Neglect VS. Hemianopsia

Hemi-inattention

VS.

Hemianopsia

Visual Fields:

Remedial:

- Searching strategies

- Objects on affected side

- Scanning

Compensatory:

- Head turning

- Placing objects within field of vision

- Add color and contrast

- Rotating paper while reading

- Line guides and anchors

Client/family education: Reinforcement

Thank You For

Listening!

Visual Field

Interventions for

Vision Deficits

“Amount of the world you can see at any one time without head or eye movements”

• Visual Input is taken from 2 sources
• Temporal and Nasal Portions

• 4 Quadrants

• Peripheral & Central Vision

• Relies on visual pathway

References:

• Remedial

• Compensatory

• Client/family education

Lundy-Ekman, Laurie (2007). Neuroscience Fundamentals for Rehabilitation 3rd edition. Saunders. ISBN: 978-1-4160-2578-8

(2006). Evaluation and Treatment of Visual Deficits Following Brain Injury. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.) ( pp. 532-572). St. Louis: Mosby.

Zoltan, B. (2007). Vision, Perception, and Cognition: A Manual for the Evaluation and Treatment of the Adult with Acquired Brain Injury (4th ed.). Thorofare, NJ: SLACK Incorporated. ISBN: 978-1-55642-738-1.

http://www.strokengine.ca/assess/

http://strokenetwork.org/newsletter/articles/vision.htm

Visual Field Deficits

Visual Attention

Common Visual Deficits:

Lesion to:

• Optic Nerve
• Optic Chiasm
• Posterior to Chiasm
• Visual Cortex

Visual Field Deficits

Remedial:

- Awareness of neglect

- Using neglected side

Compensatory:

- Placing items within visual field

- Eye movements into neglected space

- Acuity

- Oculomotor Control

- Visual Fields

- Visual Inattention

- Visual Discrimination

- Visual/ Vestibular Processing

Letter Cancellation Tests

Parietal Lobe

• Location of objects
• Constructional Tasks
• Hemi-neglect
• Visual Attention

1. The Single Letter Cancellation Test (SLCT)

2. The Double Letter Cancellation Test (DLCT)

• Used with patients with stroke
• Evaluate the presence and severity of visual scanning deficits, and are used to evaluate USN in the near extrapersonal space.

• Construct validity: Egelko et al. (1988) found that the SLCT & DLCT correlated adequately with mean CT-scan damage (r = -0.35)

The Draw-A-Man Test

The Star Cancellation Test

Frontal Lobe

• The Draw-A-Man Test (Goodenough, 1926) has been used to identify the presence of unilateral spatial neglect (USN) in adult patients post-stroke.

• All that is required is a blank piece of paper (8.5×11) entitled “Draw an Entire Man”, and a pencil. The patient is asked to draw an entire man from memory.

• Chen-Sea (1995, reported in Chen-Sea, 2000) administered the Draw-A-Man Test to 19 patients with stroke in a pilot study, and found that the test showed adequate test-retest reliability (r = 0.50).

• Chen-Sea (1995, reported in Chen-Sea, 2000) administered the Draw-A-Man Test to 19 patients with stroke in a pilot study, and found that the test showed excellent inter-rater reliability (r = 0.96).

• Saccades
• Executing motor movements
• Attention

How is the Brain

Involved in Vision?

Occipital Lobe

• Orientation
• position and movement
• smooth pursuit eye movements

Primary visual cortex = recognition of size, color, light, motion, dimensions

Visual association area = interprets information acquired through the primary visual cortex

• Screening tool that was developed to detect the presence of USN in the near extrapersonal space in patients with stroke.

• Convergent Validity: Marsh and Kersel (1993) - The test had an excellent correlation with the Line Crossing Test score (r = 0.63).

• Criterion Validity: Marsh and Kersel (1993) examined the Line Bisection Test, Star Cancellation Test, and Indented Paragraph) in a sample of elderly patients with stroke. The Star Cancellation Test was found to be the most sensitive measure of visual neglect (100%) when compared with the other tests.

Homonymous Hemianopsia

Temporal

Albert's Test

• Visual recognition
• Attention to detail

If there is a injury to

any part of the brain...

Vision may be affected!

Hemianopsia is visual field cut/loss on the left or right side of the vertical midline.

• It can affect one eye but usually affects both eyes.

* Homonymous hemianopsia is a visual field loss on the same side of both eyes.

Hemi-inattention

VS.

Hemianopsia

• Used with stroke population.

• In this test, patients must cross out lines that are placed in random orientations on a piece of paper.

• Unilateral spatial neglect (USN) is indicated when lines are left uncrossed on the same side of the page as the patients motor deficit or brain lesion is located.

• Convergent Validity: Agrell, Dehlin, and Dahlgren (1997) found that there was excellent correlations between Albert’s Test and the Line Bisection Test (r = 0.85) and adequate correlations with the Star Cancellation Test (r = 0.63).

Albert's Test

The Clock Drawing Test

Presented by:

Rachel Steiner, OTS- LIU

The Clock Drawing Test

Objectives:

• Used for screening cognitive dysfunction & dementia.

• Assesses visuospatial and praxis abilities.

• May determine the presence of both attention and executive dysfunction.

• Requires verbal understanding, memory, spatially coded knowledge and constructive skills.

• Construct Validity: High correlation with the MMSE and other tests of cognitive dysfunction.

Visual Attention

• The Brain's Involvement in Vision
• Common Visual Deficits
• Visual Field
• Visual Attention
• Assessments/screenings for vision
• Treatment for visual dysfunctions

Screening VS Assessment

Confrontation Testing

Screening= is a process for evaluating the possible presence of a particular problem.

• Yes or no

Assessment= is a process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis.

• Decreased awareness of body and spatial environment

• Optic nerves functioning, but decreased perception of sensory input

• Hemi-inattention

• Visual extinction

• Midline shift

Field Cut VS. Inattention

• A quick and easy way to measure overall field of vision.

• This eye exam will show if there is a loss of vision anywhere in the visual field.

• A problem is indicated if the patient cannot see the target or does not see both fingers simultaneously.

• Physical loss of visual field to one side

• Decreased Perceptual field

Also Called:

• Homonymous hemianopsia

Hemi-Inattention

• Combines decreased motor with decreased cognition.
• Ranges in severity
• Depending on severity you may not even notice they have the neglect
• person may have difficulty recognizing their own body parts.

Alternate terms:

• Hemi-spatial neglect
• Hemiagnosia
• Hemi-neglect
• Unilateral neglect
• Hemi-inattention
• Unilateral visual inattention
• Neglect syndrome

* Hemi-inattention is a brain (hemisphere) problem NOT a visual problem

• the right hemisphere is responsible for attention on the right and left side
• the left hemisphere is responsible for attention on only the right side

This means that...

• Person's with L CVA, might lost the attention the R side, but the R hemisphere is still functioning so they won't end up with neglect

• Person's with R CVA will lose the attention to that R hemisphere and therefore the L hemisphere is the only side that is functioning so you lose attention to the L (90% of the time you see L neglect)

Screening Tools

We Can Use ...

* It is important to determine the status of the neglect versus field loss so that proper treatments can be initiated.