Dr. Joe Clark from the University of Cincinnati will be presenting at this year’s International Symposium on Clinical Neuroscience about the Eye-Brain Axis: Brain Strength & Conditioning for Athletes.
For more information about the event, visit ISCN2019.com
– Hello, my name is Doctor Jessica Lofgren. And today I am joined by Doctor Joe Clark. Doctor Clark, how are you doing today?
– I’m good Jessica, how are you?
– I’m am doing great. Thank you so much for being here today. We’re so excited to talk to you. Go ahead and tell us a little bit about yourself.
– Sure, so my name is Joe Clark, Doctor Joseph Clark. I’m a professor of neurology at the University of Cincinnati. I am a PhD professor, but I do see patients for neurodiagnostics per se, and neuro-rehabilitation. I also am the person who helps takes care of and manage the university athletes should they have a concussion. I kinda specialize in traumatic brain injury, acquired brain injury, which includes stroke, TBI, that type of thing. So I’m very brain-centric, and do clinical work as well as research work.
– Awesome, awesome, and so I had been up there for you before for the University of Cincinnati football camp and seen some amazing stuff that you are doing. But we’re on here today to talk about the International Symposium on Clinical Neuroscience. You’re gonna be there this year, and you’re gonna be sharing some information with us. What topic did you choose to discuss this year and why?
– Well what I’m gonna be talking about is what I like to refer to as the eye-brain axis. I am very brain-centric, but the eyes provide a lot of information to the brain. And we’ve seen both with our athletes for performance enhancement and with our patients for injury rehab and recovery, that the eye-brain axis can often go wrong, and needs to be rehabilitated through what’s often referred to as vision training. However, many people, lay people as well as technical people, if you say vision training, they often think of what we do with little kids who have a weak eye, like a three year old whose eyes aren’t aligned. That is vision training, that is a component of what we do, but being in neurology and very brain-centric, we do neuro-visual training to help those people get better. And I mean people who have traumatic brain injury, people who have stroke, as well as athletes to help them be better and safer on their fields of competition.
– Great, so what you’re gonna pretty much be teaching us at the symposium this year is what exactly that neuro-vision training is and how you’ve had so much success with your athletes at the University of Cincinnati. I know you have a great track record of not having concussions or having a very low incidence of concussions with your team members.
– Yeah, so we initiated the neuro-visual training with the football team the summer of 2010. And every year where we’ve done the neuro-visual training with the football team, we’ve had a very low concussion rate. The national average is on the order of 10 concussions per year, per team, and that was our average in 2006, ’07, ’08, and ’09. Since 2010 we’ve been averaging 2.14 concussions per year, and that’s been sustained, with the exception of one year. We had a new coach one year, and he came in and discontinued the vision training, and we went back to 10 concussions. And no disrespect to any coach, you know they make decisions, and then he reevaluated the value of the vision training, re-initiated it, and we went back down to two concussions, or 2.14 concussions per year. So it is sustainable, and there appears to be a kind of wash out if you will, and I’ll be talking a little bit more about that at the ISCN as well.
– Well Doctor Clark, that is absolutely incredible. We are so excited to hear more from you at the International Symposium this year. If you’d like to hear more about what Doctor Clark is doing and hear about his topic this year, please visit our website at www.ISCN2019.com, and attend our International Symposium on Clinical Neuroscience, happening May 24th through the 26th in Orlando, Florida. Doctor Clark, thank you so much again for joining us today.
– Thanks Jessica, and I’m looking forward to May.
– In today’s video we’re gonna be discussing how to assess eye position in your patients, and why it’s important for those who are applying clinical neuroscience in their practice. Hello, my name’s Dr. Freddy Garcia, today we’re joined by Dr. Jessica Lofgren. We are gonna be talking eye position in our patients, and a device that we like to use called the Maddox rod. Dr. Lofgren, how are you doin’ today?
– Good good, how are you doing today?
– I’m doing great. Okay, so give me the scoop, what is this Maddox rod, where’d it come from?
– Yeah, so the Maddox rod, it was created in 1890 by an english surgeon and ophthalmologist, E.E Madox, and at the time he was known as an expert in the field of phorias and eye deviations. So what it is, it’s just a color tinted glass. It can come in any color, reds, greens are the common ones. And we discussed why you’d use other colors in our clinical neuroscience program. But what it is, it’s just different cylinders lined up about three millimeters apart, and when you bring it up to the eye and shine a light through it, it creates a dissimilar image which is good for our clinical examination.
– So what is it’s prime purpose? What type of information am I looking to get from the use of a Maddox rod?
– Yeah, so the only information that you get from the Maddox rod is eye position. The ability of both eyes to fixate on the same object. Traditionally, it was only used to decide what kind of prisms they’re gonna use in the ophthalmology clinic, now we use it functionally as a way to assess how the cortical and sub cortical regions are functioning as well as the eye muscle integrity that controls the ocular movements.
– Right, so I guess a Maddox rod prepared along with a good physical, neurological examination give you kind of insight into the person’s nervous system, and how well it could be functioning.
– But it’s soul purpose first, eye position, and then along with everything else, we get a little bit of more information from it.
– Exactly, yep.
– Sounds pretty good, alright, well I guess the next thing we should do is learn how to use it.
– Yeah, let’s do it.
– Okay, Dr. Lofgren, I want to use how to use this Maddox rod, how does it work?
– Yeah, so we are going to test horizontal deviations first. So what we see with many practitioners is that they will take the Maddox rod, and they’ll test both eyes. But the correct protocol to do this with is just to use the right eye during all of your Maddox rod testing. All it is is because if we’re doing both eyes, it’s just giving us the same results, and it sort of just takes up more time than we need to be using because all the Maddox rod is doing, it’s just creating a dissimilar image. So it’s just converting the light source into a line, so we see the right eye’s looking at a line, and the left eye is looking at a light. So really, just the right eye is all we need. So for horizontal, we’ll start with those first.
– So, for a horizontal deviation, the doctor is gonna be looking at horizontal lines, and the patient is gonna see a vertical line.
– So what we’re gonna do, we’re testing near first. So I’m gonna hold up the Maddox rod right up to the patient’s right eye, and I’m gonna shine the light about 33 centimeters away from them.
– So, let’s turn on our light. I’m looking at horizontal lines. I hold my light source up, and I ask the patient now, “Do you see a red line, “and a white light?”
– Alright, I see a vertical red line.
– And I see a white light.
– Perfect, now where is the light in relation to the line?
– I see the white light just a little bit past to the right of that vertical line.
– So the light is to the right of the line?
– Yep, just a little bit.
– Perfect, so there are three possibilities that we can get from looking at horizontal deviations.
– So, the first possibility, we have the red line, and the white lieu directly on top of the red line.
– That wasn’t me this time.
-So that is a normal, that means that both eyes are looking at the same
– Oh, not normal, okay.
– object. So, Dr. Garcia is not normal.
– We all knew that.
– The second outcome that we can get is having the red line, and the white light to the right of that line. That is gonna tell us that the patient has a slight exodeviation, or exophoria on the right side, or they have an esophoria on the left side.
– Got it, and figure out which one I have, we wanna follow it up with more testing. Typically, I believe it’s cover-uncover, and cross cover testing, right?
– Correct, yep.
– Sounds like we’ll have to do a future video on that.
– Definitely, let’s do a different video on that later.
– And now there’s one more response you can get, and so that would be a red line with a light on the inside, or to the left of the line. That will give you a esophoria, or esodeviation on the right eye, or an exophoria on the left eye. Again, cross cover, or cover-uncover tests it’s gonna give you which eye it is, and give you more information about it.
– Got it, well what about vertical, the vertical aspects, how do we get that?
– Yep, so vertical’s not too hard to change. So we had the horizontal lines, and we are looking for horizontal deviations. Now we’re just gonna flip it over, and we’re gonna be looking at vertical lines, so that the patient is looking at one horizontal line.
– So, same thing as before, I’m using the right eye. I’m gonna hold it up so I’m seeing vertical lines, and then I’m gonna bring the light up. And again, ask the patient, “Do you see one horizontal “line in the light?”
– Yep, I see a horizontal line, and this time the light is right on that line for me.
– Great, so Dr. Garcia is normal in the vertical plane. So he is seeing both images in the same location.
– There are three responses for that as well.
– Okay, what are those?
– So, same ones as before. So we have a horizontal line now that they’re looking at, if the light is right on the horizontal line, it’s normal, just like Dr. Garcia was. If it is above the line, it is gonna be a hyper deviation, and if it’s below the line, it is a hypo deviation. Now be aware, that’s a deviation in relative to the other eye.
– Got it.
– So, it’s a hyper deviation relative to the left eye.
– So then, we have to do future testing to find out whether it’s actually a hyper of the right eye, or hypo of the left eye?
– And again, is it cross cover-uncover, and cross cover testing for that?
– Yep, those are the same tests that we would use, and remember we always reference the hyper deviated eye when we’re doing our exam findings.
– Okay, excellent. Dr. Lofgren, that was really good explanation. I’ve always been you know, kind of confused about how to do appropriate Maddox rod testing, but I love the way you explained it. I think we have a follow up video ’cause we should definitely show everybody at home how to do appropriate cover-uncover, and cross cover testing. But for now, this is great. Thank you so much.
– You’re welcome.
– Alright guys, that’s all today on the Maddox rod and eye positioning. Until next time, this is CITV, we had Dr.Lofgren, and my name’s Dr. Garcia, we’ll catch you next time.
Here are some rules to remember when looking at eye muscles 👁:
- If the eyes are abducted, the rectus muscles are primarily responsible for looking up and down. If they are adducted, the obliques take over as the primary movers.
- If the muscle begins with “inferior”, it is an extorter. If the muscle begins with “superior”, it is an intorter.
- If the muscle begins with “superior”, it is innervated by the brainstem on the OPPOSITE side. If the muscle begins with “inferior” or is a lateral/medial rectus muscle, it is innervated by the brainstem on the SAME side.
⚠️ BONUS QUIZ! Where in the brainstem are each of the cranial nerve nuclei located for eye muscles?
This information and much more are covered in our Clinical Neuroscience Program. For more information, click here.
🧠 Carrick Insight: Did you know that praise and positive feedback activates regions in the dorsolateral prefrontal cortex, the same area of the brain involved with executive function? 👨🏼💼 Interestingly enough, this is also a common area of the brain that experiences continued trouble after a concussion or traumatic brain injury. Injuries to this area often lead to impairments in executive functioning and personality and mood disorders, such as anxiety and depression. Staying positive during patient care, offering encouragement and praise throughout care, is therefore critical in the treatment of post-concussion syndrome. 👩🏻⚕️
For information on our Advancements in TBI course, click here.
“Where do I start?!” We get this question a lot! So here is how to best tackle Carrick Institute courses in the most effective way!
Pain Reset is for practitioners who are looking to evolve and start exploring a brain-based and neuro biomechanical approach to solving chronic pain. We will show you how to accurately observe, diagnose and prescribe therapies to get patients out of chronic pain faster.
For information about Pain Reset, click here.
RBE, aka ReceptorBased Essentials, is our foundations course! This 5-module course is a great place to start if you’ve never taken clinical neuroscience courses and want to implement a functional Neurology paradigm of care for improved patient outcomes. This is for clinicians wanting a hands-on, fast track method to begin implementing functional neurology.
For information about ReceptorBased® Essentials, click here.
Ready to take the deep dive into the functional neurology paradigm? This program is for you. The CNS modules give you the breadth and the depth of knowledge needed to become highly proficient in the application of clinical neuroscience. This program gives you the core of information needed to pass the diplomate and fellowship examinations. Most of our scholars take this course.
For more information about the Clinical Neuroscience Program, click here.
You’ve made it past the CNS program, and now you’re ready to be in the top tier class of clinical neuroscience practitioners. This is when specialty courses come in. We have many topics including concussion and TBI, movement disorders, vestibular rehabilitation, eye movements, clinical neurochemistry, acupuncture, and neurodevelopmental disorders.
For a full list of programs including all of our specialty programs, click here.
Researchers suggest that a simple head tilt when working with patients with ASD could increase social engagement and focus, making the doctor or others seem less threatening and more approachable.
Many studies have demonstrated that when observing faces, there is a consistent bias for right-handed observers to look towards the left side of the face (i.e. left from the observer’s perspective). This new study, however, investigated whether this bias would remain if the head they were observing was tilted.
The study found that left gaze bias was replaced by an upper eye bias and that tilting the head also increased more eye-directed fixations, meaning subjects were more likely to make eye contact with the faces.
For more information about our upcoming Neurodevelopmental Disorders modules, click here.
- Davidenko, N., Kopalle, H., & Bridgeman, B. (2018). The Upper Eye Bias: Rotated Faces Draw Fixations to the Upper Eye. Perception. https://doi.org/10.1177/0301006618819628