7 - Oculomotor Dysfunction Flashcards
Saccades
Most are voluntary (unless sudden visual/auditory stimulus)
Once movement starts, can’t change amp —> over/under-shooting
Superior colliculus, faster than pursuits, longer latency
Microsaccades for reading
Pursuits
Considered voluntary - few can do w/o moving stimulus
Parietal lobe - a lesion causes ipsilateral impairment
Testing/evaluation: NSUCO
ONLY that looks at pursuits
Score dependent on age gender norms
Fail = suspect OMD Pass = does not rule out OMD
Testing/evaluation: DEM
Horiz adjusted time (C) = repeatability —> follow progression
Types:
1) normal
2) high H, abn ratio = OMD
3) high H & V, normal ratio = automaticity
4) high H & V, abn ratio = both
Testing/evaluation: King-Devick
Readily used for concussion testing
Testing/evaluation: visagraph II
Fixation, Span of Recognition, Regressions, Duration of Fixation
Objective - tests comprehension & saccades
Fixation: how many times eyes stopped as the moved along 100 words
Span of Recognition: avg amount of a word taken in at each stop
Regressions: how many times eyes moved backwards
Duration of Fixation: amount of time eyes stay at a fixation point
Testing/evaluation: Groffman tracings
Requires little cognitive ability
Oculomotor therapy sequence (not the activities list, the development of __, then __)
1) develop more accurate gross saccades, fine pursuits
2) devleop more accurate fine saccades, large pursuits
3) integrate accurate S&P with changes in vergence & accomm
Specific guidelines:
Emphasize
Eliminate
Increase
Accuracy —> speed
Head movements
Complexity of tasks
Specific guidelines: size of S&P
Saccades: L —> s
Pursuits: s —> L
Specific guidelines:
Motility therapy
Pt should have an __
Begin monocularly —> binocularly
Error awareness - feedback is extremely important in learning
Oculomotor therapy coaching/modifications
Use finger to point at targets
Place beanbag on head to encourage less movement
Always describe feedback to ensure learning
Oculomotor therapy sequence (activity types)
Visual/Kinetic Feedback —> General S&P Techniques —> Fine Motor w/ Ocular Skills
Visual/Kinetic Feedback activities (5)
After-image saccades Flashlight tag Cup pursuits Circle/square form Triangle form
General S&P Technique activities (6)
Basic S&P Monocular loos prism jumps Visual tracing String reading Hart saccades/decoding Bernell sticks
Fine Motor w/ Ocular Skills activities (6)
Continuous motion Symbol tracking Letter/Michigan tracking Marsden ball Rotating pegboard Wayne saccadic fixator
After-image
Visual/Kinetic Feedback
Saccades
Accuracy—>steadiness (5-10sec)
Flashlight tag
Visual/Kinetic Feedback
Saccades & pursuits
Monocular
Cup pursuits
Visual/Kinetic Feedback
Pursuits
Slow, predictable pattern -> faster, more random
Harder = smaller diameter cup (incr accuracy)
Circle/Square/Triangle Form
Visual/Kinetic Feedback
Saccades
Circle/square (easier) —> triangle (harder)
Similar to face form
Basic S&P
General S&P Techniques
Saccades & pursuits
Watch for accuracy:
P: leading/lagging
S: over/under-shooting
Loose prims monocular jumps
General S&P Techniques
Saccades
Pt indicates which way the target moves
Harder = decr prism magnitude*
*with improvement, pt should be more sensitive to small movements/prism
Goal: 0.5-1.0pd
String reading
General S&P Techniques
Saccades
Read aloud only single letters
Similar activity = saccadic workbook
Hart chart saccades
General S&P Techniques
Saccades
Mono or binocular
Pt reads 1st letter top row, 1st letter bottom, etc. down the columns
Harde = change to inner columns, oblique (1st top, last bottom, etc.), multiple charts, metronome, balance board
