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Warrens Hierarchical model of visual processing (A.C.M.P.SAV)

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view of visual processing as a process of adaptation. Both bottom up and top down processing. visual processing occurs within a hierarchy of skills rather than series of independent skills. A disruption of any level of hierarchy will affect total structure of hierarchy

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Bottom of hierarchy

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foundation skills- acuity, visual field and oculomotor control

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second level up is

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attention=alert and attending

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3rd level up in hierarchy

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scanning

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4th level up in hierarchy

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pattern recognition

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6th level up in hierarchy

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visual memory

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7th level up in hierarchy

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visuocognition

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top of hierarchy

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adaptation through vision, ability to mentally manipulate visual information and integrate with other systems to solve problems, formulate plans and make decisions

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3 purposes of occupational therapy visual assessment

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1) to identify functional impairment 2) to link presence of functional impairment to presence of visual impairment 3) to determine appropriate treatment intervention based on results of assessment

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Treatment used with ABI patients

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lenses, compensatory prism, yoked prism, filters or tints, total occlusion, partial occlusion

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lenses

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improve clarity and sight, reduce or eliminate double vision, reduce visual discomfort or stress

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compensatory prism

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eliminate strabisumus condition, alleviate double vision, reduce head tilt or turn

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yoked prism

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alter clients spatial awareness modify midline perception, change weight shifting, may benefit field loss clients

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filter or tints

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decrease light sensitvity

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total occlusion

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double vision, used when double vision is constant and no other treatment is successful

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partial occlusion

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intermittent double vision, useful for non comittent strabismus, with double vision in certain cases

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pupillary response

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normally equal in size, crucial for accurate focusing of an image, should be assessed BEFORE ACUITY! abnormal= refer to neurologist or eye care professional

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visual acuity

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near visual acuity (at 16 inches) and distance acuity (at 20 feet) and central acuity which affects ability to distinguish small details, contrast and color

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Treating visual acuity impairment

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utilize enlarged print, control density of presented stimuli, contrast and lighting utilization, motion lights, computer software to zoom in

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contrast sensitivity

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contributes to the CNS's ability to detect and recognize objects

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treating contrast sensitivity

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different colors, make background contrast, decrease clutter, bright tape or paint on stairs/doors and cabinets, bright labels, light walls and dark furniture, write with bold tip pens and markers, avoid use of patterns

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ocular alignment

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crucial to coordinated function of both eyes. Motor system that moves eyes= 6 muscles and 3 cranial nerves per eye. AKA strabismus

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comitant strabismus

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if eye of strabismus remains relatively constant in all 9 positions of gaze

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treatment for ocular alignment deficit

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prisms, arom in direction of paresis, double vision=occlusion and activities to provide fusion by target

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visual field

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area of visual system that allows for orientation to specific spatial areas. Central visual field is the macular area thought to extend about 5 degrees around point of fixation. peripheral and central vision is required for full field

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Treatment for visual field deficits

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restorative and adaptive

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restorative for visual field

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wide head turns towards blind field, attention to and detection to visual detail on blind side, work on establishing effective search strategies , placing items on poor side, cueing(verbal, tactile), computer retraining

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adaptive for visal field

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develop awareness of deficit, place items with their field of vision, anchoring techniques, add color contrast to door frames and furniture

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oculomotor control

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controlling eye movements, bringing images to the fovea for processing, binocular vision

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binocular vision

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ensures perception of a single image even though CNS is receiving 2 images

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decreased oculomotor results in

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slower speed, control, and coordination of eye movements

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visual fixation

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voluntary act, focusing gaze on item

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treatment for visual fixation

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generally addressed with scanning, letter recognition through reading, work on fixating while sitting and laying down and progress to walking,

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saccadic eye movements

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sequenced rapid eye movements that change line of sight. pre-requisite for accurate localization of visual targets in space.

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treatment of saccadic eye movement Restorative

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exercises such as pointing to letters and calling out from two columns on either side of page, provide vestibular based movement activities in conjunction with demands for saccadic skills (roll around and identify number), computer retraining utilization software,

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adaptive for saccadic eye movements

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anchoring techniques during reading, control the density of information reading

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smooth pursuit eye movements

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being able to follow moving image or object across visual fields without compensatory head movements

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treatment for organized scanning deficits Restorative

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strategies to take in information in organized manner, functional activities requiring scanning, crossing out target letters,

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Adaptive tx for scanning deficits

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adaptations and cuing such as anchoring, pacing, controlling density or spacing visual stimuli, providing consistent feedback about performance and gradually decrease cues, educate about scanning deficit and how it might affect safety

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convergence

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nearest point the eyes can converge is called "near point convergence"

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treatment convergence or accommodation

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referral, no strategies for OT

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Accommodation

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ability to adjust focus of vision at different distances, age related and decreases with age.two types 1) dynamic (target changes distances) 2) static occurs after dynamic accommodation

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Diplopia

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double vision, near distance diplopia is within 20 inches of face, far is greater than 20 inches

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treatment for diplopia

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referral but might have to help carry out occulsions, prisms, partial occlusion, visual training

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visual inattention (neglect)

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most often result of Right brain damage, decreased awareness of body and spatial environment contralateral to cerebral lesion

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neglect versus heminopsia

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with neglect the pathways for sight are intact, but the pathways and substrates to ATTEND or perceive the sensory input are NOT intact (not a visual deficit, attentiional) whereas heminopsia the substrates and pathways for sight are NOT intact but the pathways to attend ARE

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visual inattention tx Restorative

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should only be used if client can be made aware of neglect deficit and how it is affecting, activity that stimulates reorganization or patients scanning patterns (arranging activities in L to R pattern), better to scan BROAD visual space and more effective to interact physically with target, practice search strategies within context, place items needed during treatment on neglected side, cue to look to unattended space, videotape client, computer training, CIT and NDT (weight shift and postual control), evaluation for prism

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adaptive for visual inattention

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approach used with client who is unable to be made aware of own deficit and cannot be taught new

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treatment ADAPTIVE for visual inattention

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increase awareness of visual inattention and how it will affect function, emphasize need for visual scanning, compensation with head turning, have client cue himself before activity, visual imagery (light house scanning)

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visual and vestibular processing

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ability to maintain ones balance and posture is outcome of these systems.

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nystagmus

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repetitive oscillatory to and fro movements of the eyes, involuntary, also complain of vertigo, tinnitus and problems with balance

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Tx for visual and vestibular processing Restorative

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exercises to improve gaze stability, activities that change speed, surface, postures and directions

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adaptive for vestibular/visual

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utilize visual, tactile and proprioceptive cues such as running hand down wall while walking down hallway, perform activity while standing still, take care of clutter

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opthamologist

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medical doctor in eye health

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optometrist

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receives 4 yr post grad training on diagnosis on treatment of eye disease, but focus is on function and how vision affects performance and QOL

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extinction

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phenomenon of neglect that occurs when stimuli are presented in both visual fields or sides of space at one time, and only one is reported. Whereas if presented to either side individually the client reports the stimulus

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focus of OT in low vision therapy

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training patient to use remaining vision as efficiently and effectively as possible to complete ADLs and includes training in use of optical devices

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general OT Low vision tx

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environmental adaptations, compensatory techniques, assisstive devices, client/family edu

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Environmental adaptations and factors for low vision

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lighting, contrast, color, pattern, print size, working distance

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True or False. OTs do not need specialized training and or supervision to train and recommend in low vision aids

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False

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anchoring

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supplying cues on affected side to indicate starting position

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