30-Year Partnership Still Helping Patients Think and Perceive

One works with cognition, the other with perception. But together these two professionals are having a powerful impact, rebuilding the lives of people who suffer the symptoms of traumatic brain injury, stroke, and neurological diseases or who struggle with learning disorders.

“We both recognize that the brain is plastic and modifiable at any age and can be rehabilitated after injury,” says Donalee Markus Ph.D., cognitive restructuring specialist and founder of Designs for Minds in Highland Park, Ill. The “we” she references includes Deborah Zelinsky OD, founder and executive director of research at the Northbrook, Ill.-based Mind-Eye Institute.

“There is no end to how much the brain can learn,” Dr. Zelinsky adds.

The two professionals met each other about 30 years ago — in the 1990s — and have been working in partnership ever since.

“Perception is based on environmental input. The Mind-Eye Institute changes a patient’s environment using therapeutic ‘brain’ glasses, colored filters, prisms, and other optometric interventions. In so doing, we can modify a patient’s awareness of where his or her body is in space and where objects appear to be located,” Dr. Zelinsky says. “In fact, the foundation of optometry is the question Where Am I? If patients are unaware of where they are in their surrounding environment, then they are often unable to focus or remain attentive and function inefficiently, usually fidgeting to maintain balance.”

Designs for Strong Minds, on the other hand, works with the mind, enhancing a patient’s ability to think, to judge, to plan, and to organize through use of pictures and puzzles that are “hierarchically organized into specific areas – much like the brain is organized,” Dr. Markus states.

Dr. Zelinsky explains that neurological disorders and injuries to the brain can affect visual processing by disrupting the synchronization of a person’s senses, particularly integration of eyes and ears. Visual processing is what enables individuals to respond appropriately — internally and externally – to signals from their world. Abnormal processing leads to a variety of symptoms, including light and sound sensitivities; difficulties reading, concentrating, and learning; brain fog; problems organizing and staying on task; sleep and memory issues; and post-traumatic stress disorder (PTSD).

“When the brain fails to function efficiently, busy environments – sights, sounds, smells, people – can literally cause one to become dizzy, nauseous, confused, stressed,” she says.

Dr. Markus agrees. “Patients with mild to moderate traumatic brain injury oftentimes complain of visual processing difficulties. They struggle to look at something, to follow a moving object, or to find something on a grocery store shelf or in their own refrigerator. Even the smallest differences – a person’s two eyes not correctly teamed or moving at varying rates – can affect visual processing, cognition, socialization, participation in sports, work activities, and decision-making abilities.”

Designs for Strong Minds offers graphics that are intended to address a patient’s spatial perception, visual closure, part-whole relationships, variation in perspective, form constancy, figure ground, visual imagery, and memory skills – all of which can be compromised by head injury. “Some of the puzzles are specifically for children, age 5 or older, who experience developmental delays and subsequent learning problems; others are effective to enhance the cognition of gifted children. Still others challenge high-functioning professionals to achieve new plateaus of thinking,” Dr. Markus says.

“There are many different levels of exercises to build, rebuild, or enhance learning. To habituate new patterns of behavior requires patients to complete numerous complex puzzles,” she says. For example, Dr. Markus developed 5,000 graphic exercises for use by leading scientists and engineers at the National Aeronautics and Space Administration (NASA 1998-2005) to challenge and improve their critical and creative thinking.

“One aspect of visualization is being able to create pictures in your head,” Dr. Markus continues. “When we say a word, we have the ability to create a mental picture. Some individuals can conjure very complex imagery; others are able to use their minds to rotate shapes in time and space. Some can see the big pictures, others only the details. Our goal is to get patients both to see the big picture and to integrate the details in many different ways.”

“I put a lot of time and energy into developing – or re-establishing – a patient’s metacognitive dialogue, namely the dialogue we have with ourselves inside our minds to plan and strategize, reflect, and learn by recalling past events. It is this internal dialogue that separates us from other mammals. Recent studies have shown that metacognitive conversation lights up the brain’s visual cortex because, in doing it, we create mental pictures,” Dr. Markus says.

“Our goals are consistent with each other,” Dr. Zelinsky states. “Both Dr. Markus and I work to activate patient brain tissue, only in different ways.”

Not all patients need both the services of Designs for Strong Minds and the Mind-Eye Institute. “If patients require cognitive rehabilitation only, they are referred to Designs for Strong Minds,” Dr. Zelinsky says. “If injury or disease has affected more of a person’s environmental balance rather than cognitive skills, then the patient remains at Mind-Eye. Sometimes, a patient’s visual system is so delicately balanced that any thinking hurts. Those patients are not yet ready for Dr. Markus.”

Patient testing at the Mind-Eye Institute is comprehensive, involving evaluation of a patient’s ability to “see” and respond to both stationary and moving targets when the patient is seated and in motion.

“We use central eyesight to identify details of people and items. We use peripheral eyesight to subconsciously judge what is happening around us. Central and peripheral eyesight are used in tandem for movement and navigation, such as manipulating a grocery cart down a crowded, narrow store aisle,” Dr. Zelinsky says. “When visual processing is not intact, a brain’s energy budget is depleted long before bedtime. That is because it is forced to plan out every action, even those normally performed automatically, without effort.”



Dr. Zelinsky and Dr. Markus concur that “people are all different, each processing the world in unique ways.” That’s why the “brain” glasses prescribed by the Mind-Eye Institute and the puzzles used by Designs for Strong Minds are highly individualized, based on how the patient thinks, plans, learns, and reacts to situations (fight, flight, or freeze) and on what the patient most enjoys doing.”

“Dr. Zelinsky recently referred me a patient on whose chart she simply wrote the word ‘neck.’ Now, most other professionals might ask, Neck? What? But I knew exactly what Dr. Zelinsky meant. She wanted me to pay close attention to the patient’s neck position and posture while the patient was doing my exercises. That’s how long we have known each other,” Dr. Markus laughs.