.3%) were found. In the PNS-outpatient population, acuity loss of 20/100 to no light perception (1.6%) and visual field defects (3.2%) were infrequently found. In both the PRC and PNS populations, visual field defects were more often associated with blast than non-blast events. CONCLUSIONS: Blast events were the most frequent mechanism of injury associated with TBI in combat-injured servicemembers. The vision findings suggest that combat troops exposed to blast with a resulting mild TBI are at risk for visual dysfunction, and combat troops with polytrauma injuries are at risk for visual dysfunction and/or visual impairment. The visual consequences of such injuries necessitate further study and support the need for appropriate evaluation and treatment in all severities of TBI.


Assuntos
Lesões Encefálicas/complicações , Militares , Transtornos da Visão/etiologia , Guerra , Acomodação Ocular , Adulto , Afeganistão , Traumatismos por Explosões/complicações , Traumatismos por Explosões/epidemiologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Convergência Ocular , Feminino , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Iraque , Masculino , Militares/estatística & dados numéricos , Traumatismo Múltiplo/reabilitação , Músculos Oculomotores/fisiopatologia , Pacientes Ambulatoriais/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Transtornos da Visão/fisiopatologia , Transtornos da Visão/reabilitação , Baixa Visão/etiologia , Acuidade Visual , Campos Visuais , Ferimentos e Lesões/complicações
9.
J Rehabil Res Dev ; 46(6): 811-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20104404

RESUMO

Combat blast is an important cause of traumatic brain injury (TBI) in the Department of Veterans Affairs polytrauma population, whereas common causes of TBI in the civilian sector include motor vehicle accidents and falls. Known visual consequences of civilian TBI include compromised visual acuity, visual fields, and oculomotor function. The visual consequences of TBI related to blast remain largely unknown. Blast injury may include open globe (eye) injury, which is usually detected and managed early in the rehabilitation journey. The incidence, locations, and types of ocular damage in eyes without open globe injury after exposure to powerful blast have not been systematically studied. Initial reports and preliminary data suggest that binocular function, visual fields, and other aspects of visual function may be impaired after blast-related TBI, despite relatively normal visual acuity. Damage to the ocular tissues may occur from blunt trauma without rupture or penetration (closed globe injury). Possible areas for research are development of common taxonomy and assessment tools across services, surgical management, and outcomes for blast-related eye injury; the incidence, locations, and natural history of closed globe injury; binocular and visual function impairment; quality of life in affected service members; pharmacological and visual therapies; and practice patterns for screening, management, and rehabilitation.


Assuntos
Traumatismos por Explosões/complicações , Lesões Encefálicas/complicações , Traumatismos Oculares/complicações , Acesso aos Serviços de Saúde , Militares , Transtornos da Visão/etiologia , Transtornos da Visão/reabilitação , Continuidade da Assistência ao Paciente , Diplopia , Traumatismos Oculares/etiologia , Traumatismos Oculares/reabilitação , Humanos , Guerra do Iraque 2003-2011 , Qualidade de Vida , Estados Unidos , United States Department of Veterans Affairs
10.
J Rehabil Res Dev ; 46(6): 819-26, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20104405

RESUMO

The frequencies of hearing impairment (HI), vision impairment (VI), or dual (hearing and vision) sensory impairment (DSI) in patients with blast-related traumatic brain injury (TBI) and their effects on functional recovery are not well documented. In this preliminary study of 175 patients admitted to a Polytrauma Rehabilitation Center, we completed hearing and vision examinations and obtained Functional Independence Measure (FIM) scores at admission and discharge for 62 patients with blast-related TBI. We diagnosed HI only, VI only, and DSI in 19%, 34%, and 32% of patients, respectively. Only 15% of the patients had no sensory impairment in either auditory or visual modality. An analysis of variance showed a group difference for the total and motor FIM scores at discharge (p < 0.04). Regression model analyses demonstrated that DSI significantly contributed to reduced gain in total ( t = -2.25) and motor ( t = -2.50) FIM scores ( p < 0.05). Understanding the long-term consequences of sensory impairments in the functional recovery of patients with blast-related TBI requires further research.


Assuntos
Traumatismos por Explosões/complicações , Lesões Encefálicas/complicações , Avaliação da Deficiência , Perda Auditiva/etiologia , Militares , Centros de Reabilitação/estatística & dados numéricos , Transtornos da Visão/etiologia , Adulto , Campanha Afegã de 2001- , Feminino , Perda Auditiva/complicações , Perda Auditiva/epidemiologia , Hospitais de Veteranos , Humanos , Incidência , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Transtornos da Visão/complicações , Transtornos da Visão/epidemiologia
11.
J Rehabil Res Dev ; 44(7): 929-36, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18075950

RESUMO

Little is known about the visual function deficits associated with polytrauma injury. In this retrospective descriptive study, we examined the records of a clinic established to assess visual function in patients experiencing deployment-related polytrauma. We describe the clinical findings and present a vision examination protocol that may be useful for screening polytrauma patients in other settings. Data from our sample suggested that self-reported vision complaints were common (74%) and confirmed that visual impairment occurred in 38% of all cases. When examining the mechanism of injury, we found that polytrauma due to blast injuries appeared to more than double the risk of visual impairment compared with all other polytrauma causes (i.e., motor vehicle accidents, gunshot and/or shrapnel, assault, falls, or anoxia). The rate of visual impairment in blast-related injury was 52% compared with 20% for all other sources of injury. Visual complaints and impairments were common in the polytrauma patients studied. This finding suggests that comprehensive eye examinations should be routinely administered, particularly when the mechanism of injury involves a blast.


Assuntos
Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/reabilitação , Transtornos da Visão/complicações , Adulto , Traumatismos por Explosões/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Centros de Reabilitação/estatística & dados numéricos , Estudos Retrospectivos , Transtornos da Visão/diagnóstico , Transtornos da Visão/psicologia , Campos Visuais , Percepção Visual , Guerra
12.
J Rehabil Res Dev ; 44(7): 1027-34, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18075959

RESUMO

The conflicts in Iraq and Afghanistan have resulted in a new generation of combat survivors with complex physical injuries and emotional trauma. This article reports the initial implementation of the Polytrauma Network Site (PNS) clinic, which is a key component of the Department of Veterans Affairs (VA) Polytrauma System of Care and serves military personnel returning from combat. The PNS clinic in Palo Alto, California, is described to demonstrate the VA healthcare system's evolving effort to meet the clinical needs of this population. We summarize the following features of this interdisciplinary program: (1) sequential assessment, from initial traumatic brain injury screening throughout our catchment area to evaluation by the PNS clinic team, and (2) clinical evaluation results for the first 62 clinic patients. In summary, this population shows a high prevalence of postconcussion symptoms, posttraumatic stress, poor cognitive performance, head and back pain, auditory and visual symptoms, and problems with dizziness or balance. An anonymous patient feedback survey, which we used to fine-tune the clinic process, reflected high satisfaction with this new program. We hope that the lessons learned at one site will enhance the identification and treatment of veterans with polytrauma across the country.


Assuntos
Traumatismo Múltiplo/reabilitação , Administração dos Cuidados ao Paciente/organização & administração , Desenvolvimento de Programas , Centros de Reabilitação/organização & administração , United States Department of Veterans Affairs/organização & administração , Veteranos , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Comorbidade , Feminino , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Humanos , Comunicação Interdisciplinar , Masculino , Programas de Rastreamento , Militares , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/epidemiologia , Satisfação do Paciente , Equilíbrio Postural , Centros de Reabilitação/estatística & dados numéricos , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/epidemiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Guerra
13.
J Telemed Telecare ; 10 Suppl 1: 30-2, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15603602

RESUMO

We have developed an interactive patient education kiosk. The kiosk provides access to stored health information and to selected Websites via a high-speed Internet connection. The output is bilingual (English or Spanish) and an enclosed printer allows information to be printed and taken home for later reading. Each kiosk records patient usage, as well as the results of a brief, voluntary, online evaluation questionnaire. Three kiosks were placed in the patient waiting area of busy multi-specialty clinics. Two kiosks were active for 2.5 years and one was active for 1.5 years. There were 38,868 user sessions recorded and 2878 users participated in the online survey questionnaire (7% of all user sessions). Patient satisfaction was high; for example, 68% of respondents found some or all of the information they were looking for on the kiosk. In the year following the introduction of the first kiosk (the 2001/02 flu season), there was a 24% increase in the number of patients receiving flu vaccinations within the Palo Alto health-care system, compared with the previous year. Experience to date suggests that the kiosks may increase patient compliance with selected clinical guidelines and instructions.


Assuntos
Serviços de Informação/organização & administração , Internet , Educação de Pacientes como Assunto/métodos , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Humanos , Estudos Prospectivos
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