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Dysfunctions and
Assessment
Made by :Gundeep
Singh
MOT Neurology
What is visual perception ?
The ability to use vision to adapt to the
environment which requires the integration
of vision within the CNS to turn the raw data
supplied by the retina into cognitive
concepts of the perception of space and
objects that can be manipulated and used
for decision making .
The process by which this occurs is known
as visual perception .
How it works ?
It occurs through visual processes
Ventral stream
.
Assessed by :
LeaNumbers low vision test chart
and warren text card
Visual field
Visual field defect is caused due to damage to the
receptor cells in the retina optic pathway that relays
retinal information to CNS for processing results in a visual
field deficits .
Conditions occuring in VFD are :
Heminanopsia : There has been loss of vision in one half of
the visual fields in the eyes.
Homonymous : it means deficit is same in both the eyes.
The assessment of the VF is know as perimetry test these
ranges from simple confrontation test to more precise
imaging of a scanning laser opthalmoscope (SLO).
Visual field defects
Screening of visual field
deficits
Confrontation testing
Equipments: eye patch or patches
Set up : patient seated directly opposite to examiner,
approx 20 inches eye to eye .
Background behind examiner should be dark and
distraction free.
Procedure : patch the patient left eye and close or
patch your own right eye
Instruct patient to look at your left eye and tell him or
her you will be moving a target in from the side and
the patient is to indicate when the target is first seen.
Move target in from all angles
Compare the patient response with yours.
Position hands at 3 and 9 clock so that you
can just see your fingers . Ask the patient how
many fingers you are holding up .
A problem is indicated if the patient cannot
see the target when you do or does not see
both fingers simultaneously.
Visual skills for reading test provides an
effective way to measure the interference of
the VFD on reading performance.
Perimetry devices such as the Damato 30
point multifixation campimeter ( biVABA).
http://www.sussexvision.co.uk/damato-
fieldscreener-30-point-p-5638.html
Visual attention and
scanning
Condition which occurs due to defect of VA and
scanning are :
Hemi- inattention : Instead of initiating from left to
right visual search pattern, clients with right
hemisphere injuries often begin and confine search to
right side .
Visual neglect : it is a combination of hemi-
inattention and left visual field defect (VFD).clients
with this condition show exaggerated inattention
towards the left half of the visual space surrounding
the body and often do not move the eye past midline
towards the left or turn head towards the left side .
Unilateral neglect
Hemispatial neglect, also called hemiagnosia,
hemineglect, unilateral neglect, spatial neglect,
unilateral visual inattention, hemi-inattention or
neglect syndrome is a neuropsychological condition
in which, after damage to one hemisphere of the brain
is sustained, a deficit in attention to and awareness of
one side of space is observed.
It is defined by the inability of a person to process and
perceive stimuli on one side of the body or
environment that is not due to a lack of sensation.
Unsworth, C. A. (2007). Cognitive and Perceptual Dysfunction. In T. J. Schmitz & S. B. OSullivan (Eds.), Physical
Rehabilitation (pp. 1149-1185). Philadelphia, F.A: Davis Company.
Spatial neglect may result from lesions of the dominant
parietal, temporal, or frontal cortex.
There are different types of unilateral neglect:(Eskes &
Butler, 2001)
Personal neglect
Peri-personal neglect
Extra-personal neglect
Brain Imaging Studies
Assessment
Assessment of lower level visual functions
( visual acuity , oculomotor function and visual
field).
Letter cancellation test
Trail making
Brain injury visual assessment battery for
adults.(Other specific scales are to be
discussed later on)
Scan board test
Described by warren
Consist of large 20 by 30 inch board with
a series of 10 numbers displayed in an
unstructured pattern .
The board is placed at the eye level and
centered at the clients midline .
The client is asked to scan the board
Point out all of the numbers that are
seen.
The examiner records the pattern the
client follows .
Comparision of search pattern : person with
visual field defect vs hemi- inattention
Visual field defect Hemi-inattention
Search pattern is Search pattern is
abbreviated toward blind asymmetrical:
fields initiated/confined to the
right side
Attempts to direct search No attempt to direct search
towards blind side toward left side
Search pattern is organized Search pattern is random
and generally efficient and generally inefficient
Clients rescans to check Client does not rescan to
accuracy of performance check accuracy of
performance
Time spend on task is Client completes task
appropriate to level of quickly; level of efforts
difficulty applied is not consistent
with difficulty of task
From Warren M:Brain injury visual Assessment battery
Occulomotor function
deficit
Deficit in oculomotor control following brain
injury generally results from either of two
types of disruption
Specific cranial nerve
Disruption of central neural control of the
extra ocular muscles affecting the
coordination of eye movements .
Oculo motor function
The defects is associated with cranial nerve
injury .
Oculomotor nerve (3): impaired vertical eye
movements , lateral diplopia for near vision
tasks, dilation of pupil and impaired
accomodation , ptosis of eyelid.
Trochlear nerve (4) : impaired downward and
lateral eye movements, vertical diplopia for
near vision tasks
Abducence nerve (6) : impaired lateral eye
movements, lateral diplopia for far vision
Assessment of oculomotor function
Ask the client about the expercience of
diplopia :
o Look for the diplopia disappering when eye
closed
o Which side lateral or vertical
o Far or near
o The next part of the assessment is observing
the client eye and eye movement for
deficiencies
1. The eye are observed for asymmetries in
pupil size , eyelid function and eye position
Look for ptosis
Tracking of the moving object : in figure of H
or X pattern
Note the point of convergence ( normally
approx 3 inches from the bridge of nose ).
Eye ball movement
Assessment of specific visual
perceptual impairments
Visual object Agnosia : caused due to lesion to the right occipital
lobe . In this the person is unable to recognize and identify an item
using visual means.
Assessment is performed by asking the individual to identify five
common objects by sight.
Color agnosia : Refers to inability to remember and recognize the
specific colors for common objects in the environment. Also know as
Central Achromatopsia
Assessment : present the client with two common objects that are
accurately colored and two objects that are not accurately colored
. Ask the patient to pick the object that are not accurately colored.
Color Anomia: refers to the clients inability to name the color of
the object. while the client understand the differences between
the different colors of objects, they are unable to name the color
of the object accurately .
Color anomia : ask the client to name the color
of various objects in their environment .
Metamorphopsia : refers to visual distortion of
objects, such as the physical properties of size
and weight .Assessment includes presenting
the client with various objects of different
weights and sizes.
Prosopagnosia : refers to an inability to
recognize and identify familiar faces caused
due to lesion of the right posterior hemisphere .
Non standardized test : to identify the names of
the people in photographs, with family
members
Simultanognosia : refers to the inability to
recognize and interpret a visual array as a
whole and is caused by lesion to the right
hemisphere of the brain .
The person is able to identify the individuals
components of a visual scene , but are unable
to recognize and interpret the gestalt of the
scene .
Assessment : presenting the client a
photograph of a detailed visual array .
Right left discrimination :
Visual Discrimination
Visual Memory
Visual-Spatial Relationships
Form Constancy
Visual Sequential Memory
Visual Figure-Ground
Visual Closure
It Assess to determine the visual perceptual
strengths and weaknesses of students.
Items are presented in a multiple-choice format, and
responses can be made vocally (by letter of the
response choice) or by pointing to the answer
choice. This format can be used with students who
may have impairments in motor, speech, hearing,
neurological and cognitive functions.
It is untimed and takes about 25 minutes. Scoring is
quick and uncomplicated. Raw scores are reported
as scaled scores andpercentile ranksfor each
subtest; the overall total score is reported as a
standard score and percentile rank. Age-equivalents
are also provided for the subtest and overall scores.
Specific test Scales for Unilateral
Spatial Neglect
Albert's Test Unilateral spatial neglect (USN)
Behavioral Inattention Test Unilateral spatial neglect
(USN)
Bells TestVisual neglect - extrapersonal space
Catherine Bergego Scale (CBS)Visual neglect -
extrapersonal space
Clock Drawing Test (CDT)Visuospatial and praxis abilities,
may determine attention and executive dysfunctions
Comb and Razor Test Unilateral spatial neglect (USN) -
personal space
Double Letter Cancellation Test (DLCT) Unilateral
spatial neglect (USN) in the near extrapersonal space
Draw-A-Man Test-Unilateral spatial neglect (USN) in
the personal and extrapersonal space (as well as the
presence of anosagnosia). Other constructs:
intellectual ability/cognitive function/body image
Line Bisection Test-Unilateral spatial neglect (USN)
Semi-Structured Scale for the Functional
Evaluation of Hemi-Inattention-Unilateral spatial
neglect (USN) - personal and extrapersonal space
Single Letter Cancellation Test (SLCT)-Unilateral
spatial neglect (USN) - extrapersonal space
Star Cancellation Test-Unilateral spatial neglect
(USN) - extrapersonal space
ALBERTS
TEST