Vision Case Study
The implications of a cerebral vascular accident commonly known as stroke are usually grave and fatal. If the patients survives, different forms of disabilities arise and the patient may have to live with these disabilities for the rest of their lives. Stroke mostly results as a complication or outcome of hypertension which commonly causes a form of stroke which occurs after the rupture of the small sized blood vessels which supply the different part of the brain. The disability or loss of function that results from a stroke commonly depends on the part of the brain that is involved or whose supply has been affected. The brain has different parts in each hemisphere that deal with a specific function and these parts are usually known as functional parts. These areas are usually found in the different regions of the brain namely the frontal lobe, the temporal lobe, the parietal lobe and the occipital lobe. Higher cognitive functions are mostly processed in the frontal cortex, temporal lobe deals with audition and speaking, the parietal cortex processes sensory information and the occipital lobe processes visual information which is also partly done by the parietal cortex.
Tim suffered a right parietal lobe hemorrhage which affected the blood supply of the parietal cortex which acts as the association area for the visual information processing. The primary visual cortex is the occipital lobe in the brain while the parietal lobe of the brain acts as the association area to help fine tune the visual information coming from the eyes. The brain has two hemispheres with identical areas in both hemispheres which process the same kind of information in the body. It is organized in such a manner that the right hemisphere of the brain processes information from the left side and the left hemisphere processes information from the right side of the body. This is the reason that the disability suffered by Tim occur mostly in the left side of the eye because the CVA affected the right parietal lobe which deals with visual information from the left eye.
Tim suffers from a condition known as left homonymous lower quadrantanopsia which basically means that the Tim has a defect affecting vision (anopia) in the same side (left side) of the lower quadrant of his visual field. The visual field is divided into 4 quadrants having representation from superior and inferior inputs from the left and the right side. Information from the eye are relayed to the brain through the optic nerve which forms superior and inferior optic radiations which represent the upper/superior or lower/inferior quadrants of the visual field. The inferior optic radiations are located in the parietal lobes and thus the defect Tim suffers affects his lower quadrant of vision. As explained above the left side is affected because the stroke affected the right parietal lobe.
Tim also suffers from unilateral left inattention meaning that he neglects or has a problem paying attention to information on his left side of his visual field. This is because when the right parietal lobe was affected by the stroke, Tim cannot be able to process visual information from his left side. Lack of sensory input to the brain makes Tim feel like he does not have that part of the body a condition also known as neglect or hemi neglect. That is the reason why Tim has a problem when trying to find the beginning of a new sentence mostly found in the left side of his visual field. Tim also suffers from a convergence near point disorder which means that his eyes can work normally to do work at a close distance. When objects are brought close to the eyes a process known as accommodation helps the eyes converge in order to clearly see the objects. When a site distance is reached the eyes cannot process the object as one and it results in double vision as the eyes cannot converge past that point and they might be drawn outwards. This is known as the convergence near point.
Tim nevertheless has a convergence near point which is abnormal which means that he has a problem reading or doing work from a near point. From this point is means that his eyes draw out instead of converging and this is termed as exophoria. He therefore has a problem reading due to double vision and might strain and experience headaches because of trying to force the eyes to converge. The complex right/left discrimination problem means that Tim has a problem differentiating the right and the left or making decisions involving the right or left side. This is a result of the disruption of the optic radiations which are critical in the discrimination of right and left. The other problems including difficulties with complex visual processing, a problem with short and long-term visual memory, the inattention in high level attention skills, and the topographical disorientation in new surroundings are all as a result in the disruption of the visual optic radiation in the parietal region of the brain.
Most importantly Tim’s higher cognitive functions and skills of are all intact because the frontal cortex is not affected by the stroke. Tim can therefore appreciate the fact that he has difficulties in perception and cognition and knows the significance of all this. It means he can predict where he is experiencing some levels of difficulty although complex tasks are hard to predict as they involve the coordination of visual stimuli and other forms of perception which becomes a problem because of the defect in the visual pathway. The good thing about this intact cognition is that it is a positive factor in the treatment outcome of Tim as he appreciates the various therapeutic intervention and their significance in his recovery. It is therefore possible to educate Tim about his therapeutic interventions.
The short term treatment interventions are meant to alleviate the symptoms being experienced by Tim like the difficulties in reading due convergence near point problems. Long term interventions are geared towards restoring or attaining or almost near normal condition in Tim’s visual and cognitive abilities. Therapeutic interventions towards Tim’s recovery involve both medical and psychosocial interventions. This is because the occurrence of stroke does not only affect the physiological functioning of the body but most importantly affect the social life of most patients due to the disabilities which result changing their social status. An example is Tim’s visual disturbances which have interfered with his normal role as a husband and father in providing for his family. He can no longer perform complex tasks like before which have made it difficult for him to get a new job. He therefore cannot supplement his wife’s income and this makes the family struggle financially like in educating their son who is a bright student in school. This makes Tim feel useless questioning his existence as he can no longer provide for the family.
As a result one of the most important therapeutic intervention is the psychosocial therapy which is both beneficial as a short term and long term intervention. Under psychosocial therapy it is divided into individual, family and society. In the individual level, it involves the doctor talking with Tim as an individual to let him fully understand about his condition. This involves letting him know that his condition only gives him a mild disability mostly involving the complex skill and activities. The other minor symptoms can be managed medically and therefore Tim can continue to be a productive member of the society. He can adapt to the changes in life with a positive mentality that all will be well. He should therefore avoid situations like drinking too much which also put him at a higher risk of getting another stroke. He should also know of the interventions being done to help his recovery and the importance of adhering to them.
Family therapy involves Tim’s family who are vital aspect in the recovery of Tim. It involves the doctor having meetings with his wife and son to explain and talk about the condition that is affecting Tim. The family needs to know the changes they changes that are happening in Tim’s life and the reason why they are happening. They also need to be educated on the therapeutic interventions Tim is going to receive and the outcomes expected from this interventions. They need to be educated on the need to support Tim both emotionally and even physically in his recovery journey as this can have a very positive effect.
Medical interventions include short term and long term interventions. In the case of the problem with reading due the convergence near point problem a short term intervention involve the use of prismatic glasses. This glasses reduce the symptoms of double vision, straining or headaches therefore improving his life. The glasses can however make him dependent on them and even adaptation can make the patient require stronger classes over a period of time. The definitive treatment involves the use of vision therapy supervised in the clinic and also having home reinforcements. This exercises helps the eye to adapt to the new conditions helping to reduce the symptoms and the attainment of new normal state.
The quadrantanopsia is treated with the use of visual restoration therapy (VRT) which can be clinical based and then followed with home based therapy as a long term approach. The VRT usually targets the transitional zone between the quadrants with normal vision and those with no vision. The therapy is aimed at restoring vision through repetitive stimulation of the areas surviving the effects of a stroke. The size and brightness parameters of the light used are customized to the need of the customer. These stimulation over a long period can help Tim recover vision in the left lower quadrants of his visual fields.