NBCOT Ch. 5 Vision & Cognition: Assessment & Intervention – Flashcards
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Age-related macular degeneration (ARMD or AMD)
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1. Dry: drusen deposits form in the retina, increasing in number for form scotomas in macula, 2. Wet: abnormal vessel growth under the retina; the vessels leak fluid, causing damage to cells of macula.
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Astigmatism
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A condition in which the cornea is oval instead of round. Light rays converge at more than one point of focus
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Diabetic retinopathy
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Bleeding from small blood vessels in retina can lead to serious vision loss. One can develop: scotomas, decreased contrast sensitivity, dec'd color discrimination, dec'd night vision & fluctuations in vision.
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Fixation
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The process of locating and focusing on an object on the fovea; foundation of oculomotor control
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Fovea
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Center 10* of visual field; responsible for identifying details.
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Visual acuity
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The ability to recognize small details of the object; allows for speed and accuracy in processing what is seen; also aids in decision making.
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Glaucoma
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1. Acute narrow angle glaucoma (closed angle glaucoma): acute episode a. Severe redness, pain in eye, headaches, nausea. 2. Chronic open angle glaucoma (COAG): chronic episode a. Most common type, b. Decreased visual acuity and peripheral fields; light sensitivity in some cases, no pain
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Hyperopia
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Farsightedness; difficulty seeing close objects when light rays are focused on a point behind the retina.
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Legal blindness
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1. A visual acuity of 20/200 or less (in the better eye with the best optical correction), 2. A visual field of 20* or less in the best eye.
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Macula
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Area of the retina that is the area of best vision.
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Myopia
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Nearsightedness; the condition in which parallel rays of light are brought into focus in front of the retina, rather than on it
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Normal limits of visual field
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Superior 60*; inferior 75*; nasal side 60*; temporal side 100*.
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Presbyopia
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Age-related loss of accommodation.
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Retina
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Multilayer, sensory structure for the eye that contains rods and cones; initiates impulses to visual cortex via the optic nerve.
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Saccadic eye movement
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Quick eye movements that change the fixation from one point to another and allow us to redirect our line of sight.
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Smooth pursuits/tracking
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Those eye movements that maintain continued fixation on a moving target.
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Esophoria
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Tendency for the eye to turn inward when both eyes are fixating on ab object; controlled by fusion.
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Esotropia
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Inward deviation of the eye when the other is focusing on an object.
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Exophoria
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Tendency for the eye to turn outward when both eyes are fixating on ab object; conrolled by fusion.
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Exotropia
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Outward turning of the eye when the other is focusing on an object.
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Extinction
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Lack of awareness of one object when objects are presented in both sides of the body at a time, even though they are recognized when presented individually.
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Generalization
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The ability to apply learned compensatory strategies to new environments or situations; occurs with intact executive function and short-term memory.
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Hyperphoria
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Tendency for the eye to turn upward when both eyes are fixating on ab object; controlled by fusion.
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Hypokinesia
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Delayed movement of limb.
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Hypometria
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Decreased amplitude of movement.
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Hypotropia
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Downward turning of the eye when the other is focusing on an object.
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Impersistence
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Difficulty sustaining movement of posture.
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Limb akinesia
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Absence of ability to move limb.
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Motor preservation
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Difficulty ending movement.
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Accommodation
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Ability of the eye to adjust focus of vision at different distances.
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Convergence
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Ability to maintain focus as an object moves towards you; eyes move medially toward nose.
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Divergence
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Ability to maintain focus as an object moves away from you; eyes move laterally away from nose.
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Diplopia
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Double vision; occurs when the fovea of both eyes are not aligned on the same target, so the brain is not able to fuse the image.
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Optic nerve
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Carries the picture to the brain for interpretation.
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Cranial nerves impacting vision
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1. Optic nerve- II 2. Oculomotor nerve- III 3. Trochlear nerve- IV 4. Trigeminal nerve- V 5. Abducens nerve- VI
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Visual perceptual hierarchy
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1. Foundational skills: a. Oculomotor control b. Visual field c. Visual acuity 2. Intermediate-level skills: a. Attention b. Scanning or visual search c. Pattern recognition 3. Advanced-level skills: a. Visual memory b. Visuo-cognition.
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Cataracts
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Cloudiness of the lens of the eye; decreased acuity; progressively blurred vision; both central and peripheral; glare sensitivity; near vision may be better than distance vision.
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Hypophoria
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Tendency for the eye to turn downward when both eyes are fixating on ab object; controlled by fusion.
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Hypertropia
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Upward turning of the eye when the other eye is focusing on an object.
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Snellen chart
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An assessment of visual acuity; measured by the ratio of the size of a letter a client can read over the distance their eyes are from the chart.
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Peripheral visual field
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All of the field except the fovea (center); responsible for identification of shape and form and movement in the environment; aids mobility.
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Confrontation testing
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A gross assessment of visual field; therapist brings in targets from different areas in the field & client indicates when targets are seen and their location.
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Central field assessments
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1. Damato 30-Point Campimeter: Portable test card that measures the central 30* of visual field; part of the Brain Injury Visual Assessment Battery for Adults (biVABA), 2. Pepper Visual Skills for Reading Test (VSRT): Functional test that indicates scotomas and their affects on function.
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Contrast sensitivity assessments
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1. Vistech contrast sensitivity chart (not portable), 2. Lea charts (portable, inexpensive), 3. Clinical observation list in biVABA
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Saccadic eye movements
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1. biVABA, 2. VSRT, 3. Hold two different targets 16 inches from clients face and approx 8 inches apart; ask client to look from one to the other when verbally cued; repeat 10 fixations (5 cycles).
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Divergence assessment
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Place target near clients bridge of nose; slowly move target away from nose; observe eye movements; client indicates if/when two targets are seen.
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Convergence assessment
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Place target 16 inches away from clients bridge of nose; slowly move target towards nose; observe eye movements; client indicates if/when two targets are seen.
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Visual attention assessments
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1. Cancellation tests 2. biVABA 3. Figure and shape copying tests, line bisection test
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Apraxia (motor)
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Inability to carry out a movement even though the sensory system, muscles, and coordination are intact. INTERVENTION: (same as for ideomotor apraxia) a. Utilize general verbal cues as opposed to specific b. Decrease manipulation demands c. Provide hand over hand tactile-kinesthetic input d. Utilize visual cues
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Ideational apraxia
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Difficulty with sequencing steps within a task. INTERVENTIONS: a. Provide step by step instructions b. Use hand over hand guiding techniques c. Provide opportunities for motor planning & motor execution.
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Ideomotor apraxia
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Production error; can use tools but appears awkward or clumsy. INTERVENTION: (same as for apraxia (motor)) a. Utilize general verbal cues as opposed to specific b. Decrease manipulation demands c. Provide hand over hand tactile-kinesthetic input d. Utilize visual cues
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Agnosia
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Impairment in the ability to recognize and identify objects using only visual means; caused by lesions to the right occipital lobe
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Color agnosia
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Inability to recognize or remember specific colors for common objects.
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Color anomia
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Inability to name the specific color of objects.
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Object agnosia
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Inability to recognize objects using only vision.
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Metamorphopsia
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Visual distortion of objects although they might be recognizable to the client.
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Prosopagnosia (facial agnosia)
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Inability to recognize a known face or individual.
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Simultanagnosia
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Inability to recognize and interpret an entire visual array (more than one thing) at a time; usually due to damage to the right hemisphere.
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Visual spatial perception (AKA visual discrimination)
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The ability to distinguish the space around one's body, objects in relation to the body and environment, and the relationship between two objects in the environment.
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Figure ground
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Ability to recognize the foreground from the background based on differences in color, luminance, depth, texture, or motion.
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Form constancy or discrimination
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The ability to distinguish a form, shape, or object despite its location, position, color or size.
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Spacial relations (position in space)
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Ability to perceive the position of one's self in relations to objects in the environment.
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Depth perception
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The ability to judge distances and depth.
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Stereopsis
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The ability to see things in three dimensions; lack of this can affect depth perception and makes the environment appear flat.
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Topographical orientation
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The ability to navigate from one place to the next; requires ability to determine current location, goal locations, and problem solving to implement an action.
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Stereognosis
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Ability to identify everyday objects using their tactile properties and no vision.
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Graphesthesia
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Ability to identify forms, numbers, letters written on hand.
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Autotopagnosia
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Inability to identify body parts on self or someone else or the relationship between parts.
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Finger agnosia
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Inability to recognize which finger was touched or is being used.
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Anosognosia
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Lack of recognition or awareness of one's deficits.
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Right/left discrimination
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Ability to identify, discriminate, and understand the concept of right and left; can be affected by short-term memory, aphasia. INTERVENTION: a. Utilize activities that challenge underlying spatial skills. b. Utilize tasks that require discrimination of right/left.
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Metacognition
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The ability to choose and use specific mental skills to complete a task.
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Executive function
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Higher level cognition, higher order thinking abilities; involves decision making, planning, sequencing, and executing. INTERVENTION: a. Use external cues (eg. written directions, daily planners). b. Grade tasks that are increasingly complex in terms of # of steps required.
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Dyscalculia
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Inability to solve a simple problem; includes dyslexia and dysgraphia.
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Occipital lobe
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Contains visual cortex; scanning; identification of objects; awareness, and discrimination.
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Frontal lobe
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Planning, problem solving, organizing, attention, appropriate behavior, and initiation of movement.
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Parietal and temporal lobes
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Right parietal: visual spatial relations, Left parietal: understanding spoken and written language. Right temporal: visual discrimination/recognition and memory, Left temporal: verbal memory.
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Thalamus
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Eye movement; integration of visual and cognitive information.
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Cerebellum
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Eye control and coordination.
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Brainstem
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Has the cranial nerves running through it; protective eye responses.
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Hemi-inattention
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Decreased search to left field; right hemisphere deficit. INTERVENTIONS: a. Provide bilateral activities b. Guide the affected side through the activity c. Increase sensory stimulatioin to the affected side.
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Visual inattention
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Both visual field loss and hemi-inattention; may be referred to as visual neglect; right hemisphere deficit.
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Left hemisphere deficit
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Focus is on details; difficulty identifying objects; apraxia is more common vs. rt. hemisphere deficit.
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Right hemisphere deficit
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Focus is on whole; visual spatial perception disorders; hemi-inattention; visual inattention.
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Allen Cognitive Level test (ACL-90)
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Format: Task analysis of a standardized visual-motor task. Purpose: is a brief screening test to estimate the client's cognitive functioning & capacity to learn & to guide treatment goal setting. Subject is scored on the cognitive level (1 to 6) & receives a score between 3.0 - 5.8 according to completion of stitches & method described by author. Population: Adults w/psychiatric illness, cognitive impairment following TBI, dementia.
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Allen Cognitive Level 6
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"Planned action" Scoring: Able to imitate single cordovan stitch using covert (mental) trial & error absence of disability. Able to plan ahead to avoid mistakes.
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Allen Cognitive Level 5
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"Exploratory actions" Scoring: Able to imitate a single cordovan stitch using overt (pysical) trial & error; 3 stitiches. New learning occurs. May be typical level of function for 20% of population.
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Allen Cognitive Level 4
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"Goal directed actions" Scoring: Able to imitate whip stitch; 3 stitches. Ablility to carry out simple tasks to completion. Relies heavily on visual cues. May be able to perform established routines but cannot cope w/unexpected events.
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Allen Cognitive Level 3
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"Manual action" Scoring: Able to imitate running stitch; 3 stitches. Uses hands to manipulate objects. May be able to perform a limited # of tasks w long-term repetitive training.
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Allen Cognitive Level 2
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"Postural reaction" Scoring: Unable to imitate running stitch Movement is associated with comfort. Some awareness of large objects in environment may assist caregiver with simple tasks.
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Allen Cognitive Level 1
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"Automatic action" Scoring: Automatic motor responses & changes in ANS. Minimal conscious response to external environment.
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Erhardt Developmental Vision Assessment (EDVA) & Short Screening Form (EDVA-S)
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This test is designed to evaluate visuomotor development and identify delays, gaps in skill sequences, and inappropriate patterns.
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Brain Injury Visual Assessment Battery for Adults (biVABA)
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This battery identifies functional limitations resulting from visual impairment. The series of eye and visual tests includes papillary response, oculomotor performance, eye dominance, visual attention, visual search, acuity, reading acuity, contrast sensitivity, and visual fields.
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Drivers Vision Screener
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This single machine tests several visual skills, including acuity, color perception, depth, phorias, horizontal peripheral fields, and night vision.
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Lea Test System
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The cards measure static visual acuity or contrast sensitivity using numbers or letters as targets to avoid issues of literacy or language barriers.
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Visual Functioning Assessment Tool
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This battery assesses the student's visual functioning in educational settings; It yields relative strengths and weaknesses as a baseline for the individualized education plan.
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Anomia
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Loss of ability to name objects or retrieve names of people.
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Brocha's aphasia
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Loss of expressive language indicated by a loss of speech production. INTERVENTION: a. Decrease external auditory stimuli b. Give the individual increased response time. c. Use visual cues & gestures d. Use concise sentences e. Investigate the use of augmentative communication devices.
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Wernicke's aphasia
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A deficit in auditory comprehension that affects semantic speech performance, manifested in paraphasia or nonsensical syllables. INTERVENTION: a. Decrease external auditory stimuli b. Give the individual increased response time. c. Use visual cues & gestures d. Use concise sentences e. Investigate the use of augmentative communication devices.
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Global aphasia
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The symptoms are those of severe Brocha's aphasia and Wernicke's aphasia combined. An almost total reduction of all aspects of spoken and written language in expression and comprehension.
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Perseveration
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The continuation or repetition of a motor act or task. INTERVENTION: a. Bring perseveration to a conscious level & train the person to inhibit the behavior. b. Redirect attention c. Engage the individual in tasks that require repetitive action.
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Acalculia
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The acquired inability to perform calculations.
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Alexia
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The acquired inability to read
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Agraphia
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The acquired inability to write.
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Rivermead Perceptual Assessment Battery (RPAB)
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Tasks are designed to assess visual-perceptual dysfunction after a stroke or head injury; Utilizes deficit-specific tasks in isolation from ADL tasks.
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Mini-mental state examination (MMSE)
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Brief 30-point questionnaire test that is used to screen for cognitive impairment; commonly used to screen for dementia.
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Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)
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Utilized for persons who have experienced a stroke, TBI, or tumor. Measures basic cognitive functions that are prerequisite for managing everyday tasks. Consists of 20 subtests in 5 areas: orientation, visual, spatial perception, visualmotor organization, thinking operations.
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Cognistat Neurobehavioral Cognitive Status Examination
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Usually takes less than 45 min; Test explores, quantifies, and describes performance in central areas of brain-behavior relations: Level of consciousness, orientation, attention, language, constructional ability, memory, calculations, and reasoning.
