My tbi occurred during a rear end collision 10 years ago. The  back of my brain and right side were injured. I am legally blind because of it. I have excessive sleepiness all the time-diagnosed as Hypersomnia a year ago. I also found out I was misdiagnosed with Major Depressive Disorder at the time of the accident until anout a year ago. The correct primary diagnosis is Psuedobulbar affect with a comorbity of depression. I have been taking cymbalta, abilify, trintellix for those 10 years. Nothing helps. I take modafinil for the Hypersomnia. It barely helps.  I take Neudexta for PBA. It helps.  I would like to hold down a job again someday. And build a life again but cannot stay awake physically or mentally very long. I shut down completely or I cry profusely  if I'm not taking meds As drs have attempted to wean me off throughout the years. Any advice for leveraging  neuroplasticity again?  Keeping awake, how to keep awake and what's causing the sleep to be in overdrive?  What recommendations for "wake up" therapies, physicians that specialize and cognitive therapies to get my brain back. Have an MBA from pre-accident that I cannot use bc of my recall and shut down. please help. 
 
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Excessive sleepiness

Answer transcribed from <a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/3%3A-dr.-bryce-appelbaum" target="_blank">Brightway's Interview with Dr. Bryce Appelbaum</a>: If we're talking in response to a head injury, usually the first place you go with a head injury is the emergency room or hospital. They do all the diagnostic tests to make sure that there's no bleeding, swelling, or any physical damage to the brain. I think that's absolutely what needs to be done and the first place to go.&nbsp;&nbsp;However, you know a concussion is a bruise and it's a brain bruise. Almost no diagnostic imaging actually uncovers damage unless it's a functional MRI or something that's looking at the areas of the brain that are being tapped into and how you're using those areas. Very often, patients that I see with head injuries are told everything is fine or that they'll recover with time and they're not even sure whether it's diagnosed. They’ve seen neurology and their primary care physician and yet still they’re having trouble with visual symptoms like blur, headaches, dizziness, double vision, disrupted sleep, or they stand up and all of a sudden they lose blood flow to the brain.&nbsp;&nbsp;There are so many profiles that accompany head injuries that really require healthcare practitioners to look at the patient on a more holistic level. This includes really listening to how they're functioning and why they're there rather than just staying in their specific lane of one particular organ or system is not impacted. We are, as a medical community, probably 10 or so years into understanding concussion so much better than we used to with all of this research and literature coming out and everything occurring in the major sports areas. However, we're also still so far away from understanding concussion as well as we could and I think seeing practitioners who are constantly evolving and learning from their patients is really key because literature and research that prove the efficacy of certain treatments or what occurs with head injuries really follows years behind what's working in clinical practice until it's actually published. I think it’s important to make sure that you're looking holistically at the patient or at yourself to figure out how am I feeling different, what's different, and then from there figure out from the symptoms who the right person is to see.

How do you go about evaluating what part of the brain was affected and how to improve that?

You can try a couple of different websites to locate vision therapists.  One is the College of Optometrists in Vision Development: <a href="https://locate.covd.org" target="_blank">https://locate.covd.org</a> and the other is the Neuro-Optometric Rehabilitation Association: <a href="https://nora.memberclicks.net/find-a-provider#/" target="_blank">https://nora.memberclicks.net/find-a-provider#/</a>
 
That said, often neuro-physical therapists and occupational therapists do some vision therapy as well, especially if it relates to balance / vestibular issues, headaches, or other issues.  Sometimes these folks are more accessible.

Johns Hopkins Wilmer Eye  Clinic. Baltimore, Md If you come from out of town, they have a coordinator that help you with nearby accomadations. Excellent eye surgery done there.

There were answers about successful therapy but no names of vision therapists given or how they found them.

Where can I find vision therapists?

I was told by my neurooptalmologist that OT and PT can't help until you reach a certain point with vision therapy. I found this to be very true bc my Workmans comp wanted me to start with OT/PT first and it actually made it worseCall your insurance and ask them if there is a neuroptalmologist in your network. Or you can do what I did and fight them. I had to submit my whole medical file and provide evidence why this doctor is so different from any other eye doctor.It took some time but I won. Good luck!

I went to one vision therapy appointment years ago and along w my prism lens I was given exercises to do at home. Physio can be an option too as I know where I go they do eye therapy on concussion patients.

I sustained a severe TBI over 20 years ago. I have just recently started to advocate for myself on different doctors and in helping things that I’ve been struggling with for 20 years. Because as you may know 20 years ago they didn’t have the support available to TBI patients like they do now. I have been to a vision therapist who says he could help me and I was feeling like he could with the exercises and the things he was doing with me on a weekly basis. However he does not take insurance at all, and he is very very expensive. So I have to look into different avenues. Someone had suggested occupational therapy.￼￼￼￼￼

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Excessive sleepiness

How do you go about evaluating what part of the brain was affected and how to improve that?

Where can I find vision therapists?

Can occupational therapy help with someone who has vision issues?

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