Visual Dysfunction After CNS Disturbance Flashcards
(32 cards)
A 70-year-old client reports difficulty with tasks such as reading, buttoning shirts, and threading a needle. Upon assessment, the client demonstrates difficulty locating and distinguishing small objects. Which area of visual acuity is most likely affecting this client’s performance in these fine motor tasks?
A) Distance Acuity
B) Near Acuity
C) Visual Field Deficits
D) Depth Perception
Correct Answer: B) Near Acuity
Explanation: Near acuity refers to the ability to see small details up close, which is essential for tasks requiring fine motor control and precision, such as reading, buttoning, and other fine motor coordination (FMC) tasks.
A 65-year-old client reports difficulty recognizing faces across a room, locating objects at a distance, and reading road signs while driving. Which area of visual acuity is most likely impacting this client’s ability to perform these activities?
A) Near Acuity
B) Peripheral Vision
C) Distance Acuity
D) Contrast Sensitivity
Correct Answer: C) Distance Acuity
Distance Acuity: decreased ability to see distance details
necessary for topographical orientation, locating and
discriminating faces and objects, driving, and reading signs
A 70-year-old client reports difficulty with tasks such as reading, buttoning shirts, and threading a needle. Upon assessment, the client demonstrates difficulty locating and distinguishing small objects. You suspect your patient has near acuity issues.
What assessment would you perform to confirm?
A) Use a Snellan Chart 20 feet away
B) Test each eye separately and together, using glasses if applicable
C) Use a Snellen chart or read material held 16 inches away
B & C
* Test each eye separately and together, using glasses if applicableC
* Use a Snellen chart or read material held 16 inches away
A 65-year-old client reports difficulty recognizing faces across a room, locating objects at a distance, and reading road signs while driving. You suspect your patient to have distance acuity issues.
What assessment would you conduct to confirm your assumptions?
A)Test each eye separately and together, using glasses if applicable
B) Use a Snellan Chart 20 feet away
C) Use a Snellen chart or read material held 16 inches away
A & B
- Test each eye separately and together, using glasses if applicable
- Use a Snellan Chart 20 feet away
An occupational therapist is working with a client who has decreased visual acuity. Which of the following interventions would be LEAST appropriate in supporting this client’s visual needs?
A) Referring the client to an optometrist or ophthalmologist for lens correction
B) Increasing lighting and using contrasting colors in the client’s environment
C) Encouraging the client to use smaller print to improve focus
D) Providing access to community resources, such as Light House
Answer: C) Encouraging the client to use smaller print to improve focus
Visual Acuity Management
■ Refer to optometrist/ophthalmologist for lens correction
■ Safety assessment, large print, contrasts, increase lighting, color coding,
magnifier, enlargement on computer, decrease background patterns,
access to community services (Light House)
Question: A client in the OT clinic reports experiencing visual fatigue after sustained near work, such as reading, and has difficulty adjusting focus when looking between near and far objects. Which of the following functional problems is likely to affect the client’s daily activities?
A) Difficulty with depth perception, leading to challenges in estimating distances accurately.
B) Increased time and effort needed to switch focus between tasks at different distances, causing strain and decreased efficiency in activities like reading or driving.
C) Loss of peripheral vision, causing challenges in spatial awareness during movement.
D) Difficulty distinguishing colors, leading to errors in identifying objects and navigating environments.
Answer: B) Increased time and effort needed to switch focus between tasks at different distances, causing strain and decreased efficiency in activities like reading or driving.
Which of the following assessment is used for accommodation?
A) Using a Snellan Chart 20 feet away from patient.
B) Confrontation test
C) Using a 20/30 letter on a tongue depressor as it moves away from the eye, first with the left eye patched and then with the right
C) Using a 20/30 letter on a tongue depressor as it moves away from the eye, first with the left eye patched and then with the right
A client with visual accommodation difficulties has been prescribed bifocals and experiences eye strain during near work. Which of the following OT recommendations is most appropriate to help manage their accommodation issues?
A) Ensure the client uses the bottom portion of their bifocals for near work and takes frequent rest breaks.
B) Suggest reducing lighting to minimize glare and visual strain.
C) Encourage the client to look through the top of their bifocals for near work.
D) Recommend using smaller print and avoiding high-contrast materials to reduce eye strain.
Answer: A) Ensure the client uses the bottom portion of their bifocals for near work and takes frequent rest breaks.
A client with visual field loss is experiencing challenges in daily activities. Which of the following functional problems is most likely related to their visual field impairment?
A) Increased risk of bumping into objects, difficulty navigating curbs, locating items for ADLs, and a heightened fall risk.
C) Difficulty maintaining focus on near tasks, such as reading and writing.
B) Problems with depth perception, leading to misjudgment of distances when reaching for objects.
D) Inability to distinguish colors, leading to errors in identifying items during activities.
A) Increased risk of bumping into objects, difficulty navigating curbs, locating items for ADLs, and a heightened fall risk.
When performing the confrontation test (One examiner) to assess a client’s visual field, which of the following steps should be included?
A) Have the client wear glasses and track the movement of your hand.
B) Use only one position (12 o’clock) to test each eye and check for response.
C) Position yourself behind the client to prevent them from seeing your movements.
D) Ask the client to focus on your nose, patch one eye, and indicate when they see a wiggling finger as it moves toward their visual field in various clock positions.
D) Ask the client to focus on your nose, patch one eye, and indicate when they see a wiggling finger as it moves toward their visual field in various clock positions.
Which of the following are assessment for visual fields?
A) Confrontation Test
B) Perimetry
C) Both A & B
C) Both A & B
In a two-examiner confrontation test to assess visual fields, which of the following steps ensures accurate testing?
A) The patient is instructed to look at the hand of Examiner 2 as it moves into the visual field.
B) Examiner 1 stands behind the patient while Examiner 2 sits in front, with both examiners instructing the patient.
C) Examiner 1 sits in front of the patient, who focuses on Examiner 1’s nose, while Examiner 2, positioned behind the patient, moves a wiggling finger into various positions without the patient seeing Examiner 2’s arm.
D) The patient wears glasses, and both eyes are tested simultaneously to assess overall field of vision.
C) Examiner 1 sits in front of the patient, who focuses on Examiner 1’s nose, while Examiner 2, positioned behind the patient, moves a wiggling finger into various positions without the patient seeing Examiner 2’s arm.
A client undergoes a perimetry test to map their visual field. Which of the following is a key consideration when using the results of this test to plan OT interventions?
A) The perimetry test helps identify the specific areas of the visual field the client can no longer detect, which can inform interventions for tasks requiring peripheral awareness, like driving and walking.
B) The test results are only useful for determining the client’s visual acuity and do not impact intervention planning for activities of daily living.
C) The perimetry test results provide insight into the client’s cognitive function, which is the primary focus for OT interventions in daily tasks.
D) The perimetry test only measures the client’s ability to focus on near tasks, such as reading, and is not relevant to interventions for mobility or safety.
A) The perimetry test helps identify the specific areas of the visual field the client can no longer detect, which can inform interventions for tasks requiring peripheral awareness, like driving and walking.
A client with a visual field deficit is receiving occupational therapy to improve safety and independence in daily activities. Which of the following strategies should be included in the therapy plan?
A) Encourage the client to use a circular scanning technique to visually explore the entire environment, use auditory cues to detect movement in the affected field, and incorporate red strips on the left side of reading materials.
B) Focus on teaching the client to rely on their central vision alone without any compensatory strategies, and discourage the use of visual anchors or scanning techniques.
C) Recommend the client use line guides while reading, without practicing scanning or mobility techniques to accommodate the visual field loss.
D) Suggest that the client should use prism lenses for reading tasks, without incorporating any mobility or ADL practice.
Answer: A) Encourage the client to use a circular scanning technique to visually explore the entire environment, use auditory cues to detect movement in the affected field, and incorporate red strips on the left side of reading materials.
A patient with left homonymous hemianopia is receiving occupational therapy to improve functional independence. Which of the following strategies would be most effective in helping the patient compensate for their visual field loss while reading and performing ADLs?
A. Practicing only central vision activities without using peripheral scanning
B. Focusing exclusively on using prisms without incorporating compensatory scanning strategies or environmental modifications
C. Encouraging rapid eye movement across the entire visual field without using line guides
D. Utilizing a red strip as an anchor on the left side of a reading page to promote scanning into the affected field
D. Utilizing a red strip as an anchor on the left side of a reading page to promote scanning into the affected field
Explanation:
Visual Fields Management
■ Scanning strategies
● Scan visually into affected eye field by eyes or hear movement
● General environment: circular scan
● Searching for objects: lateral scan
■ Anchors for reading
● Red strip on left side of page
● Line guides
■ Prism
■ Practice with walking and ADLs with compensatory strategies
Clinical Question:
A patient with decreased ocular motility presents with difficulties in performing daily activities. Which of the following is most likely a functional problem they may experience as a result of impaired saccades, pursuits, and fixation?
A. Difficulty with tasks that require precise eye-hand coordination, such as writing and reading
B. Improved accuracy in gathering small objects, like peas, from a plate
C. Enhanced ability to quickly locate items on a top shelf
D. Increased stability and balance during activities that require dynamic movement
A. Difficulty with tasks that require precise eye-hand coordination, such as writing and reading
Explanation:
Ocular motility (saccades, pursuits, fixation, scanning)
○ Functional Problems:
■ Decreased in quantity and quality of ocular motility affect efficiency of
visual information gathering
■ Less accurate ability to scan for objects such as looking for items at a top shelf, gathering peas on a plate, writing, reading etc.
■ Eye hand coordination and balance may also be affected.
An occupational therapist is assessing a patient’s saccadic eye movements to evaluate visual efficiency and ocular motility. Which of the following procedures should the OT follow to conduct an accurate assessment of saccades?
A. Instruct the patient to move their head while following a single target across their visual field
B. Position two colored targets about 8-10 inches apart, 16 inches away from the patient’s eyes, and instruct the patient to look at each target using only their eyes upon verbal cue
C. Test the eyes together only, without patching, while positioning targets at various heights in the patient’s peripheral field
D. Use rapid head movements to test each eye individually and check for over/under-shooting
Correct Answer: B. Position two colored targets about 8-10 inches apart, 16 inches away from the patient’s eyes, and instruct the patient to look at each target using only their eyes upon verbal cue.
Explanation:
Saccades Assessment:
■ Have patient sit facing OT
■ Test each eye individually (patch) then together (With or without glasses)
■ Hold 2 pens of different color tips or tongue depressors with different color
ends about 8-10 inches apart and 16 inches away from patient’s eyes.
■ Give following instructions “when I say green look at green target and
when I say red look at red target. Do not move your head, just your eyes”
■ Should be performed superior, middle , and lower (superior may be
weaker as we functionally rarely use superior saccades)
■ Note: head movement & re-fixation (in what direction),
overshooting/undershooting (slight is normal), jerkiness.
An OT is administering the Developmental Eye Movement (DEM) Test to assess a patient’s saccadic eye movements and visual tracking skills. Which of the following steps is part of the correct procedure for administering the DEM test?
A. Having the patient read template A and B vertically, followed by template C horizontally, and recording the time and errors for each template
B. Testing monocularly to accurately record each eye’s performance separately
C. Allowing the patient to use their finger as a guide while reading templates A, B, and C
D. Directing the patient to read all templates horizontally without recording errors
A. Having the patient read template A and B vertically, followed by template C horizontally, and recording the time and errors for each template
An occupational therapist is using the NSUCO Oculomotor Test to assess a patient’s pursuits and saccades. Which of the following steps is part of the correct procedure for this assessment?
A. Allowing the patient to move their head while following the target with their eyes to assess tracking ability
B. Testing binocularly only and instructing the patient to use their finger as a guide to follow the target
C. Evaluating both eyes individually and then together without head movement, using a fixed target to assess both saccadic accuracy and smooth pursuits
D. Only evaluating pursuits, using a target to move in a circular pattern without observing saccades
Correct Answer: C. Evaluating both eyes individually and then together without head movement, using a fixed target to assess both saccadic accuracy and smooth pursuits.
An occupational therapist is assessing a patient’s ability to maintain visual fixation. Which of the following procedures should the therapist use to evaluate fixation accurately?
A. Instructing the patient to follow a moving target across their visual field without pauses
B. Having the patient fixate on a near target, then shifting their gaze to a distant target to observe the stability and duration of fixation
C. Asking the patient to alternate fixation between two distant targets while allowing head movement
D. Having the patient close one eye and fixate only on a near target without testing distance fixation
Correct Answer: B. Having the patient fixate on a near target, then shifting their gaze to a distant target to observe the stability and duration of fixation.
An occupational therapist is conducting a scanning assessment using a letter cancellation worksheet to evaluate a patient’s visual scanning and attention. Which of the following describes the correct approach for this assessment?
A. Allowing the patient to use their finger as a pointer to locate each letter and permitting exaggerated head movements
B. Taping the worksheet at the patient’s midline, instructing them to cross out a specific letter, and observing speed, organization, omissions, and head movements
C. Giving the patient verbal cues for each letter location to help them keep their place on the worksheet
D. Testing only one side of the worksheet to evaluate scanning accuracy on that side
Correct Answer: B. Taping the worksheet at the patient’s midline, instructing them to cross out a specific letter, and observing speed, organization, omissions, and head movements.
A patient with visual tracking difficulties requires compensatory strategies to improve their ability to complete reading and daily visual tasks. Which of the following would be an effective occupational therapy intervention to assist with scanning, pursuits, and saccades?
A. Instructing the patient to avoid head movement while tracking a target during visual tasks
B. Avoiding large print materials to encourage reliance on natural vision tracking abilities
C. Lowering the working area below eye level to encourage a downward gaze
D. Using line guides or allowing the patient to use their finger as a guide while reading or scanning to maintain focus
D. Using line guides or allowing the patient to use their finger as a guide while reading or scanning to maintain focus
An occupational therapist is working with a patient to remediate visual tracking deficits, focusing on improving accuracy before speed. Which of the following therapeutic activities would be most appropriate to enhance the patient’s saccades, scanning, and pursuits?
A. Instructing the patient to read without any aids or tools to encourage natural tracking
B. Using HART charts and letter tracking exercises to improve saccadic accuracy and flashlight tag to enhance pursuit skills
C. Limiting visual activities to only stationary objects to avoid over-stimulation
D. Practicing functional tracking by encouraging the patient to move their head frequently while looking for objects
Correct Answer: B. Using HART charts and letter tracking exercises to improve saccadic accuracy and flashlight tag to enhance pursuit skills.
Explanation:
Remediation
● Vision therapy (accuracy then speed)
○ Saccades & Scanning
■ Computer games
■ HART charts
■ Letter & symbol tracking
■ Ball on string
○ Pursuits
■ Computer games
■ Visual Tracing, Pen & Paper tracing
■ Functional tracking (look for items in room without
head movements)
■ Dynavision
■ Stickers on wall
■ Flashlight tag.
A patient with binocular vision deficits reports frequent falls, headaches, and difficulty with tasks requiring depth perception. Which of the following functional problems might this patient experience due to issues with oculomotor alignment, convergence/divergence, and stereopsis?
A. Enhanced ability to perform fine motor tasks like pouring liquids and reaching for objects accurately
B. Increased balance and reduced eye strain when reading for extended periods
C. Diplopia and challenges with ADLs and IADLs, such as driving and reading, due to overlapping images and impaired depth perception
D. Improved visual alignment and fewer headaches while completing tasks requiring depth perception
C. Diplopia and challenges with ADLs and IADLs, such as driving and reading, due to overlapping images and impaired depth perception.
Explanation:
Binocular Function (oculomotor alignment, convergence/divergence & stereopsis)
○ Functional Problems
■ Deficits in binocular vision most often results in diploplia (overlapping of
two images)- the eyes are not aligned
■ Falls, headaches, difficulty with ADLs and IADLs that require depth
perception (driving, reaching for objects, pouring liquids), confusion, balance issues, fatigue, eye strain, cosmetic problem (strabismus), movement on print, reading issues.
