Auditory/Visual Integration Assessment and Treatment in Brain Injury Rehabilitation
by Deborah G Zelinsky, OD
Recent research has demonstrated that activating the retina – in particular, the peripheral retina – can influence inputs to the brain in ways that may be useful in rehabilitation.
Retinal stimulation should be considered as a possible treatment for brain injury. Recent research has demonstrated that activating the retina – in particular, the peripheral retina – can influence inputs to the brain in ways that may be useful in rehabilitation. The specific treatment involves designing non-traditional eyeglasses that intentionally alter signaling pathways, rather than simply sharpening central eyesight. These often overlooked peripheral retinal pathways are activated or inhibited by feedback mechanisms linked with internal body systems, such as metabolism and attention. Changes in peripheral retinal stimulation can affect internal perception and can occur at conscious, or beneath conscious, processing levels.
Traumatic brain injury often disrupts retinal circuitry, because the retina is an extension of brain tissue. This disruption can trigger innate protective mechanisms, some of which can include alteration of peripheral retinal sensitivity. Patients’ ability to integrate various sensory, motor, cognitive and emotional pathways is often impaired after both focal and diffuse brain injuries, causing a wide range of symptoms. For instance, after a stroke or concussion, patients may have difficulty making accurate judgments in space and time, misjudging object location and/or speed. Current rehabilitative methods could easily be augmented by the use of selective retinal stimulation to take into account the interactions between external sensory inputs and internal processing.
The mechanism underlying this approach lies in the retinal activity that occurs before signals are transmitted to the midbrain, brainstem, limbic system and cortex. The eye’s linkage with sounds is concurrently involved in feedback and feedforward signaling pathways from both internal and external sources. Studies that demonstrated correlations between retinal function and auditory stimuli  paved the way for research on retinal plasticity. Although it was thought that the visual cortex changed in deaf people to meet increased visual demands of watching sign language, recent research discovered changes at the actual peripheral retinal level . The concept of the retinal cells being plastic caters toward unique internal processing in each patient. Interaction between a person and their external environment can become confusing if incoming sensory information is mismatched, e.g., if the ears are receiving a signal that is not properly linked with visual input. Treatment of brain injury can be more individualized by implementing visual/auditory integration activities during visual rehabilitation.
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‘Dr. Zelinsky Is Renowned'
~ Norman Doidge, M.D. & Clark Elliott, Ph.D., and Patricia S. Lemer praise her accomplishments
“Zelinsky fit Elliott with a series of eyeglasses designed to improve the perceptual damage that made his life so difficult… Getting fitted for Zelinsky's eyeglasses is like no eye appointment you've ever had… Now, Elliott says, he is almost entirely symptom-free, able to problem-solve, multi-task and find his way easily — all abilities he lost in the auto accident in 1999. When he put on his Phase VI glasses he felt something that he hadn't felt for years: “I felt normal.”
Review: ‘The Ghost in My Brain'
– The Chicago Tribune
“One brilliant Chicago-area optometrist I know, Deborah Zelinsky OD, FNORA, FCOVD, has developed a unique, patented, easy-to-administer evaluation called the Z-Bell Test. This test measures the efficiency of integration between visual processing and listening….A 2014 study at Vendarbilt University found that children with autism do not synchronize their seeing and hearing…I have watched Dr. Zelinsky administer this test to disbelieving coleagues, who were astounded by its accuracy and results…Over the past two decades, the Z-Bell Test has become internationally recognized by the scientific community.”
– Patricia S. Lemer, Licensed Profesional Counselor (LPC)
“I visited Dr. Zelinsky, and she showed me how she can use optical lenses to alter sensory filtering, by directing light to different retinal cells and brain circuits. This can influence activity in the brain and the hypothalamus to better regulate body chemistry, sensory integration, and even some auditory processing. [Dr. Zelinsky] works frequently with patients working with learning and cognitive disorders as well as TBIs.”
– Norman Doidge, M.D.
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