Winter TBI

Well folks, Idaho has officially been taken over by “Snowpocalypse.” While this record amount of snow poses a lot of challenges (school cancellations, treacherous driving, shoveling, flooding, etc.) it can also be an exciting time for outdoor enthusiasts! Anytime there is precipitation coming down in town winter sports enthusiasts can be spotted with enormous grins. What does that grin mean? Powder day, the best day of the year!

Many people live in Idaho for the abundance of outdoor activities, meaning the slopes will be busy. Outdoor sports pose a risk for injury, and awareness is important to help prevent injury. January is National Winter Sports Traumatic Brain Injury Awareness Month to educate the public about increased risks associated with winter sports.

According to the National Ski Areas Association (NSAA) skiing and snowboarding injuries and deaths have decreased about fifty percent from the 1970's. While this is a positive statistic it is important to note it doesn't mean we can be complacent on the slopes. Safety is key! Traumatic brain injuries can be very debilitating, not only the person who is injured but their families. Head and neck injuries sustained while skiing or snowboarding are more likely to be lethal and are most commonly caused by a collision with a tree. Keep in mind other skiers/snowboarders pose a collision risk. Seventeen years ago the NSAA initiated a “Heads Up” campaign that downhill enthusiasts are very familiar with. Such as ski in control, before merging look up the hill and yield to skiers coming down the run, etc. This initiative was to help prevent injuries on the hill. In 2012 the NSAA developed the “Lids on Kids” campaign to promote helmet wear while on the mountain. While there is an initiative to promote helmet wear in children, it is important to note that everyone should wear helmets, not just kids. Even the most experienced skiers can have an accident or collision and sustain head trauma.

Winter sports are not just limited to activities on the ski hill. They can include ice skating, hockey (go Steelheads!), sledding, luge (for those daring individuals), and snowshoeing (to name a few). Helmets are not going to be worn in all of these occasions so environmental awareness is important. Only participate in activities if the area is free of obstacles

Not all traumatic brain injuries sustained while participating in winter sports result in debilitating injuries; however, even a minor TBI (concussion) can interfere with daily activities. Many people are unaware that sustaining a TBI can interfere with how the eyes work together and visual quality. Common visual symptoms of a person who has sustained a TBI can be:

• Double Vision (diplopia): double vision can be secondary to an acquired convergence insufficiency (see our blog: Convergence Insufficiency and Convergence Insufficiency Part 2) or an acquired strabismus (eye-turn).

• Difficulty Reading: difficulty reading can be secondary to an acquired oculomotor dysfunction (see our blog: Eye Movement Disorder Following Brain Injury)as well as convergence insufficiency

• Difficulty with Visual Surroundings: following a TBI people's visual environments may seem overwhelming or over stimulating or they may feel as though they are “in a fog.”

• Blurred or Fluctuating Vision: blurred or fluctuating vision can be secondary to an acquired accommodative dysfunction (visual focusing system), dry eye, or generalized binocular vision dysfunction (see our blog: Binocular Vision Assessment)

• Eye-strain/ Visual Fatigue: eye-strain and visual fatigue can also be secondary to accommodative dysfunction and binocular vision dysfunction.

• Discomfort on the Computer: working on the computer can induce more fatigue secondary to the increased accommodative demand and can be visually over-stimulating.

• Difficulty Concentrating: sustained focus (reading or computer work) can be more difficult secondary to the near demand.

• Light Sensitivity: the exact cause of light sensitivity is unknown in association with a TBI but can occur indoors and outdoors.

• Dry Eye: dry eye is a common side effect of a TBI because the individual has a decreased blink rate. Depending on the severity of the dryness it can cause other problems on the ocular surface such as corneal damage and increased risk of eye infections.

• Slow Visual Processing Speed: slow processing speed is secondary to damage to the brain.
   

When a person sustains a TBI it is important to establish an appropriate care team to assist with rehabilitation. This team may need to include a neurologist, neuro-optometrist, physical therapist, speech therapist, and an occupational therapist. It is important to have a Neuro-Optometrist on the care team. A residency trained Neuro-Optometrist will assess and treat associated vision conditions. Treating associated vision conditions can help to improve participation and results of associated rehabilitation treatments with therapists.

This winter while enjoying “Snowpocalypse” be safe, check the surroundings, and wear a helmet. If a head injury is sustained, be sure to include a residency-trained Neuro-Optometrist a member of your team.