Week 11

Question 1

Warrens Visual Hierarchy

Answer 1

1 - Oculomotor control / Visual Fields / Visual Acuity
2 - Attention = alert and attending
3 - scanning
4 - pattern recognition
5 - visual memory
6 - visual cognition
7 - adaptation through vision

Question 2

1 - oculomotor control

Answer 2

CONTROL - effective coordination of eye movement

fixation/tracking/saccades/smooth pursuits

Question 3

1 - visual fields

Answer 3

Fields - amount of the visual scene you take in without movement
homonymous hemianopsia - loss of the right or left half of the field in both eyes
Teach Scanning

Question 4

Visual Field Test

Answer 4

confrontation test - assesses all 4 quads, pt should be able to count fingers held in each quad

Question 5

1 - Visual acuity

Answer 5

allows for sharp, clear, accurate pictures
myopia - near sightedness
hyperopia - far sightedness
presbyopia - farsightedness assoc with aging

Question 6

2 - Visual Attention

Answer 6

focusing on visual information
selective / focal
ambient / peripheral

Question 7

visual attention deficits

Answer 7

• left neglect - disregard for the left side of body after right sided brain injury
• right inattention - after left sided brain injury

Question 8

3 - visual scanning

Answer 8

allows you to shift and focus selected areas / information on the macula
typical scanning - left to right, top to bottom, and clockwise. Lighthouse pattern.

Question 9

4 - Pattern recognition

Answer 9

identify the most important features of an object and use that to distinguish an object from its surroundings
pt with right sided brain injuries will fail - due to “not seeing”
pt with left sided brain injuries may be aware of the objects but have trouble identifying them

Question 10

5 - visual memory

Answer 10

retaining a two dimensional mental pic of a 3 dimensional object
ROCF - rey-osterrieth complex figure test

Question 11

6 - visual cognition

Answer 11

ability to manipulate visual information

allows us to understand the mental image and to integrate it with other sensory information

Question 12

6 - visual cognition deficits

Answer 12

spatial agnosia (spatial relation)
somatognosis (poor body scheme)
alexia - difficulty reading
Agraphesthesia - inability to recoginze numbers/letters, on the skin
tactile agnosia - can’t identify through touch
apraxia - inability to plan or perform purposeful movement

Question 13

types of apraxia

Answer 13

Ideomotor:inability to perform motor action at will, but can perform spontaneously.
ideational - inability to form the concept of the movement, unable to perform by command
constructional - inability to copy, draw or construct
Dressing - inability to plan and perform motor actions to dress oneself & linked w/ deficits in body scheme, orientation, and constructional

Question 14

4 cranial nerves involved with vision

Answer 14

Optic CNII-damage anterior to optic nerve results in loss of vision on same side; damage to optic nerve itself results in loss laterally in both visual fields; damage posterior to optic nerve causes loss in visual field on side opposite to damage.
Oculomotor CNIII-results in drooping eyelid, difficulty focusing on near items.
Trochlear CN IV-causes decreased ability to look down and out
Abducens CN VI- causes decreased ability to move eyes laterally, crossed eyes. Damage to CNIII, CN IV , and CN vi causes double vision

Question 15

ideomotor

Answer 15

• inability to perform on command/ spontaneously can do
  treatment - use short, clear, concise, concrete and repetitive instructions, try simply putting pt in front of a bathroom mirror and handing them a comb to see if they spontaneously perform hair combing task.

Question 16

ideational

Answer 16

• inability to form the concept of the movement, unable to perform by command
  treatment - use short, clear, concise, concrete and repetitive instructions, can break it down and use hand over hand guidance. Use verbal and demonstrated instructions. After each step is completed, clinician can combine steps

Question 17

constructional

Answer 17

• inability to copy, draw or construct
  treatment - functional retraining: practice in natural context, perform at appropriate times of day, encourage an organized system of gathering items, establish regular sequence & gradually provide fewer cues over time, use colored tabs sewn into clothing to provide cues

Question 18

Perceptual deficits & treatment

Answer 18

• body scheme, apraxia, alexia, graphesthsia, impaired visual closure and figure/ground, agnosia ( cannot identify object by touch)
• perceptual treatments: functional retraining, practice in natural context at appropriate times of day, use color tab cues, tactile stim to affected area, use a mirror, avoid using words right & left, use visual cues, practice identifying objects by sight and touch, label & organize items, position garments in same position each time, use hand over hand, attempt to have client perform entire task in typical context,