All right. I promised you it was coming.
Now, you got homonymous hemianopsia.
Also sounds like a wrestler to me
if you want to do it, but
here's how your vision really works.
The left half of the brain
processes visual information from
both eyes about the right side
of their visual world. Now it's the
opposite on the right side.
The right half of the brain processes the
visual information from both eyes
about the left side of the visual world.
So, kinda looks like this.
So, with homonymous hemianopsia, a person
can only see the right or left
side of their visual world.
Okay. This is really a bizarre feeling,
and we've tried to give you a
taste of this, and I'm so thankful I've
never experienced it personally.
So, what are the symptoms? I mean, how
would you pick this up in your patient?
You may be the first one who
notices this with your patient.
Well, if they were walking, you might
notice them bumping or falling
into things. That's -- notice that one
side, the same side, they keep
running into the wall when they go through
your doorway, or they keep bumping into
furniture that's on a certain side
of the room. So, this makes
everyday tasks like crossing the
street, or driving a car,
for various obvious reasons,
very, very unsafe.
So, if Mr. Johnson is experiencing
this, he's not going to be able
to drive for a while until we can figure
out if this will resolve itself.
Now, you might show them an eye
chart, they might be missing entire
parts of an eye chart on a certain
side of where they're affected.
They might not notice objects on their
bedside table or on the desk or
even food on their plate. They may just eat
right down a certain side of
their plate if it's really severe.
Now, this will be very frustrating for your
patient. Remember, their brain's taken a hit,
right? They've had a stroke. So it's very
frustrating and they can already
be kind of emotional labile, so be patient.
If you ask them to read something, it's
going to be hard for their eyes
to pick up the beginning of the next line.
So they're not going to understand
what's happening, they might turn the head
or body away from the side of where they
can't see. Isn't that weird? So like,
if they can't see the left,
you may notice they turn their body or their
head that way. So be aware and alert
if you're patient seems to be doing
any of these behaviors.
They also might kind of drift in a direction
away from the side when they're walking.
So if I can't see here, I may kind
of drift to the right.
They also might see some weird lights and
shapes or figures or floating things,
instead of recognizable objects, so their
vision is significantly impaired.
Now, sometimes, a movement on the normal
side of vision they also think is, at the same
time, on the side of loss. So, you
know, that's a lot of very
specific examples, but just
know that it is bizarre
to have that type of vision, and it's going
to take them a while to adjust to it.
Would be great if it's just, you know,
temporary, but this may
be what the patient has to deal with
for the rest of their life. So,
what's my job as a nurse? First of all, I'm
going to be on the alert to know that
this may be happening to Mr. Johnson.
And I'm going to assess him
for any of those behaviors we
just discussed. Now,
here's what you can do if we know that he
does have it. Okay. So, when we're moving
through the environment, you're going to
teach him to learn to direct his eyes
toward the good side, right, toward the
good visual field. When he's walking into
a new environment, we want him to pause
and move his head from side
to side, right? Want him to observe where
objects and people are located, so he's
kind of getting a game plan before he
ever walks into the room. So,
he doesn't want to just -- we don't ever want
him rushing into a room, right? We want
him to pause, be casual, make
sure he scans the room,
using his good visual field. So he can
almost like paint a picture of what
he sees in his brain. By practicing this,
particularly in the 6 months
after vision loss, can help him train
his brain to do it automatically.
I mean, your brain is amazing. My eyes
have gone through the change, right?
So, you have where I can't see things up
close as much as I used to be able to.
Used to make fun of people. Now I realize
it's not that funny when it happens to you.
But when I was at the eye doctor, you
know how it goes; this one, that one,
this one, that one, this one, that one,
this one that one, which just
breaks me out in a sweat. But he talked
to me about instead of
using bifocal contacts, would I consider
putting one in the eye
and not wearing a contact in the other eye.
Well, as I'm talking to him, I had
the vision on. I was like,
"I don't really know if I can do that," because
I was very nervous. He said, "Stop.
Rhonda, you're doing it now. I have this set.
So it'd be if you're wearing only 1 contact
in your eye," and I was like,
"Oh." My brain did that naturally.
I didn't even have to train it. So, your
brain is able to do things,
even brains that have taken a hit like
stroke, without you being aware of it.
But if we teach him to do it with his
body first, his brain will catch on,
and hopefully, will start to do that naturally.
Now, if he's walking with someone,
we want the partner to walk on the blind
side. So, when you're walking with
Mr. Johnson, or when the physical
therapist is walking with Mr. Johnson
or his wife or family, you want them
to walk on the blind side,
and make sure he has your arm just to
kind of provide for guidance.
Now, if you're in a group situation, this
will be literally after discharge, we
don't usually have any group parties in
the hospital. But when you're
in a group situation, you want
people in the good
field of vision as much as possible.
So, you know, when you go out to dinner, you
want to make sure that you find a seat
for this patient that will allow them to
see the people in their good
vision. So, it's kinda like I am
almost deaf in my left ear.
So when I go to restaurants, I'm always very
particular and my friends and family know,
so I sit with my good ear towards the
conversation. Same thing for Mr. Johnson,
you'd want to sit him so his field of
vision is toward the people.
Now, how about if you go to a movie?
Yeah, we go to a movie,
you want to sit far over to the
blind side, so that
all the action takes place in
the normal visual field.
These are examples of things that we
would teach Mr. Johnson and his
family to let them know, "Hey, yes,
this is a difficulty,
but we can overcome it." Now, we wanted
to play real life, not computer-based
card games. We want to do crossword puzzles,
and that'll help him regain coordination
between his vision and his touch. So,
here's a recipe for playing games.
My favorite is spades. Love a
good game of spades,
but there's lots of games to choose from.
So help him do word searches or
picture searches. And remember,
they have word searches with
jumbo letters. Let's start with that
instead of the little tiny letters.
Puzzles are a great thing for dexterity,
and to help him improve
eyes scanning at near distances.
Okay. That's lots of information, but these
are the kind of things that nurses
and therapists -- these are
real life applications
that we want to help our patients learn
about because this is going to change
the ability for them to lead
a full life of quality.