Transcript Vision MESPA Handout

+
"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 Largo
+
Terminology

Tracking- 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.
+

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 outward
rhythmic oscillations or tremors of the eyes
+  Nystagmuswhich occur independently of the normal eye movement

Occlusion- 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 noncorresponding 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.
+
Extra Ocular Muscles
Visual Pathway
+
+
Visual Pathway
+
Scope of practice: ST



According 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)
+
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 nonoptical 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 nonoptical devices)
+
Scope of practice: PT

Examining individuals with impairment, functional limitation,
and disability or other health-related conditions.

Tests 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 interventions
+
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).

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.

Input 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 movement
+
Fixation Treatment

Activities 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 – Staring contest … 1.2.3 GO!

Use bright colors and familiar objects

Reduce stimulation in environment

Provide postural stability
+
Saccades

Definition: 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, selffeeding, writing

Impaired safety
+
Saccades

Assessment

Hold 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 gaze
+
Saccades Treatment

Have 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 targets
+
Column Activity
3
5
7
8
2
9
6
1
4
7
5
1
9
6
3
7
Try anything alternating
• i.e. words, colors, names, objects
+
Trail Making Activity

25 circles distributed over a sheet of paper

Explain and demonstrate task on a separate sheet of paper

Give a worksheet (Part A, then B)

Part A : circles are numbered 1-25


Part B : Circles are labeled with both 1-13 and A-L.


Direction: Draw a line to connect circles in ascending order
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)
+
Small Precise Saccadic Movements

Puzzles

Word puzzles

Newspaper cancellation tasks

Last letter cancellation


For right hemiparesis
Wall fixation
+
Large Saccadic Training

Dynavision and similar training devices

http://dynavisioninternational.com/

Head and eye shifts

Descriptive walking

Search Strategies

Large Table Cards

Wii Tennis
+
Visual Fields
The
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 larger
+
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 motion
+
Peripheral Field

The total area around central vision

Becomes 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 detail
+
Visual Field

WNL:

50°-60° upward

70°-75° downward

60° nasally/medial

90°-110° temporally/laterally
+
Field Loss vs. Visual Neglect
Visual Neglect
Visual Field Loss

Physical loss of visual field to
one side

Decreased Perceptual field
Attention impairment where
pt. is unable to attend to one side
of their body



Also Called:

Homonymous
hemianopsia
Pt. with both have a worse
prognosis for recovery, due to
difficulty learning to
compensate
Also Called

Hemi-spatial neglect

Hemiagnosia

Hemi-neglect

Unilateral neglect

Hemi-inattention

Unilateral visual
inattention

Neglect syndrome
+
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 function
+
Visual Field Loss Treatment

Determine 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 increases
+
Visual Field Loss or Cut

Assessment






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.
+ Importance of assessing patients with
neurological involvement for visual neglect
 Visual-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.

+
Neglect
Most
severe
• Personal – their own body
awareness
Moderately
severe
• Peri-personal – Their world
within arms reach
Least
severe
• Extra-personal – The world
beyond arms reach
+
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 box
+
Visual Field Loss Treatment
PT 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 box
+
Visual Field Loss Treatment
OT
Examples:
 Activities
of daily living – Dressing, self-feeding,
toileting
 Safety awareness
 Body awareness in transfers, dressing
 Reach/Extension
 Independent living skills
 Store scanning/shopping
 Money Management
 Driving
 More – think in and out of the box
+
Technologies:
Interactive
Metronome
DynaVision
Visual
Prism
Restoration Treatment
glasses – specialized
opthomologist neuroophthomologists
+
Visual Neglect Treatment
 Increase
 Self
awareness of deficits
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 task
+ 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

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
seconds

Have patients manipulate tokens vertically and horizontally across
board
+
Visual Neglect Treatment
 Use
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 ADLs
+
Vergence

Eye 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 eyes
+
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.
+

Convergence Treatment
Brock 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 2nd and 3rd beads

Repeat entire process 5 times
Method 2

Place 1st bead at the place of double vision

Place 2nd bead at the place of single vision


Have patient focus on each
Method 3

See treatment hand outs
+
Convergence Tasks

Jump 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 Card






Draw a straight line in the across the middle a sheet of paper
Draw 5 or more dots equally spaced along the line with different color inks
Position 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.
+
Divergence
Assessment
 Position
pt in front of your left side, where
they can look over your shoulder.
 Have 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.
+
Divergence Treatment
 Divergence
 “Dynamic
divergence”
 http://www.forbestvision.com/eye-exercisesfor-myopia-dynamic-divergence/
 Divergence
 Use
& convergence /fusion
ipad
 http://www.forbestvision.com/dynamicfixation-trainer-fusion-indivergenceconvergence/
+
Ocular Alignment

Alignment 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)
+
Ocular Range of Motion

Assessment

Hold 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 bead
+
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.
+
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, such 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 lifestyle
+
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 light
+
Visual Spatial Skills
 Skills
used to understand directional concepts in
space
 Signs





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 directions
+
Visual Orientation

Laterality:


Directionality


Awareness of the two body sides and knowing they are different.
Awareness 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. **
+
Visual Orientation Assessment
 Asses
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.
+
Visual Orientation Tx

Incorporate:

sequencing,

auditory comprehension

reading 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 left
+
Bilateral Integration
Ability
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
+
Visual Analysis/ Visual
Discrimination


Ability to identify, sort,
organize, store, and recall
information from visual
stimuli.

Includes:

Figure Ground

Visual Form Recognition/
Discrimination and
Constancy
S/S

Literacy Impairment

Visual Closure

Easily distracted

Visual Spatial Memory

Attention Impairment

Visual Sequential Memory

Difficulty understanding
directions/ sequencing

Visualization
+
Figure Ground

Ability 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/
+
Visual Form Recognition/
Discrimination and Constancy

Ability 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 = horse
+
Visual Closure
 The
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:3
+
Visual Spatial Memory

Ability 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
reference
+
Visual Sequential Memory

Ability 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 Simon Says
+
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:

Tangram puzzles

Pegboard

Functional mobility around hospital, office, home with prompts to
check visualization accuracy
+
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 Midline
+
VMSS Assessment

Patient position:


Therapist:





sitting or standing
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 side
+
VMSS Treatment

Neuro-opthamologists

Prescription of yoked prisms


OT


Changes orientation, and concept of midline
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 prism
+
VMSS Treatment

Allow patient success 70%-80% of the time

OT:





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
Tracing
+
VMSS Treatment

PT:


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 task
+
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
Rotations
+
Visual-Auditory Integration

Visual-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.
+
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
movement
+
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 issues
+
Documentation for vision
treatments


Discipline specific goals

OT: 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.
+
Resources

Information on hemianopsia and visual neglect


Trail Making App


www. Hemianopsia.net
https://www.apptweak.com/trail-makingtest/ipad/australia/en/app-marketing-app-store-optimizationaso/report/689951658
Visual Perceptual/Ocular Motor activities

https://www.pinterest.com/kirstenot/ot-visual-perception-ocularmotor-activities/