Week 8 (after midterm) Flashcards
1
Q
majority of our sensory input is through our sense of ____.
A
vision
2
Q
up to what % of visual and visual-cognitive disorders are found in neurologically impaired patients?
A
60%
3
Q
up to what % of individuals with CVA have increased length of rehab. stay due to perceptual and visual spatial deficits?
A
20%
4
Q
___ ___ ___ have been shown to be associated with poor performance in reading, accident proneness, and dependence in self-care activities after CVA.
A
visual processing problems
5
Q
the pathology of visual or VP impairments is found to be similar in people with which 2 neuro conditions?
A
TBI and stroke
6
Q
name 4 different types of visual impairment after stroke.
A
- eye alignment and movement impairment
- visual field impairment
- low vision
- perceptual difficulties
7
Q
as high as what % of individuals with TBI can have visual changes?
A
90%
8
Q
name 4 common symptoms/visual impairments following a TBI.
A
- diplopia
- photophobia
- eye strain
- reading complaints-blurriness,
9
Q
what percent of people of several TBIs were found to have VP impairments 1 year post injury?
A
31%
10
Q
name 8 complications related to visual impairments.
A
- reading deficits
- decreased speed
- increased risk of falls - twice the risk
- over 4x risk of hip fractures
- increased social isolation
- decreased confidence
- higher level of depression
- impact potential for cognitive improvements
11
Q
visual impairments lead to how much of a greater risk of hip fractures?
A
4x
12
Q
describe Mary Warren’s Hierarchical Model of Visual Processing.
A
- vp is viewed holistically and as a unified process
- hierarchy of skills rather than a series of independent skills
- skills at the bottom of the hierarchy form the foundation for each level above it
13
Q
the sharpness of eyesight. ensures that visual info sent to CNS is accurate; quality of information.
A
visual acuity
14
Q
the area the eyes can see at any one time; register the visual scene; quantity of information
A
visual field
15
Q
efficient conjugate eye movements
A
oculomotor control
16
Q
___ ___ is the quality of information, while ___ ___ is the quantity of information.
A
visual acuity, visual field
17
Q
visual acuity is the ___ of information, while visual field is the ___ of information.
A
quality, quantity
18
Q
name the 3 components on the first (bottom) level of Mary Warren’s Hierarchy of Visual Processing.
A
- visual acuity
- visual field
- oculomotor control
19
Q
the ability to view all details of a scene systematically in an organized and thorough manner; critical to making a correct identification while ignoring unessential elements.
A
scanning
20
Q
the ability to attend to stimuli and shift attention between stimuli. triggered by events in the environment - such as flash of light, busy interactions
A
attention
21
Q
name the 2 components in the 2nd level of Mary Warren’s Hierarchy of Visual Processing.
A
- visual scanning
- visual attention
22
Q
requires ability to create a picture of object in the mind’s eye while visual analysis is completed; to store image and retrieve upon command.
A
visual memory
23
Q
the ability to identify salient features of an object such as shape, contour, and specific features (ex: color, details, shading, and texture); essential for object recognition.
A
pattern recognition
24
Q
name the 2 components in the 3 level of Mary Warren’s Hierarchy of Visual Processing.
A
- visual memory
- pattern recognition
25
- highest order VP skills
- the ability to mentally manipulate visual information and integrate it with other sensory information to problem solve, and plan
- visually analyze the environment - reading, writing, solving math problems, certain professions rely heavily: architect, surgeon, artist
visual cognition
26
name 3 components within visual cognition.
- visual spatial
- figure ground
- visual closure
27
name the 1 component in the 4th level of Mary Warren's Hierarchy of Visual Processing.
visual cognition
28
- the ability to make decisions, interpret and adapt to the environment through information gathered visually
- learning and adaptation tasks take place at this higher level but won't occur if there is a disruption of vision at one of the foundation levels
adaptation through vision
29
name the 1 component in the 5th and final level of Mary Warren's Hierarchy of Visual Processing.
adaptation through vision
30
each skill level depends on the ___ of those before it.
integration
31
skill level disrupted at one level can have adverse effect on the ___ ___.
total structure
32
a deficit at a ___ ___ may actually be caused by an impairment in the ___ ___ of the hierarchy.
higher level, lower level
33
provides the initial evaluation of the foundation skills that then form the bases for higher level visual-perceptual skills and cognition.
basic vision screen
34
name 3 general ways in which eye ROM and strength is tested.
- visual fixation
- visual saccades
- visual scanning
35
the ability to hold a stationary gaze
visual fixation
36
the ability to track a target in unpredictable areas of the visual field
visual saccades
37
the ability to follow an object a smooth and continuous path, which allows for skills such as reading
visual scanning
38
- comprised of battery of subtest
- clinical observation checklist
- assessments of visual acuity (distance and reading)
- contrast sensitivity function
- visual field
- oculomotor function
- visual attention and scanning
- developed by Mary Warren
brain injury visual assessment battery for adults (biVABA)
39
the acuteness or clearness of vision; both near and distant acuity; quality of information entering the CNS
visual acuity
40
____ can cause shearing or tearing of the optic nerve or corneal scarring from direct trauma to the eye.
TBI
41
name 2 symptoms of visual acuity.
- client complains of fuzzy or blurry print
| - print too small; glasses don't work as well as before injury
42
name 2 ways to assess visual acuity.
- snellen eye chart
| - lea symbol test
43
name 3 effects of visual acuity on function.
- difficulty with reading/writing tasks
- trouble with driving
- inability to recognize faces
44
what is the criteria for referral for visual acuity?
20/40 or poorer, or if there is greater than a two line difference between the 2 eyes
45
what does the NJ DMV require for visual acuity?
20/50 binocularly
46
name 3 interventions for visual acuity.
- refer to eye doctor - to get evaluated for appropriate prescription
- may been referral to low vision specialist
- educate on proper use of glasses
47
name 5 compensatory strategies for visual acuity.
- increased illumination
- increased contrast
- increased size (enlarge or magnify)
- decreased background pattern or clutter
- organize the environment
48
- field of view of the external world by both eyes without headturning
- quantity of information entering the CNS
visual field
49
describe the two components of a person's full field of vision.
- peripheral vision
| - central vision
50
visual field loss will depend on the __ __.
lesion site
51
inferior field loss has been linked to which 3 impairments?
- decreased balance
- decreased mobility
- decreased seeing steps or curbs
52
superior field loss has been linked to problems with which 3 things?
- problems with seeing signs
- decreased reading abilities
- decreased writing abilities
53
field loss to the entire right field of both eyes, caused by a lesion to the left optic radiation
right homonymous hemianopia
54
what is the name of the test that assesses one's visual fields?
confrontation testing
55
- gross assessment, client to detect a moving target
- may miss mild/subtle field cuts
- observe the client during function tasks
confrontation testing (visual field)
56
name 7 intervention techniques to teach if a patient has a visual field deficit.
- visual search strategies (left to right for reading, scanning)
- lighthouse technique
- large scale eye movements for environment
- small scale eye movements for reading and near tasks
- increased head turns
- use of anchors or rulers to keep track of lines, edge of text
- grading treatment tasks - start with organized move to random, start with slow work toward increasing speed, large and small area tasks
57
allows for efficient conjugate movements (eyes moving together in the same direction)
ocular-motor control
58
___ ___ are common after brain damage and can vary depending on the size and location of the lesion or injury.
oculomotor deficits
59
name 2 common impairments associated with ocular-motor control.
- slower speed, control, and coordination of eye movements
| - disruption of visual scanning and attention
60
name 8 "symptoms" associated with deficits in ocular-motor control.
- excessive head movement
- decreased attention to details
- line skipping
- headaches
- fatigue
- squinting
- head tilt
- shutting one eye
61
name the 3 areas/components of ocular-motor control.
- fixation stability
- saccadic function
- pursuit function
62
the ability to visually attend by extra-ocular muscles maintaining an eye position.
visual fixation
63
name 3 interventions for visual fixation.
- select activities that will require client to focus attention to a target or time
- functional activities - pouring and filling, threading beads, using tweezers or tongs to sort items
- remedial tasks: HART charts, computer-based programs
64
- quick eye movements that occur when the eyes fix on various targets in the visual field
- essential for reading and scanning the environment
saccades
65
name 3 deficits associated with saccades.
- undershooting or overshooting targets
- difficulty shifting gaze
- inability to isolate head and eye movement
66
what is the name of the screening for saccades?
developmental eye movement test
67
name 7 interventions for saccades.
- treatment tasks: copying tasks, card games, sudoko, writing checks, puzzles
- provide education such as giving examples of how this will impact daily life - reading, searching for objects, etc.
- use line guide such as a finger or ruler
- increase print size
- decrease clutter
- saccadic exercise - one eye at a time, start with large movements then to smaller movements
- have patient keep head still and focus on moving eyes not head
68
- eye movements that maintain continued fixation; allows us to follow a moving image or object across the visual field without head movement
- ex: following a ball with your eyes, watching people or animals run or walk, watching pen or pencil while writing, etc.
pursuits
69
name 3 deficits associated with pursuits.
- difficulty crossing midline
- overshoot/undershoot, jumpiness
- client will have problems with mobility esp. through moving crowd, driving, navigating a store aisle, etc.
70
name 5 interventions for pursuits.
- start with one eye at a time
- pt. should keep head still
- start with small movements progressing to large movements
- teach compensatory techniques such as increased illumination, enlarge print, reduce clutter, visual markers
- treatment tasks - mazes, following remote control car, shape tracing, ball games, pen light on wall, ball games
71
- adjusting and sustaining focus from one distance to another
- decreases with age
accommodation insufficiency
72
name 5 symptoms of accommodation insufficiency
- excessive blinking
- headaches
- eye strain
- blurred vision during self care (make up, buttoning)
- driving difficulties
73
name 9 strategies for OT generalist to reinforce for accommodation.
- pt. to wear prescription glasses, if bifocals make sure they are using bottom during close work
- large print may relieve symptoms
- take frequent rest breaks
- increase illumination
- decrease clutter
- use line guide
- avoid glare
- limit time doing visual tasks
- take frequent rest breaks
74
when the brain perceives an object at near to be farther away than it is, which results in the need for extra effort to be used as the eyes and brain must work harder in order to point accurately at the object. therefore, the eyes have a tendency to turn slightly outward when viewing close objects due to this problem with localization.
convergence insufficiency
75
name 4 deficits associated with convergence insufficiency.
- difficulties with close up tasks
- difficulties with reading and writing
- complaints of blurred vision
- eye strain or fatigue when reading
76
what is the screening for convergence called?
break point recovery test
77
___ or ___ treatment activities to be performed by OT specialized in vision and under direction of neuro-optometrist.
accommodative or convergent
78
name 5 strategies for convergence insufficiency that an OT generalist can recommend.
- illumination
- decrease clutter
- visual markers
- avoid glare
- time limit
79
-ocular alignment, coordinated function of both eyes
binocular vision
80
how many muscles and cranial nerves are there for both eyes?
12 muscles, 6 cranial nerves
81
eye misalignments
strabismus
82
name the 3 most common strabismus.
- esotropia
- exotropia
- hypertropia
83
eye turning in
esotropia
84
eyes turn out
exotropia
85
one eye turns up
hypertropia
86
name 3 strategies/treatments if both eyes are not aligned.
- client may close one eye
- use a patch
- develop an awkward head turn (compensate for paralyzed muscle)
87
proper eye alignment is key to what?
depth perception
88
which technique is used for binocular vision testing?
hirschberg technique
89
name the screening used for binocular vision.
Maddox Rod screening tool
90
when would you refer someone for strabismus (deficits in binocular vision)?
-if esophoria is 5 or more, if exophoria is 10 or more, if hypo or hyperphoria is 2 or more
91
- double vision, blurriness, difficulty with near task, words moving when reading, headaches with near tasks, eye strain, squinting with one eye
- double vision can occur when looking into different fields - side to side, up down
diplopia
92
if screening indicates double vision, what is necessary?
referral to neuro-opt.
93
regarding binocular vision, if the neuro-opt determines that the problem is a muscle imbalance, what is initiated?
eye exercises
94
if the client has double vision, provide which 2 things?
- occlusion (as directed by eye MD)
| - activities to obtain fusion (ex: maintain focus on a clock, menu)
95
what is a short-term method for diplopia?
patching - determine dominant eye and alternate eye patch daily.
96
name 5 compensatory strategies for diplopia.
- increase illumination, contrast, or print size
- decrease clutter
- line guide, anchor, markers
- avoid glare
- limit time doing visual tasks and take frequent rest breaks
97
awareness of the body and spatial environment
visual attention
98
a deficit in visual attention is most often a result of what kind of damage?
right brain damage
99
visual attention deficits do not always but may co-exist with what other kind of deficits?
visual field deficits
100
name 3 types of visual inattention deficits.
- personal - on body
- peri personal - near body
- extra personal - in environment
101
__ __ needs to be addressed with visual inattention deficits.
self-awareness
102
name 3 assessments for visual attention.
- kessler foundation neglect assessment
- behavioral inattention test
- bells assessment
103
name 8 treatment interventions for visual inattention.
- increase client's awareness of inattention
- place items in neglected space for remediation
- work with neuro-opt for prism use
- use of visual imagery (eyes like a lighthouse)
- reading left to right, circular pattern for large scan
- use line guide - ruler, anchoring
- brightly colored line at edge of text
- adjust density, structure of task, speed
104
name 3 components of selecting the best environment for vision treatment.
- well lit, no glare
- clutter free and quiet (unless working on more complex tasks)
- determine patient's position - seated, standing, or walking
105
the ability to distinguish foreground from background
figure-ground discrimination
106
the ability to identify forms or objects from an incomplete array of features or stimuli
visual closure
107
the ability to coordinate info from the visual system with body movements during an activity or task
visual-motor integration
108
involves the ability to organize and interpret visual info to give it meaning
visual processing skills
109
name 5 components of visual processing skills.
- figure-ground discrimination
- visual closure
- visual-motor integration
- visual discrimination
- visual memory
110
- no motor involvement needed to make a response
- can be used for screening overall visual perceptual ability in children and adults (ages 4-70)
- visual multiple choice - individual is shown a line drawing and is then asked to choose the matching drawing from a set of four one the following plate
motor-free visual perceptual test (MVPT)
111
name 5 categories of visual perception measured in the MVPT.
- spatial relationship
- visual closure
- visual discrimination
- visual memory
- figure ground
112
- battery of 6 subtests that measure different but interrelated visual-perceptual and visual-motor abilities; normed to age 75
- pediatric and adult versions available
development test of visual perception (DTVP)
113
name the 6 subtests within the DTVP.
- copying
- figure-ground
- visual-motor search
- visual closure
- visual-motor speed
- form constancy
114
individuals are shown a simple figure and asked to draw it on a piece of paper. the figure serves as a model for the drawing.
copying
115
individuals are shown stimulus figures and asked to find as many of the figures as they can on a page where the figures are hidden in a complex, confusing background.
figure-ground
116
the individual is shown a page covered in numbered circles, randomly arranged on the page. the individual connects the circles with a line, in numerical sequence as quickly as possible.
visual-motor search
117
individuals are shown a stimulus figure and asked to select the exact figure from a series of figures that have been completely drawn.
visual closure
118
individuals are shown four different geometric designs, two or which have special marks in them, and a page filled completely with the four designs, none of which have marks in them.
visual-motor speed
119
individuals are shown a stimulus figure and asked to find it in a series of figures. in the series, the targeted figure will have a different size, position, and/or shade, and it may be hidden in a distracting background.
form constancy
120
the ability to recognize and distinguish the distinctive features of a form or object (ex: shape, size, and color)
visual discrimination
121
deficits in visual discrimination will cause which 4 issues?
- difficulty reading
- difficulty recognizing signs
- difficulty recognizing faces
- decreased attention to details
122
name 4 strategies for visual discrimination.
- blocking
- chunking
- verbalization
- organized scan
123
name 2 activities for visual discrimination.
- matching
| - spot the difference
124
the visual skill that allows us to record, store, and retrieve info. allows us to learn and later recall what is learned.
visual memory
125
similar to visual memory in that it allows us to store and retrieve info when necessary or useful.
visual sequential memory
126
involves the ability to distinguish the foreground from the background
figure-ground
127
name 2 deficits associated with figure ground.
- problems distinguishing a figure with competing background
| - problem locating objects that are not well defined.
128
name 5 strategies for figure-ground.
- reduce clutter
- organize items
- color contrast
- labeling
- locate key salient features easier to find
129
the ability to know that a form or shape is the same even if it has been rotated, made smaller/larger or observed from up close or far away
visual form constancy
130
being able to see only parts of an object and mentally complete the object. often objects are partially occluded by other objects in the environment and our visual system fills in the missing info.
visual closure
131
deficits in visual closure will cause significant problems in which 3 areas?
-reading, spelling, writing
132
name 1 strategy for visual closure.
visual imagery
133
- effective communication btwn the eyes and hands
| - can lead to difficulty with writing and poor coordination
visual motor integration
134
VMI involves ___ ___ ___.
visual perceptual skills
135
the ability to correctly perceive a form in order to correctly replicate it.
visual perceptual skills
136
name 2 examples of visual motor integration.
- correctly perceiving and copying shapes
| - correctly perceiving and copying letters and numbers
137
- understanding the relationships of objects within the environment compared to other objects or oneself
- above or below
- right and left side
- under and over
visual spatial relations
138
name 3 examples of visual processing activities.
- hidden pictures games
- picture drawing
- dot-to-dot
139
initial evaluation/screenings
treatment stage 1
140
minimize sensory deficit by introducing assistive devices (ex: eyeglasses, prisms, patching, large print, etc.) or corrective surgery
treatment stage 2
141
education provided to client on visual processing areas, providing feedback and teaching self-monitoring techniques
treatment stage 3
142
exercise and retraining activities to improve function; utilize training exercises, daily living tasks, and strategy training; address basic visual deficits first before proceeding to higher level visual processing deficits.
treatment stage 4
143
promote compensation and self-management; practice generalization to various daily life situations
treatment stage 5
144
provide recommendations for general adaptations (increased lighting, increased contrast, line guides)
OT generalists
145
provide advanced training during ADLs, environmental adaptation, compensatory techniques, community reintegration, caregiver training and training with optical (prisms, magnifiers) and non-optical devices (assistive tech)
OT specialists
146
name 4 types of deficits that generalist OTs can directly treat.
- visual scanning
- visual inattention
- oculomotor deficits
- VP disorders
147
recognizing what something is going to be like from far away
pattern recognition
148
when is the Lea Symbol Test used?
for children or patients with a language barrier or patients with aphasia
149
highlighting one side of the page in a bright color
anchoring
150
blocking device used to keep track of lines, edge of text
rulers
151
focusing attention from one object to another or one letter on one page to a letter on the next page
HART charts (visual fixation)
152
sharpness and actual viewing of something
visual acuity
153
actually understanding what you are seeing
visual cognition
154
which strategies would you use for a patient with right temporal hemianopsia who has trouble navigating their environment?
- practice head turning and scanning the environment
| - lighthouse technique
155
how can you distinguish hemianopsia from unilateral neglect?
once you start to diagnose and note the level of awareness, it is easier to teach strategies - pt. with hemianopsia may begin to compensate and use strategies on their own if they have hemianopsia
156
what type of cognitive rehab approach is used when practicing figure ground pictures?
remedial approach
