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Vision Therapy > Assessment and Diagnosis of Oculomotor Dysfunction > Flashcards

Assessment and Diagnosis of Oculomotor Dysfunction Flashcards

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1
Q

T/F poor pursuits and/or saccades can exist in isolation but can also be found with vergence/accommodative disorders

A

true, more likely to be with vergence/accommodative disorders

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2
Q

A comprehensive VT eval gives insight into a patient’s…

A

attention skills

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3
Q

Focus vs focus

A

Focus: attention, focus: clear image on retina

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4
Q

What are the three areas of VT eval testing?

A

free-space, psychometric and electrodiagnostic

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5
Q

What is the Maples NSUCO test?

A

free-space, direct observation of pursuits and saccades while the patient stands

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6
Q

What is the patient graded on during NSUCO/Maples?

A

ability, accuracy, head movements, body movements

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7
Q

What is the scale for the Maples/NSUCO?

A

1 to 5 (best), perfect= 20 points

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8
Q

T/F girls show better Maples/NSUCO scores earlier

A

true, boys catch-up around age 9

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9
Q

For saccades and pursuits, ability should be 5 for all ages EXCEPT…

A

for boys age 5 and 6 the pursuit ability is 4

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10
Q

What is the King Devick?

A

psychometric, visual-verbal format, tests saccades only (not RAN individually)

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11
Q

How is King Devick performed?

A

three tests cards after the demo at Harmon’s distance, patient calls out digits horizontally as quickly as possible

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12
Q

How is the King Devick scored?

A

compare time to average ranges for age 6-14, calculate the z-score although it is not part of standard protocol

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13
Q

How do you calculate z-score?

A

(average - raw)/standard deviation

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14
Q

Which test is used most in sports medicine as a concussion test?

A

King devick, looks at RAN and eye movements as a whole

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15
Q

What are the different athlete responses to KD?

A

athletes without concussions show slight learning effect and improve slightly over the season, athletes with concussions have worse scores on sideline testing compared to baseline

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16
Q

What is the median KD score decrease in athletes with concussions?

A

5 second worse

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17
Q

What is the DEM?

A

psychometric testing, determines a possible saccadic problem, also looks at rapid automatic naming

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18
Q

How does the DEM work?

A

read numbers as fast as you can vertically twice and horizontally ones

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19
Q

How is the DEM scored?

A

z-scores are calculated based off of time for vertical, horizontal, and ratio times, norms are for ages 6 to 34

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20
Q

What are four possible outcomes of the DEM?

A

normal performance, saccadic dysfunction, difficulty with RAN, difficulty with both saccades and RAN

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21
Q

What is the ReadAlyzer/Visagraph?

A

electrodiagnostic infrared recording device, provides info on fixations, regressions, fixation duration, reading rate, and grade equivalence

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22
Q

What is the procedure for readalyzer?

A

patient reads a grade level-appropriate (or below) passage silently while wearing infrared goggles, patient answers 10 true/false questions and must score 70% for a valid reading

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23
Q

What does a regression look like?

A

short backwards horizontal line

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24
Q

What does a return sweep look like?

Study These Flashcards
A

long backwards horizontal line

25
What does a fixation look like?
a vertical line
26
What does a saccade look like?
a short forwards horizontal line
27
One a readalyzer trace what is shown on the vertical axis?
time
28
What should you see on a readalyzer trace?
stair-step pattern, good yoked movement, full return sweeps, minimal regressions, minimal long fixations
29
What is RightEye?
newer tech, patient reads present paragraphs and/or follows moving targets, eye movements are mapped and evaluated based on norms, particularly useful for ABI/TB
30
What is the 1st theory relating eye movement and reading?
eye movement disorders can cause below-average reading ability
31
What is the 2nd theory relating eye movement and reading?
random, unskilled eye movements found in poor readers are secondary to deficient language skills that cause reading disorders
32
What is the 3rd theory relation eye movements and reading?
combination, in some cases, the primary problem is an eye movement disorder affecting fluency, in other cases, the eye movement disorder is a reflection of poor reading ability
33
What is oculomotor dysfunction?
eye movement disorder– fixations, saccades, and/or pursuits, can occur in isolation but are often found together
34
When should children have the gross ability of normal eye movements?
1-2 years old
35
When do eye movement skills continue developing until?
throughout elementary school ages accuracy, success and smoothness occur
36
What plays a role in children's eye movement ability?
attention
37
What are fixations?
the ability to maintain steady, stable fixation on a target
38
When should you be able to hold fixation for 10 seconds?
age 3
39
T/F fixations are affected by attention and motivation
true
40
When do fixations occur?
during reading between saccades, average duration 200-250 msec and ranges from 100-500+
41
What would a 500+ msec fixation indicate?
problem disengaging attention
42
What are saccades?
rapid redirection of line of sight for foveal viewing
43
Which eye movement is the fastes?
saccades
44
What is the saccadic latency?
200-250 msec, related to luminance, contrast, predictability, motivation, attention
45
In the reading task what is the visual angle of a saccade and how many characters does it span?
2 degree visual angle, 8-9 characters
46
How much of reading time is saccades?
10%
47
Which takes up more of reading time, saccades or fixations?
fixations
48
What are pursuits?
continuous clear vision of moving targets through foveal fixation, affected by age, attention, motivation
49
What is the maximum velocity of a pursuit?
60 deg/sec
50
What is the latency of a pursuit?
100-130 msec
51
What deficits are associated with poor sports performance?
difficulty catching and hitting, maybe difficulty running
52
What are symptoms of OMD, specifically saccades?
excessive head movement w/ reading, slow reading speed, poor comprehension, short attention span, difficulty aligning columns, difficulty with scantrons, losing place when reading, skipping words or lines, difficulty copying from board
53
What are symptoms of OMD, specifically pursuits?
excessive head movements, poor sports performance, reading difficulty
54
What are signs of OMD, specifically saccades?
observational evidence, below-average readalyzer/visagraph/rightEye, z-score below -1.00 on DEM ration, outside average range on KD, performance below norms on Maples NSUCO
55
What are signs of OMD, specifically pursuits?
observational evidence, below average performance on RightEye, performance below norms on Maples
56
What are potential causes of OMD?
functional and pathological
57
What are functional causes of OMD?
difficult to pinpoint a specific cause, can be congenital/idiopathic, can be developmental delay, rule out pathology
58
What are pathological causes of OMD?
many etiologies: cerebellar disease, oculomotor nerve paresis, internuclear ophthalmoplegia, myasthenia gravis, Alzheimer's, Parkinson's, TBI, ABI
59
What does it mean if a medical code ends in 9?
generally indicates "nonspecific" should avoid when possible

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