Over the last month our everyday life has been quite shaken up by the COVID pandemic. It is the first pandemic during which technology has played such a central role. It has made it possible for us to stay in touch with family and friends, to keep working from home for many of us, to continue learning for students, to order online grocery and other necessities, etc. However, screens easily exacerbate visual symptoms in patients recovering from concussion. Too much screen time can also lead to Computer Vision Syndrome, a self-limited condition causing uncomfortable symptoms like headaches, eyestrain, blurred vision, dry eyes and light sensitivity, many symptoms that resemble those experienced after a concussion.
Our experts at YRCC have compiled tips to navigate more easily the digital world with a concussion during these unprecedented times.
When using digital devices, we often become so focused on the task at hand that we do not blink adequately. A good blink is important as it helps replenish the tear film. The tear film is extremely important to lubricate, nourish, and protect the eyes. The less often we blink, the more our eyes are exposed to the environment and the faster the tear film evaporates leading to dry eyes. So write ‘BLINK!!’ on a post-it and place it on your laptop to remind yourself of blinking.
Visual breaks are also essential. They not only allow the eyes to blink, but they also allow the eyes to relax. A simple rule to follow is the 20-20-20 rule: give your eyes a break from the screen every 20 minutes by looking at an object located 20 feet away for 20 seconds. Another way to take a visual break is to engage in other activities that do not require screen time, such as listening to podcasts, baking, listening to music, gardening, home renos, going outside for a jog or walk (while complying with the current social distancing measures of course). Another suggestion is to pace screen time: do it in small chunks, spread throughout the day.
And when it is screen time, take it easy. Therapists caution about using more than one device at a time, even within the visual field like a TV on CP24 in the background, as the visual system could easily become overloaded with visual input.
Keeping an arm’s length distance from the screen will reduce the amount of work the eyes need to do. The closer the material is, the harder the eyes have to work. Also contrasting levels of light, such as a bright screen and dark room, can increase eye strain. Making sure the surrounding light is similar in strength to the background lighting from the digital device will be easier on the visual system. Furthermore, there are simple steps to mitigate the effect of the screen. Dim it. Use a blue light filter. Limit the amount of information/items on the screen. For example, have only one thing open and make the text bigger than usual so there is less for your brain to sort through. Also limit movement, think about using the grid setting on video chat apps and limit scrolling.
Ideal posture is when the ears are aligned with the shoulders and hips. Prolonged sitting makes us susceptible to poor posture. Oftentimes people with desk jobs showcase a forward head posture meaning that the head shifts anteriorly in relation to the neck and shoulders. Anterior head carriage can load and strain the muscles around the neck. However, it is important to note there is no perfect posture, especially when held prolonged. The body is dynamic. It is the lack of movement that is problematic. If you have a standing desk, try to change from sitting to standing every 30 minutes. If you have a traditional desk, try to get up once every 20 minutes.
To favour a good posture, keep the screen at eye level, or aim to have your eyes level with the top half of the screen. If necessary use an external monitor, hook up your laptop to the tv, or place your laptop on boxes or books and use an external keyboard.
Neck issues can cause visual problems and vice versa. Patients often subconsciously recruit neck muscles to help stabilize or focus on an image (this is one of the reasons why your neck might feel sore after vision therapy). Hence, it is important to recognize and offload unnecessary tension in the neck.
Learning how to breathe properly (by using the diaphragm rather than accessory neck muscles) helps generate core stability and offload tension in the neck. Paced diaphragmatic breathing increases parasympathetic nervous system activation which helps with visual relaxation.
Lastly, chin tucks when performed properly can help stretch out posterior neck muscles that are often recruited during vision exercises. Accessory neck muscles such as the sternocleidomastoids are often painful and overactivated after a concussion or neck injury. Chin tucks also recruit and strengthen deep neck stabilizers which help offload accessory neck muscles.
‘Patients often think that vision therapy is all it takes to fix their visual issues. But even if access to vision therapy is limited during COVID, there are many strategies patients can employ to improve their visual symptoms and build up their screen tolerance like diaphragmatic breathing, good ergonomics, energy management, relaxation techniques, and vestibular or neck therapy if indicated’, concludes Dr. Maude Boulanger, MD. The pyramid of vision care in mild traumatic brain injury by Ciuffreda et al. illustrates this simply. Many patients enrolled in our program have also notice improvements, for some significantly, in their visual issues with a multimodal, multidisciplinary approach, and thus their ability to navigate the digital world.
IF YOU NEED ADVICE ON YOUR INDIVIDUAL SITUATION OR HAVE CONCERNS, REACH OUT TO YOUR CONCUSSION TEAM
Last updated: April 2020