Visual Minds Learning
Back to VPA™

Specialized Population Protocols

Phase-based OT protocol branches that layer onto the standard VPA™ intervention library when a student's presentation requires it. Each branch defines entry triggers, intake add-ons, dosing rules, phase-by-phase goals, outcome measurement, and discharge criteria.

Standard intervention library →

Post-Concussion / mTBI Vision Rehab

Symptom-guided return-to-learn and vision-vestibular reintegration.

Applies to students within 12 months of a concussion / mTBI who present with post-trauma visual, oculomotor, or vestibular-visual symptoms. OT operates within scope on occupational participation; physician clearance for return-to-play remains outside OT scope.

Entry Triggers

  • Rule-out screener positive for post-concussion pattern (< 90 days from injury).
  • Post-Concussion Vision Symptom Scale ≥ 20, OR CISS-15 ≥ 21 with reported photophobia / motion sensitivity.
  • VPA™ profile of reduced pursuits + convergence + reading endurance with symptom exacerbation.

Intake Add-Ons (in addition to standard clinical intake)

  • Date of injury, mechanism, loss of consciousness / amnesia duration.
  • Prior concussion history and cumulative count.
  • Current medical management team (MD, ATC, PT, SLP).
  • Post-Concussion Vision Symptom Scale (self + parent).
  • Screen-time diary (baseline 3-day log) and current academic accommodations.

Precautions

  • Never push symptoms above +2 on a 0–10 provocation scale from baseline.
  • Screen every session for red flags: worsening headache, new focal weakness, vomiting, vision loss → refer to physician / ER.
  • Coordinate with the school concussion team; document any change in accommodation status.

Contraindications

  • Acute (< 48 h) post-injury intensive oculomotor loading.
  • Undiagnosed post-traumatic seizure activity — physician clearance required.

Dosing Rules (FITT-P modifiers)

  • Sub-symptom threshold dosing: begin at 50% of tolerance, advance by ≤ 10% per session.
  • Break-to-symptom rule: stop the drill when provocation reaches +2 from baseline; log time-to-symptom.
  • Frequency 4–5× / week short bouts > 1–2× / week long bouts (chronic loading tolerated better in fractionated doses).

Phase Model

Phase 1

Phase I — Symptom Stabilization (Weeks 0–2)

Goal: Establish sub-symptom baseline; restore basic saccade, pursuit, and near-point convergence tolerance.

Activities

  • Slow horizontal + vertical pursuits, 30 s bouts, seated, no head motion.
  • Small-amplitude saccades (5–10°) with rest intervals.
  • Push-up NPC 3× with 60 s rest; monitor break/recovery.
  • 20-20-20 rule reinforcement + Harmon working distance re-training.

Progression rule: Time-to-symptom > 60 s across 3 consecutive sessions AND self-reported symptom score ≤ 3/10 during task.

Phase 2

Phase II — Vision-Vestibular Reintegration (Weeks 2–6)

Goal: Reintroduce head motion coupled to gaze, expand saccade amplitude, restore reading endurance.

Activities

  • Gaze stabilization (VOR × 1) horizontal then vertical, 30 s × 3.
  • Wide-amplitude saccades (20–30°) with metronome pacing.
  • Near-far accommodative rock in seated → standing positions.
  • Graded reading ladder: 1 → 5 → 10 minutes at 40 cm, comprehension check every block.

Progression rule: Sustained 10 minutes of near-work at symptom score ≤ 3/10, AND VOR × 1 tolerated with no more than +1 provocation.

Phase 3

Phase III — School / Community Integration (Weeks 6–12)

Goal: Return to full academic load and, where relevant, driving-readiness pre-screen.

Activities

  • Simulated classroom: board copy tasks, split-attention listening + note-taking.
  • Dynamic visual acuity walking 1 m/s with fixation cards.
  • Return-to-screen ladder with blue-light-neutral protocol.
  • Driving-readiness saccade + peripheral awareness drill (adult / teen driver only).

Progression rule: Full academic day tolerated 3 consecutive days AND symptom log stable → transition to monitored consult.

Outcome Measures

II

Post-Concussion Vision Symptom Scale

Weekly re-measure; target ≥ 50% reduction from baseline.

I

CISS-15

Bi-weekly; secondary tracker for near-work symptom load.

I

COPM

Baseline + 6 wk + 12 wk. Reading, homework, screen time as target occupations.

II

Goal Attainment Scaling

One −2 → +2 scale per academic accommodation.

Regression Criteria

  • Time-to-symptom drops by ≥ 30% across 2 consecutive sessions → return to prior phase for 3 sessions.
  • New headache pattern, sleep disruption, or emotional lability → hold, coordinate with medical team.

Discharge Criteria

  • Full academic day without accommodation-triggered breakdown × 10 school days.
  • VPA™ Visual Efficiency composite returned to age-band expected range.
  • Symptom scales at or below individual pre-injury baseline for 4 consecutive weeks.

References

  • Master et al., 2016 — Vision diagnoses common after sports concussion.
  • Storey et al., 2017 — VOMS clinical reliability.
  • Ellis et al., 2015 — Vestibulo-ocular dysfunction in mTBI.
  • CanChild Return-to-Learn protocol (2021).

Full peer-reviewed reference list with DOIs on the Technical Manual §17.