Download Evaluating and Treating Vision for Neurological Patients in Acute Care

EVALUATING AND TREATING
VISION FOR NEUROLOGICAL
PATIENTS IN ACUTE CARE
SARA HESS, OT STUDENT
OBJECTIVES
• Recognize common neurological eye impairments
and deficits they cause
• General evaluation of vision
• Evaluation and treatment for oculomotor control
• Difference between visual inattention, visual field
cut, and visual neglect; evaluation and treatment
of each
NEUROLOGICAL EYE IMPAIRMENTS
• Oculomotor dysfunction (ocular control)
• Visual deficits (quantity of input)
• Perceptual deficits (processing speed)
GENERAL ASSESSMENT/EVALUATION
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Visual gaze preference
Basic ROM in visual fields (mono/binocularly)
Pupil size and symmetry, response to light
Visual field cut
Visual acuity
Visual perception
Oculomotor control
*Consider lighting
OCULOMOTOR CONTROL/FUNCTION
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What is it, how does it become impaired
Diplopia
Strabismus
Convergence insufficiency
EVALUATION OF OCULOMOTOR
CONTROL
• Characteristics of diplopia
• Symmetry and movement of eyes
• Observation of behaviors and physiological
symptoms
• Head tilt, shutting one eye, squinting, headaches, muscle
aches, increased spasticity, nausea, BP/HR with movement,
decreased cooperation, increased agitation
TREATMENT FOR OCULOMOTOR
FUNCTION
• Occlusion*
• Full or partial
• Application of a prism
• Eye exercises
• Surgery
VISUAL FIELD DEFICIT VS.
INATTENTION VS. NEGLECT
• VFD + inattention = neglect
• Visual Field: external world that can be seen when
person looks straight ahead, homonymous
hemianopsia
• Visual Inattention: avoidance in searching half of
the visual space (usually to the left)
• Visual Neglect: no visual input and no
compensation, severe inattention
• Head turning vs. eye turning
VISUAL INATTENTION
• Also known as hemi-inattention
• Tendency to fixate first on the most peripheral visual
stimuli occurring the R visual field
• Unorganized and inefficient visual search strategies
• Eye turning
CAUSE OF VISUAL NEGLECT
EVALUATION OF VISUAL INATTENTION
• How a patient initiates and carries out visual
scanning to complete a task requiring visual search
• Worksheets
• Letter cancellation, star cancellation copying figures,
drawing a clock, draw a person
VISUAL NEGLECT
TREATMENT FOR VISUAL NEGLECT
AND INATTENTION
• Activities that stimulate affected side
• Activities that force patient to look to affected side
• Bilateral tasks to facilitate increased total body
awareness
• Visual guides during reading if neglecting left half of
page
• Tasks requiring visual search in ADLs
• Compensatory strategies and environmental
modifications
VISUAL FIELD DEFICIT
• How it happens
• Homonymous hemianopsia
• Occlusion of posterior cerebral artery (PCA), at
times middle CA
• Narrow scope of scanning
• Organized search pattern
• Head turning
VISUAL FIELD DEFICIT CONT’D
• 4 behavior changes as a result of VFD
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Decreased scope of scanning
Scanning slow to affected side
Miss or misidentify visual detail
Decreased visual monitoring of the hand during activities
EVALUATION OF VFD
• Peripheral vision
• Visual midline shift
• Visual scanning (star cancellation, letter
cancellation)
• Copy figure, draw a person, draw a clock
• Client performance, clinical observations
TREATMENT FOR VFD
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Faster, wider, more efficient, and thorough
Wider head turn
Increase head/eye movements
Increase anticipatory behavior
Increase attention to detail
Organized and efficient
Visual guides during reading
SUMMARY
• Always consider the lighting during vision evaluation
and treatment
• Take into account clinical observations
• Note visual scanning/search pattern
• Suggest environmental modifications and
compensatory strategies when needed
• Document for next level of care and referrals
REFERENCES
Smith-Gabai, H. (2011) Occupational Therapy in Acute Care.
Bethesda, MD: AOTA Press
Warren, M. (n.d.). Brain Injury Visual Assessment Battery for Adults.
Warren, M. (2013). Evaluation and treatment of visual deficits
following brain injury. In H. M. Pendleton & W. SchultzKrohn (Eds.), Pedretti’s Occupational Therapy (590-630).
St. Louis, MO: Elsevier.
QUESTIONS?