January 19, 2018

Vision Rehab Helps Kathleen Recover from Brain Hemorrhage

Alexander resident Kathleen Johnson has goals. At the top of her list is driving. Next up is a return to teaching yoga. And then there are a host of everyday activities – areas in which she wants to regain full independence. Her husband, Michael, believes she’ll get there. “She’s a very determined person,” he said. “She’s always achieved what she’s put her mind to.”

A Knack for Transformation

Kathleen’s past achievements included earning her law degree in her 40s, attending law school at night and working during the day, and then later changing careers to pursue her passion for yoga.

“In New Jersey where we’re from, Kathleen (pronounced “Kathlyn”) was an attorney – a sole proprietor,” said Michael. “When we moved down here, she worked in conflict resolution for a while. But when she started taking yoga classes at Asheville Community Yoga, she enjoyed it so much she decided to take the training to become an instructor. That’s been her personality her whole life – someone says she can’t do it, she finds a way to do it. She has totally transformed herself time and time again.”

In her quest to perform another metamorphosis, 70-yearold Kathleen is working hard on recovery exercises and therapies with CarePartners. She has come a long way since July 9, 2015, the day of her brain hemorrhage.

In the early days, following her discharge from the hospital, she received inpatient rehabilitation from CarePartners. “When I went to CarePartners, I had no idea what was going on,” she said. “I could barely talk, I couldn’t do anything.”

Kathleen was at CarePartners for about a month, where she received physical therapy, occupational therapy and speech therapy. Following her stay there, she was released to outpatient care.

Vision Rehabilitation

While Kathleen has made strides in many areas of recovery, one of her remaining hurdles is her vision. The hemorrhage occurred in the rear left portion of her brain, which impacted her vision in the upper right corner of her eye. This affects her peripheral vision on that side, which is an important visual component in driving.

According to Cynthia Piasta, OTR/L, Kathleen’s vision rehabilitation therapist at CarePartners, vision loss due to an event like a brain hemorrhage or stroke is somewhat common. “Vision takes place in various areas of the brain; any direct injury to those areas or subsequent injury due to swelling on the brain can lead to a visual impairment,” she said.

Fortunately, recovery of vision loss is often possible, and when it’s not, compensations and adjustments can be made, said Piasta. “Studies show that vision rehabilitation has been successful in treating many of these impairments,” she said. “In cases where people do not progress with rehabilitation or the prognosis with rehabilitation is poor, modifications or compensations can be used to help people adapt to their visual changes and continue to lead successful lives. We also work closely with our optometrists, neuro-ophthalmologists and low-vision therapists to discuss further needs such as prisms or surgery.”

The therapies Piasta has taught Kathleen, which she works on at home every day with Michael when she doesn’t have an appointment with Piasta, have been strengthening her vision, she said. She also finds she’s learning to compensate for her blind spot better.

The exercises she practices include one in which she visually follows her thumb as far right as possible, another in which a pen is extended by a string and must be focused on until the configuration forms a cross shape, and the final one involves visually following a laser pointer in a dark room or closet. This one the Johnsons have found entertaining: “Our cat tried to join in on the exercise!” Kathleen laughed.

There is a range of vision therapies and resources available to those who are recovering from stroke or hemorrhage, said Piasta – although not all come with feline endorsement. “In vision rehabilitation, we look at how vision is affecting a person’s ability to perform daily living activities, and we use techniques to work on those tasks,” she explained. “Some techniques that we use are visual motor exercises, accommodation techniques, bilateral integration techniques, use of fine motor tasks, visual perceptual exercises and use of manual therapy to decrease cervical tension or to provide assistance with lymphatic drainage affecting the ocular tract. We will also provide compensation techniques to allow people to return to functional tasks when rehabilitation is not effective or appropriate.”

The Support of Experts

According to the Johnsons, Kathleen wouldn’t have progressed this far without the care she received through Mission Health and CarePartners.

“The doctors we dealt with in the neurology department at Mission were wonderful, and really all the people she’s dealt with have been — and there have been a lot,” said Michael. “At CarePartners, they really worked with her intensely, and after about two weeks, you could see her coming back in all the different phases.”

Kathleen said everyone at CarePartners is well aware of her desire to drive again, and that they have all been very encouraging to her.

“They know she’s someone who tries very hard, and I think that motivates them even more,” said Michael.

According to Piasta, “CarePartners focuses on patients’ individual needs and capabilities in order to help them achieve the best possible outcomes. We strive to provide our patients with a strong understanding of their injury in order to empower them,” she said. “We believe in patient-centered therapy that allows people to return to happy and productive lives after therapy.”

Kathleen is planning on doing just that. She has high hopes for her future, but plans to adapt no matter what. “Things are getting better and better with my vision, and it’s a lot easier now for me to compensate,” she said. “What I always say to myself, and what I’d like others to know, is that no matter what you’re up against, you can always try.”


Cynthia Piasta, OTR/L, is a vision rehabilitation therapist with CarePartners.

To schedule an appointment with CarePartners Vision Services, call (828) 274-6100. It’s strongly recommended that patients seek an evaluation from an ophthalmologist or optometrist prior to setting up vision rehabilitation with an occupational therapist, because therapists don’t diagnosis medical conditions.


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