Neural Visual Postural Posttest, Level 2-2017 Neuro-Visual Processing Optometric Rehabilitation and Visual Postural Dysfunction Following a Neurological Event Posttest, Level 2 This Posttest consists of 101 Multiple Choice questions. For each question, indicate the single, best answer from among the choices given. There is no time limit for completing the test. You must answer at least 71 of the questions correctly (70%) to successfully pass the course and claim your CE credits. Once you've submitted your answers, the posttest will be automatically scored and the results summarized. If you don't pass the test on your first attempt, you can retake the test to improve your score. Click the link to review the Course Summary for this course. NOTE: While you can use any source you wish to complete the exam, the final answers you submit must be based on your own work. Name* First Last Email* State*License No.*OE Tracker No.*1. Developing a model for rehabilitating vision dysfunction for persons who have had a neurological event involves:a. Creating a model of vision for neuro-rehabilitationb. Prismsc. The need for understanding development related to posture and visiond. The need to observe and assess posturee. All of the above2. The ambient process is:a. Established as a foundation together with motor through postural organization and the base of support (BOS)b. Established through a ‘stimulus-response’ methodc. Must await cognitive developmentd. Involves a ‘top-down’ method of organizatione. None of the above3. When posture is affected by the Visual Midline Shift Syndrome (VMSS), it causesa. A lack of sensorimotor organization and a lack of support reinforcement of the visual process to organize in its developmental nature with congenital neurological eventsb. Previous experience of motor and sensory organization to be mismatched when there is an acquired neurological eventc. Increased postural toned. A reinforcement of the hemiparesis or weight shift toward the unaffected sidee. All of the above4. Neuro-Visual Postural Therapy (NVPT) is:a. The same as vision therapyb. The same as orthopticsc. Treatment of convergence insufficiencyd. An approach to re-establish the ambient visual process with the base of support (BOS) for postural organization upright against gravity as well as to disengage the 'focal binding'e. a, b and c5. If flexor and extensor patterns represent the expression of motor-sensory distortion, then:a. Spasticity will always prevail when there is a convergence insufficiencyb. Change in tone is the fluency of this expressionc. Convergence insufficiency will always produce low tone associated with the ability to suppress one eyed. Spasticity will result with exotropia because the person is trying to pull their eye ine. a, c and d6. The parietal lobe matches information about the spatial visual process with:a. The frontal eye fieldsb. The superior colliculusc. Occipital cortexd. Establishes the action for the intended movemente. All of the above7. The temporal lobe provides information with the visual process regarding:a. Space and movementb. Auditory input about focal sounds to attend toc. Auditory processing for eye movements in the frontal eye fieldsd.Temporal relationships about sound together with visual processing about temporal-spatial processinge. b, c and d8. The midbrain:a. Establishes the relationship between the spatial visual process, auditory visual process and sensorimotor informationb. Is the primary place for focal processingc. Incorporates the spatial visual process to establish spatial volume for feed forwardd. a and ce. None of the above9. The brain stem:a. Provides the proprioceptive base support for the spatial sensorimotor organizationb. Includes the Abducens Nerve (6th cranial nerve) important for innervation of the lateral rectus musclec. Provides trunk stabilityd. Receives input from the spinotectaltracte. All of the above10. The neocortex is:a. Composed of the innermost layer of the cortexb. 2.5 mm. thickc. Composed of six layersd. 80% of the human braine. b, c and d11. The layers of the neocortex are:a. Layers I - III are mylenated fibers and axons (II and III project to other areas of the neocortexb. Layer IV receives input connections from outside neocortex especially from thalamus (feed forward)c. Layer V –VI are output connections to outside neocortex especially thalamus and brain stem (feedback)d. a, b and ce. None of the above12. The visual neocortex:a. Is composed of the original six sub-layers plus an additional three layersb. Includes additional layers because of the significant increased input from midbrain and thalamusc. Is composed of only feature detectorsd. Combines information with auditory processinge. a and b13. The visual neocortex:a. Serves by organizing lines and patterns of informationb. Provides simultaneous relays with other pattern recognizers to enhance or inhibit erroneous datac. Determines useful data by redundancy and averagingd. Has 300 million pattern recognizerse. All of the above14. The lateral geniculate:a. Integrates (blends together) the parvo-, magno- and konico-cellular pathwaysb. Maintains segregation of the parvo-, magno-, and konico-cellular pathwaysc. Directly sends parvocellular information to the frontal eye fieldsd. Maintains a ‘top-down’ cognitive organization for development and movement’e. a and c15. The frontal eye fields:a. Is for conscious thinking onlyb. Receives information regarding preconscious spatial volume from the superior colliculus and develops mapping together with the posterior parietal lobe and occipital cortex of the spatial fieldc. Organizes an ‘anticipatory’ quality for vision and visual motor function together with the preconscious nature of the spatial visual processd. b and ce. None of the above16. Saccades are:a. Voluntaryb. Non-voluntaryc. a and bd. Slow trajectory oculomotor movementse. None of the above17. Focal binding:a. Causes difficulty with the disengagement of focalization and thereby fixationb. Causes the focal process to over-ride the ambient preconscious anticipation of the spatial domainc. Focal binding can cause postural bindingd. Postural binding can reinforce focal bindinge. All of the above18. The occipital lobe, unlike the midbrain, includes:a. Feature recognition before preconscious spatial processingb. Parvo-, magno-, and konicocellular pathwaysc. And receives feed-forward from and provides feed back to the superior colliculusd. b and ce. None of the above19. The superior colliculus is important for organization of:a. Conscious focal processingb. Temporal organization for control of the trunkc. Vertical saccadesd. None of the abovee. All of the above20. The basal ganglia:a. Provides stability of the extremitiesb. Coordinates stability for the frontal eye fields to initiate motor visual action together with the posterior parietal lobe and the occipital cortexc. Assists in coordinating eye movementsd. a, b and ce. a and c21. Steady gaze is a function of:a. The horizontal gaze center in pons and where the 6th nerve nucleus is locatedb. The vertical gaze center within rostral midbrain and where the 4th cranial nerve nucleus is locatedc. The cerebellum for integration of head and body position as well as eye positiond. a and ce. All of the above22. The most appropriate model of learning and performance theory to be applied to the bimodal model of visual processing is:a. Response-stimulus-responseb. Stimulus-responsec. The function model of visiond. The medical-pathological model of visione. None of the above23. The characteristics of Post Trauma Vision Syndrome (PTVS) are:a. Exotropia and exophoriab. Convergence and accommodative insufficiencyc. Oculomotor dysfunctiond. Increased myopiae. All of the above24. The symptoms of PTVS are:a. Diplopia and blurred visionb. Perceived movement of objects or patternsc. Headaches and astenopiad. Hallucinations and photophobiae. All of the above25. Visual skills such as pursuits, saccades, accommodation and vergence of the eyes are brought into functional relationship with vast variety of:a. Practiceb. Movements of the body that are whole and fine and which include head rotations, lateral flexion and extension, lateral extension and flexion with rotation of the bodyc. Extension of the body away from gravity and flexion of the body with gravityd. b and ce. a and c26. Visual Midline Shift (VMS) to the right is characterized by:a. Weight shift to the rightb. Shoulder elevated on the rightc. Pelvic tipped down on the right sided. Elongation of the right side of the body and compression on the left side of the body with a possible left hemiparesise. All of the above27. Visual Midline Shift (VMS) to the left is mostly characterized by:a. Weight shift to the rightb. Shoulder elevated on the left sidec. Pelvis tilted down on the left sided. b and ce. None of the above28. A posterior Visual Midline Shift (VMS) is mostly characterized by:a. A weight shift posteriorb. Possible tendency for the upper body to lean forward in compensation or backward but with increased pressure on heel strikec. A tendency increased weight shift anteriord. b and ce. None of the above29. An anterior Visual Midline Shift (VMS) is most often characterized by:a. Increased weight shift forward on the toesb. Possible shuffling of feet or even toe-walkingc. a and bd. Tendency to fall backwarde. Ataxia30. A Visual Midline Shift (VMS) posterior and to the right would be most often characterized by:a. A tendency to fall to the left in compensationb. Increased weight shift over the right heelc. A possible right ‘scissor step’ or crossing over of the right foot over the left footd. b and c31. Anterior and posterior weight shift in Visual Midline Shift Syndrome (VMSS) are:a. Difficult to assess because the trunk or upper body may be leaning opposite the weight shift in compensationb. Always recognized by the lean or tilt of the headc. Best analyzed by observing the maximum weight shift either on the heels or the toesd. a and ce. b and c32. The key to understanding the means to use yoked prisms in Neuro-Visual Processing Rehabilitation and an instrument of rehabilitation is to recognize:a. That prisms are only good for compensation for strabismusb. That the ‘focal’ process sees the image move toward the apex of the prism, However, the ‘ambient’ process does not see the image move but instead interprets that the person shifts opposite the imagec. That the eyes will shift toward the direction of the image shiftd. a and ce. None of the above33. In the model of Neuro-Visual Processing Rehabilitation yoked prisms should always be positioned:a. Base end toward the direction of increased weight shiftb. Apex end toward the affected sidec. Base end opposite the eye turnd. Base end opposite the direction of maximum weight shifte. Apex opposite the direction of maximum weight shift34. A base right yoked prism will:a. Shift the image to the leftb. Shift the visual midline to the rightc. Increase weight bearing on the right sided. a, b and ce. a and b35. A base down yoked prism will:a. Shift the image upward toward the apexb. Cause the effect of a weight shift posteriorlyc. Cause the effect of a weight shift anteriorlyd. a and ce. a and b36. Base right yoked prisms has the rehabilitative effect of:a. Compressing the x axis on the right and expanding the x axis on the person’s leftb. Expanding the z axis of the person’s right and compressing the z axis on the person’s leftc. Increasing weight shift to the rightd. a and be. a, b and c37. The Paradoxical Visual Midline Shift Syndrome is characterized by:a. A weight shift in the direction of the affected sideb. A weight shift in the direction of the non-affected sidec. By the ‘Pusher’ Syndrome causing the person to push or weight shift into the affected sided. None of the abovee. a and c38. Except for the Paradoxical Visual Midline shift Syndrome, the weight shift in VMS will always be:a. Opposite the affected sideb. Toward the affected sidec. Toward the toes if it is posteriord. Toward the heels if it is anteriore. b, c and d39. A prescription of OD: 8 prism diopters out and down @ 225 degrees and OS: 8 prism diopters in and down @ 225 degrees will increase weight shift:a. Anterior and to the leftb. Posterior and to the rightc. Posterior onlyd. To the right onlye. None of the above40. A prescription of OD: 4 prism diopters up and in @ 35 degrees and OS: 4 prism diopters up and our @ 35 degrees:a. Would be used for a person with increased weight shift to the left and anteriorb. Would be used for a person with increased weight shift to the right and posteriorc. Would have the rehabilitative effect of increasing weight shift to the left and anteriord. Would have the rehabilitative effect of increasing weight shift posterior and to the lefte. None of the above41. The Center of Mass refers to:a. The center of the bodyb. The center of all weight distributionc. The weight shiftd. The direction of leane. None of the above42. The Center of Mass is:a. A function of the lean or weight shiftb. Affected by asymmetry of visual-spatial organizationc. Affected by Visual Midline Shift Syndrome (VMSS)d. Should be the stable point and disassociated from the Center of Pressure or weight shift with alternate stepse. b, c and d43. The Center of Gravity is located slightly above your waist because:a. Your legs are movingb. There is more weight in the top half of your body than the lower halfc. That is the thickest part of your bodyd. a and be. None of the above44. The higher the Center of Gravity:a. The more difficult it is to topple something overb. The less likely it is for a person to fallc. The easier it is to topple something overd. The more stable the person ise. None of the above45. Yoked prisms affect:a. The Center of Gravity through the ambient visual processb. The Center of Weight Bearingc. The Center of Gravity through the focal visual processd. Postural organization through the base of support (BOS)e. a and d46. If the Center of Gravity is displaced so that a perpendicular line dropped from the CG is displace outside the base of support (BOS):a. There will be no problemb. There will be a high risk of fall for a person attempting to stand or walkc. It will only have an effect if the Center of Mass is moved in the opposite directiond. There will be a postural extension opposite the CGe. b and c47. A postural analysis reveals a shift on the VMS Scale of 10 to the right and 10 posteriorly. The following is true:a. The equation of Anterior/Posterior divided by Left/Right = 1b. The person would demonstrate a weight shift before using the yoked prisms to the right and posteriorc. The person is at a high risk of falld. Rehabilitative yoked prisms would be most effective if place base up and left @ 45 degreese. All of the above48. A postural analysis reveals a shift on the VMS Scale of 4 to the left and 12 anteriorly. The following is true:a. The equation of Anterior/Posterior divided by Left/Right = 12 divided by 4 =3b. The yoked prisms would be best placed for maximum rehabilitative effect at base down and right @ 240 degreesc. The person would demonstrate a weight shift with the yoked prisms back to the right and posterior or toward the right heeld. The maximum risk of fall without the yoked prisms is forwarde. All of the above49. Asymmetrical yoked prisms can be effective for:a. Prescribing for a person with a VMSS and a strabismusb. Prescribing for only strabismusc. Prescribing for only VMSSd. Prescribing for weight shift opposite the Center of Masse. None of the above50. When there is a strabismus and a VMSS:a. Prescribe maximum compensating prism for the strabismusb. Determine the position, direction and amount of yoked prism to be used before prescribing the amount of prism for the strabismusc. Patch the strabismic eyed. Patch the eye with the best visual acuitye. None of the above51. For a person with an intermittent right exotropia and a left VMSS, the asymmetrical yoked prism:a. Should be positioned with the base direction opposite the maximum weight shift or toward the rightb. The prism should be increased asymmetrically before the non-deviating eye until alignment is determined only after the person has been evaluated for VMS and after the person has walked with the yoked prismsc. Would be placed with the base end to the rightd. Would have the higher amount of prism before the left eyee. All of the above52. Postural Binding is due to:a. Lack of growth in infancyb. Constant repetition of abnormal movementsc. Muscle skeletal deformitiesd. Tissue restrictionse. b, c and d53. The Cerebral Palsy infanta. Is born with tissue restrictionsb. Develops tissue restrictions through the use of abnormal movement patternsc. Learns abnormal movement patterns that interfere with development of postural reactions postural reactionsd. Can spontaneously arrest primitive reflex patternse. b and c54. Body alignment refers to:a. All body segments in all postures in static and in motionb. Only to the standing posturec. Only to sitting postured. Only in static posturese. Only during movement55. Biomechanical misalignment:a. Affects postural toneb. Prevents expression of efficient postural reactionsc. Challenges stability in postures against gravityd. Is related to the extend of inefficiency in Posture/Movemente. All of the above56. Human Performance:a. Takes place in a gravity bound environmentb. Is not influenced by gravityc. Relates only to motor learningd. Requires only cognitive controle. Is independent of environment demands57. The BOS is:a. The same to all posture and movement requirementsb. The launching platform for body performancec. Refers to the body sized. Dependents on cognitive controle. Is a primitive reflex58. Balance over the BOS:a. Is required to be upright against gravityLateral extension on the affected sideb. Does not affect quality of posture/movementc. Is independent of postural toned. Is refined through the developmental processe. a and d59. The BOS:a. Is always the same regardless of the performed movementb. Can be organized through external supportsc. Can be organized through different relationships of body segmentsd. Remains the same through motor responsese. b and c60. A narrow BOS:a. Requires precise trunk adjustmentsb. Elicits balance and equilibrium reactionsc. Does not involve participation of distant body segmentsd. Is always present at birthe. a and b61. A wide BOS:a. Provides stability against gravityb. Is only used in a standing posturec. Is always the same regardless of environmental demandsd. Does not restrict expression of balance and equilibrium reactionse. Is only used in stressful movements62. Postural observation:a. Is done only in standingb. Is done only in sittingc. Is done only in static posturesd. Is done only during movemente. None of the above63. Head and neck misalignment:a. Is a feature of persons with neurological damageb. Is a characteristic only found in orthopedic patientsc. Is a feature that can be observed in both neurological and non-neurologically involved individualsd. Happens only in sittinge. Is a result of poor posture64. Shoulder tilt is a result:a. Poor nutritionb. Slow growth during childhoodc. Postural imbalancesd. Poor sitting habitse. Only happens to individuals with brain insult65. Efficiency of performance depends:a. Only with intensive practice of movementsb. Cognitive controlc. Verbal instructionsd. Observation on how the movement is performede. Organization of the Neuro-Postural Base of Support66. Vision is a:a. Sensory responseb. Sensorimotor responsec. Dependent only on acuityd. Can be affected by cognitive controle. Unchangeable through optical elements67. “Vision is Motor” is a statement from:a. Developmental cliniciansb. AM Skeffingtonc. Teachers and educatorsd. Pediatricianse. Ophthalmologists68. Body ‘Key Points of Control’:a. Are always used to keep the body stableb. Are used to facilitate movementc. Can be proximal or distald. Are only used in sittinge. Are only used in lying prone69. The NVPT Approach:a. Is a mulidisciplinary approachb. Is practiced only by Neuro-Optometristsc. Is only practiced by Physical Therapistsd. Is used only with severely involved patientse. Is only used to position the patient70. In NVPT it is important to understand:a. Developmentb. Development of Posture/Movementc. Focal Bindingd. Postural Bindinge. All of the above71. In NVPT:a. Prisms are use to change the relationship of the body to groundb. Lenses are use to responds to the acuity needs of the patientc. Gymnastic equipment is use to challenge balanced. Changes of the organization of the BOS is expect through the use of prismse. All of the above72. Goals in NVPT are:a. Practice of vision skills to perfect themb. Repeat the same procedure until the patient learns itc. Improve Postural control while performing a visual taskd. Improve visual skills with or with out movemente. c and d73. Proprioception, auditory and visual inputs:a. Integrate at different levels of the CNSb. Do not need to be integrated to respond efficiently to environmentc. Are organized according to body side preferenced. Depend on cognitive controle. Are processed at cognitive level74. Requirements for efficient perceptual postural control:a. Muscle skeletal structures free of deformities and restrictionsb. Sensory receptors free of structural damagec. Secure BOSd. Freedom to move in organized symmetry and asymmetrye. All of the above75. In a normal standing posture:a. All body segments are aligned in relation to each otherb. Alignment depends on body strength.c. Alignment is maintained without any trunk adjustmentsd. Alignment depends only on visual cuese. Alignment depends on cognitive control76. Postural shifts:a. Occur in only one body planeb. Occur in all body planesc. Depend on the activity to be performedd. Depend on verbal commande. b and c77. The NVPT approach:a. Is protocol dependentb. Is a problem-solving approachc. Is practiced only when the individual can follow verbal instructionsd. Is practiced only when the patient can assume standing independentlye. Is practiced only on a sitting posture78. The NVPT approach:a. Is practiced using lenses to solve acuity problemsb. Is practiced using specific lenses and prisms for each individual patientc. Takes in account development status of the patientd. Initial posture of the patient is crucial to start visual procedurese. b, c and d79. The NVPT approach:a. Uses concept of the Bobath approachb. Uses concepts of Developmental theoriesc. Facilitates normal alignment through positioning of the patientd. Facilitates normal postural reactionse. All of the above80. The NVPT approach:a. Is used only with young patientsb. Can be use with patients of all agesc. Can be use with patients of different diagnosisd. Can only be used with verbal patients that can answer “which one is better, one or two?”e. b and c81. The NVPT approach:a. Uses central and distal Key Points of Control to facilitate movement responsesb. Uses different stable and moving surfaces according to the patient potential of responsec. Design the visual tasks according to the individual identified visual inefficienciesd. Uses different optical elements to influence the relationship of the patient to space.e. All of the above82. The correct means of prescribing for strabismus is:a. Only prescribe for the deviated eye by measuring the deviation and applying prism to this eye first assess the postural BOS and orient the prisms to affect the VMSb. Design asymmetrical yoked prisms after the alignment of prism is determined for the VMSc. a and bd. None of the above83. Asymmetrical yoked prisms for treatment of strabismus and VMS requires:a. Assessing posture firstb. Design yoked prism first to affect the VMSc. Align the asymmetry of the prisms not based on the deviating eye but on the abnormal weight shiftd. Design the asymmetrical prism accordingly for the deviation using the yoked prism carrier as the base for both eyese. All of the above84. The vestibular system has:a. A central component of four vestibular nucleib. A peripheral component of the sensory nerves and the ascending and descending tractsc. The 3rd nerve or oculomotor nerved. a and be. a, b and c85. Without proprioception:a. We would have much difficulty listening to voicesb. Both the ambient visual process and the spatial vestibular process would be rogue, uninhibited systems taken over by focal processingc. There would be no difficulty because the ambient process can function by itselfd. a, b and ce. None of the above86. The Reflex Heirachy Theory:a. Associates segmental static reactions of more than one body segmentb. Involves changes in position of the whole body in response to changes in head positionc. Is the same as the patellar reflexd. None of the abovee. a and b87. The reflexes responsible for orienting the head in space are:a. Optical rightingb. Labyrinthine rightingc. Body-on-head rightingd. a, b and ce. None of the above88. The following are correct:a. Reflexes are present in early development to set the postural organization to be up-right against gravityb. Become latent with the organization of the ambient visual process of vision, the vestibular process and the proprioception systemc. Spontaneous reflexes occurring in movement that re-occur later in adulthood are considered pathologicald. a, b and ce. a and c89. The Systems Model of Reflexes:a. Demonstrates that vision maps spatial information to the muscles and proprioceptive systemb. The visual system will elicit organized postural responses in standing infants at an earlier stage than the somatosensory systemc. Shows that the eyes, ears and smell must work togetherd. All of the abovee. a and c90. Abnormal Reflex Responses can occur:a. When the ambient visual process is no longer grounded in the proprioceptive BOSb. Over-focalization occursc. If music is played too loudd. a and be. None of the above91. Facilitation refers to:a. Eliciting postural movement responses by using the clinicians hands to apply proprioceptive cues to specific sites on the body called ‘key points of control’b. Determining the method of aligning the prismsc. Methods of patterningd. All of the abovee. None of the above92. Proximal ‘key points of control’ are:a. Used to elicit a movement responseb. Used to give the feeling and direction of a movementc. The headd. The upper and lower trunke. All of the above93. An efficient neuro-postural base requires:a. Normal postural alignmentb. Equal distribution of weightc. Ability to weight shift in all directions with graded controld. Efficient righting and equilibrium reactions as an underlying foundation for volitional movemente. All of the above94. NVPT is a treatment approach is:a. Only for the pediatric populationb. Only for normal intelligent childrenc. For all TBI patients and persons with neuro-visual-postural imbalancesd. For treating only non-degenerative neurological disorderse. Performed at hospitals95. A Paradoxical VMSS is:a. A shift of the visual midline toward the non-affected sideb. A shift of the visual midline away from the affected sidec. A shift of the visual midline toward the affected sided. a and be. None of the above96. Pusher’s Syndrome is a VMSS where the person shifts their weight:a. Away from the affected sideb. Toward the affected sidec. Toward the non-affected sided. a and ce. None of the above97. When considering treatment for a person with a Paradoxical Visual Midline Shift the clinician should:a. Wait one year and whatever the patient is left with is what they have to live withb. Wait one month after the event and prescribe yoked prismsc. Prescribe yoked prisms as soon as possible and confer with the neurologist, physiatrist, physical and occupational therapistd. Refer for physical therapy before prescribing yoked prismse. None of the above98. Vertical ocular motilities (sursumduction):a. Are paired with head extensionb. Are paired with head rotationc. Are paired with head flexiond. Are independent from head movementse. Occur only with head movements99. NVPT should always be performed with:a. Good lighting and the eyes openb. With the appropriate yoked prismsc. In prone positiond. In supine positione. None of the above100. The ambient visual process is:a. Proactiveb. Preconsciousc. Oriented to posture and balance upright against gravityd. Faster in processing speed than the focal processe. All of the above101. NVPT and Neuro-Visual Processing Rehabilitation is:a. A patient-centered approachb. Incorporates the use of yoked prisms and facilitation of movementc. For the purpose of organizing the ambient spatial visual process with the proprioceptive BOSd. All of the abovee. None of the above