The author of this book Amy Chang, has plowed a path in the acquired brain injury and vision rehabilitation sector. As a neuro optometrist, she developed a vision rehabilitation clinic in the US Army at Womack Army Medical Center, serving wounded soldiers who suffered visual deficits after traumatic brain injury.
This book introduces the concept of neurovision rehabilitation by addressing the components of the visual system: visual acuity, visual field, accommodation, fixation, pursuits, saccades, binocular vision (fusion, stereopsis, vergence) and visual perception, and their specific roles in the visual system. By laying out the components for effective vision therapy, it sets the framework for the essentials.
It dives right into the evaluation of a patient with traumatic brain injury (TBI), differentiating mild-moderate and severe, clearly and succinctly listing the necessary tests, describing what can be done by the evaluator and the therapist. This section could be expanded in future editions to offer an even better understanding of test interpretation. A case example would allow the reader to better understand the immense information gathered in a neurovision evaluation.
The bulk of this book is dedicated to rehabilitative therapy programs, containing more than 80 vision therapy procedures. The procedures are well organized with a chapter dedicated to each visual component (ocular motility, accommodation, and binocularity). Easy-to-follow instructions describing the purpose, necessary equipment, duration, set-up, and step-by-step instructions help guide the patient.
These procedures are straightforward; I imagine this section to be very useful for a therapist in clinical practice to consult routinely for independent therapy management. The variations to each activity help in altering its difficulty, allowing the procedures to become relevant to a wider variety of patients. What I liked most within this section were the flow-charts which show progression through therapy in a structured manner.
The visual perception chapter briefly addresses the type of visual perception affected in mild and moderate-to-severe TBI based on location of injury (parietal vs temporal lobe). It describes the various visual perceptual skills comprehensively, although briefly (at a level appropriate for a therapist), and goes through the perceptual standardized tests with their subtests listed. The authors further describe a therapy activity or two for each area of perceptual deficiency with references to where the products can be acquired.
In terms of the specific procedures, the authors make very good use of computer/electronic programs such as the Neurovision Rehabilitator, Sanet Vision Integrator, and Computer Perceptual Therapy. While these programs are invaluable in large vision therapy/rehabilitation clinics, it may be unrealistic to expect all centers to have access to them, and renders those procedures virtually impractical for some practitioners. Furthermore, with the fast-pace changes and updates to these programs, the instructions as written in this book may no longer be accurate in a few years’ time.
The concluding chapters break down the psychological implications and low vision consequences of TBI (magnification, contrast sensitivity, and field enhancement) in a way that makes the reader aware of these deficiencies and offers an understanding of how to improve them, or who to refer to. The authors address the more common low vision aids, a starting point for how to prescribe them, with an opinion on the more successful versus less utilized ones.
Overall, the book offers valuable information for both the optometrist and their therapist in treating patients with TBI. It would serve as a great starting point.
The book is chock full of activities that are organized by their goals/purpose and detailed descriptions of how to perform them. Some of the information goes so deep into the management without offering the background/what/why that a reader who considers themselves a beginner in neurovision rehab may seek other resources to fill in the gaps prior to performing therapy.