"The Basics of Vision Impairments and Functional - PowerPoint Presentation

Slide1

"The Basics of Vision Impairments and Functional Applications”

Tina

Mastrangelo

,

MCD,

CCC-SLP, Senior SLP

Janine E. Pacheco, PT, DPT, C/NDT,

Melissa Lorenzo, B.S

Brianna Morris, SPT

HealthSouth Rehab Hospital of LargoSlide2

TerminologyTracking

- the eye’s ability to move smoothly while following a moving object. *NOT reading*

Fixation

- the

eye’s ability to select an object in the environment and focus it’s gaze on

it; and, inspecting a series of stationary objects (reading).

Acuity

- clearly seeing, inspecting, and identifying objects.

Accommodation

- the eye’s ability to automatically change focus from seeing at one distance to seeing at another.

Ptosis

- drooping eyelid.

Convergence

–the eye’s

ability to turn inward. People with convergence insufficiency have trouble with near tasks such as reading and frequently report eye strain and blurred vision.Slide3

Divergence- the ability to use both eyes as a team and be able to turn the eyes out toward a far object.Diplopia- when two images of the same object are perceived by one or both eyes.(double vision)

Fusion-

the union of images from each eye into a single image

.

Strabismus

- a misalignment of the eyes. The eyes don’t point at the same object together.

Tropia

-always present

Esotropia

- when one or both eyes point inward.

Exotropia

- When one or both eyes point outward.

Phoria

- you have to break fusion

Esophoria

- when one or both eyes point inward

Exophoria

- when one or both eyes point outwardSlide4

Nystagmus- rhythmic oscillations or tremors of the eyes which occur independently of the normal eye movementOcclusion- to block out light. An eye can be completely or partially blocked. Occlusion is often used to promote the use of one eye or both eyes. (ex: patching, squinting)

Suppression

- Stimulated by dissimilar stimuli or when non-corresponding retinal areas are stimulated by similar stimuli or the other is temporarily inhibited or suppressed to prevent confusion.

Binocular Vision

- Ability of both eyes to work together to achieve proper focus, depth perception and range of vision.

Monocular Vision

- Ability of one eye to focus. No depth perception (when changing surfaces

).

Saccades

- Rapid shifts , or little jumps, of the eyes from object to object allowing quick localization of movements in the periphery. The ability of the eye to change fixation from point to point.Slide5

Extra Ocular MusclesSlide6

Visual PathwaySlide7

Visual PathwaySlide8

Scope of practice: STAccording to ASHA’s Practice Policy on Scope

of Practice in Speech-Language

Pathology, it is in an SLP’s scope of practice to asses and treat:

Cognition

attention

memory

sequencing

problem solving

executive functioning

Language

literacy (reading, writing, spelling

)Slide9

Scope of practice: OT

AOTA resource manual: Practice Guidelines for Adults With Low Vision

Use remaining vision to participate in desired occupations

Support independent lives

Modify home environment to facilitate safe participation in ADLs

Recommend adaptive devices and assistive technology (optical and non-optical devices)

(

www.aota.org

)

The AOTA recognizes that occupational

therapists help

address visual impairment difficulties

Activities of Daily Living

Evaluate specific daily task

Evaluate environment, and recommend modifications

Recommend adaptive devices and assistive technology (optical and non-optical devices) Slide10

Scope of practice: PTExamining individuals with impairment, functional limitation, and disability or other health-related

conditions.

T

ests

and measures may include the following

:

environmental, home, and work (job/school/play) barriers

gait, locomotion, and balance

neuromotor

development and sensory integration

sensory integrity

work (job/school/play), community, leisure integration or reintegration (including instrumental activities of daily living)

Design, implement, and modify therapeutic interventionsSlide11

FixationThe eye’s ability to select an object in the environment and focus it’s gaze on it;

and inspecting

a series of stationary objects (reading)

.

Assessment

Hold stick with a round bead 16-20 inches away from face

Ask them to look at the bead for five seconds

Observe their ability to focus

If they are unable to complete task:

Have them hold out their own thumb & stare at it for 5 seconds.

I

nput from their own hand may increase the ability to focus

Scoring

WFL: Able to stare at bead for 5 seconds with no apparent eye movement.

Impaired: Unable to stare at bead for 5 seconds and/or has abnormal eye movementSlide12

Fixation TreatmentActivities to encourage holding gaze on a single object

Start with short duration and increase accordingly

Goal:

for eyes to fixate and not dart in any other direction

Achieving attention to a single object

Notes:

“Fixation” requires “attention”

Make it fun –

S

taring contest … 1.2.3 GO!

Use bright colors and familiar objects

Reduce stimulation in environment

Provide postural stabilitySlide13

SaccadesDefinition: Rapid shifts, or little jumps, of the eyes from object to object allowing quick localization of movements in the periphery. The ability of the eye to change fixation from point to point.

Implications:

Reading

Losing their place often

skipping lines

rereading lines

words appearing to jump around the page

letter order confusion.

Poor hand-eye coordination, i.e. ball throwing and catching, self-feeding, writing

Impaired safetySlide14

SaccadesAssessmentHold two sticks, with different colored beads on top (

i.e

red and green), about shoulder width apart.

Ask them to hold their head still and look at one of the colored beads (red).

While they fixate on the red bead, move the other bead (green) up or down. Then ask them to look at the other bead.

Repeat this process until you have assessed their visual pattern.

Look for accuracy, under or over shooting, nystagmus (shaky movements), extended search time, ability or inability to isolate eyes from head movements, and ability or inability to shift into all fields of gazeSlide15

Saccades TreatmentHave them call out letters from two columns on opposite sides of the page

Change the distance between the letters by increasing blank space or adding more columns.

Trail making

Yardstick Activity

Focus on both small and large saccadic training

Vestibular based movement activities with demands for saccadic skills

Always watch for speed and accuracy of fixations on targetsSlide16

Column Activity

3

7

2

6

4

5

9

3

5

8

9

1

7

1

6

7

Try anything alternating

i.e. words, colors, names, objectsSlide17

Trail Making Activity25 circles distributed over a sheet of paperExplain and demonstrate

task

on a separate sheet of paper

Give a worksheet (Part A, then B)

Part A : circles are numbered 1-25

Direction: Draw a line to connect

circles in ascending order

Part B :

Circles

are labeled with both 1-13 and A-L.

Pt. draws lines to connect 1 to A, A to 2, 2 to B,

etc.

Record time it takes them to finish worksheet. (Baseline – Treatment – Reassessment)Slide18

Small Precise Saccadic MovementsPuzzlesWord puzzles

Newspaper cancellation tasks

Last letter cancellation

For right hemiparesis

Wall fixation Slide19

Large Saccadic TrainingDynavision and similar training devices

http

://dynavisioninternational.com

/

Head and eye shifts

Descriptive walking

Search Strategies

Large Table Cards

Wii TennisSlide20

Visual FieldsThe part of space where objects can be seen in the peripheral even though the person is fixating their gaze on one single object ahead of them.

Broken in nasal (medial) and temporal (lateral) hemi fields

Temporal (lateral) hemi field is much largerSlide21

Central Field Also called peripheral field

Highly

detailed area of the

retina

5° around

fixation point

Responsible for

Detailed

vision

Reading

Recognizing faces

Detecting colors

Highly sensitive to light

Low sensitivity to motionSlide22

Peripheral FieldThe total area around central visionBecomes a secondary visual process to central vision.

This process is then used as general spatial orientation system and is integrated into the sensory-motor feedback loop

Characterized by:

High sensitivity to movement

Low sensitivity to light and detailSlide23

Visual FieldWNL: 50°-60° upward

70°-75° downward

60°

nasally/medial

90°-110°

temporally/laterallySlide24

Field Loss vs. Visual NeglectPhysical loss of visual field to one

side

Decreased Perceptual field

Also Called:

Homonymous

hemianopsia

Attention impairment where pt. is unable to attend to one side of their

body

Also Called

Hemi-spatial neglect

Hemiagnosia

Hemi-neglect

Unilateral neglect

Hemi-inattention

Unilateral visual inattention

Neglect

syndrome

Visual Field Loss

Visual Neglect

Pt. with both have a worse prognosis for recovery, due to difficulty learning to compensateSlide25

How Lesions Effect the Visual Field

Level 1 lesion- Can lose sight fully in one eye

Level 2-4 lesions – Cortical blindness

Treatment: Compensate- NOT regain functionSlide26

Visual Field Loss TreatmentDetermine available range

Use of target localization tasks to train

them

to make large eye movements and systematic scanning strategies

Incorporate efficient

ROM/head

turning training with PT and OT treatment

Use of visual/auditory anchors

Colored electric tape on table edges, doorways (red for left, green for right)

Placing objects that provide auditory feedback on the affected side (alarm

clock,

phone)

Appropriate challenge

only (Safety first)

Compensate first to reduce stress

Grade

activities up as skill increasesSlide27

Visual Field Loss or CutAssessment

Have pt. cover one eye and fixate on an object in front of them

Stand behind

them

with a long wand

Ask them to tell you when they see something in their field of view and slowly

bring the wand into

their

view from behind them at various angles, including:

top, bottom, horizontal, diagonal approach to test each quadrant.

Present target multiple times to confirm deficit.

Be cautious not to let

them

see your arm move because they may guestimate when they will see the wand based on

your body movement

Repeat with other eye and both eyes together

Scoring

WFL: They see wand within appropriate degree measures

Impairment:

They don’t see the wand in their peripheral field within the specified degrees. Slide28

Importance of assessing patients with neurological involvement for visual neglectVisual-spatial neglect has been reported in:

up to 82% in right hemisphere strokes and

65% of left hemisphere strokes.

Yet, by using the cross-out task only as an assessment tool, neglect was found in:

only 25% of right hemisphere strokes and

2% of left hemisphere strokes. Slide29

NeglectSlide30

Visual Field Loss Treatment

SLP’s

Targets:

Communication targeting – identification of object/picture/word/paragraphs – midline, right, left

Impacts swallowing treatment ex: ability to recognize labial loss, pocketing,

etc

; Neck posturing

Cognition - Attention, focus, safety judgement – Fixation and Saccadic

Eye Movement

Training

Social interaction- pragmatics – eye contact, turn-taking

More – think in and out of the boxSlide31

Visual Field Loss TreatmentPT

Examples:

Mobility training

Safety awareness

Central and Peripheral training

Head

and eye turns with gait

retraining

Postural/Trunk midline positioning

Balance

Car

scanning

More – think in and out of the boxSlide32

Visual Field Loss TreatmentOT Examples:

Activities of daily living – Dressing, self-feeding, toileting

Safety awareness

Body awareness in transfers, dressing

Reach/Extension

Independent living skills

S

tore scanning/shopping

Money Management

Driving

More – think in and out of the boxSlide33

Technologies:Interactive Metronome

DynaVision

Visual Restoration Treatment

Prism glasses – specialized

opthomologist

neuroophthomologistsSlide34

Visual Neglect TreatmentIncrease awareness of deficits

Self grading

Have client grade how they think they will perform

How long will it take?

What percentage will you get correct?

Do you understand the activity?

Will you need to ask more questions?

What might effect your performance

Have client re-grade themselves after they’ve completed the taskSlide35

Visual Neglect Treatment Ideas

Red Velcro Strip

Red guides on side of page

Tracking printed words from book on tape

Vibrating pager -

Set to vibrate on effected side every 12 seconds

Place items on effected side and have patient look for them and retrieve them.

Marking each box of a grid with a X

Money counting

Checker Board

Have patients manipulate tokens vertically and horizontally across boardSlide36

Visual Neglect TreatmentUse of stimuli known to activate the affected side of the brain

Left brain: use letters and numbers

Right brain: use shapes and blocks

Environmental modifications at home

Incorporate motor movements of the affected side

PT: clenching and unclenching affected hand during gait retraining

OT: Use the affected arm as a perceptual anchor for full visual field scanning during performance of ADLsSlide37

VergenceEye teaming – or using both eyes together efficiently

Eye teaming is a reflex related to accommodation

Accommodation

- eye’s ability to automatically change focus from seeing at one distance to seeing at another

.

Convergence – with accommodation

Divergence – relaxation of accommodation

This reflex allows object fuse into single and clear, both at a distance and near.

Impairment of

vergence

leads to:

Dioplia

, or double

vision

Confusion

Phorias

- misalignment of eyes

Strabismus – noticeable eye turns in or out

Suppression- the brain ignores all or part of an image in order to avoid

dioplia

Amblyopia – brain disregards most information coming from one or both eyesSlide38

Convergence The eye’s

ability to turn inward. People with convergence insufficiency have trouble with near tasks such as reading and frequently report eye strain and blurred vision

.

Assessment

Hold a colorful target approximately 16 inches away from the

pt’s

nose

Instruct the

pt

to keep there eyes on the target as it moves closer to them and to tell you when they see double.

Slowly move the target towards the

pt’s

face.

Observe the

pt’s

eyes to see when one of the deviates from the target, signifying the point where the

pt

should see double.

Scoring

WNL: deviation when target is 3-4 inches from

pt’s

nose

WFL: deviation when target is 4-6 inches from

pt’s

nose

Impaired: deviation when target is more than 6 inches from

pt’s

nose. Slide39

Convergence TreatmentBrock String

A white string approx. 10-15 ft. long with three beads of various colors

Tie one end of string to a stationary objects such as a door knob of cabinet

Have pt. hold the other end at the tip of their nose

Method 2

Bead positions

six

inches, 18 inches and four feet from the loose

end

Push gaze to focus on first bead. Strings should cross

Hold for 10 seconds

Repeat on 2

nd

and 3

rd

beads

Repeat entire process 5 times

Method 2

Place 1

st

bead at the place of double vision

Place 2

nd

bead at the place of single vision

Have patient focus on each

Method 3

See treatment hand outsSlide40

Convergence TasksJump Convergence

Give patient two

different color pencils and

position them approx. 5

feet in front of a

blank wall

.

Have pt. hold

one pencil in

left

hand with

their arm

fully extended in front of

the

face

.

Hold

the other pencil

right hand and position midway

between

pt.’s

nose and the other pencil.

Look

at the pencil that is further away.

Pt . should

see the closer one in double.

Look

at the closer pencil.

Pt. should

see the further pencil in double

Have patient bring both pencils closer to their face and look

at each of them again. Repeat this exercise until patient is unable to avoid double vision when looking directly at one of the pencils.Dotted CardDraw a straight line in the across the middle a sheet of paperDraw 5 or more dots equally spaced along the line with different color inksPosition the paper

in front of

pt’s

face so

that the line extends outward

so they can see

the dots on the line.

Have pt. look

at the furthest dot for 10 seconds.

The

rest of the dots should form a blurry

letter

A.

Move

to the next closest

dot, while maintaining

a single image of the furthest dot.

Focus on the second farthest dot for 10.

Continue

moving closer, looking at each dot for

10

seconds until

the

pt

can no longer maintain a single image of the dot

they are focusing on.

The

blurry A shape should gradually transform into a blurry V-like shape as

the pt.

focus on points that are closer to

their

nose

.Slide41

DivergenceAssessment

Position

pt

in front of your left side, where they can look over your shoulder.

H

ave pt. look at a pencil topper approx. 6 inches in front of them.

Next have

pt

look at an object behind you.

Observe how the

pts

eyes turn in and out between convergence and divergence.

Repeat with

pt

positioned on right side.Slide42

Divergence TreatmentDivergence

“Dynamic divergence”

http://www.forbestvision.com/eye-exercises-for-myopia-dynamic-divergence

/

Divergence & convergence /fusion

Use

ipad

http://www.forbestvision.com/dynamic-fixation-trainer-fusion-in-divergenceconvergence/Slide43

Ocular AlignmentAlignment is crucial to coordination/function of both eyes. If unaligned, pt. may experience double vision, vertigo, etc.

Assessment

Sit directly in front of pt. at midline. Instruct pt. to look into your eyes.

Shine pen light between pt.’s eyes from 16-20 inches away

Observe if the reflections in pt.’s eyes are in approximately the same positions.

Scoring

WFL: light reflects in the same position in each eye (typically in the center of each pupil)

Impaired: light reflects in different position in each eye (strabismus of one or both eyes)Slide44

Ocular Range of MotionAssessmentHold a stick with a bead on top approximately 16-20 inches from

pt’s

face.

Instruct

pt’s

to keep their eyes on the bead everywhere it goes while keeping their head still

Move bead through the horizontal, vertical, and diagonal planes, holding 5 seconds between each movement.

*slow and steady*

Observe the

pt’s

eye movements to see if they complete

the full range or if

their eyes

drift instead

Repeat with each eye individually and together

Scoring

WFL: Able to follow target through full range

Impaired: if pt. is unable to follow beadSlide45

Smooth Pursuits

Movements that allow the image to stay in focus on the retina while tracking a moving target.

Quality of ROM

Assessed in conjunction with ROM

During ROM assessment:

Observe

the

pt’s

eye

movements. Do they jerk

, shake, or have

erratic/ballistic

movements.

Scoring

WFL: Movements are smooth while tracking bead

Impaired: Eyes jerk, have

nystagmus

(shaky movements) or move erratically. Slide46

Treatment for Alignment, ROM and Smooth Pursuits

Medication

Surgical

SLP treatments

Acquired alignment impairments are different from congenital deficits.

If problem is due to muscle imbalance,

begin eye exercises,

s

uch as ROM exercises

If problem is due to double vision

occlude the affected eye **

Begin fusion exercises

Place an object where the

pt

can see it without double vision, then slowly move the object into the

pt’s

double vision range.

Adaptation of lifestyleSlide47

Treatment for Alignment, ROM and Smooth Pursuits Therapist’s

Role:

Visual tracking exercises

Move head with eyes stable

Move eyes with head stable

Complete exercises with eyes closed

Turn head right and scan left, and vice versa

Grid searches

Follow lines on ceilings and walls

Track

people walking

pen lightSlide48

Visual Spatial SkillsSkills used to understand directional concepts in spaceSigns and Symptoms

Difficulty distinguishing left and right

Lack of coordination and balance

Reverses letters or numbers when writing or copying

Does not cross midline when doing tasks

Gets lost following directionsSlide49

Visual OrientationLaterality:

Awareness

of

the two

body sides and knowing they are different.

Directionality

A

wareness of up, down, ahead, behind, and any combination there after

Consists

of two orientations:

Internal Self

Awareness

i.e

. left and right

hands

Projection

into the external visual space

i.e. Understanding the difference between the left and right side of the room.

** If

a

pt’s

internal self awareness is impaired, their concept of external visual space will also be impaired

. **Slide50

Visual Orientation AssessmentAsses

pt’s

awareness of left, right,

up, down, ahead,

behind with both auditory and visual tasks.

Reading of minimal pairs with graphemes that have similar orthographic representations.

i.e. ben, den, pen,

qen

If visual orientation is impaired letter decoding will be impaired.Slide51

Visual Orientation Tx

Incorporate:

sequencing,

auditory comprehension

r

eading comprehension

upper

extremity movement with laterality

Encourage crossing of midline

Examples:

Catch and throw a ball with the left and right

hands

Look left – look right

Place all the red items on your left and yellow ones on the right

Go down the hall and turn right and tell me what picture is on the leftSlide52

Bilateral IntegrationAbility to use both sides of the body separately and/or simultaneously

i.e. typing, walking

Must have a solid visual orientation foundation

Using both hands to put on a shirt Slide53

Visual Analysis/ Visual DiscriminationAbility to identify, sort, organize, store, and recall information from visual stimuli.S/S

Literacy Impairment

Easily distracted

Attention Impairment

Difficulty understanding directions/ sequencing

Includes:

Figure Ground

Visual Form Recognition/ Discrimination and

Constancy

Visual

Closure

Visual Spatial

Memory

Visual Sequential

Memory

Visualization Slide54

Figure GroundAbility to attend and search for specific visual information or ignoring irrelevant information.

i.e

searching for a specific word or sentence in a paragraph, specific tool in the tool box, or railing in a bathroom.

Treatment examples:

Hidden picture puzzle

Where’s Waldo puzzle

Word Search

Cancellation

exercises

App:

http://

tactustherapy.com

/app/vat/Slide55

Visual Form Recognition/ Discrimination and ConstancyAbility to discriminate differences in form including size, shape, color and orientation

i.e

CAT= Cat = cat; (Which one is lower case?)

Which is more water? The water in the glass or the water in the bowl?

Of these 2, which is larger?

Treatment examples:

Tetris

Recognition of word similarities with variation of orthographic forms

i.e. Horse = HORSE = horseSlide56

Visual ClosureThe ability to recognize visual stimuli which cues the

pt

to determine what an object or word should look like.

i.e. Being able to complete a word or picture that is partially obstructed, such as words on a road sign or pictures on a warning sign.

Treatment examples:

Trail making with dots, letter, numbers, or words

Choose the missing piece given F:3Slide57

Visual Spatial MemoryAbility to recall the spatial location of an object or stimuli. The ability to be able to recall, identify, or reproduce a design or dominant feature of an object. Example: Being able to picture a lost object; seeing a printed word and developing a mental picture to the corresponding object.

Treatment examples:

Memory

Card

Game,

Reduplication of bicolored block designs without a visual referenceSlide58

Visual Sequential MemoryAbility to view and recall a sequence of numbers, letters, objects in the order they were presented.

i.e

recalling a phone number, how to spell a medication name, or dosage instructions.

Treatment example:

Electronic

S

imon SaysSlide59

Visualization Ability to mentally manipulate a previously viewed stimuli. i.e. deciding if a flattened box will fit an object you want to ship, if a walker will fit through a doorway, or if there is enough room to safely stand up between the chair and a supportive surface (table, grab bar, therapist)

Treatment examples:

T

angram puzzles

Pegboard

Functional mobility around hospital, office, home with prompts to check visualization accuracySlide60

Visual Midline Shift Syndrome“mismatch between spatial information received through ambient visual process and kinesthetic, proprioceptive, and vestibular system”

Ambient visual process

From the peripheral portion of the retina to the midbrain (sensory-motor loop) to occipital cortex (feed-forward)

Responsible for body awareness in space

Results

in a tilt in the horizontal space causing balance

deficits

Visual MidlineSlide61

VMSS AssessmentPatient position: sitting or standing

Therapist:

Move an object horizontally in front of patient’s facial plane

Ask patient to tell you when it is directly in front of their nose

Move an object vertically in front of patient’s facial plane

Ask patient to tell you when it is directly at eye level

Result:

Perception to the left means visual midline has shifted to that direction resulting in right neglect

Perception of eye level when target is above eye level means there was a posterior shift resulting in backward lean

* Shift is typically away from neurologically affected sideSlide62

VMSS TreatmentNeuro-

opthamologists

Prescription of yoked prisms

Changes orientation, and concept of midline

OT

Performance of ADLs in sitting and standing position with yoked prism

PT

Gait retraining with yoked prism

Static and dynamic balance training in sitting and standing with yoked prismSlide63

VMSS TreatmentAllow patient success 70%-80% of the timeOT:

Parquetry blocks

Copy a pattern

Increase challenge by progressively increasing number of blocks

Puzzles

Discourage trial and error

Hidden picture puzzle

Highlight magazines to Where’s Waldo?

Complete the picture

TracingSlide64

VMSS TreatmentPT:Visualizing direction

Have

pt

give the therapist directions from point A to point B

Follow the directions (even if wrong)

Have the

pt

perform the task, then report it to therapy

Real life hidden picture

Teach scanning strategies during performance of taskSlide65

Visual-Motor Integration

Aka. Hand-eye coordination

Coordination of visual perceptual skills with gross and fine motor movements

i.e. Written word repetition

S/S

Poor organization

Poor awareness of mistakes

Sloppy writing

Close working distance

Treatment examples:

Interactive Metronome

Utilize visual stimuli

/ guides

RotationsSlide66

Visual-Auditory IntegrationVisual-auditory integration Visual-auditory integration involves correlating visual information with information heard. i.e. such as seeing a word and saying it aloud, or hearing a word and writing it down.

Involves auditory

and

visual skills in: Attention,

Discrimination, Memory, Figure ground, and Closure

Signs and symptoms:

Slow reading speed

Requires frequent repetition of directions

Poor spelling ability

Difficulty learning to read phonetically

Difficulty relating phonemes to print symbol. Slide67

Missing things on one side

Hemi neglect

and/or field cut

Head turn to one side

Hemi neglect and/or field cut

Head tilt

Restriction of gaze

(usually superior oblique),

nystagmus

or

Double

Vision

Closing one eye intermittently

Double

Vision

Closing

one eye all the time

Oculomotor

nerve (CN III) palsy

Squinting in the distance

Distance acuity, double vision, divergence insufficiency

Headache when watching TV

or words getting jumbled up when completing activity close to

pt

Convergence insufficiently,

near acuity, decreased saccadic movementSlide68

Eyes asymmetrical

Double vision, restriction of gaze,

erratic tracking

Excessive blinking

Convergence insufficiency, distance/near acuity

Difficulty identifying faces

Distance acuity ***

Over/under shoots when reaching for an item

Double vision

Pushing toward weaker side

Visual midline shift

Dizziness with tracking

Erratic Oculomotor skills

Unable to track laterally past

midline

Abducens

nerve (CN VI) palsy,

double vision

Keeping eyes

closed

Decreased visual attention, double vision, eye strain, contrast sensitivity issuesSlide69

Documentation for vision treatmentsDiscipline specific goalsOT: Complete ADLs

PT: Balance, Stand, Walk

ST: Communicate, Read, Think

Keep the goals you

are doing

, but add the modality and facilitation of the vision prior to and throughout the task. Slide70

ResourcesInformation on hemianopsia

and visual neglect

www

.

Hemianopsia.net

Trail Making App

https://www.apptweak.com/trail-making-test/ipad/australia/en/app-marketing-app-store-optimization-aso/report/

689951658

Visual Perceptual/

O

cular

M

otor activities

https://www.pinterest.com/kirstenot/ot-visual-perception-ocular-motor-activities

/