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Motility Bloick 10 > Eval Of Ocular Eye Movements 2 > Flashcards

Eval Of Ocular Eye Movements 2 Flashcards

1
Q

NSUCO oculomotor test

A

Assess pursuits and saccades, direct observation test

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2
Q

Substitutions on DEM

A

Cross out number with a slash if an error in naming. If there was an immediate correction, it can be accepted as correct

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3
Q

Transposition (t) in DEM

A

Place an arrow where a number has been read out of sequence

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4
Q

Omissions on DEM (o)

A

Circle the number if it is omitted

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5
Q

Additions (a) on DEM

A

Places a cross when the extra number has been added or a number has been repeated

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6
Q

Interpretation of DEM

A

Use the DEM examiners manueal to compare the patients values with expected age matched norm data

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7
Q

Type I DEM

A

Average performance in all subtlest values

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8
Q

Type II DEM

A

High horizaontal time, normal vertical time

-oculomotor dysfunction

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9
Q

Type III DEM

A

High horizontal and vertical times, normal ratio

-difficulty in automaticity of number naming

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10
Q

Type IV DEM

A

Horizontal time, vertical time, and ratio all abnormal

  • deficiency in oculomotor skills and in automaticity
  • combo of type II and III
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11
Q

DEM ratio

A

Horizontal adjusted time/vertical adjusted time

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12
Q

Adjusted horizontal time for DEM

A

Horizontal (C) x (80/(80-omissions +additions)

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13
Q

Total vertical time in DEM

A

Add subset a and B

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14
Q

if the diagnosis is
Average vertical time (47%)
High horizontal time (19%)
Abnormal ratio (9%)

DEM

A

Type II: high horizontal time, normal vertical time

-oculomotor function

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15
Q

Purpose of king-devick test

A

Visual-verbal ocular motor assessment tool

  • relies on rapid number naming
  • assess saccadic eye movements
  • assess neuro function

Can also be used for conclusion detection

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16
Q

Set up king-devick test

A

Lenses: habitual at near
Normal illumination
Test distance: Harmon distance

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17
Q

Procedure overview of king-devick test

A
  • patient calls off a series of numbers as quickly as possible, NO finger or pointers
  • compare response times and number of errors to table of expected values
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18
Q

Demonstration card for king-devick test

A
  • Note on the score sheet if the patient reports difficulty in reading at their age level
  • call out the numbers on the card as quickly and carefully as possible
  • point tot he upper left then the second left hand number, and the third number, etc
  • instruct the patient to not use their finger to track the numbers
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19
Q

Test card I in king devick test

A
  • place card I in front of patient
  • use a stopwatch to I’d time it takes to complete the card
  • call out all the number so not he card as quickly as possible
  • record the number of errors and record the time it took
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20
Q

King devick test card II and III

A
  • same procedure as test card I
  • test card I: if greater than 50s, stop at test card I
  • test card II: if total time of test card I and II is greater than 100s, stop at test card II
  • of patient is less than or equal to 10yo and unable to complete test card III, take the sum of test cards I and II time and errors
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21
Q

Errors in king-devick

A

Do not count the error if the patient quickly corrects the error

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22
Q

Interpretation of king-devick test

A

Use the score sheet scoring guide to compare the patients values with expected age-matched normative data

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23
Q

Purpose of groffman tracings

A
  • Ocular motor assessment tool, assess pursuit eye movements
  • detects reading disability
  • requires little cognitive ability
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24
Q

Set up for groffman

A
  • habitual near correction
  • normal room illumination
  • test distance: Harmon distance
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25
Q

Procedure for groffman tracings

A
  • hand the demo card to patient
  • this is a test to see how quickly accurately you can follow a line using only your eyes. Look at the line that starts with the letter A. Follow it with your eyes.when it reaches another line (point to the first intersection), follow it straight ahead and do not turn off onto a line that crosses the line you are traveling on.
  • now follow the lines starting at A with your eyes and tell me at what number it ends at the bottom of the page
  • after the pt completes A, repeat for D and say, we are going to trace 5 more lines, your score will depend on accuracy and speed so work quickly, nut try not to make a mistake
  • pt cannot use finger to trace line
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26
Q

Scoring for Groffman

A
  • each letter is scored individually
  • if the pt reached the incorrect number- “0” point for that letter
  • if he or she reached the correct number but persisted in using his/her finger to trace the path- “0” points for that letter
  • if he/she reached the correct number visually- points give according to the scale, based on time elapsed in seconds
  • the individual scores for each letter are added and the total is compared to age matched normative data
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27
Q

Diagnosis for groffman

A

Use patients score comparison to age matched Norms to determine performance level
Also use observations during testing for diagnosis

Satisfactory rating with excessive head movement, body squirming and facial grimaces- oculomotor-motor coordination problem

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28
Q

NSUCO oculomotor test

A
  • using red and white beads at 40cm
  • saccades: look at red when i say red, look at white when i say white
  • pursuits: watch the ball as it goes around. Don’t ever take your eyes off the ball
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29
Q

What to observe in the NSUCO oculomotor test

A

Eye movement
Head movement
Body movement

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30
Q

Scoring the patient in NSUCO test

A

Ability
Accuracy
Head movement
Body movement

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31
Q

Saccades scoring in NSUCO oculomotor test: ability

A
  1. No attempt made
  2. Completes 2 round trips
  3. Completes 3 round trips
  4. Completes 4 round trips
  5. Completes 5 round trips
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32
Q

Pursuits scoring in NSUCO oculomotor test: ability

A
  1. No attempt is made to perform the task to 1/2 rotation
  2. Completes 1/2 rotations but not one ful rotation
  3. Completes 1 rotation but not 2
  4. Completes 2 rotations in one direction but not 2 in the other
  5. Completes 2 rotations in both directions
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33
Q

Saccades scoring in NSUCO oculomotor test: accuracy

A
  1. Gross overshooting or undershooting is noted
  2. Large to moderate overshooting or undershooting noted
  3. Constant slight overshooting or undershooting noted
  4. Intermittent slight overshooting or undershooting noted
  5. No overshooting or undershooting noted
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34
Q

Pursuits scoring in NSUCO oculomotor test: accuracy

A
  1. No attempt to follow the target to 10 refixations
  2. Refiations 4-10x
  3. Refixations 2-4x
  4. Refixations 2 or less times
  5. No refixations
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35
Q

Scoring head and body movements on NSUCO

A
  1. Gross movement of head/body
  2. Large to moderate movement of the head/body
  3. Consistent slight movement of the head/body
  4. Intermittent slight movement of the head/body
  5. No movement of the head/body
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36
Q

Purpose of DEM test

A

Visual-verbal ocular motor assessment tool
-accounts for difficulties in naming numbers
To check on vision therapy progresses

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37
Q

Setup for DEM

A
  • habitual near
  • normal illumination
  • Harmon distance
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38
Q

Procedure overview of DEM

A

-patient calls off a series of numbers as quickly as possible, no

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39
Q

Procedure overview for DEM

A
  • patient called off a series of numbers as quickly as possible, no finger or pointers
  • compare response times and numbers of errors to table of expected values
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40
Q

Pre=test for DEM

A
  • to ensure child knows their numbers
  • practice saying these numbers as fast as you can
  • child must complete within 12 seconds
  • do not administer DEM is child fails pre test
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41
Q

DEM subtext A and B

A
  • tests vertical saccades
  • testing 40 single digit numbers
  • read as quickly and accurately as possible
  • record time
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42
Q

Subtest C on DEM

A
  • tests horizontal saccades
  • 80 single digit numbers
  • record time
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43
Q

Most common sign of a neuromuscular problem

A

Deviation of the visual axis (tropica or phoria)

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44
Q

Proper alignment needs good

A

Sensory and motor fusion

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45
Q

Abnormalities with sensory fusion can lead to

A

A disruption in motor fusion, then a deviation of the visual axes producing a tropia or phoria

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46
Q

A latent tendency for the eyes too deviate when fusion is broken

A

Phoiria

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47
Q

Needed for binocular fusion, to prevent diplopia and suppression

A

Fusion

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48
Q

What test picks up phoria

A

Alternating

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49
Q

Fusion can be disrupted/due to

A

Alternating cover test
Fatigue
Illness
Stress

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50
Q

Decompensating phoria

A

Had it before, coming out now

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51
Q

A manifest deviation of the eyes seen on unilateral cover test

A

Tropia (strabismus)

52
Q

This results in amblyopia, diplopia and/or suppression

A

Tropia

53
Q

Recording phoria or tropia

A 
Without or with glasses
Distance or near 
Amount of deviation 
Type of phoria or tropia 
Constant or intermittent (with freq)
Unilateral or alternating
54
Q

Patient fixates with the other eye

A

Unilateral tropia

55
Q

Fusion inadequate to keep aligned

A

Constant tropia

56
Q

Fusion functions at some times, but not all times

A

Intermittent tropia

57
Q

Patients having tropia and phoria

A

Remember that a patient could have a tropia at a certain distance and/or gaze, but a phoria at another distance and/or gaze

58
Q

Deviation in one eye, in one gaze a only

A

Noncomittant

59
Q

Cover test norm

A

Dist: 1XP (+/-2pd)
Near: 3XP (+/-3pd)

60
Q

Neutralizing exo

A

BI

61
Q

Neutralizing eso

A

BO

62
Q

Neutralizing hypo

A

BU

63
Q

Neutralizing hyper

A

BD

64
Q

Neutralizing ortho

A

Verify by using BI and then BO

65
Q

If both eyes have BU or BD and the value isn’t split, the prism will produce

A

A version (conjugate eye movement)

Both eyes will move down and the problem didn’t get treated

66
Q

How do you treat someone with prism vertical

A

By splitting the vertical prism, the deviation is treated with the resultant and net binocular effect (the absolute sum of the prism)

8pd hyper

Rx 4BU OD with 4BD OS= 8BU OD, or 8BD OS

2BU OD with 3BD OS=5BU OD or 5BD OS

67
Q

How do you split horizaonrtal prism

A

You have to keep the same base OU

8BO will be 4BO OD and 4BO OS
By doing this, the resultant amount of 8BO causes a vergence eye movement to move each eye out

68
Q

What is BI and BO are RXed together

A

This will only reacte a version eye movement and not correct the deviation because they are yoked prisms and the effect will be canceled out in a version movement

69
Q

This is an abnormal head posture (head tilt, turn, chin up or down)
Can have one or more of these together

A

Torticollis

70
Q

Can be present in a variety of eye movement disorders. Requires early detection and correction of the cause

A

Torticollis

71
Q

Prolonged torticollis

A

Prolonged could lead to permanent facial asymmetry and contracture of the neck muscles

72
Q

A compensatory response to an ocular problem by a head tilt

A

Ocular torticollis

-attempts to maintain binocularity and VA, or use of limited VF

73
Q

Case history of torticollis

A

When did it start

Need to eval to determine if an ocular problem is the cause

74
Q

What tests would you perform and why for torticollis?

A 
CT
EOM
Forced duction 
Parks 3 
Dolls head 
Saccades 
Pursuits 
VA
Dilate, look at retina
Pupils
75
Q

What do we want to rule out in torticollis

A

Nystagmus

-the head tilt is being held at the null point where the nystagmus is 0

76
Q

Abnormalities that can cause torticollis

A
  • nystagmus (at null point for dampening) for better VA
  • paretic strabismus
  • refractive strabismus
  • Supra nuclear disorders (gaze palsied, dorsal midbrain syndrome)
  • AV pattern strabismus
  • monocular blindness
  • ptosis
  • refractive error
  • VF defect
77
Q

Deviations are either ___ or ____

A

Comitant or noncomitant

78
Q

Deviation size remains same (or within 5PD in all positions of gaze, implying no muscles are underacting or overacting

A

Comitant

79
Q

Deviation size is different in different positions of gaze. Due to an over action or under action of one or multiple muscles

A

Non-comitant

80
Q

How to you determine comitancy

A

CT is done in all positions of gaze. Non-comitant can be due to innervation problems (paralytic) or mechanical restrictions

81
Q

Non comitancy can be caused by

A

Innervation problems or mechanical restriction

82
Q

Comitancy and ____ play a role in neuromuscular abnormalities

A

Vergences

83
Q

Anomalies of vergences

A 
Convergence insufficiency (exo at near)
Convergence excess (eso at near)
Divergence insufficiency (eso at dist)
Divergence excess (exo at distance)
84
Q

Accommodative eso tropia

A

Caused by overaccommodating

85
Q

Vergences insufficiencies can affect

A

Tropias AND phorias

86
Q

Sites OD lesions in neuromuscular problems

A

Supra nuclear
Nuclear
Infranuclear
Myotonic (at muscle)

87
Q

Pathologies that can cause strabismus

A

Anomalies of the face or orbit due to hydrocephalus, craniostynosis, and other Crain official conditions

88
Q

Time of onset of neuromuscular abnormalities

A
  • congenital (birth to 6 months)
  • acquired (after 6months of age)
    • acute (trauma, tumor)
    • longstanding
    • consecutive (surgical overcorrection from fixing the first tropia)
89
Q

HS for congenital neuromuscular deviations

A

Uncertain of onset, only intermittent diplopia and may be a symptomatic

90
Q

He of acquired neuromuscular deviations

A

Diplopia; exact time of onset is known, symptomatic

91
Q

Head posture of someone with a congenital neuromuscular deviations

A

Patient/family unaware of posture; some facial asymmetry may be possible; deviation may now be comitancy

92
Q

Acquired neuromuscular deviations for head posture

A

Aware of head posture, needs to adopt intermittently because of symptoms, obvious

93
Q

Comitancy of someone with a congenital neuromuscular deviations

A

May appears comitancy because of developed muscle sequalea, primary and secondary angle appear similar

94
Q

Acquired neuromuscular deviations fusional amplitudes

A

Patient have large vertical fusional amplitude (>10PD)

95
Q

Acquired neuromuscular deviations and suppression

A

Occurs in young children in the critical period, rare in adults

96
Q

Congenital suppression in neuromuscular deviation

A

Often present

97
Q

Congenital neuromuscular deviations and torsion

A

Rarely seen

98
Q

Acquired neuromuscular deviations and torsion

A

Seen

99
Q

Action of muscle or group of muscles completely eliminated ( no movement seen)

A

Paralysis

100
Q

Action of muscle or muscles is impaired (some movement seen)

A

Paresis

101
Q

General term for paralysis or paresis (since could be difficult to differentiate)

A

Palsy

102
Q

What kind of deviations do palsied cause

A

Non-comitant deviations because of over action of under action of the involved muscles

103
Q

When looking at a palsy, and there is a difficulty moving the eye in a certain direction, what should be considered

A

Mechanical restriction

104
Q

Deviation in neurogenic

A

Marked deviation in primary

105
Q

Mechanical deviation

A

Little deviation seen in primary

106
Q

Diplopia in neurogenic

A

Diplopia same in different gazes

107
Q

Diplopia in mechanical

A

Diplopia may reverse

108
Q

Head posture in neurogenic

A

Head tilt seen with vertical palsies

109
Q

Head posture in mechanical

A

Head tilt is rare, chin down or up may be seen for vertical deviations

110
Q

Ocular movement in neurogenic

A

Movement on unctions>versions

111
Q

Ocular movement in mechanical

A

Duction and version movements are equally limited

112
Q

Fusion disrupted by sensory impairment

A

Trauma, disease

113
Q

What could mechanical restrictions be caused by

A

Agenisis or abnormal insertion of the EOMs; abnormal adhesions at tissue or fibrosis of the muscles; tumor metasasis; sarcoidosis etc

114
Q

What could an uncorrecrted hyperope get

A

Eso phoria

115
Q

Hess Lancaster in neurogenic

A

Field of affected eye is smaller; but both fields are displaced according to the deviation

116
Q

Less hancaster in mechanical

A

The fields are irregular and close to each other

117
Q

Retraction of globe in neurogenic

A

None

118
Q

Retraction of globe in mechanical

A

Retracts when turned in direction opposite the restriction

119
Q

Pain on movement in neurogenic

A

None

120
Q

Pain on movement in mechanical

A

Could be present

121
Q

Forced duction in neurogenic

A

Able to move

122
Q

Forced duction in mechanical

A

Limited movement

123
Q

Tropia seen is fusion is

A

Not enough to overcome these abnormalities

124
Q

Neurological abnormalities that can affect oculomotility

A
  • brain stem abnormalities
  • innervation anomalies resulting in paresis or paralysis
  • neurological deficits such as birth injuries, cerebral palsy, development/special needs, retinopathy or prematurity
  • vestibular abnormalities
  • problems along visual pathway
  • assault during gestation (smoking)
125
Q

A patient may have a small pohioria but no symptoms why

A

Because the sensorimotor system is able to cope with the deviation

126
Q

Why are vertical deviations likely to cause symptoms

A

Vertical fusional amplitudes are naturally limited

127
Q

Poor fusion can be associated with

A 
Fatigue 
Asthenopia 
HA (frontal)
Avoidance
Diplopia 
Suppression

Motility Bloick 10 (3 decks)

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