TBI Impairs Visualizing; Can’t Describe It, Then Can’t Share It

By Deborah Zelinsky, O.D., Founder of the Mind-Eye Institute

Remez Sasson, author and creator of www.successconsciousness.com, defines visualization as “the ability to create mental images,” integrated with other sensory sensations like sounds, smells, and tastes. Visualization “means using your imagination.” This visual skill takes place internally on what Mind-Eye practitioners term a “mental desktop”,  one aspect of visual processing.

Visual processing – namely, the processing and interpretation of many diverse kinds of sensory signals from the surrounding environment – makes each of us who we are. Visual processing combines incoming sensory information with previously stored experiences. That combination then attaches with emotion to enable other processes to occur – like communication, comprehension, self-expression, decision-making, organization of time and thoughts, and judgment.

But what happens when a traumatic brain injury (TBI) interferes with mental imagery, creativity, perception, and all the other skills required for visualization? When parts of the brain are damaged, or pathways are disrupted? When initiating conversation becomes difficult because conceptualization of what one wants to communicate, whether it be an idea, a request, an offer, or simply a comment, is blurry, uncertain, or hampered? Many times, in cases of mild brain injuries, structural testing does not detect  damage. Yet some brain pathways are still dysfunctional, creating symptoms hindering communication abilities or the ability to maintain thoughts on the mental desktop.

Ask Hallie, a Mind-Eye Institute patient who struggled for seven years after sustaining a TBI in a motor vehicle crash.

Once an avid reader who also enjoyed using social media to interact with friends, Hallie could no longer read and was unable to converse following her head injury. “I simply could not comprehend – or understand – new information. I had neither the attention span nor the tolerance. That is why I only watched television reruns – seeing the same programs over and over and over again,” she recalled. Her communication impairments caused her a loss of social relationships, as well as a strained relationship with her mother – facts underscored by authors of a 2020 study published in the American Journal of Speech-Language Pathology (https://pubs.asha.org/doi/10.1044/2020_AJSLP-19-00020). They reviewed 30 years of informational sources and concluded, “Social communication problems in adults post-TBI are common.”

Hallie’s inability to visualize underlied her struggles. Based on Lynn Hellerstein’s extensive and wonderful work on visualization, “the optometrists at the Mind-Eye Institute asked me to close my eyes and form a mental image of a light bulb,” Hallie said. “Now, I know what a light bulb looks like, but I could not picture it in my mind. That was scary, yet not surprising. I had not even had a dream since the car accident.” Dreaming, of course, also relies on the mind’s ability to create visual images or reawaken memories of sounds and smells.

Then there is JoAnn. whose apparent TBI-related symptoms developed suddenly and unexpectedly. Among other problems, “I experienced difficulties using the right words” and communicating “logical next steps” because they “no longer seemed that logical anymore,” she said.

Communication consists of two primary categories: the actual mental processing of what one wants to share and the motor action to express it through language, gesture, and facial expression. If an individual cannot visualize something, he or she cannot describe or share it. In the mid-1950s, A.M. Skeffington, the father of developmental optometry, created four circles to express “vision,” a concept involving multiple brain pathways and systems. One of those circles was labeled, “How do I describe it?”

For patients whose brains have been disrupted by trauma, stroke, autonomic dysregulation, or a neurological disorder, the Mind-Eye Institute works to modify their visual pathways and rebuild visual processing skills. Desired results can be frequently achieved by using therapeutic eyeglasses, colored filters, prisms, and other advanced optometric tools to alter the amount, angle, and intensity of light dispersed on the retina. Stimulating the retina with light triggers retinal neuromodulation, a process whereby signals propagate through neurons and interact with the visual cortex and other key brain structures.

Light-induced changes to the brain occur in both space and time, altering the dynamic relationship between the mind’s retinal inputs and the body’s internal reactions and responses. This implies that retinal stimulation using light promotes modifications in basic physical, physiological, and even psychological systems involved in motor control, posture, emotions, and thinking. In other words, external inputs can influence internal systems.

Other experts agree. For example, a fact sheet from the Model Systems Knowledge Translation Center (MSKTC) web site (https://msktc.org/tbi/factsheets/vision-problems-and-traumatic-brain-injury) details how TBI can “affect posture, balance, or moving through space” and impact the “brain’s ability to take in and understand visual information,” thus hindering a person’s communicative abilities and other skills. Options for improvement include therapeutic eyeglasses and “specialized” lenses, including “prism glasses,” these experts suggest.

If central and peripheral eyesight fail to interact properly or if perceived visual and auditory space are uncoordinated, a patient’s ability to visualize can be affected and decision-making suffers due to sensory mismatches. These mismatches put the body on overload, thereby triggering production of stress chemicals. People become confused about their surrounding environment, have limited perception and awareness, and experience difficulties in learning, attention, memory, reading, posture, balance, and of course, communication because brain circuitry is unsynchronized.

And, yes, in case the reader is wondering, the prescription of therapeutic “brain” glasses proved the appropriate approach for both Hallie and JoAnn.

In a 2021 interview, Hallie reported mitigation of some of her worst symptoms. “I am sleeping better, am less explosive, my reading skills are coming back, and my relationships, especially with my mother, have greatly improved.” Meanwhile, JoAnn indicated, “Today (May 2022), a year since my first Mind-Eye appointment, I am about 95 percent back to normal. I have my life back. I have hope; I have excitement.”

“This all began with Skeffington’s circles which were created decades ago and are still at the forefront of optometric care in the neurologically challenged population,” Mind-Eye practitioners add.

Perhaps, playwright and critic Bernard Shaw best described the interplay between visualization and communication when he said, “The single biggest problem in communication is the illusion that it has taken place.” Here is hoping you rebuild your visualization and communication skills.

Deborah Zelinsky, O.D., is a Chicago optometrist who founded the Mind-Eye Connection, now known as the Mind-Eye Institute. She is a clinician and brain researcher with a mission of building better brains by changing the concept of eye examinations into brain evaluations. For the past three decades, her research has been dedicated to interactions between the eyes and ears.