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Vision Therapy > Assessment and Diagnosis of Oculomotor Dysfunction > Flashcards

Assessment and Diagnosis of Oculomotor Dysfunction Flashcards

1
Q

T/F poor pursuits and/or saccades can exist in isolation but can also be found with vergence/accommodative disorders

A

true, more likely to be with vergence/accommodative disorders

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2
Q

A comprehensive VT eval gives insight into a patient’s…

A

attention skills

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3
Q

Focus vs focus

A

Focus: attention, focus: clear image on retina

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4
Q

What are the three areas of VT eval testing?

A

free-space, psychometric and electrodiagnostic

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5
Q

What is the Maples NSUCO test?

A

free-space, direct observation of pursuits and saccades while the patient stands

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6
Q

What is the patient graded on during NSUCO/Maples?

A

ability, accuracy, head movements, body movements

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7
Q

What is the scale for the Maples/NSUCO?

A

1 to 5 (best), perfect= 20 points

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8
Q

T/F girls show better Maples/NSUCO scores earlier

A

true, boys catch-up around age 9

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9
Q

For saccades and pursuits, ability should be 5 for all ages EXCEPT…

A

for boys age 5 and 6 the pursuit ability is 4

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10
Q

What is the King Devick?

A

psychometric, visual-verbal format, tests saccades only (not RAN individually)

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11
Q

How is King Devick performed?

A

three tests cards after the demo at Harmon’s distance, patient calls out digits horizontally as quickly as possible

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12
Q

How is the King Devick scored?

A

compare time to average ranges for age 6-14, calculate the z-score although it is not part of standard protocol

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13
Q

How do you calculate z-score?

A

(average - raw)/standard deviation

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14
Q

Which test is used most in sports medicine as a concussion test?

A

King devick, looks at RAN and eye movements as a whole

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15
Q

What are the different athlete responses to KD?

A

athletes without concussions show slight learning effect and improve slightly over the season, athletes with concussions have worse scores on sideline testing compared to baseline

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16
Q

What is the median KD score decrease in athletes with concussions?

A

5 second worse

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17
Q

What is the DEM?

A

psychometric testing, determines a possible saccadic problem, also looks at rapid automatic naming

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18
Q

How does the DEM work?

A

read numbers as fast as you can vertically twice and horizontally ones

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19
Q

How is the DEM scored?

A

z-scores are calculated based off of time for vertical, horizontal, and ratio times, norms are for ages 6 to 34

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20
Q

What are four possible outcomes of the DEM?

A

normal performance, saccadic dysfunction, difficulty with RAN, difficulty with both saccades and RAN

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21
Q

What is the ReadAlyzer/Visagraph?

A

electrodiagnostic infrared recording device, provides info on fixations, regressions, fixation duration, reading rate, and grade equivalence

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22
Q

What is the procedure for readalyzer?

A

patient reads a grade level-appropriate (or below) passage silently while wearing infrared goggles, patient answers 10 true/false questions and must score 70% for a valid reading

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23
Q

What does a regression look like?

A

short backwards horizontal line

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24
Q

What does a return sweep look like?

A

long backwards horizontal line

25
Q

What does a fixation look like?

A

a vertical line

26
Q

What does a saccade look like?

A

a short forwards horizontal line

27
Q

One a readalyzer trace what is shown on the vertical axis?

A

time

28
Q

What should you see on a readalyzer trace?

A

stair-step pattern, good yoked movement, full return sweeps, minimal regressions, minimal long fixations

29
Q

What is RightEye?

A

newer tech, patient reads present paragraphs and/or follows moving targets, eye movements are mapped and evaluated based on norms, particularly useful for ABI/TB

30
Q

What is the 1st theory relating eye movement and reading?

A

eye movement disorders can cause below-average reading ability

31
Q

What is the 2nd theory relating eye movement and reading?

A

random, unskilled eye movements found in poor readers are secondary to deficient language skills that cause reading disorders

32
Q

What is the 3rd theory relation eye movements and reading?

A

combination, in some cases, the primary problem is an eye movement disorder affecting fluency, in other cases, the eye movement disorder is a reflection of poor reading ability

33
Q

What is oculomotor dysfunction?

A

eye movement disorder– fixations, saccades, and/or pursuits, can occur in isolation but are often found together

34
Q

When should children have the gross ability of normal eye movements?

A

1-2 years old

35
Q

When do eye movement skills continue developing until?

A

throughout elementary school ages accuracy, success and smoothness occur

36
Q

What plays a role in children’s eye movement ability?

A

attention

37
Q

What are fixations?

A

the ability to maintain steady, stable fixation on a target

38
Q

When should you be able to hold fixation for 10 seconds?

A

age 3

39
Q

T/F fixations are affected by attention and motivation

A

true

40
Q

When do fixations occur?

A

during reading between saccades, average duration 200-250 msec and ranges from 100-500+

41
Q

What would a 500+ msec fixation indicate?

A

problem disengaging attention

42
Q

What are saccades?

A

rapid redirection of line of sight for foveal viewing

43
Q

Which eye movement is the fastes?

A

saccades

44
Q

What is the saccadic latency?

A

200-250 msec, related to luminance, contrast, predictability, motivation, attention

45
Q

In the reading task what is the visual angle of a saccade and how many characters does it span?

A

2 degree visual angle, 8-9 characters

46
Q

How much of reading time is saccades?

A

10%

47
Q

Which takes up more of reading time, saccades or fixations?

A

fixations

48
Q

What are pursuits?

A

continuous clear vision of moving targets through foveal fixation, affected by age, attention, motivation

49
Q

What is the maximum velocity of a pursuit?

A

60 deg/sec

50
Q

What is the latency of a pursuit?

A

100-130 msec

51
Q

What deficits are associated with poor sports performance?

A

difficulty catching and hitting, maybe difficulty running

52
Q

What are symptoms of OMD, specifically saccades?

A

excessive head movement w/ reading, slow reading speed, poor comprehension, short attention span, difficulty aligning columns, difficulty with scantrons, losing place when reading, skipping words or lines, difficulty copying from board

53
Q

What are symptoms of OMD, specifically pursuits?

A

excessive head movements, poor sports performance, reading difficulty

54
Q

What are signs of OMD, specifically saccades?

A

observational evidence, below-average readalyzer/visagraph/rightEye, z-score below -1.00 on DEM ration, outside average range on KD, performance below norms on Maples NSUCO

55
Q

What are signs of OMD, specifically pursuits?

A

observational evidence, below average performance on RightEye, performance below norms on Maples

56
Q

What are potential causes of OMD?

A

functional and pathological

57
Q

What are functional causes of OMD?

A

difficult to pinpoint a specific cause, can be congenital/idiopathic, can be developmental delay, rule out pathology

58
Q

What are pathological causes of OMD?

A

many etiologies: cerebellar disease, oculomotor nerve paresis, internuclear ophthalmoplegia, myasthenia gravis, Alzheimer’s, Parkinson’s, TBI, ABI

59
Q

What does it mean if a medical code ends in 9?

A

generally indicates “nonspecific” should avoid when possible

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