7 - Oculomotor Dysfunction

Question 1

Saccades

Answer 1

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

Question 2

Pursuits

Answer 2

Considered voluntary - few can do w/o moving stimulus

Parietal lobe - a lesion causes ipsilateral impairment

Question 3

Testing/evaluation: NSUCO

Answer 3

ONLY that looks at pursuits

Score dependent on age gender norms

Fail = suspect OMD
Pass = does not rule out OMD

Question 4

Testing/evaluation: DEM

Answer 4

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

Question 5

Testing/evaluation: King-Devick

Answer 5

Readily used for concussion testing

Question 6

Testing/evaluation: visagraph II

Fixation, Span of Recognition, Regressions, Duration of Fixation

Answer 6

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

Question 7

Testing/evaluation: Groffman tracings

Answer 7

Requires little cognitive ability

Question 8

Oculomotor therapy sequence (not the activities list, the development of __, then __)

Answer 8

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

Question 9

Specific guidelines:
Emphasize
Eliminate
Increase

Answer 9

Accuracy —> speed

Head movements

Complexity of tasks

Question 10

Specific guidelines: size of S&P

Answer 10

Saccades: L —> s

Pursuits: s —> L

Question 11

Specific guidelines:
Motility therapy
Pt should have an __

Answer 11

Begin monocularly —> binocularly

Error awareness - feedback is extremely important in learning

Question 12

Oculomotor therapy coaching/modifications

Answer 12

Use finger to point at targets

Place beanbag on head to encourage less movement

Always describe feedback to ensure learning

Question 13

Oculomotor therapy sequence (activity types)

Answer 13

Visual/Kinetic Feedback —> General S&P Techniques —> Fine Motor w/ Ocular Skills

Question 14

Visual/Kinetic Feedback activities (5)

Answer 14

After-image saccades
Flashlight tag
Cup pursuits
Circle/square form
Triangle form

Question 15

General S&P Technique activities (6)

Answer 15

Basic S&P
Monocular loos prism jumps
Visual tracing
String reading
Hart saccades/decoding
Bernell sticks

Question 16

Fine Motor w/ Ocular Skills activities (6)

Answer 16

Continuous motion
Symbol tracking
Letter/Michigan tracking
Marsden ball
Rotating pegboard
Wayne saccadic fixator

Question 17

After-image

Answer 17

Visual/Kinetic Feedback

Saccades

Accuracy—>steadiness (5-10sec)

Question 18

Flashlight tag

Answer 18

Visual/Kinetic Feedback

Saccades & pursuits

Monocular

Question 19

Cup pursuits

Answer 19

Visual/Kinetic Feedback

Pursuits

Slow, predictable pattern -> faster, more random

Harder = smaller diameter cup (incr accuracy)

Question 20

Circle/Square/Triangle Form

Answer 20

Visual/Kinetic Feedback

Saccades

Circle/square (easier) —> triangle (harder)

Similar to face form

Question 21

Basic S&P

Answer 21

General S&P Techniques

Saccades & pursuits

Watch for accuracy:
P: leading/lagging
S: over/under-shooting

Question 22

Loose prims monocular jumps

Answer 22

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

Question 23

String reading

Answer 23

General S&P Techniques

Saccades

Read aloud only single letters

Similar activity = saccadic workbook

Question 24

Hart chart saccades

Answer 24

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

Question 25

Hart chart decoding

Answer 25

General S&P Techniques

Saccades & scanning techniques

Usually binocular, towards the end of training

Question 26

Bernell sticks

Answer 26

General S&P Techniques

Saccades & anti-suppression

Question 27

Continuous motion

Answer 27

Fine Motor with Ocular Skills

Saccades & fine motor

Harder = incr # of targets

Question 28

Symbol tracking

Answer 28

Fine Motor with Ocular Skills

Saccades

Question 29

Michigan letter tracking

Answer 29

Fine Motor with Ocular Skills

Saccades

Move from large —> small font

Harder = slashes

Question 30

Marsden ball

Answer 30

Fine Motor with Ocular Skills

Pursuits & anti-suppression

1) read off stationary ball
2) read off moving ball, incr speed/size as proficiency incr

Pursuits & hand-eye coordination

1) hit ball w/ dowel rod (-) missing, head movement
2) hit w/ certain color of the bat
3) hit on certain letter

Question 31

Rotating pegboard

Answer 31

Fine Motor with Ocular Skills

Pursuits

Instruct to put golf tee into a hole

Innermost = easiest (s pursuits)
Outermost = hardest (L pursuits)

Question 32

Wayne fixator

Answer 32

Fine Motor with Ocular Skills

Saccades & rapid hand-eye coord, spatial integration, reaction times

Touch-sensitive membrane panels

Question 33

Miscellaneous activities

Answer 33

Figure ground: can you find that object in a crowded background

Highlights, I-Spy, Where’s Waldo, Spot-It