How can a physical therapist tell if a patient is over focalized in their examination?

Answer:

“So if they’re over focalized and you don’t know that, and you have them start to track, I’m going to see if I can get a closeup of my eye movements. When they start to track, a normal tracking will appear like this, where the spatial process literally anticipates the change and focalization is maintained on the target. If you go into over focalization, you literally become locked into a time and space, so that you’re going to see this happen. So what’s occurring is they fixate, the target is moved, they lose the anticipation for the change. They’re still stuck here and then make a quick eye movement, a saccade over to the next point. So when you see these patients and they’re having jerky eye movements and fixation losses, this isn’t a muscle problem. What it is, it’s an imbalance in the spatial process, not anticipating the change.

Same thing will happen with a saccade. So you have two targets just as you saw the young girl before to make a shift from one point in space to another point in space requires the release of the fixation. You go into a high trajectory movement, and you don’t see the world during that high trajectory movement. Because the extra ocular muscles sent up to the brain that their eyes are in high velocity and a shearing effect occurs where the focal process is shut off. Yet the spatial processes never shut off because it’s mapped and it’ll deliver you to the next point of fixation, even though you’re not seeing the world move. With patients that have over focalization and no release to focalization, when they make a quick shift of their eyes, they’re going to be shifting their eyes and not making it accurately, just like I’m doing in front of the camera. So when you see inaccurate shifts, when you see that they get stuck on a point and they can’t release from that point and it takes them time to get to the next fixation point, these are all characteristics of focal binding.”

RESOURCES & LINKS:

  • This Q&A is an excerpt from the Concussion Health Summit Sessions
  • The Concussion Health Summit Sessions are included with 360NeuroGO Enterprise

FACULTY:

William V. Padula, OD

William V. Padula, OD is the Director of the Padula Institute of Vision Rehabilitation in Guilford, CT. He is the Founding President of the Neuro-Optometric Rehabilitation Association (NORA) and Senior Fellow of the National Academy of Practice Dr. Padula is an Associate Professor at Salus University of Health Sciences College of Optometry in Philadelphia, PA and is an Adjunct Professor at Western University of Health Sciences College of Optometry in Los Angeles, CA. He is the Founding Chairperson of the American Optometric Association Vision Rehabilitation Section. Dr. Padula has been a consultant to the National Academy of Sciences Committee of Vision. Research has been conducted by Dr. Padula discovering Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS). Dr. Padula also served as the National Consultant in Low Vision Services for the American Foundation for the Blind and Director of Vision Research to the Gesell Institute of Human Development.

Charlie Shearer, OD

Charlie Shearer, OD has been a nationally recognized leader in the areas of vision therapy, visually related learning problems and sports vision enhancement. He has worked with US Olympic athletes and teams, professional and amateur athletes, and coordinated national screening of both Special Olympics and Junior Olympics. Charlie is a leader in the field of instrumentation development as related to his role of Vision Science Consultant for Bertec Corporation, as well as his work with other companies. Charlie was born in Mishawaka, Indiana. He received his undergraduate and optometry degrees from Indiana University. When Charlie returned to Mishawaka, he resumed care of the patients of retiring Dr. Lou Fishman. Soon after, Charlie relocated his practice with Jonathan Kintner, OD.