Visual Dysfunction After CNS Disturbance

Question 1

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

Answer 1

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.

Question 2

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

Answer 2

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

Question 3

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

Answer 3

B & C
* Test each eye separately and together, using glasses if applicableC
* Use a Snellen chart or read material held 16 inches away

Question 4

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

Answer 4

A & B

• Test each eye separately and together, using glasses if applicable
• Use a Snellan Chart 20 feet away

Question 5

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 5

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 6

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 6

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.

Question 7

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

Answer 7

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

Question 8

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 8

Answer: C) Ensure the client uses the bottom portion of their bifocals for near work and takes frequent rest breaks.

Question 9

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.

Answer 9

A) Increased risk of bumping into objects, difficulty navigating curbs, locating items for ADLs, and a heightened fall risk.

Question 10

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.

Answer 10

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.

Question 11

Which of the following are assessment for visual fields?

A) Confrontation Test
B) Perimetry
C) Both A & B

Answer 11

C) Both A & B

Question 12

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.

Answer 12

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.

Question 13

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.

Answer 13

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.

Question 14

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 14

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.

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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.

Question 18

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

Answer 18

A. Having the patient read template A and B vertically, followed by template C horizontally, and recording the time and errors for each template

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

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.

Question 22

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

Answer 22

D. Using line guides or allowing the patient to use their finger as a guide while reading or scanning to maintain focus

Question 23

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

Answer 23

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.

Question 24

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

Answer 24

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.

Question 25

A 30-year-old client presents with a deviation of one eye when focusing on a target, where one eye intermittently turns outward or inward. Based on these symptoms, what condition might this client have, and which assessment would you conduct to evaluate it?

A. The client may have nystagmus; conduct a smooth pursuit assessment.

B. The client may have diplopia; conduct a visual acuity test.

C. The client may have convergence insufficiency; conduct a saccades assessment.

D. The client may have strabismus; look at the eye to check for the deviation (Sometimes, patients will not see double due to suppression).

Answer 25

D. The client may have strabismus; look at the eye to check for the deviation (Sometimes, patients will not see double due to suppression).

Question 26

A patient is suspected to have a non-strabismic vision disorder (phoria), which may indicate a misalignment or muscle imbalance when focusing on a distant point. Which of the following assessments would be most appropriate for an occupational therapist to conduct to evaluate this condition?

A. Administering a smooth pursuit test by having the patient follow a moving target without moving their head

B. Performing the cover-uncover test by covering one eye while the patient fixates on a distant point, then uncovering to observe for any eye movement

C. Conducting a saccades assessment by having the patient rapidly switch focus between two points

D. Using a visual acuity chart to test clarity of vision at various distances

Answer 26

B. Performing the cover-uncover test by covering one eye while the patient fixates on a distant point, then uncovering to observe for any eye movement.

Explanation:
Non-Strabismus vision disorders (phoria) ■ Assessment
● Cover uncover test:
○ Cover one eye and have patient fixate at distant point
(slightly lateral to midline) with other eye
○ Suddenly uncover the other eye and observe any
movement of the uncovered eye
○ Repeat with other eye
○ No movement= eye are aligned; Movement= misalignment
or muscle imbalance
● Eye alignment Kit

Question 27

An occupational therapist is assessing a patient’s convergence and divergence. Which of the following steps should the therapist take to conduct the convergence/divergence assessment accurately?

A. Hold a target 16 inches from the patient’s eyes, slowly move it towards their nose, and ask the patient to report when they see double (break point) and when they see single again (recovery point)

B. Instruct the patient to fixate on a distant target and report when they feel eye strain or dizziness

C. Use a ruler to measure the distance between the patient’s eyes and the target while the patient keeps their gaze fixed without moving their eyes

D. Ask the patient to focus on a moving target while standing and report when they lose track of the target

Answer 27

A. Hold a target 16 inches from the patient’s eyes, slowly move it towards their nose, and ask the patient to report when they see double (break point) and when they see single again (recovery point)

Explanation:
Convergence/divergence assessment
○ Have patient sit in front of OT (Glasses worn, if applicable)
4
○ Hold target (pen)16 inches away between the eyes
○ Tell patient you will be slowly moving the target towards their eyes and to
report when they see double (break point)
○ Record that distance with a ruler
○ Then slowly move target away and ask patient to report when they see
single again (recovery point) and record

Question 28

You are conducting a stereopsis assessment for a patient with binocular vision. Which of the following steps should the therapist follow to accurately measure the patient’s depth perception using the Stereo Fly Test?

A. Instruct the patient to look at a flat card and identify the objects by color

B. Have the patient wear 3D glasses, hold a stereopsis card 16 inches from their eyes, and ask them to point to the 3D objects and identify which ones appear closer

C. Place a target at varying distances and ask the patient to report when the target appears to move

D. Have the patient focus on a distant object and then switch to a nearby object without moving their head

Answer 28

B. Have the patient wear 3D glasses, hold a stereopsis card 16 inches from their eyes, and ask them to point to the 3D objects and identify which ones appear closer

Explanation:
Stereopsis assessment
○ Can only be measure with people who have binocular vision
○ Stereo Fly Test
○ Have patient place 3-d glasses on (glasses worn if applicable)
○ Place stereopsis card around 16 inches from head
○ Patient should: (Ask patient if they see something coming towards them)
■ Point to 3-d objects
■ Which items are close

Question 29

A patient with oculomotor misalignment presents to the OT with difficulty focusing and maintaining depth perception. Which of the following management strategies would be most appropriate, in collaboration with a neuro-optometrist, to address the patient’s binocular vision dysfunction?

A. Referring the patient to a neuro-optometrist for prism therapy (e.g., Fresnel lenses, base in/out), vision therapy, and possible partial occlusion or patching for compensatory strategies

B. Prescribing corrective glasses only, without further referrals or interventions

C. Advising the patient to engage in visual exercises independently to address the misalignment

D. Suggesting surgical intervention for strabismus without referral to an optometrist

Answer 29

A. Referring the patient to a neuro-optometrist for prism therapy (e.g., Fresnel lenses, base in/out), vision therapy, and possible partial occlusion or patching for compensatory strategies.

Explanation:
○ Referral to Optometrist (Neuro preferably)
■ Oculomotor misalignment
● Compensatory
● Patch
● Partial occlusion
■ Prisms (Fresnel, base in, base out)
● Remediation
● Vision therapy (eye exercises)
● Surgical management (strabismus)

Question 30

A patient with convergence insufficiency has difficulty focusing on near objects and reports eye strain during tasks such as reading. Which of the following compensatory strategies would the occupational therapist most likely recommend to assist with near activities?

A. Full occlusion for both eyes and prescribing reading glasses

B. Eye exercises for distant activities and no interventions for near tasks

C. Partial occlusion for one eye and the use of prisms for near activities

D. Avoidance of near tasks and focusing solely on distant activities

Answer 30

Correct Answer:
C. Partial occlusion for one eye and the use of prisms for near activities.

Explanation:
Convergence
■ Compensation
● Partial occlusion
● Prisms for near activity
■ Remediation
● Convergence exercises (brock string, vectograms)

Question 31

A patient with convergence insufficiency is experiencing difficulty with near tasks like reading and focusing on small print. Which of the following remediation strategies would the OT likely incorporate to improve the patient’s convergence skills?

A. Prescribing corrective lenses for distance vision

B. Using convergence exercises such as the Brock string and vectograms to improve convergence ability

C. Advising the patient to avoid reading and focusing on near tasks

D. Recommending partial occlusion to address eye strain during near tasks

Answer 31

Correct Answer:
B. Using convergence exercises such as the Brock string and vectograms to improve convergence ability.