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What Is Hemianopsia and Why Does It Happen After TBI?

Gregory Goodrich, PhD

Ask the Expert: What Is Hemianopsia and Why Does It Happen After TBI?
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I fell down some stairs nine months ago and hit my head. In the hospital, they noticed that I had some serious vision problems like my not being able to see anything in the left fields of both eyes. I keep bumping into things when I don’t turn my head; it’s like the right side of my world doesn’t exist. Is there anything I can do? Are there any treatments that can help? And what about driving again?

 

What you are describing is a condition called hemianopsia with neglect — a visual field loss where half of your visual field, either vertically or horizontally, is gone; you cannot see it. The fact that you can’t see anything in your left field of vision is because the visual-spatial processing in your brain was damaged in your injury. Typically visual neglect occurs in the left field, but it can also occur in the right visual field.

To date, treatments for this don’t have as much research backing as we’d like but vision rehabilitation therapy may be effective. This therapy basically retrains the brain to see into that damaged hemianopic field. It takes advantage of the brain’s plasticity — of the brain’s ability to rewire itself and overcome damage. The literature says that vision rehabilitation therapy can help restore 3-5 degrees of that lost field.

Another therapy technique is called compensatory scanning, done with the eyes and head. Even if you don’t know that your “left world” exists, you can learn to scan toward that field loss. In essence, you use your intact field of vision to “look into” the lost field.

Scanning with the head is often more successful than simple scanning with the eyes since there is more muscle pull in your neck than in your eyes. Head scans give you more awareness that you are looking left because you feel more of a pull in your neck muscles. Learning to put your chin on your left shoulder and recognizing the neck muscle strain teaches you to then recognize that you are doing the scan.

We had a patient who sustained a brain injury when he crashed his motorcycle going 60-80 mph. If you asked him what happened, he would say that he hit his head and has a brain injury. He could point to a diagram of the brain exactly where his injury occurred, the area of damage which caused the hemianopsia with neglect on his left side. But then if you ask him if he has vision problems, he says no. With compensatory scanning, we have taught him to do head turns to the left so he can pick up hazards. His rate of tripping on things on his left or banging into things on his left side has been greatly reduced because of this scanning therapy.

As for driving, here is a good resource about driving evaluations after TBI.

 

Click here to go to About Ask the Expert.

Gregory L. Goodrich, PhD Gregory L. Goodrich, PhD, Dr. Goodrich received his PhD in Experimental Psychology in 1974 from Washington State University. His career with the US Department of Veterans Affairs began in 1974 and he is currently supervisory research psychologist (Psychology Service) assigned to the Western Blind Rehabilitation Center.


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