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Thinking, Motion No Longer Automatic After Back Injury

Pain Disrupts Visual Processing; Planning Becomes Exhausting

The recent injury to my back – I twisted it in an effort to prevent a fall – did more than cause me significant pain and a lengthy period of recovery and rehabilitation. It disrupted my internal visualization. It broke the normal continuum between thought and action. In so doing, it sharpened my realization of what patients with brain injuries and other neurological disorders experience on a daily basis.

What do I mean?

Something I would have done unconsciously before my back injury, such as stand up from my seat and immediately walk over to the kitchen countertop six feet away to retrieve an item I was considering using, now required much more conscious thought and planning. Pain restricted my movement, so I had to carefully consider the best way to get to the item. An empty chair partially blocked my route to the countertop. I had to weigh whether the extra steps required to walk around the chair would be more advantageous than trying to stretch and push the chair away. In the end, I did neither. I simply opted to sit where I was, thinking that I probably did not need the countertop item that badly anyway.

For me, thinking became separate from – not concurrent with – action. I was frozen in thought. The planning required to complete this simple task, which typically I would have done without consciously considering it, was exhausting. What is the best and simplest way to get to the countertop, considering my back pain? How far away is the item that I want? Is it even possible to get there?

The mental effort reminded me of the difficulties a patient with a traumatic brain injury describes during her recent foray through an airport terminal.

To understand her issues, one must first know that brain disorders and injuries to the brain can disrupt the synchronization of a person’s senses, particularly integration of eyes and ears, and affect visual processing. Visual processing is what enables us to respond appropriately – internally and externally — to our surrounding world. Abnormal processing leads to a variety of discomforting and debilitating 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.

So, back to the brain-injured patient in the airport where people are rushing around her, voices in overhead speakers making incessant announcements, and signs and arrows of all types seemingly pointing in a myriad of directions. How does she make sense of all this? Which way should she go? Movement is governed partially by peripheral awareness of the environment and the ability to make spatial judgments. But what happens when peripheral awareness is no longer normal, when one loses the ability to judge time, space, and motion. The patient’s progress is halted because her thinking has become divorced from action in the disordered brain. She is left anxious, alone, exhausted – even scared — in the confusing world of an airport terminal.

Oftentimes while driving my car, I am talking business to an outside world on a hands-off phone. At the same time, I am both consciously and unconsciously aware of the vehicles whizzing past me, the street signs and traffic signals, the pedestrians in crosswalks. I can multitask in this way because there is balance between my internal world and the external world. Peripheral awareness of my outside environment is functioning normally, thus allowing me to concentrate on a phone conversation while driving safely, with full cognizance of the unrelated activity around me.

Our thinking and action centers, our emotions, even our body’s metabolism are all connected to the eye and, more specifically, the retina, which is composed of brain tissue. Thought processes are intertwined with action processes, which, in turn, are interconnected to emotional memories. Planning is one form of visual processing. It is this processing that enables us, first, to determine whether we can stop at the dry cleaners, the bakery and the post office and still be back home for an 11 a.m. Zoom meeting and, secondly, to decide in what sequence to make these stops to best utilize our time. Memories aid visual sequencing. We remember that the bakery is farthest away and should be our first errand stop because we realize standing in line, holding customer ticket 23, takes longer than a quick fly past the dry cleaners and the postal box.

We use our central eyesight to identify people and items. We use our peripheral eyesight to judge (consciously and unconsciously) what is happening around us. And we use central and peripheral eyesight in tandem for movement and navigation, such as manipulating a grocery cart down a crowded, narrow store aisle. Together, these skills require intact visual processing. When it is not intact, our brain becomes exhausted. Its energy bucket is depleted long before bedtime. That is because it is forced to plan out every action, even those which are normally performed automatically and unconsciously.

We are all different. Each of us processes our world in unique ways. At the Mind-Eye Institute, we are acutely aware of these differences. Our “brain” glasses are highly individualized. They are prescribed only after comprehensive testing of a patient to determine how he or she thinks, plans, learns, and reacts to situations (fight, flight, or freeze) and what the patient most enjoys doing.

“Brain” glasses are intended to resynchronize a person’s sensory signaling pathways by varying the angle, intensity, and amount of light passing through the retina. Because it is a crucial part of the central nervous system, the retina acts as a conduit between the outside environment and internal physiological systems. By using therapeutic eyeglasses to manipulate the way light disperses across the retina, the Mind-Eye team literally helps develop new informational signaling pathways in a patient’s brain. These new pathways circumvent damaged – or under-developed — neurological ‘communication’ lines and re-establish more normal signaling patterns between the retina and deeper brain structures.

The Mind-Eye is about restoring relief and comfort to patients with injured, diseased, or learning-disordered brains. We do this not on our own terms as optometrists, but in ways that address each individual’s uniqueness – their preferences and differences. Indeed, our goal is to advance optometry to new scientific levels. We are taking our practice beyond 2020 to build better brain function and restore people to who they are and to whom they have always been.

Deborah Zelinsky, O.D.
Founder, Executive Research Director
Mind-Eye Institute