Visual and Perceptual Impairments Flashcards
Dysfunction in visual functional skills is associated with _______.
Cranial nerve palsy
What is visual acuity? Function?
Visual Acuity: Ability to produce a focused image on retina
Function: Collecting detailed visual information allowing for interpretation
List and describe 3 acuity dysfunctions.
- Astigmatism cause of blurred vision: an unequal curving of one or more of the refractive surfaces of the eye, usually the cornea.
- Myopia light entering the eye is focused in front of the retina and distant objects cannot be seen sharply.
- Hyperopia focused behind the retina, distant objects being seen more distinctly than near ones
Describe the examination, treatment and prognosis for visual acuity.
- Examination: Near and Distant Acuity Charts (Snellen)
- Treatment: Corrective Lenses
- Prognosis: Good with Correction
What is ocular movement? Function? Examination? Prognosis?
- Ocular Movement: Ability to move eyes
- Function: eye alignment, binocular vision
- Examination: Visual screen
- Prognosis: Fair to good
List 3 remediation and 2 compensation treatments for problems with ocular movement.
- Remediation: Eye Exercises & Patching, Surgery
2. Compensation: Prisms and Patching
What is accommodation? Function? What 2 conditions occur as a result of dysfunctional accommodation?
- Accommodation: Ability to bring near objects into focus quickly
- Function: note-taking
- Dysfunction: blurry vision, diplopia (double vision)
What is convergence? 3 Functions? What 2 conditions occur as a result of dysfunctional convergence?
- Convergence: ability to move eyes inward in a coordinated fashion
- Function: Near vision, tracking approaching objects, hand-eye coordination
- Dysfunction: decreased hand-eye coordination, blurry vision
What is divergence? 3 Functions? What 2 conditions occur as a result of dysfunctional divergence?
- Divergence: ability to move eyes away from midline
- Function: Maintaining a single image as objects move away from you, depth perception, orientation in space
- Dysfunction: diplopia, disorientation
What are pursuits? Function? What 2 conditions occur as a result of dysfunctional pursuits?
- Pursuits : ability to visually track objects moving through space
- Function: Hand eye coordination
- Dysfunction: clumsiness, dizziness
What are saccades? Function? What 2 conditions occur as a result of dysfunctional saccades?
- Saccades: ability to shift focus from one object to another rapidly without head movement.
- Function: Driving
- Dysfunction: clumsiness, dizziness
Visual functional skills involve acquiring visual information at the _____.
RETINA
Where does visual perception begin and end?
- Brain begins to interpret and attach meaning to visual information in the hypothalamus.
- Process is completed in the occipital, parietal and temporal lobes.
Visual gnosia is the ability to attach ____ to visual ____.
Meaning to visual stimuli
What is the difference between visual and facial agnosia?
Visual agnosia: inability to attach meaning to visual stimuli despite normal functional vision and expressive language
Facial agnosia: inability to recognize faces
Visual field loss is an impairment of visual ____.
Perception
List 2 examples of spatial perception deficits.
Sensory neglect (inattention) Motor neglect
Visual field loss is caused by ____ anywhere along the visual pathway.
LESIONS
VISUAL FIELD LOSS
REFER TO DIAGRAM ON SLIDE 31 (IMPORTANT)
What is the cause of homonymous hemianopsia? List 2 characteristics associated with this condition.
- Caused by lesion along the optic tract as it passes through the Parietal and Temporal Lobes
Characterized by:
- Loss of vision in the nasal field ipsilesional eye
- Loss of vision in peripheral field of the contralesional eye.
How is homonymous hemianopsia diagnosed? List 3 characteristics that make up the clinical presentation of this condition.
Diagnosis: Visual Field Testing
Clinical Presentation
1. Bumps into objects
Hugs one side of hallway
Stares to one side or at floor
List 2 examinations that can be done to identify homonymous hemianopsia.
- Line bisection
2. Cancellation test
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.
Patient will not be able to:
1. Attend to visual stimuli in the contralesional space
Patient will be able to:
- Move into contralesional hemispace
- Direct gaze into contralesional hemispace
- Attend to sound and somatosensory input in the contralesional hemispace
Describe the prognosis of patients with homonymous hemianopsia.
Lower FIM scores at admission and discharge from rehabilitation
List 1 remediation and 3 compensation treatments for homonymous hemianopsia.
Remediation: Scanning activities
Compensation
- Prisms
- Anchoring
- Encourage patient to outline workspace
Hemispatial inattention is also known as _____. What is hemi spatial inattention?
Sensory neglect
A disorder of attention and perception where all sensory pathways are intact but information is not being used functionally.
List 5 areas where a lesion could cause hemi spatial inattention.
- Posterior parietal cortex
- Frontal eye fields
- Cingulate gyrus
- Striatum
- Thalamus
List 2 characteristics of the clinical presentation for patients with hemi spatial inattention.
- Bumps into obstacles in new environments
2. Scans right side to middle
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
Will not be able to:
1. Attend to sound and somatosensory input in the contralesional hemispace
Patient may be able to:
- Move into contralesional hemispace
- Direct gaze into contralesional hemispace
- Attend to visual stimuli in contralesional space
List 4 treatment interventions used for REMEDIATION of hemispatial inattention.
- Scanning emphasizing head movement & COG displacement
- Eye patching and occluders
- Tracking and pursuit activities – from area of function to dysfunction and back
- Limb Activation Strategies
List 3 treatment interventions used for COMPENSATION of hemispatial inattention.
- Outlining
- Anchors
- Prisms
Patients with motor neglect will be unable to move into a _____ despite being aware of sensory info in that space.
Hemi space
List 3 characteristics of the clinical presentation for patients with motor neglect.
- Intact or non-intact visual fields
- Will not cross midline when cued
- Won’t wash or dress hemiplegic side of body
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.
Will not be able to
- Move into contralesional hemispace
- Move eyes into contralesional hemispace
Patient may be able to:
- Attend to visual stimuli in contralesional space (peripheral vision)
- Attend to sound and somatosensory input in the contralesional hemispace (passive)
List 4 treatment interventions used to treat motor neglect.
- Turn trunk to left
- Patching an eye
- Occluding right fields
- Arranging room or workspace
Pusher Syndrome is a ____ response to a perceptual impairment that predominantly occurs with ____, with a lesion at the _____.
MOTOR
Right CVA
Lesion: Posterior-lateral thalamus
List 3 characteristics of Pusher Syndrome.
- Characterized by patient actively pushing toward paretic side with non-paretic extremities
- Visual vertical perception is intact
- Graviceptive orientation is 18 degrees toward paretic side
What is the prognosis of Pusher Syndrome? When is the majority of the improvement seen?
Prognosis: Lower FIM scores and slower improvement
Majority of improvement in pushing behavior in the first month
List 5 interventions used to treat Pusher Syndrome.
- NDT: Lean against walls
- Utilize intact visual vertical
- Work in gravity reduced postures
- Consider involved side transfers
- Tens on contra lesional side of neck
What is coordination? What 3 things must be intact to ensure proper coordination?
- Ability to execute smooth movement
2. Dependent on intact: somatosensory, visual and vestibular input
What is ataxia?
Lack of voluntary control over movement
List 5 interventions used to treat ataxia.
- Damping (weighting to reduce oscillation in movement)
- Tracking resistance (ie. weighted walker to provide resistance in opposition direction of pt.’s motion)
- Control degrees of freedom (distal splinting/ sliding)
- Enhancing proprioceptive input
- Core and proximal UE/LE strengthening
What is the difference between dysmetria and dysdiadokinesia?
- Dysmetria: Over and undershooting
2. Dysdiadokinesia: Trouble with rapidly alternating movements
