August/September 2019 - 23

TREATING THE ATHLETE
processing. This can be framed within the " fight or flight "
survival actions, as they require fast analysis and response in
an almost automatic manner.
We know that 20% of the eye's nerve fibers do not go to
the occipital cortex, but to the midbrain, which delivers this
sensorimotor function. Spatial visual processes include preconscious
and proactive actions, and reception of cortical feedback.
The complexity of neuro-organization possibilities is structured
to move the person beyond a static position or posture, smoothly
responding to constant change. When this loop and progression
fails, the patient can become immobile and isolated.
What this means is that the balance and interaction between
vision and motor is compromised. Vision dysfunction causes
recovery delays, interferes with learning, creates problems in
communication, and effects memory by disrupting time and
space. This causes " focal binding. "
Focal
binding
compromises
preconscious/proactive
relationships between the dorsal system (peripheral/motor),
vestibular and proprioception. Movement becomes conscious
(top down), and reduces function and fluency. There is no
fluency, because the systems are no longer able to anticipate
(e.g. reading, walking in a crowded space).
Essentially, focal binding inhibits the release of " detail, "
with the environment becoming overstimulated. In essence,
these individuals can't see the forest for the trees. Movement
in the environment becomes chaos to the visual system. Print
on a page becomes a mass of detail, and movement of the
eyes is projected into the field, causing movement of print or
the perception of movement of the ground being walked on.
Focal-binding is why you never start with pencil push-ups - it
makes the student-athlete worse.
Rehab: Vision and vestibular together?
Cognitive issues that linger show up as unresolved visual
vestibular issues. Anxiety problems show up as a consequence
of unresolved vision vestibular issues. Cervical issues are more
prevalent than previously reported, and they linger because of
unresolved vision vestibular problems.
We found that eye tracking is an excellent screening tool. It
enables us to help identify potential problems in the vestibular
and ocular motor conditions:
* RightEye: High tech.
* VOMS, KD, NSUCO: Low-tech eye tracking.
Post-injury assessment
Here is a breakdown of our post-injury assessment:
√ History and clinical interview.
√ Self-reporting symptom assessment. We use the
post-concussion symptom survey(PCSS).
√ Vision. Acuity, with a refraction, looking for blowout √
fractures, iritis, due to trauma. Looking for detached retina.
√ Vision/vestibular/balance. We are using VOR testing √
and VMS sensitivity. RightEye with eye tracking software.
√ Cognitive assessment. ImPACT testing, CNS Vital signs
or CBS Heath.
√ Heart rate variability (HRV). To understand HRV, we
first need to understand our nervous system and heart
rate. Heart rate variability can be traced back to our
autonomic nervous system. The autonomic nervous system
regulates important systems in our body, including heart
and respiration rate and digestion. The autonomic nervous
system has a parasympathetic (rest) and a sympathetic
(activation) branch. HRV is an indicator that both branches
TRAINING-CONDITIONING.COM
are functioning - the parasympathetic, in particular.
√ Reaction time. This is the length of time it takes to
respond to a stimulus. Reaction time is important when
driving, playing sports, during emergencies, and in many
day-to-day activities. Reaction time depends on nerve
connections and signal pathways.
Treating the athlete
Once we've completed our
testing and established the
athlete's condition, this is how we proceed with treatment
during the first three days.
√ Rest. Rest is still the cornerstone of recovery - we must √
get them sleeping. We have them take magnesium 30 minutes
before they go to bed.
√ Diet. Reduce gluten and casein in their diet. These two
categories of food are the most irritating to the system. Studies
show that within five to 15 minutes of a concussion the bloodbrain
barrier opens up, as well as the gut barrier. If these
barriers do not close up in a timely fashion, this leads to a
prolonged recovery. We need athletes to get more protein,
reduce the intake of sugar and caffeine, and stay clear of
alcohol.
√ Planning & pacing. Depending on symptoms and
presentation, we must help the athlete understand that
" pushing through " can make them worse. They must
plan and pace their day. We offer suggestions for school/
work attendance, along with planning and pacing.
√ Reduce internet/phone/computer time. No more than
10 to 15 minutes of screen time during each hour.
√ Therapy. After being assessed, we have them do 10 to 20
minutes of light therapy; either photobiomodulation or
syntonics.
√ Epley maneuver. We have them perform this maneuver,
as long as the neck is cleared.
√ Cranio-sacral therapies. Do this for the head and neck.
√ Cervical evaluation. Icing and taping as needed.
Matrix therapy
We will see the athlete every day until the symptoms are
down - sleeping better, ROM on the neck, RightEye or
VOMS better, HRV shows parasympathetic and sympathetic
system are more balanced.
We then start the exertion protocol to get them moving. We
conducted a study of 200 concussions that presented at zero to
seven days of the injury. In the self-reported symptom survey,
we averaged 19% to 24% reduction in symptoms with 45
minutes of therapy - light, cranio sacral and Epley maneuver.
We are working to get it published.
It takes a team to help student-athletes of all ages recover
from a concussion. Vision, vestibular and cervical are
the pathways to start with, along with understanding the
parasympathetic-sympathetic system with HRV. We must get
athletes sleeping, and make sure they're getting good protein,
and reducing sugars and caffeine in their diet. If there is
success, anxiety, post-trauma migraine, and cognitive issues
can be better resolved. n
DeAnn M. Fitzgerald, OD, is the owner of Dr. Fitzgerald &
Associates, the founder of Cedar Rapids Vision in Motion,
and vice president of the Neuro-Optometric Rehabilitation
Association (NORA). She can be reached at
drfitz4eyes@hotmail.com.
T&C AUGUST/SEPTEMBER 2019 23
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August/September 2019

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