From War Injured to the Elderly, Brain Injuries Are on the Rise for Vision Rehabilitation Practitioners

Serving the growing population of adults with brain injury and related visual impairments provides our field with unprecedented challenges, but also new opportunities for growth, professional expansion, and collaboration with professionals from a wide range of rehabilitative services. Whether they are returning service members from the wars in Iraq and Afghanistan; adults injured in motor vehicle accidents, falls, or other trauma; or survivors of stroke or other brain injury, these presenting patients are forcing us to rethink some of our rehabilitation strategies and adapt our methods to meet their complex needs. Rehabilitation training, particularly traditional methods of teaching the special skills needed by people who are visually impaired (that is, who are blind or have low vision), often relies on the use of cognitive processes such as attention, memory, and auditory processing. Although each brain injury is unique and multifaceted in its effect on rehabilitation learning, the performance of these skills may be the most challenging to a person with a brain injury (Lew, 2005). Nevertheless, a growing body of research and collaborative teamwork with other professionals treating brain injury give us many tools for working with an individual with such an injury. The future is exciting for those of us who work in blind or vision rehabilitation, and we all have a chance to make a positive impact on a substantial population. CALLING ALL SERVICE PROVIDERS Medical treatment is improving the rate of survival among those wounded by war or trauma, but survivors often live with multiple disabilities, including traumatic brain injuries (TBIs) that can result in vision loss. As the number of individuals with brain injury-related vision loss increases, all levels of vision rehabilitation service providers will need to be involved in working with this population, especially as returning service members with brain injuries and vision issues who are served at military treatment centers and the network of Department of Veterans Affairs (VA) facilities will begin dispersing into their home communities. Veterans are not the only group of individuals with brain injuries and related visual impairments that will soon be overwhelming health care. Adults in the general population are living longer, but with age-related health conditions that may affect the brain or vision. The chance of having a stroke approximately doubles for each decade of life after age 55. Heart or artery disease, diabetes, obesity, and hypertension are more common with age and are major risk factors for stroke, which can damage the brain and vision (American Heart Association, 2010). Not only are individuals living longer, but the number of individuals living into old age is rapidly increasing as well. In the United States and around the world, the aging of populations is unprecedented, pervasive, and enduring, and this growing cohort of elderly individuals will require more rehabilitative and health services than ever before (United Nations Department of Economic and Social Affairs, 2002). According to a United Nations report (2002), persons 65 years or older numbered about 39.6 million in 2009, and they represented 12.9% of the U.S. population (about one in every eight Americans). By 2030, there will be about 72.1 million older persons (that is, 19% of the U.S. population-more than twice the number in 2000). The sheer number of the people reaching ages associated with increased health risks suggests there will be ubiquitous opportunities to interact with and serve a population with brain injury and vision impairment (Administration on Aging, 2010; Ghusn, Stevens, & Atassi, 1998). DEFINING TBI AND ABI Brain injury is receiving more press and research attention as "the signature wound of the war[s]" in Iraq and Afghanistan (Oakie, 2005), but terms involving brain injury are often used imprecisely or are misunderstood in popular literature. …