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Bryn Mawr Rehab Expands Scope of Neurocognitive Vision Therapy

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Neurocognition was the farthest thing from Phil Jones’ mind in 1986. Playing his seventh and final season with the Canadian Football League was his focus. Jones played defensive back with the Toronto Argonauts and Edmonton Eskimos, so he knew a thing or 20 about the importance of peripheral vision, reaction timing, lateral movement and hand-eye coordination.

That’s why, as Jones made plans for post-CFL life in retirement, he acquired the technology for equipment that consisted of a giant monitor and a series of lights. The Eskimos’ athletic trainer was using it, and Jones was convinced that other teams in other sports would find value in what he calls “strength conditioning for the eyes.”

Improving the field of vision became a field of dreams for Jones, who spent four years improving the technology, and then had the first 500 Dynavisions created in his house. “I made it as robust as possible so it could take the pounding of a pro athlete,” he says. And soon, players from the NHL, NFL and NBA did just that.

Unbeknownst to Jones, occupational therapists specializing in neurological impairments were also incorporating Dynavision into rehabilitation for patients with multiple sclerosis, spinal cordinjuries, Parkinson’s disease and balance disorders, plus those recovering from stroke and concussions. Jones finally found out via correspondence from the OTs. “To hear that something I helped make was being used to heal people was amazing,” he says. “Then therapists started writing to me about changes that would make Dynavision better for their medical purposes.”

Clint Beckley was one of those who contacted Jones. An OT with the Comprehensive Outpatient Neurorehabilitation Center at Bryn Mawr Rehabilitation Hospital, Beckley specializes in neurocognitive vision therapy. “It was wonderful to hear from people like Clint,” Jones says. “He honestly wanted to help his patients and took the time to send detailed explanations of how we could change Dynavision for the better.”

In 2010, Dynavision was reincarnated as D2—a jumbo flat screen monitor with 64 LED lights in a circle. Like a child’s drawing of the sun, straight, LED-lighted lines radiate from that circle. They extend to the left and right, overhead and to knee length. The lights turn red or green in random patterns that comprise a minute-long sequence. The goal is to reach and bend to hit the red lights, but not hit the green lights—and read aloud the words and numbers that flash on a small screen in the center of the monitor. Does that sound difficult? Imagine doing it with a traumatic brain injury.

“It’s definitely challenging, especially considering that it was originally conceived for athletes—but our patients love using it,” Beckley says. “I alter it depending on the patient’s ability. I monitor the level to which they’re exerting themselves so they’re working hard but not to the point of exhaustion or harm.”

Beckley knows the challenge is part of D2’s appeal. “People like to push themselves to get better scores—and it’s fun to use,” she says. “It’s a life-size video-game that just happens to be a great therapy tool.”

In addition to the vision strength-training provided in its first iteration, D2 activates neurocognitive processing, decision-making and visual system integration for midline awareness. “It’s about telling your left from your right and testing your peripheral vision,” Beckley explains. “At the same time, the monitor on D2 works on patients’ cognitive functions—like reading strings of letters or numbers and words that are missing letters, and solving math problems.”

D2’s new computer software allows OTs to run a variety of light patterns, providing them with instant reports on how patients’ perform. “Data was very important for medical professionals to have,” says Jones. “They need it to track their patients’ progress.”

Jones admits that he’d been hearing for years from OTs that Dynavision was working. “But other medical professionals said, ‘Show me the proof.’” he says. “Now we can.”

Results have been demonstrated in patients with a variety mild traumatic brain injuries—concussions among them. At Bryn Mawr Rehab, the number of concussed patients has skyrocketed. In 2012, the hospital treated 338 cases, a startling 310 more than in 2008. Of those, 40 percent were caused by motor vehicle accidents; sports-related injuries among those ages 12 to 30 made up another 40 percent.

“I don’t think more concussions are happening,” says Beckley. “I think there’s more awareness of the signs of concussion, so more people are getting treated for them.”

Despite his experience on the football field, Jones was never diagnosed with a concussion. “Which is not to say that I didn’t have one,” he says. “I never lost consciousness during a game. But my generation was always taught to lead with their heads, and we all gave—and took—really big hits.”

If Jones spent his first career knocking people’s lights out, his second career is turning them on. Debuting in September, the RT1 Reaction Trainer is a high-tech version of Twister. Round lights—blue, red, green, yellow and white—are placed around a room. The goal is to race from one light to the other, tapping them in a specific order. Speed and accuracy are recorded through wireless technology.

“The U.S. military is thinking about using RT1 for target practice that would be done with laser guns instead of bullets, because it would save money on ammunition,” Jones says. “And I’m sure we’ll find more therapeutic uses for it.”

Visit mainlinehealth.org/rehab.
 

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