One part of the brain that can be concussed is the area that determines vision, moves our eyes and helps us act on what we see.
When I began my work on examining athletes who have sustained concussions in that part of their brain, I included computer based testing as well. Computer programs designed for vision therapy and testing the visual system have existed for quite some time and are constantly evolving.
Last year, my work culminated in the publishing of the See To Play Vision Concussion Protocol which includes some use of computer testing and exercises.
I like to use this illustration:
Have you ever been in a parked car in a parking lot and the car beside you slowly backs out while you are not paying attention? All of the sudden, you get this huge sensation that the car you are in is moving forward and you, for an instant, see and feel that event happening. Your brain has just been faked out by the information sent to it from the dorsal vision stream.
It is the breakdown of the dorsal vision stream from a traumatic brain injury that causes a concussion in the vision part of the brain.
The ultimate vision concussion app would have to diagnose this area (which would probably even be providing some degree of treatment as well).
Let’s break down what we need test! This part of the brain is comprised of three senses:
1. Input from vision (object recognition and motion)
2. Input from the vestibular canals of the inner ear (body rotation, gravitation and movement)
3. Input from the proprioceptors (information from body’s muscles/bones/joints regarding the spatial relationship of body parts and movement)
Let’s build the ultimate vision concussion app!
First, we use an app for testing vision.
Next, start shaking your head left and right (or turn in circles and reverse often) while performing that app. You’ve just engaged your vestibular senses.
Finally, keep doing the above motions and app testing while standing on a balance board and move the hand that is holding your smart phone in and out and up and down. You’ve just engaged your proprioceptive senses.
Yay! We did it, right?
Now you may be beginning to understand how difficult it is use a stationery computer or a hand held device while trying to test body senses whose core basis are motion and movement in space and time.
Some advocate the use of dynamic vision acuity testing. This achieves adding movement to testing by having athletes stand and determine objects on a rotating eye chart. Unfortunately, this type of movement doesn't seem to fully engage the dorsal vision stream.
Companies are working on virtual reality helmets for athletes to wear which simulate objects, space and movement. Other companies are developing machines that use projector to place objects out in space and time, like a virtual reality room, for the purpose of this testing. The goal is to incorporate all three of the senses areas in this discussion.
I have also worked with developers to help design testing tools that could be on a handheld device, a computer or even on a television screen or smartboard.
In my book, See To Play: The Eyes of Elite Athletes, I discuss the virtue of fixed space vision exercises (such as the use of computers) versus free space vision exercises (which use objects out in real space). Free space exercising seems to win the battle when the goal is to involve the vestibular and proprioceptive senses.
We’ve been able to test and train the vision, vestibular and proprioceptive senses in the See To Play Vision Concussion Protocol by having athletes simply pitch and catch a ball with a clinician standing 10 to 15 feet away. We use prism glasses to cause the world to shift to the left, to the right, up and down. The athlete gets a “real world feel” for what is happening to him or her and has to respond to movement and tasks in real space and time. The use of a balance board and picking up objects on the floor bring in the proprioceptive and vestibular senses.
See To Play is excited to be on the forefront of this type of testing and will continue to help find or develop The Ultimate Vision Concussion App.