* * No financial interests to declare. Graham Peachey B.Optom, FCOVD, FACBO. Australia. To champion the availability and delivery of evidence based, gold standard, functional vision care.
March/April 2010
ASSESSMENT TRAINING 3
Individuals performance compared to normative database. Developmental expectations for KPI’s at each age. (Ref. 1) Samples : Samples : Express Eye. FonoFix. Fixation Instability (Mon.) Saccadic Organization. p17 P36 Anti-Saccade Performance in Dyslexia Binocular Instability (B ) CountFix. 4
1. Functional Vision Defect : Defect : A fault or imperfection in the ‘hardware’ of the visual A fault or imperfection in the hardware of the visual system. 2 F 2. Functional Vision Defi i l Vi i D f D fi i ficit: t: Less than required or expected ‘software’ due to neuro- developmental delay &/or schemata breakdown. p y / 3. Visual Dysfunction: Dysfunction: Has ‘behaviour’ indicative of aspects of Functional Vision not working properly.
Optomotor Factors : Deficits Optomotor Factors : Deficits Ocular-Motor Factors : Ocular-Motor Factors : Defects Defects (Deve (Developmen (Developmental (Developme opmental al Voluntary al Voluntary Voluntary Control) Voluntary Control) Control) ontrol) (Structure & Physiology) (Structure (Stru (Struct cture & Physiology) Physiology) Physiology) Fixation Stability Strabismus; Palsy; Nystagmus; Binocular Stability Heterophorias; Fixation disparity; (B (Between fixations) fi i ) CI CI; Myasthenia; etc. M h i Saccadic Organisation (Measures response time, accuracy and self correction) and self correction) Visual Visual Ins Inspecti tion on “Op and Endur Endurance nce” “Opera ration tional Orga al Organisa sation tion a Performance Performance Tests Tests : : Dysf Dysfunction ction #21 Point; NSUCO Ocular Motility Test, DEM; Groffman Tracking; Accomm, :Ret – MEM; # cyl; +/- Flipper; Keystone FVP – VEE ; VO Star ; Cheiroscopic Tracing ; Visagraph etc Keystone FVP VEE ; VO Star ; Cheiroscopic Tracing ; Visagraph etc. 6
ENVIRON ENVIRONMENT BIOLOGY / PHYSICS Genetics Social BODY BODY Structure , eg. Optical Integrity Optical Integrity, System S ystem Physiology, Ocular Motor, Pathways & Defect Defect Pathology. Diet Trauma/Disease PERCEPTION - OPTOMOTOR COACH COACH ZPD MIND MIND Theory of Mind Developmental Develop ental ( Neuro ( Neuro Developmental Developmental ) Acquisition Acquisition of of Schemata Schemata / Break / Breakdown n COGNITION Deficit COGNITION Deficit Deficit Deficit BEHAVIOUR HAVIOUR Operational organisation Perfo Performa manc nce e & endurance, DYSFUNCTION DYSFUNCTION 7
Functional Vision – A cascading interaction of three areas; Area 1; Body factors, systemic and ocular health, clarity of sight, integrity of neurology, structures , general & ocular motor physiology, etc. structures , general & ocular motor physiology, etc. Area 2; Visual Inspection ; A. Assessing the developmental status of; Fixation Stability Fixation Stability, Binocular Stability Binocular Stability, Saccadic Organisation, Subitizing and Count. B. Operational organisation and Endurance. Schemata breakdowns with Tracking, Focus & Teaming. Area 3; Visuo-cognitive Operations; Three domains – (Ref’s. 2, 3) Sensory Motor ( aka :VIP ) , Evolving Self , Problem Solving. Visual Spatial Mindful Awareness of eg. Object Permanence p g j Visual Analysis Body Construct Size , Shape Constancy Visual Motor Self Awareness Motor / Visual Hierarchy Self Monitoring Visual Auditory sua ud to y Se Self Correction Co ect o Impulsive / Reflective pu s e / e ect e (Fono Test ) Self Organisation Conservation / Logic (Ref’s. 4, 5) 8
Fischer et.al. (Ref. 6) state ........... “... it is not not the saccade control the saccade control system as as a a whole which whole which exhibi exhibits de developmen velopmental defic tal deficits in dyslexia. The eye muscles and the brainstem mechanisms for saccade generation are usually intact and do not show any systematic deficits.”............... .....” It is the frontal It is the frontal lobe lobe component, component, which regulates the synchronization of the ongoing reading process & saccade generation, that is not well that is not well established.” establishe d.” p 18. p 18. Clinical Pearl (1): Clinical Pearl (1): “ These These Neuro – Neuro – Developmental KPI evelopmental KPI Deficits Deficits are are not not detected detected by by a a traditional traditional defect defect ‘Eye ‘Eye Exa Exam’ .” ’ .” 9
Research on Optomotor & Perceptual factors is extensive Research on Optomotor & Perceptual factors is extensive. Prof. Fischer and team have made significant contributions eg: 1. 1. Discovered scovered Express Saccades, 1983 (Ref.7); 1984 (Ref.8) 2. Established develop velopmen ental tal KPI I milesto lestones es . 3. Showed develo 3. velopment ental d l deficit icits co-exist with Dyslexia, ADHD, Dyscalculia and General Learning Dysfunctions. 4. 4. Demonstrated that developmental KPI deficits are typically treatabl treatable (87% prognosis). 5. 5. Successful treatment of KPI deficits transfe transfers to related educational areas. 6. 6. Turn-Key system Turn-Key system for clinical neuro developmental assessment: 2002. (Ref. 9) 10
Express Eye. E E Uses three mini-lasers and infrared Sensors that make about 1000 readings per second. Stability of projected lights determined by body/head control. p j g y y/ Two measurement protocols : * Pro-Saccades, * Anti-Saccades. Each have 200 presentations takes about 8 minutes Each have 200 presentations takes about 8 minutes . Data Recorded Data Recorded : ( New Informati ( New Information ) n ) 1. Fixation Stability, b l 2. Binocular Stability, 3. Saccadic Organisation : Response Time, Response Accuracy, Self Correction ~ % of errors, Self Correct Response Time & Accuracy. 11
Fix Test : Fall back procedure when Express Eye can not be done ! Can be used as a ‘screening’ Performance Test. Not able to measure Response Times (b t gi es o erall time to Response Times (but gives overall time to • complete); Number of Express Saccades; • Pattern of self correction. • 12
Count Fix: Challenges the visual system as to its capacity to recognize the number of items that are simultaneously presented for a short period of time time. (Basic Tachistoscopic Procedure for ‘Where is It” ; depends on Fixation engagement, short term memory & attention shifts to Count above 4 ) memory & attention shifts to Count above 4 ). Comp ter contains ‘de elopmental e pected’ Computer contains ‘developmental expected’ data for subjects aged 7 to 55 years. Results are displayed relative to this data . ( Ref. 11, 12. ) 13
Assessing 5 aspects of Auditory-Spatial Integration. 14
S h Schemata Model. t M d l ( Ref. 12,13,14,15,16,17,18,19. ) Fix Train Fix Train VT: VT: Used to treat & monitor progress with : Used to treat & monitor progress with : Unstable Fixation ( Poor Magno to Parvo switch ) Slow Fixation Release ( over hold on Parvo ) Anti Saccade deficits. Used at Clinic and complemented with : MIT ; After Image death ray; Peg rotator; Head torch ; Yoke Prism orientation; Accommodative procedures etc. We do not use the Fix Train for home training. VT Rx. changes used to foster visual engagement ; Held affect (Ref.17) Vegan affect (Ref.20) A/CA relationship (Ref’s. 21, 22) Clinical Pearl (2 Clinical Pearl (2 ): ): Diagno Diagnosis is drives drives VT VT curricu curriculum um plan. plan. Activities Activities are are - - Specific; pecific; Se Sequential; Ada quential; Adaptive; Repetitive: tive; Repetitive: VT ~ Can not be “busines VT ~ Can not be “business as usual”. as usual”. 15
Started after ‘anti-saccade’ performance is about equal to developmental expected or plateau. Samples of activities include; Geoboard/peg boards (Battleships codes), Parquetry blocks. Parquetry blocks. Parquetry tack. Space Fixator for ‘soft looking’. Touch induced visual imagery. Matching – Domino’s, Dice, Cards, Sorting. 100 Squares. Flashcards. (Dots.) Count Train : Used as a Clinic VT station & to assess progress. 16
Commenced after the individual has organised their personal space construct and has reached developmental personal space ‘construct’ and has reached developmental expected with Count Train. Sample home activities include; Sample home activities include; Rhythm activities, Metronome, Point to bell. Listen – Visualise and Repeat. VADS. Xylophone – Intensity Frequency Side Order Gap Detection Xylophone Intensity, Frequency, Side Order, Gap Detection. Rosner Auditory. Fono Train: Used as a Clinic VT station & to assess progress Fono Train: Used as a Clinic VT station & to assess progress. 17
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