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Transcript
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 • • • • • • • • 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 • • • • 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 • • • • 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 • • • • • • • 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?
