JAVS Fall 2022

Example 1: Demonstration of Saccades exercise.

things considered, it was a bit much to process with Post concussion syndrome, and I had a lot of information overload. Trying to think about the significance and subjectivity of the music on top of all of this added another layer of intensity and endurance required. K: Yet to your colleagues, you appeared normal: none of this could be detected from looking at you, right? D: I looked normal if I was walking around and talking to people, but internally I was struggling. So, all through that fall, I had headaches, occasional dizziness, nausea, sensitivity to sound and light, and nothing was really helping except resting. Around then, I also started to wear earplugs more consistently in day-to-day life, and sunglasses when the light was too intense outside. This helped to lower the threshold of intensity of sensory stimuli. K: Something that really helped you was finding a specialist that focused on vision. What were the visual skills that you were struggling with, and what were some of the exercises and treatments that helped the most? D: Concussions often can affect visual processing, and I “saw stars” for a long time. For me, they looked similar to what you see after a camera flash. Maybe I was exhausted from reading notes and accidentals. I also had general eye strain, which felt like wearing someone else’s glasses all day even though my vision prescription has not changed for about ten years. I struggled with changing focus from side to side as well as near and far. I also had issues processing busy images like crowds of people walking in different directions or handwritten music. Some of the exercises that helped me were the Brock String, practicing saccades, and then incorporating those into reading music and switching to distance vision. 5 The OT had me walk through the grocery store aisles for five to ten minutes a day with a soft gaze, which was not easy. The combination of working with you and the OT was really helpful. Post-concussion syndrome usually comes with a constellation of symptoms, and it’s important to remember that they can all affect each other. Vision and balance have a lot of interplay. Some other exercises that helped were focusing on a spot while turning and nodding my head and, later, also walking while doing that. I also enjoyed the alphabet ball toss we did. 6

Example 2: Demonstration of Accommodation exercise.

K: What were the specific visual skills that you were working on? D: The main ones were saccades, gaze stabilization, convergence, divergence, and the VOR. 7 We also made these more specific to music, using sheet music as a visual target, watching a conducting baton from a distance, and so forth. There are many visual skills that play a role in ensemble playing!

Journal of the American Viola Society / Vol. 38, No. 2, Fall 2022

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