Test 2 Flashcards
Prematurity
Less than 37 weeks gestation
Low birth weight
Very low birth weight
Extremely low birth weight
5lbs 5 oz, 2500 g
3 lbs 4 oz, 1500 g
2 lbs 2 oz, 1000 g
Integration
Disappearance of motor development reflexes. If the reflexes persist, it could indicate delays. (send to OT/VT)
Moro “startle” reflex
- What is the reflex
- When does this occur
- What is abnormal?
- What if the reflex is absent bilaterally?
- What is the reflex is absent unilaterally?
- Lay baby on back, lift head then dropped and picked up again. Baby should have startled look/arms move sideways
- Occurs at birth to 2 months
- Abnormal if absent in infant or present in child/adult
- Absent bilaterally indicates damage to brain or spinal cord.
- Absent unilaterally indicates possible brachial plexus injury.
Tonic Labyrinthine Reflex (TLR)
- What is the reflex
- When does this occur
Birth to 4 months
Labyrinths for balance. Stimulated by head movement.
Move head back, arms and legs should extent
Move head forward, arms and legs should curl.
Rooting reflex
- What is it
- When does it occur
- Touch infant on cheek, it will turn its head and open mouth.
- birth to 3-4 months
Grasping reflex
- What is it
- When does it occur
Birth to 5-6 months
Infant will grab object tightly that is placed in palm of hand or hand stroked.
Asymmetric tonic neck reflex ATNR
- What is it
- When does it occur
Birth to 6 months
Turn head to one side. Arms/legs on that side of the body will extend. On opposite side of the body, they will bend.
Spinal Galant reflex
- What is it
- What does this prepare baby for
- Tests for ____ damage
- When does it occur
- Stroking one side of the body and infant will flex towards the side
- Prepares baby for walking/crawling.
- Test for brain damage at birth
- Birth to 4-6 months
When should baby be able to sit without support
6 months
When should baby be able to walk without assistance
12-13 months
When should baby be able to walk up stairs
24 months
Fine motor development takes longer to acquire than gross motor skills.
When should you be able to pick up objects with thumb and fingers
Copy vertical, horizontal and circle
Copy cross, square, triangle.
7-12 months
3 years
5 years
Basic Piaget components
Schema/Schemata
Organized patterns of knowledge based on interactions with the environment.
Reflexes –> Complex actions –> mental representation
Basic Piaget components
Assimilation
Interpreting external objects, places, people, events in terms of our present way of thinking.
Basic Piaget components
Accommodation
Changing cognitive structure (schema) and expanding what we know.
ex: Not all animals are dogs, there are different cars.
3 Basic Piaget components and their order
Schema –> Assimilation –> Accommodation
4 piaget cognitive stages
Sensorimotor (birth-2 years) with 6 substages
Preoperational (2-7 years)
Concrete operations (7-12 years)
Formal operations (12+ years)
6 stages of sensorimotor
Reflex activity (birth - 1 month)
Primary circular reactions (1-4 months)
Secondary circular reactions (4-8 months)
Coordination of secondary schemes (8-12 months)
Tertiary circular (12-18 months)
Beginning of representational thought (18-24 months)
What 3 behaviors emerge during the preoperational stage?
Deferred imitation
Symbolic play
Sophisticated language skills
Preoperational stage components
3 behaviors: Deferred imitation, Symbolic play, Sophisticated language skills
Egocentric- world revolves around child. Unable to think from other perspectives.
Conservation- amount remains same even though shape changes
Tendency to focus on single aspect
Irreversibility of thought- addition/subtraction
Acquires concepts- shapes are easy. Numbers are harder.
Concrete operations components
Increased capacity for memory
Understands reversibility- thinks logically. Can add/subtract
Conservation- Able to recognize change in multiple features and can reciprocate (ex: water in glass.)
Seriation- able to arrange objects in series
Transitive reasoning- can think forwards and back
Formal operations components
Able to think in the abstract and solve problems systematically.
Full term infant has an average Rx of ___. There is a significant decrease between months -. Emmetropization is complete by __ months.
+2.00
3-9
18 months
Infants with Rx greater than +3.50
___x more prone to strabismus by age 4
___x more prone to amblyopia
13x
6x
Rosner and Rosner study
Grades 1-5
Significantly lower achievement test scores among children with refractive errors over +1.25D dry.
+1.25D is a marker for school age. Might Rx
Over minus by 2D can cause ____ symptoms
ADHD
What type of astigmatism is most common by 4-5 years? What is the most uncommon?
WTR at 4-5 years
Oblique
When to rx for astigmatisms
1 year. Highest risk of amblyopia.
NICER study concluded what about astigmatism?
Difficult to predict from refractive data who will demonstrate changes. Everyone unique and should have eye exams.
ATR. Small amounts may indicate ____
Accommodative dysfunction.
When to correct astigmatism in toddlers
Rx if greater than ___ at 15 months
Rx if greater than ___ at 2 years
When to correct astigmatism in preschool
Rx if greater than/equal to ___ at 4 years
When to correct astigmatism in school age
Rx if greater than/equal to ___
Toddlers:
2.50 DC
2.00 DC
Partial correction OK in toddlers
preschool:
1. 50 DC give full Rx
School age:
0.75 DC give full Rx
**Trend. Cut cyl in little kids, not older.
When to correct for myopia
Infants
Toddler
Preschool
School
Infants: Greater than/equal to -5.00D. Partial OK.
Toddler: Greater than/equal to -3.00D
Preschool: Greater than/equal to -1.00D
School: Full Rx if decreased VAs.
Juvenile onset myopia
6-15 years of age onset. Progression due to axial elongation.
Expected progression each year is:
Pathological consequences to myopia?
Increased risk for glaucoma
Myopic macular degeneration.
Causes of myopia?
Genetics
Environment- near work, less time spent outside.
Peripheral hyperopic defocus/refraction from lag of accom.
Binocular vision anomalies. Accommodative dysfunction.
Genetics and risk
Both parents
One parent
Both parents: 5-6x risk
one parent: 2x risk
Does under correcting a myope help with myopia progression?
Under correction is associated with an increase in progression or no change as compared to fully corrected controls.
Do bifocal lenses help with myopia progression
No significant difference in myopia patients.
Except exophoric patients.
How does ortho K work for myopia control?
Flattens the central cornea by redistribution of epithelial cells. This steepens the mid-peripheral cornea and causes a decrease in peripheral hyperopic defocus/increase in peripheral myopia.
Results in a decrease in axial length and myopia progression.
What methods are least to most effective in controlling myopia progression?
Bifocal specs 12-15% reduction Bifocal specs in eso patients 20-45% Ortho K 32-42% Multifocal contacts 50-70% Atropine 58-90%
Signs of accommodative insufficiency
Low PRA- don’t take a lot of minus
Low amp- don’t take a lot of minus
High FCC- take a lot of plus
Can’t clear minus lenses with infacility
Myopia COMET study
Progressive lenses. Clinically insignificant. No difference in myopia progression.
Myopia ATOM study
1% Atropine for treatment of childhood myopia.
77% reduction in amount of myopia progression.
Myopia BLINK Study
Bifocal contact lenses in nearsighted kids.
Distance Rx with a +1.50 or +2.50 add.
As add increased in power, myopia progression decreased.
Rosner Hyperopia study
School age children grades 1-5.
Kids with ref error greater than +1.25D have significantly lower achievement test scores.
**marker for school age.
+1.25D and likes to read, A/B student? Don’t need to Rx.
+1.25D and hates reading, C student, parents concerned? Give Rx.
VIP-HIP hyperopia study
Vision in preschools uncorrected Hyperopia and preschool early literacy.
Why would a patient with non strabismic binocular vision disorder have more symptoms than someone with constant strab?
Non strabismus BV disorder is transient = symptoms.
Constant Strab may suppress= less symptoms.
Learning to read K-3rd grade. Focus is _____ dependent.
Is accommodative and binocular vision at this stage critical?
Vocab.
Skills: letter knowledge, word recognition and recall.
Accom and binocular vision at this stage not very critical.
Convergence insufficiency triad
Exo at near.
Receded NPC
Exo at near greater than exo at distance
Reduced PVF/BO vergences.
Additional: Low NRA. Exos hate plus.
What happens to ACA and convergence during NRA
NRA. add plus lenses.
Patient will relax accommodation and eyes will diverge.
ACA (accommodative convergence) will decrease.
Patient either will see double or converge to keep single.
What happens to ACA and convergence during PRA
PRA. Add minus.
Patient will accommodate and eyes will converge. ACA (accommodative convergence) will increase. Patient will either see double or diverge to keep single.
CITT
CI treatment trial
Most effective treatment for CI was office based (VT) therapy + home reinforcement activity. 75% achieved improvement with this combo.
Pseudo CI
Accommodative problem.
Presents with signs of CI- reduced NPC and PVF and XP
May have reduced amp and high lag.
How to test for a psedo CI during NPC
Use accommodative target (E) compared to non accommodative target (pen light)
If NPC is reduced when you use the non-accommodative target(pen light), that means that the patient can improve convergence when they accommodate. = CI
If NPC is the same= pseudo CI. Pt is not using accommodation to converge better. Should improve if you give them plus because you helped their accommodation.
Accommodative insufficiency What is it? Symptoms Direct and indirect measures Associations of meds and conditions
Difficulty stimulating accommodation. They will like plus!
Prolonged reading gets blurry
Direct measures- Reduced amp, high lag (MEM/FCC)
Indirect measures- Reduced PRA, high NRA. Indirect because they involve accommodation and convergence.
Associations:
ADHD and SSRI meds
Conditions:
Down Syndrome, cerebral palsy
Accommodative infacility
What is it
Direct measures
Difficulty changing accommodative response
Direct measures (accommodation only) Difficulty clearing -2.00/+2.00 mono
Indirect measures (accommodation and convergence)
Difficulty clearing -2.00/+2.00 bino
Reduced PRA and NRA.
Expected -2.00/+2.00 cpm mono and bino
Mono more than bino
mono:
8-12 years: 7 cpm
12+ years: 11 cpm
Bino:
8-12 years: 5 cpm
Adult: 10 cpm
What is more common in kids? Esotropia or exotropia
Esotropia is more common
85% are intermittent
Alternating is common
Why should you be cautious in an infant/young child with constant unilateral exo?
70% have neuro/ocular anomaly
Ways to treat exotropia?
VT
Over minus lenses to stimulate accommodative convergence (-1.00D to -4.00D over cyclo. )
BI relieving prism to help with fusion
Alternating patching 3-4 hours a day
Surgery: Bilateral lateral rectus recession. Usually 15+ prism diopters.
Consecutive exotropia
After surgical treatment for esotropia.
After plus correction for esotropia.
Eyes are exo but patient acts like eso.
3 broad types of esotropia
Infantile (congenital)
Accommodative- refractive, partially refractive, non-refractive.
Non-accommodative
Infantile esotropia
Onset at birth-6 months Large angle- 40 prism diopters in 50% Latent nystagmus Refractive error usually greater than +3.00 D 50% have amblyopia
Refractive accommodative esotropia
Complete resolution with full Rx.
Refractive error +2 to +6
35% are due to inferior oblique overaction.
Partially refractive accommodative esotropia
Incomplete resolution with full hyperopic correction.
Usually unilateral
Amblyopia common
Non refractive accommodative esotropia
CE esotropia.
Minimal at distance. 10 pd or more at near.
Minimal hyperopia.
Non-accommodative esotropia
Early (usually associated with retinoblastoma) and late onset.
No significant Hyperopic refractive error.
Esotropia tx
Correct refractive error- plus
Prism
VT
Surgery bilateral Medial rectus recession. or bilateral lateral rectus resection.
Amblyopia definition AOA
Poorer than 20/20 in the absence of any obvious structural anomalies or ocular disease.
Critical period for amblyopia development is first __ years of life
8
Functional amblyopia 5 categories
Refractive (isoametropic or anisometropic) Strab Refractive + strab Image degradation 90% are combo
Image degradation amblyopia
Physical obstruction in line of sight.
- Cataract
- Ptosis
- Hyphema
- Prolonged occlusion/patching
Could be unilateral or bilateral
Refractive isoametropic amblyopia
High, equal refractive errors in both eyes
Bangerter foil
As effective as patching and less obvious
Fogged glasses
Percentage of amblyopia regression
24% due to discontinuing patching.
Amblyopia syndrome
Decreased fine motor skills, decreased luminance perception. Ex: First and last letters of chart easier. Single letter easier.
Specific learning disorder definition
Difficulties for 6+ months despite help.
Ex: difficulty reading, understanding meaning of what is read, spelling, written expression, math
Skills below age expected
Concept of dyslexia
Reading issue
Unilateral cerebral dominance. Right brain strengths- conceptual reasoning. Not left brain strengths- reading, spelling, writing.
Dyslexia definition
Difficulty connecting letters seen on a page with the sound they make. Reading becomes slow, effortful and not fluent.
NOT explained by other disorders- developmental, vision/hearing, motor, neuro.
Dysphonesia
Spelling errors that are not phonetic
Forng= foreign.
Child may make semantic substitutions when reading (house vs home)
Difficulty with rules of phonics.
Dyseidesia
Spelling errors phonetic.
Foren= foreign
Reading is slow because child has to decode phonetically.
Dyslexia treatment options
One on one tutoring
Orton-Gillingham method
Wilson Reading system
Method involving multi sensory tasks- seeing, touching, saying, hand movements.
Standard scores vs scaled scores
Standard: Set of scores with the same mean and sd so they can be compared. Can convert to percentile from table.
Scaled: Mean score is 50th percentile. Can be determined from Z score and converted to percentile. Subtests: WISC, TVPS.
IEP
Individualized education plan through the government by IDEA. Maximizes child’s potential.
Addresses unique learning issues. Specialized instruction Legally binding Public schools Annual review
Team written document by support system.
Measureable goals created.
504 plan
Law that prohibits discrimination against public school students with handicap/disability. Although disability does not equal 504 plan.
Less detailed than IEP
Annual review not required
OT vs PT
OT: Fine motor, activities of daily living, sensory issues.
PT: Gross motor. Ex: balance, cerebral palsy.
VIP (visual perceptual skills) development related to motor development
As child gets older, performance moves from motor to visual. (visual motor hierarchy)
Visual Perception Tests
Form boards
Laterality vs directionality
Laterality= Left and right on self Directionality= Left and right in space
Test of visual perceptual skills (TVPS)
Tests that look at visual perceptual skills.
Psychologists/ OTs/ ODs
7 subtests:
- Visual discrimination- find identical form.
- visual spatial relations- Identify differences between orientation. Ex: b, d
- Form constancy- find design among others.
- Visual figure ground. Ex: Fed ex arrow in ground.
- Visual closure- Match completed design with incomplete
- Visual memory and reading- Ability to recall visually presented material. Child shown design that they must match on next page.
- Visual sequential memory. Shown 5 designs and must match sequence on next page.
5 subtests of laterality/directionality
- Have child show right and left on their body
- Have child show right and left on your body
- Coin and pencil on both sides of table
- Coin in right hand, watch on left hand.
- Pencil, key, coin
Scoring for laterality/directionality
Pass vs not pass
No percentile rank
2 tests for reversals
Jordan left/right reversal test
Gardner Frequency reversal test
Jordan left right test
Level 1A: Child identifies which drawing is reversed
Level 1B: Show child b. Child crosses out all letters on page that are not b.
Level 2A: 20 rows of words. Child identifies words where letters are backwards.
Level 2B: 20 sentences. Child identifies sentences with words written backwards.
2C: Child indicates which letters in second column are out of sequence compared to those in first column.
Add up total errors.
Gardner Reversal Frequency Test
Part 1: Child told to write letters in lower case
Part 2: Mark which pair of numbers/letters are backwards
Part 3: Indicate to the right high figure matches the one on the left.
Visual motor integration
Handwriting, hand eye coordination.
Auditory visual
Hear a story- picture it. Phonics.
Symptoms of visual motor integration problems
Slopping handwriting
Writing letters of different sizes
Cant stay on line
Visual motor integration tests
Beery (VMI)
Wold sentence copy
Beery VMI test and subtests
- Motor coordination- dot to dot
- Visual perception
- VMI- draw shapes you see
- Use ruler and protractor
- Score: Stop when 3 incorrect in a row. Specific criteria for line size, angles, spaces.
Wold sentence copy
Copy sentence while being timed.
Quantitative score- Can calculate letters per minute child is able to execute and compares to expected for grade level
Qualitative score- how child holds paper, working distance, spacing
AVIT Auditory Visual Integration Test
Tap out patterns out of sight from child.
Score- 1 point for each correct response.
If poor, refer to speech/auditory pathologist.
Mepeds
Prev of astig
Hispanic- expect cyl
two IQ tests
Weschler - performance and verbal IQ
Stanford-binet - Full IQ with 10 subtests that are scaled.
two dyslexia treatments
Wilson, Orton
Pedig 2019
not good to over minus exotropes bc it will make their myopia worse.
