{"id":4264,"date":"2016-09-27T11:24:00","date_gmt":"2016-09-27T09:24:00","guid":{"rendered":"https:\/\/www.acotv.org\/?p=4264"},"modified":"2022-04-24T22:24:14","modified_gmt":"2022-04-24T20:24:14","slug":"loclusio-binasal","status":"publish","type":"post","link":"https:\/\/www.acotv.org\/ca\/loclusio-binasal\/","title":{"rendered":"L’OCLUSI\u00d3 BINASAL"},"content":{"rendered":"\n

L\u2019oclusi\u00f3 binasal \u00e9s un tipus d\u2019oclusi\u00f3 sectorial utilitzat per tractar problemes visuals. En aquest article el Marc Argil\u00e9s<\/strong> ens l’explica amb m\u00e9s detall.<\/p>\n\n\n\n

Est\u00e0 documentat que l’oclusi\u00f3 binasal<\/strong> es realitza des de fa m\u00e9s de 60 anys i est\u00e0 recomanada per tractar endotr\u00f2pies, ambliopies i altres problemes funcionals no estr\u00e0bics.<\/p>\n\n\n\n

Diversos estudis indiquen l\u2019efic\u00e0cia d\u2019aquest tractament, per exemple un estudi realitzat per un optometrista franc\u00e8s va indicar que l\u2019oclusi\u00f3 binasal realitzada en 384 endotr\u00f2pies constants va aconseguir un 90% de recuperaci\u00f3 en l\u2019ambliopia, un 44% van acabar en ortotr\u00f2pia i un 41% van requerir cirurgia. En la mateixa l\u00ednia, el mateix autor va examinar l\u2019efic\u00e0cia dels exercicis visuals junt amb l\u2019oclusi\u00f3 binasal amb 151 nens amb endotr\u00f2pia cong\u00e8nita i va concloure que un 96% van eliminar l\u2019ambliopia i un 75% no va requerir cirurgia.<\/p>\n\n\n\n

Per aquest motiu, l\u2019oclusi\u00f3 binasal no \u00e9s prescrita com a tractament permanent i rarament \u00e9s l\u2019\u00fanic tractament i la majoria dels casos es compagina amb exercicis de ter\u00e0pia visual. Existeixen molts tipus d\u2019oclusi\u00f3 binasal i s\u2019utilitza diferent segons els casos, majorit\u00e0riament es prescriuen en endotr\u00f2pies i traumatismes cranioencef\u00e0lics. Tamb\u00e9 es pot utilitzar com una eina de ter\u00e0pia visual per treballar la consci\u00e8ncia perif\u00e8rica.<\/p>\n\n\n\n

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Figura 1.<\/strong> Diferents opcions d\u2019oclusi\u00f3 binasal.
<\/figcaption><\/figure>\n\n\n\n

1. Endotr\u00f2pies<\/strong> <\/p>\n\n\n\n

En els casos d\u2019endotr\u00f2pia l\u2019oclusi\u00f3 pret\u00e9n inhibir qualsevol adaptaci\u00f3 sensorial present (correspond\u00e8ncia sensorial) eliminant la fixaci\u00f3 a nivell temporal de la retina, trencant qualsevol proc\u00e9s quan l\u2019ull est\u00e0 divergint (Figura 2) per\u00f2 evitant la complerta oclusi\u00f3 de tot l\u2019ull (permet certa fusi\u00f3 perif\u00e8rica). <\/p>\n\n\n\n

\"\"
Figura 2. <\/strong>Exemple esquem\u00e0tic d\u2019una oclusi\u00f3 binasal en una endotr\u00f2pia de l\u2019ull dret. La f\u00f2vea de l\u2019ull desviat (representat en un triangle) queda tapada evitant que hi hagi una correspond\u00e8ncia sensorial. Extret de Tassinari JD. <\/strong>
<\/figcaption><\/figure>\n\n\n\n

Depenent de la condici\u00f3 que es vol tractar, la simetria entre els 2 pot ser diferent, per exemple, en casos d\u2019endotr\u00f2pies intermitents o alternants l\u2019oclusi\u00f3 \u00e9s equivalent en els 2 ulls, per\u00f2 en casos d\u2019endotr\u00f2pies unilaterals es tapa passant just per la pupil\u00b7la de l\u2019ull desviat, deixant l\u2019altre ull amb una oclusi\u00f3 m\u00e9s petita. Inclinar l\u2019oclusi\u00f3 cap dins inferiorment permet realitzar converg\u00e8ncia visual. D\u2019altra banda, aquest tipus d\u2019oclusi\u00f3 permet m\u00e9s consci\u00e8ncia perif\u00e8rica ajudant a ser m\u00e9s perif\u00e8rics en els casos d\u2019endotr\u00f2pies amb processament central.<\/p>\n\n\n\n

 2.Traumatismes craneo-encef\u00e0lics<\/strong><\/p>\n\n\n\n

Els traumatismes cranioencef\u00e0lics donen com a resultat una constel\u00b7laci\u00f3 d\u2019efectes adversos en el sistema sensorial, motor, perceptual, ling\u00fc\u00edstic cognitiu i atencional. Les conseq\u00fc\u00e8ncies visuals (problemes oculomotors, defectes en al camp visual, d\u00e8ficits d\u2019atenci\u00f3 visual) s\u00f3n comuns. L\u2019oclusi\u00f3 binasal s\u2019utilitza per disminuir el s\u00edmptomes de mareig, n\u00e0usees, problemes d\u2019equilibri o desorientaci\u00f3 en aquests casos. Una teoria de la millora amb aquest tipus d\u2019oclusi\u00f3 \u00e9s que la supressi\u00f3 creada en el camp visual redueix el \u201csoroll neuronal\u201d a causa del trauma, ja que inhibeix una \u00e0rea central que requereix molta demanda de fusi\u00f3, que \u00e9s on es solapen les 2 \u00e0rees dels 2 ulls, per tant, modificant l\u2019input d\u2019aquesta \u00e0rea serveix per alleugerar l\u2019estr\u00e8s visual. Hi han varis estudis recents que indiquen que l\u2019\u00fas d\u2019oclusi\u00f3 binasal juntament amb prismes de base nasal augmenten el rendiment viso-motor i els potencials evocats visuals.<\/p>\n\n\n\n

 3. Prescripci\u00f3<\/strong><\/p>\n\n\n\n

La prescripci\u00f3 dels binasals dependr\u00e0 de cada cas, una eina \u00fatil \u00e9s utilitzar la regla d\u2019Streff per ajudar a marcar les l\u00ednies on passar\u00e0 l\u2019oclusi\u00f3  (Figura 3). En els casos de traumatismes \u00e9s important anar baixant molt lentament la regla fins que el pacient noti algun canvi de s\u00edmptomes. En cas de no notar una millora immediata, alguns autors apunten que l\u2019\u00fas de binasals d\u2019amplada m\u00ednima ja aconsegueix millores importants en poc temps.<\/p>\n\n\n\n

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Figura 3.<\/strong>Regla d\u2019Streff. Dibuix extret de Bernell Corporation VTP\u00ae
<\/figcaption><\/figure>\n\n\n\n

Un cop marcat amb retolador les l\u00ednies on volem col\u00b7locar l\u2019oclusi\u00f3 binasal, el segon pas \u00e9s aplicar cinta adhesiva transl\u00facida per la part interna del vidre arran la l\u00ednia marcada anteriorment. Despr\u00e9s s\u2019aplica per dins la zona de la l\u00ednia pinta-ungles transparent, i sense esperar agafem un escuradents i anem puntejant tota la zona pintada. Deixem assecar 1-2 minuts i traiem la cinta adhesiva. \u00c9s important comprovar que el puntejat de l\u2019oclusi\u00f3 quedi transl\u00facid i no transparenti del tot. Rascant una mica es pot treure perfectament i sense danyar el vidre per si es vol tornar a repetir. Tamb\u00e9 es pot deixar directament la cinta adhesiva si no volem utilitzar pinta-ungles, tal com alguns autors realitzen.<\/p>\n\n\n\n

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Figura 4.<\/strong>Passos per col\u00b7locar una oclusi\u00f3 binasal<\/figcaption><\/figure>\n\n\n\n

L\u2019\u00fas de la oclusi\u00f3 binasal resulta efectiva amb combinaci\u00f3 d\u2019exercicis de terapia visual pel tractament d\u2019endotr\u00f2pies i la millora de s\u00edmptomes en casos de traumatismes craneoencef\u00e0lics. El material per a la seva utilitzaci\u00f3 \u00e9s econ\u00f2mic, vers\u00e0til i l\u2019efic\u00e0cia en l\u2019\u00fas optom\u00e8tric el situa en una posici\u00f3 per tenir en compte durant la ter\u00e0pia visual.<\/p>\n\n\n\n

Bibliografia<\/strong> <\/p>\n\n\n\n

Ciuffreda KJ, Yadav NK, Ludman DP<\/strong>. Effect of binasalocclusion (BNO) in the visual evokedpotential (VEP) in mildtraumaticbraininjury (mTBI). BrainInjury,<\/em> 27(1), 2013. <\/p>\n\n\n\n

Gallop S<\/strong>. A variationonthe use of binasalocclussion, a case study. Journal of BehavioralOptometry,<\/em> 9(2), 1998. <\/p>\n\n\n\n

Gallop S<\/strong>. BinasalOcclusion, immediatesustainablesymptmaticrelief.  Optometry&Vision Performance, <\/em>2(2), 2014. <\/p>\n\n\n\n

Kapoor N, Ciuffreda KJ<\/strong>. Visiondisturbancesfollowingtraumaticbraininjury. CurrentTreatmentOptions in Neurology<\/em>2002;4:271-280. <\/p>\n\n\n\n

Padula WV, Argyris S, Ray J.<\/strong> Visual evokedpotentials (VEP) evaluatingtreatmentfor post-trauma visionsyndrome (PTVS) in patientswithtraumaticbrain injuries (TBI). BrainInjury<\/em>1994;8:125-33. <\/p>\n\n\n\n

Proctor A<\/strong>. Traumaticbraininjury and binasalocclusion. Optometry&VisionDevelopment<\/em> ,40(1), 2009. <\/p>\n\n\n\n

Sarniguet-Badoche J<\/strong>. Early Medical treatment of strabismusbeforetheage of 18 months. StrabismusII<\/em>.New York, 1984;83-89. <\/p>\n\n\n\n

Sarniguet-Badoche J<\/strong>. Le traitment Medical des pseudo-apresies des droitsexternes.BullSoc Opht France<\/em>, LXXXII:23-27. <\/p>\n\n\n\n

Tassinari JD<\/strong>. BinasalOcclusion. Journal of BehavioralOptometry<\/em>, 1(1), 1989. <\/p>\n\n\n\n

Yadav NK; Ciuffreda KJ<\/strong>. Effect of binasalocclusion and Base-in prismsonthe visual evokedpotential (VEP) in visually-normal and mildtraumaticbraininjurypopulations.\u00a0InvestigativeOphthalmology& Visual Science,<\/em>\u00a055(3498), 2014.<\/p>\n\n\n\n

Article elaborat per Marc Argil\u00e9s Sans<\/strong>
Diplomat en \u00d2ptica i Optometria
M\u00e0ster en Optometria i Ci\u00e8ncies de la Visi\u00f3\u00a0<\/em><\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

L\u2019oclusi\u00f3 binasal \u00e9s un tipus d\u2019oclusi\u00f3 sectorial utilitzat per tractar problemes visuals. En aquest article el Marc Argil\u00e9s ens l’explica amb m\u00e9s […]<\/p>\n","protected":false},"author":2,"featured_media":4265,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ocean_front_end_style_editor":"no","ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"0","ocean_post_oembed":"","ocean_post_self_hosted_media":"","ocean_post_video_embed":"","ocean_link_format":"","ocean_link_format_target":"self","ocean_quote_format":"","ocean_quote_format_link":"post","ocean_gallery_link_images":"off","ocean_gallery_id":[],"footnotes":""},"categories":[24],"tags":[66,67],"class_list":["post-4264","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bloc","tag-optometria-ca","tag-terapiavisual-ca","entry","has-media"],"yoast_head":"\nL'OCLUSI\u00d3 BINASAL - Asociaci\u00f3n Catalana de Optometr\u00eda y Terapia Visual<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.acotv.org\/ca\/loclusio-binasal\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"L'OCLUSI\u00d3 BINASAL - Asociaci\u00f3n Catalana de Optometr\u00eda y Terapia Visual\" \/>\n<meta property=\"og:description\" content=\"L\u2019oclusi\u00f3 binasal \u00e9s un tipus d\u2019oclusi\u00f3 sectorial utilitzat per tractar problemes visuals. 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