[Hockey]

Do any of you have difficulty maintaining eye contact?

I have a tendency to look away, and down, when people speak to me. I get a lot of complaints about this, especially from my family. They think I'm disinterested in what they're saying. I'm not, I just can't look at them.

This issues is among those identified in studies of TBI patients. Great, I know it's real - but does anyone have suggestion for dealing with it? I can't will myself (I try) to just do it.

Below is some info on vision issues and TBI. Recent studies indicate that 90% are affected, in one way or another.

Vision Therapy Vancouver:

A recent study noted that people with traumatic brain injury often have a constellation of eye movement (sometimes called oculomotor) deficits. The study noted that over 90% of patients with mild traumatic brain injury (TBI, some times called acquired brain injury) were found to have one or more oculomotor dysfunctions, including nystagmus and/or other abnormalities of version, vergence, accommodation, and eye alignment. Related symptoms include difficulty tracking objects, difficulties in visual scanning and slow reading.
Oculomotor and Visual Symptoms in TBI

The following list comes from the study, "Clinical Oculomotor Training in Traumatic Brain Injury" by Dr. Kenneth Cuiffreda and colleagues:

Avoidance of near tasks
Oculomotor-based reading difficulties
Eye tracking problems
Eye focusing problems
Eyestrain
Diplopia
Dizziness
Vertigo
Vision-derived nausea
Increased sensitivity to visual motion
Visual inattention and distractibility
Short-term visual memory loss
Difficulty judging distances (relative and absolute)
Difficulty with global scanning
Difficulty with personal grooming, especially involving
the face
Inability to interact/cope visually in a complex social situation (e.g., minimal eye contact)
Inability to tolerate complex visual environments (e.g., grocery store aisles and highly-patterned floors)

Oculomotor signs in TBI

The following list also comes from the study, "Clinical Oculomotor Training in Traumatic Brain Injury" by Dr. Kenneth Cuiffreda and colleagues:

Reduced amplitude of accommodation
Increased lag of accommodation
Reduced relative accommodation
Slowed accommodative facility
Uncorrected hyperopia/ astigmatism (due to inability to compensate accommodatively)
Receded near point of convergence
Restricted relative convergence (BO) at far and near
Restricted overall fusional vergence ranges at far and near
Abnormal Developmental Eye Movement test (DEM) results
Low grade-level equivalent performance on the Visagraph II
Impaired versional ocular motility

- See more at: http://www.visiontherapy.ca/braininj....OFzDmvZe.dpuf

[Bruins88]

Yup I do it all the time now. Half the time Im doing it it is because I dont realize it. The other times I think its because I purely want the convo to end because its hurting my head.

[MomWriterStudent]

I do this, and it's mainly because it hurts my eyes (and head) to focus on one thing for too long. I usually just tell people, "Sorry, my eyes are really hurting right now, so I apologize in advance if it seems like I'm not paying attention."

[Mokey]

Thanks for posting that. That is a huge complaint for me. I feel so bad when I realize that I'm looking away from the person's face. In my culture and probably many of yours, eye contact is so important in developing and maintaining relationships.
My vestibular therapist told me it was because heads move when you're looking at them and people with brain injury prefer to look at things that don't move such as the ground or wall.

[Sitke]

Yes, I had the same thing going on, had more damage in my right eye, also moving things were so hard to look at, my eyes felt as though they were bouncing all over the place.

[Hockey]

Originally Posted by Mokey

Thanks for posting that. That is a huge complaint for me. I feel so bad when I realize that I'm looking away from the person's face. In my culture and probably many of yours, eye contact is so important in developing and maintaining relationships.
My vestibular therapist told me it was because heads move when you're looking at them and people with brain injury prefer to look at things that don't move such as the ground or wall.

Thanks so much for the explanation.

I don't look away, consciously, it's just, sort of, a reflex. However, I do know that I don't like to look at moving object (no TV for this gal) - and heads do move.

This might also explain why the person I have the hardest time looking at, when he talks, is my poor husband. He's very animated when he speaks (plenty of bobble head gestures and flailing arms - that's his culture) He shaved off his beard - and I didn't even notice. Yes, he does talk a lot.

[music-in-me]

Hi everyone,

I had a great deal of trouble keeping my eyes on the person I was talking to, mostly due to distractibility at first. But even now after 5 months of neuro rehab, I still have trouble maintaining eye contact. I don't know if it's continuing distractibility or inattention, but I just can't force my eyes to stay fixed on anything for very long.

My ST told me I had improved a lot with this since I began, but she was always reminding me to focus on her when she was speaking. I also found myself staring at a person during groups long after they had finished saying something, but I continued looking at them, even when they were done speaking. (awkward!!) They usually smiled and pointed to the person actually doing the speaking!!

Thank you, Mokey, for the "things that don't move" explanation. I am also a bilateral hearing aid wearer, ( got them 1 year prior to injury) and I used to read lips to help compensate for my hearing loss, but now I find it is too difficult and just plain exhausting when I try to do it over a small span of time. Maybe this is why I don't tend to focus on the person talking(??) Take care, M-i-m

[berkeleybrain]

Thanks for all these explanations!

It's all been intuitive. Even when my kids come into hug me, I turn away. A lot of times it's just because watching their eye and facial movements make me too dizzy.

As kermit the frog says, it's hard been green; for us, it's hard being PCS/mtbi.

[Superstition]

Thank you, thank you, thank you for posting this! Holy cow! People have pretty much been telling me that my vision problems that suddenly appeared immediately after my accident are really just because I'm "at that age when you have to get glasses". I'm struggling to come up with the right word but I feel kind of vindicated (?) I knew this was something more than that.

Originally Posted by MomWriterStudent

I do this, and it's mainly because it hurts my eyes (and head) to focus on one thing for too long. I usually just tell people, "Sorry, my eyes are really hurting right now, so I apologize in advance if it seems like I'm not paying attention."

Thank you for the great idea about what to say in advance. I like that.


Now that I'm seeing that other people have visual problems too, I'm curious if any of you felt like your eyeballs were too big for the sockets right after your accident. For me, for a couple months it felt like my eyes were rubbing on bone all the time. It was very uncomfortable.

[cerebellarmaniac]

I recently had a brain tumor resected from my cerebellum. The tumor has affected some of my ocular functions and I find it is very difficult for me to track moving objects or text. The tumor/surgery also impaired my vestibular apparatus, so I often feel dizzy or overwhelmed.

They say the tumor was a slow growing tumor, and I have probably had it for most of my life. The impairments I talked about were always issues for me to some degree. Unfortunately, I shrugged it off as shyness/social anxiety. In reality it was the symptoms (feeling overwhelmed, trouble tracking) that manifested into low-confidence and anxiety.

Now my short term visual memory/attention is below norm, according to neuropsych testing. Most of the psychologists I spoke to couldn't explain this to me. I suspect my poor eye tracking/coordination, has made it extremely difficult to attend to minute details.

Oddly, I think I always struggled in those areas in the past. However, I found ways to compensate. Now these issues greatly affect my quality of life. The good news is that I have noticed some improvement.