Professional Documents
Culture Documents
Vision
Jilianne Normandy
Vision
3 basic functions:
- Visual acuity
- Visual field
- Oculomotor control
(Gillen, 2009)
Deficits in the visual field produced by lesions at
various points in the visual pathway
(Gillen, 2009)
Visual impairments
- increased risk for falls
- May be limited in mobility
- May have significant reading deficits
- May display a higher prevalence of depression
- Inability to recognize faces
- Getting lost
- Driving problems
- Difficulties with ADLs
- Poor rehab outcome
- Cover test: focus on a central target, with one eye covered to see if uncovered eye can fixate
- Saccades test: alternate fixating between two objects at 6 inches apart and 16 inches from
bridge of nose to observe eye’s ability to rapidly and smoothly move between objects
- Tracking test: moving a pen light or target through 9 gaze positions to observe speed,
coordination, and ROM of eyes.
- H and O pattern
- Convergence test: moving a pen light toward the bridge of nose until it reaches point of
convergence, usually 3 inches from bridge of nose, to observe the eye’s ability to converge
- Target and fixation: patient visually locates and fixates on a target
Visual Screening
Perception
- Visual fields:
- Peripheral vision: have patient say “now” when they first see your glove on the left and
right side, as well as superiorly.
- Confrontation field test
- Adding fingers together
- Examiner will present one or two fingers randomly for 1 second duration to each
quadrant of the visual fields. The fingers are presented 18 inches away from the
client and at approx 20 degrees from the line of fixation
Visual Screening
Perception
- Hirschberg test:
- A screening test to assess whether a
person has strabismus
- Strabismus: ocular misalignment. A
visible turn of one eye and may result
in double vision. The person is unable
to keep the eye straight with the
power of fusion
Visual Screening
Visual attention and scanning evaluations
- 33% of all patients admitted at least one area of visual concern that interfered with ADL performance
- 55% of patients diagnosed with a CVA demonstrated visual concerns
- Out of 326 people with CVA’s: 68% had eye alignment or movement impairment, 49% had visual field
impairment, 27% had low vision, and 21% had perceptual difficulties
- Procedure
- Participant A: Participant B:
- Day 1: 18:58 min, FIM:3 - Day 1: 22:42 min, FIM:3
- Day 2: 10:29 min, FIM:4 - Day 2: 9:55 min, FIM:4
- Day 3: 14:50 min, FIM:4 - Day 3: 12:58, FIM:4
- Day 4: 8:44 min, FIM:5 - Day 4: 11:34 min, FIM:5
- Timed data and FIM scores indicated that increased lighting sources resulted in less time at a higher
functional level for grooming. This result suggests that increasing the amount of light may improved
performance of the occupation of grooming
- Findings:
- Visual function should be routinely assessed in acute care settings
- Lighting preferences (type position, power) should be considered as an adjunct to therapeutic intervention
- OT’s should consider lighting as a visual cue for visual-spatial neglect and visual field deficits
Visual Field Deficits
Functional training
Compensatory strategies
- Visual search strategies, including left-to-right for reading. Start in at the far end of the affected side,
use a circular pattern for larger scanning activities
- Large-scale eye movements for mobility and scanning in the environment
- Lighthouse
- Small-scale eye movements for reading and near tasks
- Increased head turns, especially into the affected area
Visual processing component skills training
Visual scanning or eccentric viewing strategies
- Scanning is an effective intervention to improve search skills when measured with a functional search
task
- Training strategies skills such as sweeping eye movements, timed visual tracking activities, scanning,
tracing exercises, repetitive writing exercises can help with reading and writing tasks for persons with
visual field deficits
- Scanning activities:
- word search
- connect the dots
- Reading
- Mazes
- Crossword puzzles
- Scavenger hunt
- Walk down a hallway and identify what is on the wall (or place sticky note with numbers or
letters on them)
Saccades impairment
Basic saccade exercise Alternate saccadic exercise
- Use two targets and an eye patch or - Use columns of numbers or letter on paper
occluder. Ask the patient to look back and and an eye patch or occluder
forth between the two targets - Have patient read the two columns left to
- Start slowly, holding the gaze for several right, moving from top to bottom
seconds, and move back and forth - As needed, have the patient use fingers or
between targets. As patient improves, other anchors, progressing to no anchors
gradually increase speed - Use stopwatch to document progress
- Move targets so patient moves gaze into - Change speed using a metronome
different directions of view (have the - Start with two columns, then increase the
targets as if at the end points of a + sign number of columns
and an X; move side to side, up and down,
diagonal
Decreased oculomotor control/diplopia
Functional training Other suggestions
Exercises:
Chung, A., Wiemer, H., Richards, C, Richman, S. (2017). Visual dysfunction: Occupational therapy. Cinahl Information Systems, 1-18.
Gillen, G. (2009). Managing visuospatial impairments to optimize function. Cognitive and Perceptual Rehabilitation: Optimizing Function (45-
65). St. Louis, Missouri: Mosby Elsevier.
Gillen, G., Nilsen, D. M., Attridge, J., Banakos, E., et. al. (2015). Effectiveness of interventions to improve occupational performance of people
with cognitive impairments after stroke: An evidence-based review. The American Journal of Occupational Therapy, 69(1), 6901180040p1-
6901180040p9.
Green, M., Barstow, B., & Vogtle, L. (2018). Lighting as a compensatory strategy for acquired visual deficits after stroke: Two case reports. The
American Journal of Occupational Therapy, 72(2), 7202210010p1-7202210010p6.
Wagener, S. G., Anheluk, M., Arulanantham, C., & Scheiman, M. (2013). Vision assessment and intervention. Mild TBI Rehabilitation Toolkit,
97-146.