Optical Stroke Recovery: Can Exercise Help?

Exercise after a stroke is possible, but it's important to consult with a medical professional to determine the best course of action. For those experiencing vision problems, which affect about 60% of stroke survivors, eye exercises can help improve visual perceptual skills and oculomotor skills, which are the eye muscles' control. These exercises include directional tracking, near/far focusing, and word or letter searches. Social activity groups, dance and exercise groups, and specialist rehabilitation groups can also aid in recovery. It's important to note that recovery is a gradual process, and it may take several months of consistent practice and training to see improvements.

Eye exercises can help improve vision after a stroke

Vision problems are a common effect of strokes, with over half of stroke survivors experiencing visual impairments. These impairments can affect the ability to move the eyes or the brain's ability to accurately perceive what the eyes are seeing. However, eye exercises can help improve vision after a stroke.

When a stroke occurs, blood flow within the brain is disrupted, resulting in damage to the affected areas. While the occipital lobe is primarily responsible for visual functions, other areas of the brain such as the parietal lobe, cerebellum, and brainstem also play a role in vision. Therefore, damage to these areas can lead to visual changes.

The ability to see involves multiple components, including oculomotor skills (control over the muscles of the eyes) and visual perceptual skills (the brain's ability to understand what the eyes are seeing). If either of these skills is impacted by a stroke, survivors will experience changes in their vision, ranging from mild to severe.

Practicing eye exercises after a stroke can help survivors regain their vision by promoting adaptive rewiring in the brain through a process called neuroplasticity. This allows healthy areas of the brain to take over the functions of the affected areas.

Repetitive practice of exercises is key to promoting these adaptive changes in the brain. While some eye exercises may feel awkward, they should not be painful. It is important to take breaks as needed but also to resume practicing to optimize improvements. While a full recovery of vision is not guaranteed, many survivors find that they can at least partially recover their vision.

Types of eye exercises

There are two main types of eye exercises that can help improve vision after a stroke: oculomotor exercises and visual perceptual exercises.

Oculomotor exercises

These exercises help improve control over the muscles of the eyes. Some generalized oculomotor exercises that can be helpful include:

• Directional tracking: This involves practicing visual tracking by focusing on a pencil held about 18 inches from the face and moving it in different directions without moving the head.
• Clock rotations: This exercise involves picturing a clock in front of the face and looking at each number without moving the head, feeling a gentle stretch in the eye muscles.
• Near/Far Focusing: This exercise helps with focusing issues by alternating between focusing on a finger extended an arm's length away and gazing into the distance.

Visual perceptual exercises

These exercises target the brain's ability to understand what the eyes are seeing. Some examples of visual perceptual exercises include:

• Word or letter searches: These activities improve visual tracking, discrimination, and attention skills.
• Hidden picture puzzles: These puzzles involve searching for small images within a larger picture, improving visual memory, form constancy, and figure-ground skills.
• Peripheral vision stimulation: This exercise helps improve peripheral vision and understanding of visual spatial relationships by asking the person to observe two pencils held at the far sides of their visual field and guessing which one is closer.
• Mazes and visual tracing: Practicing mazes and visually tracing lines or outlines can enhance the brain's ability to process visual spatial relationships.

Other considerations

While eye exercises can be beneficial, it is important to consult with a vision therapist, optometrist, or other professionals who can provide individualized recommendations and treatments. Additionally, specific therapies such as optical therapy, eye movement therapy, and visual restoration therapy may also be encountered during rehab to help improve eye movement control and train the brain to see despite impairments.

Computer games and word searches can aid recovery

Playing computer games and word searches can be beneficial for recovery after an optical stroke. Hours spent playing video games are positively correlated with overall recovery. This is especially true for highly immersive games and first-person shooters or action games.

Computer games can be a form of digital therapy that helps stroke patients with their eye-training exercises. These games can improve visual-tracking skills and aid in visual perception. Word searches, in particular, can be an excellent tool for recovery as they encourage a wider vocabulary and test cognitive abilities and pattern-finding skills. They can be customized for different ages and reading levels, and they can be easily adapted to different languages, making them a versatile tool for recovery.

Additionally, word searches require visual tracking skills, visual discrimination, and attention. They can help improve visual perceptual skills and aid in the recovery process. For example, when doing a word search, individuals can choose to search for a specific letter or only vowels, which adds a level of complexity to the task. This can be particularly helpful for individuals experiencing visual field cuts or visual neglect, as it encourages them to use their peripheral vision and expand their field of vision.

The repetitive practice of these exercises is essential for promoting adaptive changes within the brain and improving eye functions. While some eye exercises may feel awkward, they should not be painful, and it is important to take breaks as needed. However, it is crucial to resume practicing to achieve optimal improvements. While a full recovery of eyesight after a stroke is not guaranteed, many survivors find that they can at least partially recover their vision with the help of these exercises.

Vision rehabilitation can help with eye-brain connection issues

Oculomotor skills refer to the patient's control over the muscles of the eyes. Visual perceptual skills refer to the brain's ability to understand what the eyes are seeing. Both of these skills can be impacted by a stroke, leading to changes in vision that can range from mild to severe.

Eye Exercises

Eye exercises can help survivors regain their vision by promoting adaptive rewiring in the brain through neuroplasticity. This allows healthy areas of the brain to take over affected functions, thereby improving the patient's eyesight. Examples of eye exercises include directional tracking, near/far focusing, and visual perceptual exercises such as word searches and hidden picture puzzles.

Limb Activation Treatment

For patients experiencing visual neglect, moving the affected limbs within the neglected environment can help improve visual attention on the neglected side. For example, an individual with left neglect would practice moving their left arm and leg.

Visual Scanning Training

Visual scanning training involves drawing a line down the affected side of a book with a highlighter and then practicing moving the eyes down a sentence until reaching the highlighter. This helps retrain the brain and improve conditions such as hemianopia and quadrantanopia.

Visual Training

Visual training refers to a program of vision-improving exercises, such as eye exercises or visual scanning training, practiced consistently over a prolonged period. This activates neuroplasticity and stimulates positive changes in the brain.

Compensatory Strategies

While compensatory strategies do not encourage recovery, they can be necessary for boosting the patient's safety and self-efficacy in daily life. Examples include using glasses with prisms or eye patching.

Neuro-Optometric Vision Rehabilitation

A neuro-optometrist focuses specifically on vision problems that stem from brain disorders such as a stroke. They can diagnose vision problems and recommend a course of action to improve the patient's vision.

Occupational Therapy

Occupational therapists can also play a vital role in improving visual impairments and helping patients participate in daily life with vision problems. They can integrate vision exercises along with more conventional occupational therapy exercises to optimize the patient's time and stimulate the brain to improve.

Neuroplasticity can help the brain reorganize itself

Neuroplasticity is the brain's ability to form and reorganise new synaptic connections, especially in response to injury. This process begins after a stroke and can continue for years. The brain's inherent adaptability presents a fertile ground for developing innovative strategies that optimise recovery and restore lost functions.

Neuroplasticity can help the brain reorganise itself through various mechanisms, including:

• Interhemispheric lateralisation: the formation of new connections between cortical regions within the injured area.
• Reorganisation of cortical representational maps: the remapping of sensory and motor maps within the brain to accommodate changes in the body.
• Dendritic remodelling: structural changes in dendrites, including sprouting and arborisation, which modify synaptic connections.
• Synaptic plasticity: the strengthening or weakening of synapses based on activity and experience, facilitating vital processes like memory formation and learning.
• Neurogenesis: the generation of new neurons in specific brain regions, such as the hippocampus and subventricular zone.
• Axonal sprouting: the formation of new connections or sprouting of existing axons, facilitating the restoration of functional connections.

These mechanisms enable the brain to adapt, learn and repair itself, leading to functional improvements. For example, in the case of an optical stroke, neuroplasticity can help the brain reorganise visual information processing. This may involve the activation of healthy areas of the brain to take over affected functions, such as allowing the unaffected hemisphere to process visual information.

To promote neuroplasticity, rehabilitation activities and exercises are often recommended. These activities encourage the brain to form new connections, improving its ability to control the body. There is no time limit on neuroplasticity, and it can occur outside of therapy sessions as well. Every step, word, or hand exercise can contribute to the brain's ability to rewire itself.

Seek professional advice for a suitable exercise routine

Exercise is an important part of recovery after a stroke, but it is crucial to seek professional advice to ensure a suitable routine that is tailored to your specific needs.

A stroke can cause a range of vision problems, and the right exercise routine can help to address these issues and aid in the recovery process. It is important to consult with a healthcare professional, such as a neuro-optometrist or an occupational therapist, who can assess your individual condition and recommend appropriate exercises. They can also advise on any necessary adaptations to ensure a safe and effective routine.

Vision therapists, optometrists, or other eye care professionals can provide valuable guidance on eye exercises to improve specific aspects of vision, such as oculomotor skills (control over eye muscles) and visual perceptual skills (the brain's ability to interpret what the eyes see). These specialists can tailor eye exercises to your unique needs, ensuring a more effective recovery process.

Additionally, if you were previously very active or sporty, consulting a professional can help you gradually return to your previous fitness levels and avoid injuries. They can advise on suitable adaptations or alternative sports that align with your interests and abilities.

By seeking professional advice, you can develop a personalised exercise routine that addresses your specific needs and helps maximise your recovery potential after an optical stroke.

Frequently asked questions