Low vision rehabilitation for a patient with a traumatic brain injury

The client described in this article had undergone intensive rehabilitation for physical and cognitive deficits that resulted from an anoxic encephalopathy. Her recovery was good in all areas except visual functioning. Her reading and writing deficits were initially thought to result from visual-perceptual problems. A low vision evaluation identified the deficits as resulting from a macular visual field loss. Warren (1993) has proposed that an intact visual field is one of the basic components of vision that must be present before higher visual processing can occur. Until the macular perimetry was performed on this client, the extent of her central field loss was unknown, and the treatment that focused on the higher level visual processing was unsuccessful. The low vision program targeted the central field loss as the probable cause for her difficulties and an effective treatment protocol was established. The client was instructed regarding the nature of her visual field deficit and was trained in methods to compensate for this deficit. Although she has not returned to work as of this writing because of financial disincentives, the training resulted in a measurable and functional improvement in the client's ability to read continuous print text, a task she had not performed in 4 years, and in her ability to perform all writing tasks needed for daily living.