Thursday, May 22, 2014

Phantom Blindness and Taking a Break after Strokes

I met with my eye doctor last week about taking some time off from my vision therapy. I have been doing therapy since my stroke almost two and a half years ago. I am tired, and a need a break.

My doctor said, “This is completely understandable. Take some time off.”
At the appointment, my doctor tested my vision. Because of the strokes, my vision was affected, and I have a problem in my field of vision on the right side. I have a deficit with my right side peripheral vision. However, it is getting better.

During the test, I told him that I “sense things on the right side of my peripheral vision.” It seems that I know that something is there, but I cannot really distinguish what it is.

He told me that there is a body of thought describing phantom vision or phantom blindness.

A Polish researcher, L. Bieganowski, described this phantom blindness this way:   “The subject of the paper is the phenomenon of phantom vision. It occurs among the blind (or almost blind) and is characterized by perceiving various visual sensations, for example: light, geometrical shapes, buildings, people, flowers etc. The paper presents views explaining the generation of phantom vision. According to Melzack's theory, the occurrence of these sensations is explained in relation to the phenomenon of transforming the neuro-activity of the brain in a specific--for each organ--neuronal network called neuromatrix. Even if some organs do exist but have ceased to function completely (or to a significant degree) and consequently the brain does not receive any sensory stimuli from them, the neuromatrix in brain can generate visual sensations constituting the phantom vision phenomenon.”

I said, “This is really interesting. However, is this good or bad considering my vision issues?” He stressed “This is great news!”

So, I am going to take a month or two off from therapy. However, I will continue doing home vision therapy.

I will continuing doing the “Hart Chart” to improve ability to organize and visually track while maintaining peripheral awareness.

What you do is this:

1. The patient stands in a relaxed an balanced posture. One eye is patched.

2. The Hart Chart is placed at eye level. The patient should be a comfortable distance (2-3 feet) from the chart. Set the metronome at sixty beats per minute.

3. The patient is asked to read the letters out loud in a rhythmic fashion without moving their head – one letter per beat of the metronome. The patient reads the entire chart proceeding from left to right, top to bottom. The patient should be encouraged to maintain peripheral awareness of the whole chart and of other objects in the room.

4. Repeat for the other eye. As this becomes easier, take several steps back from the chart.

5. If there are significant differences between the eyes, practice the poorer eye more frequently.

Level II – Outside In

1. Have the patient start with the first line of letters and read in the following order: first letter, last letter, second letter, second from last letter, and so on.

2. The patient should read each line from the ends to the middle in this fashion.

Level III – Columns 1. The patient reads the first and last letter of each line. When they get to the bottom of the chart, they should proceed to the second and second-to-last letter of each row. When these two columns are completed, the patient should move to the next two columns in and so on. 

Level IV – Obliques

1. When the above activities have been mastered, the patient begins reading the first letter of the first column, last letter of the last column, second letter in the first column and next to last letter in the last column. (He reads the first column top to bottom alternating with the last column bottom to top.)

2. When this has been achieved, the patient should progress to the second and second to last column. Repeat with the remaining columns.

Here is a YouTube video about the Hart Chart:


Also, “Slap Tap” which is described this way:

This activity is a sheet that hangs on the wall in front of the patient. There are a series of symbols which represent left arm, left leg, right arm, and right leg. During this activity the patient will read each symbol and call out the direction while moving the corresponding body part. Once this has become automatic for the patient, they will move to the second series which adds both arms and both legs. This activity will help patients gain a better sense of their own body and directions. By making directionality automatic for patients, visualization will become easier. For many patients activities such as slap tap help if there is difficulty reversing letters or numbers. 

Here is a YouTube video about this:


It is amazing that I have been doing therapy for two plus years. I have done about 300#  therapy sessions since my strokes. I will continue doing therapy plus I will continue working on the Boards that I am on including the College of Western Idaho, the Idaho Housing and Finance Board, and the Idaho Chapter of the American Heart and Stroke Association.

But, years ago when I completed my first round of therapy after the strokes, my doctor and my therapists at St. Al’s Rehab told me that part of my therapy was "just to live" and be with my family.

I will take that advice. For now. Like Arnold Schwarzenegger, "I will be back!"

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