Visual and Perceptual Impairments

Question 1

Dysfunction in visual functional skills is associated with _______.

Answer 1

Cranial nerve palsy

Question 2

What is visual acuity? Function?

Answer 2

Visual Acuity: Ability to produce a focused image on retina

Function: Collecting detailed visual information allowing for interpretation

Question 3

List and describe 3 acuity dysfunctions.

Answer 3

1. Astigmatism cause of blurred vision: an unequal curving of one or more of the refractive surfaces of the eye, usually the cornea.
2. Myopia light entering the eye is focused in front of the retina and distant objects cannot be seen sharply.
3. Hyperopia focused behind the retina, distant objects being seen more distinctly than near ones

Question 4

Describe the examination, treatment and prognosis for visual acuity.

Answer 4

1. Examination: Near and Distant Acuity Charts (Snellen)
2. Treatment: Corrective Lenses
3. Prognosis: Good with Correction

Question 5

What is ocular movement? Function? Examination? Prognosis?

Answer 5

1. Ocular Movement: Ability to move eyes
2. Function: eye alignment, binocular vision
3. Examination: Visual screen
4. Prognosis: Fair to good

Question 6

List 3 remediation and 2 compensation treatments for problems with ocular movement.

Answer 6

1. Remediation: Eye Exercises & Patching, Surgery

2. Compensation: Prisms and Patching

Question 7

What is accommodation? Function? What 2 conditions occur as a result of dysfunctional accommodation?

Answer 7

1. Accommodation: Ability to bring near objects into focus quickly
2. Function: note-taking
3. Dysfunction: blurry vision, diplopia (double vision)

Question 8

What is convergence? 3 Functions? What 2 conditions occur as a result of dysfunctional convergence?

Answer 8

1. Convergence: ability to move eyes inward in a coordinated fashion
2. Function: Near vision, tracking approaching objects, hand-eye coordination
3. Dysfunction: decreased hand-eye coordination, blurry vision

Question 9

What is divergence? 3 Functions? What 2 conditions occur as a result of dysfunctional divergence?

Answer 9

1. Divergence: ability to move eyes away from midline
2. Function: Maintaining a single image as objects move away from you, depth perception, orientation in space
3. Dysfunction: diplopia, disorientation

Question 10

What are pursuits? Function? What 2 conditions occur as a result of dysfunctional pursuits?

Answer 10

1. Pursuits : ability to visually track objects moving through space
2. Function: Hand eye coordination
3. Dysfunction: clumsiness, dizziness

Question 11

What are saccades? Function? What 2 conditions occur as a result of dysfunctional saccades?

Answer 11

1. Saccades: ability to shift focus from one object to another rapidly without head movement.
2. Function: Driving
3. Dysfunction: clumsiness, dizziness

Question 12

Visual functional skills involve acquiring visual information at the _____.

Answer 12

RETINA

Question 13

Where does visual perception begin and end?

Answer 13

1. Brain begins to interpret and attach meaning to visual information in the hypothalamus.
2. Process is completed in the occipital, parietal and temporal lobes.

Question 14

Visual gnosia is the ability to attach ____ to visual ____.

Answer 14

Meaning to visual stimuli

Question 15

What is the difference between visual and facial agnosia?

Answer 15

Visual agnosia: inability to attach meaning to visual stimuli despite normal functional vision and expressive language

Facial agnosia: inability to recognize faces

Question 16

Visual field loss is an impairment of visual ____.

Answer 16

Perception

Question 17

List 2 examples of spatial perception deficits.

Answer 17

Sensory neglect (inattention)
Motor neglect

Question 18

Visual field loss is caused by ____ anywhere along the visual pathway.

Answer 18

LESIONS

Question 19

VISUAL FIELD LOSS

Answer 19

REFER TO DIAGRAM ON SLIDE 31 (IMPORTANT)

Question 20

What is the cause of homonymous hemianopsia? List 2 characteristics associated with this condition.

Answer 20

1. Caused by lesion along the optic tract as it passes through the Parietal and Temporal Lobes

Characterized by:

1. Loss of vision in the nasal field ipsilesional eye
2. Loss of vision in peripheral field of the contralesional eye.

Question 21

How is homonymous hemianopsia diagnosed? List 3 characteristics that make up the clinical presentation of this condition.

Answer 21

Diagnosis: Visual Field Testing

Clinical Presentation
1. Bumps into objects
Hugs one side of hallway
Stares to one side or at floor

Question 22

List 2 examinations that can be done to identify homonymous hemianopsia.

Answer 22

1. Line bisection

2. Cancellation test

Question 23

List 1 thing a patient with homonymous hemianopsia will NOT be able to do. List 3 things a patient with homonymous hemianopsia WILL be able to do.

Answer 23

Patient will not be able to:
1. Attend to visual stimuli in the contralesional space

Patient will be able to:

1. Move into contralesional hemispace
2. Direct gaze into contralesional hemispace
3. Attend to sound and somatosensory input in the contralesional hemispace

Question 24

Describe the prognosis of patients with homonymous hemianopsia.

Answer 24

Lower FIM scores at admission and discharge from rehabilitation

Question 25

List 1 remediation and 3 compensation treatments for homonymous hemianopsia.

Answer 25

Remediation: Scanning activities Compensation 1. Prisms 2. Anchoring 3. Encourage patient to outline workspace

Question 26

Hemispatial inattention is also known as _____. What is hemi spatial inattention?

Answer 26

Sensory neglect A disorder of attention and perception where all sensory pathways are intact but information is not being used functionally.

Question 27

List 5 areas where a lesion could cause hemi spatial inattention.

Answer 27

1. Posterior parietal cortex 2. Frontal eye fields 3. Cingulate gyrus 4. Striatum 5. Thalamus

Question 28

List 2 characteristics of the clinical presentation for patients with hemi spatial inattention.

Answer 28

1. Bumps into obstacles in new environments | 2. Scans right side to middle

Question 29

List 1 thing a patient with hemispatial inattention will NOT be able to do. List 3 things a patient with hemispatial inattention MAY be able to do

Answer 29

Will not be able to: 1. Attend to sound and somatosensory input in the contralesional hemispace Patient may be able to: 1. Move into contralesional hemispace 2. Direct gaze into contralesional hemispace 3. Attend to visual stimuli in contralesional space

Question 30

List 4 treatment interventions used for REMEDIATION of hemispatial inattention.

Answer 30

1. Scanning emphasizing head movement & COG displacement 2. Eye patching and occluders 3. Tracking and pursuit activities – from area of function to dysfunction and back 4. Limb Activation Strategies

Question 31

List 3 treatment interventions used for COMPENSATION of hemispatial inattention.

Answer 31

1. Outlining 2. Anchors 3. Prisms

Question 32

Patients with motor neglect will be unable to move into a _____ despite being aware of sensory info in that space.

Answer 32

Hemi space

Question 33

List 3 characteristics of the clinical presentation for patients with motor neglect.

Answer 33

1. Intact or non-intact visual fields 2. Will not cross midline when cued 3. Won’t wash or dress hemiplegic side of body

Question 34

List 2 things a patient with motor neglect will NOT be able to do. List 2 things a patient with motor neglect MAY be able to do.

Answer 34

Will not be able to 1. Move into contralesional hemispace 2. Move eyes into contralesional hemispace Patient may be able to: 1. Attend to visual stimuli in contralesional space (peripheral vision) 2. Attend to sound and somatosensory input in the contralesional hemispace (passive)

Question 35

List 4 treatment interventions used to treat motor neglect.

Answer 35

1. Turn trunk to left 2. Patching an eye 3. Occluding right fields 4. Arranging room or workspace

Question 36

Pusher Syndrome is a ____ response to a perceptual impairment that predominantly occurs with ____, with a lesion at the _____.

Answer 36

MOTOR Right CVA Lesion: Posterior-lateral thalamus

Question 37

List 3 characteristics of Pusher Syndrome.

Answer 37

1. Characterized by patient actively pushing toward paretic side with non-paretic extremities 2. Visual vertical perception is intact 3. Graviceptive orientation is 18 degrees toward paretic side

Question 38

What is the prognosis of Pusher Syndrome? When is the majority of the improvement seen?

Answer 38

Prognosis: Lower FIM scores and slower improvement Majority of improvement in pushing behavior in the first month

Question 39

List 5 interventions used to treat Pusher Syndrome.

Answer 39

1. NDT: Lean against walls 2. Utilize intact visual vertical 3. Work in gravity reduced postures 4. Consider involved side transfers 5. Tens on contra lesional side of neck

Question 40

What is coordination? What 3 things must be intact to ensure proper coordination?

Answer 40

1. Ability to execute smooth movement | 2. Dependent on intact: somatosensory, visual and vestibular input

Question 41

What is ataxia?

Answer 41

Lack of voluntary control over movement

Question 42

List 5 interventions used to treat ataxia.

Answer 42

1. Damping (weighting to reduce oscillation in movement) 2. Tracking resistance (ie. weighted walker to provide resistance in opposition direction of pt.'s motion) 3. Control degrees of freedom (distal splinting/ sliding) 4. Enhancing proprioceptive input 5. Core and proximal UE/LE strengthening

Question 43

What is the difference between dysmetria and dysdiadokinesia?

Answer 43

1. Dysmetria: Over and undershooting | 2. Dysdiadokinesia: Trouble with rapidly alternating movements