Neural Visual Postural Posttest, Level 2-2017 | Optometry Continuing Education

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.

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1. Developing a model for rehabilitating vision dysfunction for persons who have had a neurological event involves:
- Creating a model of vision for neuro-rehabilitation
- Prisms
- The need for understanding development related to posture and vision
- The need to observe and assess posture
- All of the above
2. The ambient process is:
- Established as a foundation together with motor through postural organization and the base of support (BOS)
- Established through a ‘stimulus-response’ method
- Must await cognitive development
- Involves a ‘top-down’ method of organization
- None of the above
3. When posture is affected by the Visual Midline Shift Syndrome (VMSS), it causes
- A lack of sensorimotor organization and a lack of support reinforcement of the visual process to organize in its developmental nature with congenital neurological events
- Previous experience of motor and sensory organization to be mismatched when there is an acquired neurological event
- Increased postural tone
- A reinforcement of the hemiparesis or weight shift toward the unaffected side
- All of the above
4. Neuro-Visual Postural Therapy (NVPT) is:
- a. The same as vision therapy
- b. The same as orthoptics
- c. Treatment of convergence insufficiency
- d. 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'
- a, b and c
5. If flexor and extensor patterns represent the expression of motor-sensory distortion, then:
- a. Spasticity will always prevail when there is a convergence insufficiency
- b. Change in tone is the fluency of this expression
- c. Convergence insufficiency will always produce low tone associated with the ability to suppress one eye
- d. Spasticity will result with exotropia because the person is trying to pull their eye in
- a, c and d
6. The parietal lobe matches information about the spatial visual process with:
- The frontal eye fields
- The superior colliculus
- Occipital cortex
- Establishes the action for the intended movement
- All of the above
7. The temporal lobe provides information with the visual process regarding:
- a. Space and movement
- b. Auditory input about focal sounds to attend to
- c. Auditory processing for eye movements in the frontal eye fields
- d.Temporal relationships about sound together with visual processing about temporal-spatial processing
- b, c and d
8. The midbrain:
- a. Establishes the relationship between the spatial visual process, auditory visual process and sensorimotor information
- b. Is the primary place for focal processing
- c. Incorporates the spatial visual process to establish spatial volume for feed forward
- a and c
- None of the above
9. The brain stem:
- Provides the proprioceptive base support for the spatial sensorimotor organization
- Includes the Abducens Nerve (6th cranial nerve) important for innervation of the lateral rectus muscle
- Provides trunk stability
- Receives input from the spinotectaltract
- All of the above
10. The neocortex is:
- a. Composed of the innermost layer of the cortex
- b. 2.5 mm. thick
- c. Composed of six layers
- d. 80% of the human brain
- b, c and d
11. The layers of the neocortex are:
- a. Layers I - III are mylenated fibers and axons (II and III project to other areas of the neocortex
- b. 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)
- a, b and c
- None of the above
12. The visual neocortex:
- a. Is composed of the original six sub-layers plus an additional three layers
- b. Includes additional layers because of the significant increased input from midbrain and thalamus
- c. Is composed of only feature detectors
- d. Combines information with auditory processing
- a and b
13. The visual neocortex:
- Serves by organizing lines and patterns of information
- Provides simultaneous relays with other pattern recognizers to enhance or inhibit erroneous data
- Determines useful data by redundancy and averaging
- Has 300 million pattern recognizers
- All of the above
14. The lateral geniculate:
- a. Integrates (blends together) the parvo-, magno- and konico-cellular pathways
- b. Maintains segregation of the parvo-, magno-, and konico-cellular pathways
- c. Directly sends parvocellular information to the frontal eye fields
- d. Maintains a ‘top-down’ cognitive organization for development and movement’
- a and c
15. The frontal eye fields:
- a. Is for conscious thinking only
- b. 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 field
- c. Organizes an ‘anticipatory’ quality for vision and visual motor function together with the preconscious nature of the spatial visual process
- b and c
- None of the above
16. Saccades are:
- a. Voluntary
- b. Non-voluntary
- a and b
- d. Slow trajectory oculomotor movements
- None of the above
17. Focal binding:
- Causes difficulty with the disengagement of focalization and thereby fixation
- Causes the focal process to over-ride the ambient preconscious anticipation of the spatial domain
- Focal binding can cause postural binding
- Postural binding can reinforce focal binding
- All of the above
18. The occipital lobe, unlike the midbrain, includes:
- a. Feature recognition before preconscious spatial processing
- b. Parvo-, magno-, and konicocellular pathways
- c. And receives feed-forward from and provides feed back to the superior colliculus
- b and c
- None of the above
19. The superior colliculus is important for organization of:
- Conscious focal processing
- Temporal organization for control of the trunk
- Vertical saccades
- None of the above
- All of the above
20. The basal ganglia:
- a. Provides stability of the extremities
- b. Coordinates stability for the frontal eye fields to initiate motor visual action together with the posterior parietal lobe and the occipital cortex
- c. Assists in coordinating eye movements
- a, b and c
- a and c
21. Steady gaze is a function of:
- a. The horizontal gaze center in pons and where the 6th nerve nucleus is located
- b. The vertical gaze center within rostral midbrain and where the 4th cranial nerve nucleus is located
- c. The cerebellum for integration of head and body position as well as eye position
- a and c
- All of the above
22. The most appropriate model of learning and performance theory to be applied to the bimodal model of visual processing is:
- Response-stimulus-response
- Stimulus-response
- The function model of vision
- The medical-pathological model of vision
- None of the above
23. The characteristics of Post Trauma Vision Syndrome (PTVS) are:
- Exotropia and exophoria
- Convergence and accommodative insufficiency
- Oculomotor dysfunction
- Increased myopia
- All of the above
24. The symptoms of PTVS are:
- Diplopia and blurred vision
- Perceived movement of objects or patterns
- Headaches and astenopia
- Hallucinations and photophobia
- All of the above
25. Visual skills such as pursuits, saccades, accommodation and vergence of the eyes are brought into functional relationship with vast variety of:
- a. Practice
- b. 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 body
- c. Extension of the body away from gravity and flexion of the body with gravity
- b and c
- a and c
26. Visual Midline Shift (VMS) to the right is characterized by:
- Weight shift to the right
- Shoulder elevated on the right
- Pelvic tipped down on the right side
- Elongation of the right side of the body and compression on the left side of the body with a possible left hemiparesis
- All of the above
27. Visual Midline Shift (VMS) to the left is mostly characterized by:
- a. Weight shift to the right
- b. Shoulder elevated on the left side
- c. Pelvis tilted down on the left side
- b and c
- None of the above
28. A posterior Visual Midline Shift (VMS) is mostly characterized by:
- a. A weight shift posterior
- b. Possible tendency for the upper body to lean forward in compensation or backward but with increased pressure on heel strike
- c. A tendency increased weight shift anterior
- b and c
- None of the above
29. An anterior Visual Midline Shift (VMS) is most often characterized by:
- a. Increased weight shift forward on the toes
- b. Possible shuffling of feet or even toe-walking
- c. a and b
- d. Tendency to fall backward
- e. Ataxia
30. 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 compensation
- b. Increased weight shift over the right heel
- c. A possible right ‘scissor step’ or crossing over of the right foot over the left foot
- b and c
31. 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 compensation
- b. Always recognized by the lean or tilt of the head
- c. Best analyzed by observing the maximum weight shift either on the heels or the toes
- a and c
- b and c
32. 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 strabismus
- b. 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 image
- c. That the eyes will shift toward the direction of the image shift
- a and c
- None of the above
33. In the model of Neuro-Visual Processing Rehabilitation yoked prisms should always be positioned:
- Base end toward the direction of increased weight shift
- Apex end toward the affected side
- Base end opposite the eye turn
- Base end opposite the direction of maximum weight shift
- Apex opposite the direction of maximum weight shift
34. A base right yoked prism will:
- a. Shift the image to the left
- b. Shift the visual midline to the right
- c. Increase weight bearing on the right side
- a, b and c
- a and b
35. A base down yoked prism will:
- a. Shift the image upward toward the apex
- b. Cause the effect of a weight shift posteriorly
- c. Cause the effect of a weight shift anteriorly
- a and c
- a and b
36. 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 left
- b. Expanding the z axis of the person’s right and compressing the z axis on the person’s left
- c. Increasing weight shift to the right
- a and b
- a, b and c
37. The Paradoxical Visual Midline Shift Syndrome is characterized by:
- a. A weight shift in the direction of the affected side
- b. A weight shift in the direction of the non-affected side
- c. By the ‘Pusher’ Syndrome causing the person to push or weight shift into the affected side
- None of the above
- a and c
38. Except for the Paradoxical Visual Midline shift Syndrome, the weight shift in VMS will always be:
- a. Opposite the affected side
- b. Toward the affected side
- c. Toward the toes if it is posterior
- d. Toward the heels if it is anterior
- b, c and d
39. 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:
- Anterior and to the left
- Posterior and to the right
- Posterior only
- To the right only
- None of the above
40. A prescription of OD: 4 prism diopters up and in @ 35 degrees and OS: 4 prism diopters up and our @ 35 degrees:
- Would be used for a person with increased weight shift to the left and anterior
- Would be used for a person with increased weight shift to the right and posterior
- Would have the rehabilitative effect of increasing weight shift to the left and anterior
- Would have the rehabilitative effect of increasing weight shift posterior and to the left
- None of the above
41. The Center of Mass refers to:
- The center of the body
- The center of all weight distribution
- The weight shift
- The direction of lean
- None of the above
42. The Center of Mass is:
- a. A function of the lean or weight shift
- b. Affected by asymmetry of visual-spatial organization
- c. 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 steps
- b, c and d
43. The Center of Gravity is located slightly above your waist because:
- a. Your legs are moving
- b. There is more weight in the top half of you body than the lower half
- c. That is the thickest part of you body
- a and b
- None of the above
44. The higher the Center of Gravity:
- The more difficult it is to topple something over
- The less likely it is for a person to fall
- The easier it is to topple something over
- The more stable the person is
- None of the above
45. Yoked prisms affect:
- a. The Center of Gravity through the ambient visual process
- b. The Center of Weight Bearing
- c. The Center of Gravity through the focal visual process
- d. Postural organization through the base of support (BOS)
- a and d
46. 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 problem
- b. There will be a high risk of fall for a person attempting to stand or walk
- c. It will only have an effect if the Center of Mass is moved in the opposite direction
- d. There will be a postural extension opposite the CG
- b and c
47. A postural analysis reveals a shift on the VMS Scale of 10 to the right and 10 posteriorly. The following is true:
- The equation of Anterior/Posterior divided by Left/Right = 1
- The person would demonstrate a weight shift before using the yoked prisms to the right and posterior
- The person is at a high risk of fall
- Rehabilitative yoked prisms would be most effective if place base up and left @ 45 degrees
- All of the above
48. A postural analysis reveals a shift on the VMS Scale of 4 to the left and 12 anteriorly. The following is true:
- The equation of Anterior/Posterior divided by Left/Right = 12 divided by 4 =3
- The yoked prisms would be best placed for maximum rehabilitative effect at base down and right @ 240 degrees
- The person would demonstrate a weight shift with the yoked prisms back to the right and posterior or toward the right heel
- The maximum risk of fall without the yoked prisms is forward
- All of the above
49. Asymmetrical yoked prisms can be effective for:
- a. Prescribing for a person with a VMSS and a strabismus
- b. Prescribing for only strabismus
- c. Prescribing for only VMSS
- d. Prescribing for weight shift opposite the Center of Mass
- None of the above
50. When there is a strabismus and a VMSS:
- Prescribe maximum compensating prism for the strabismus
- Determine the position, direction and amount of yoked prism to be used before prescribing the amount of prism for the strabismus
- Patch the strabismic eye
- Patch the eye with the best visual acuity
- None of the above
51. For a person with an intermittent right exotropia and a left VMSS, the asymmetrical yoked prism:
- Should be positioned with the base direction opposite the maximum weight shift or toward the right
- 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 prisms
- Would be placed with the base end to the right
- Would have the higher amount of prism before the left eye
- All of the above
52. Postural Binding is due to:
- a. Lack of growth in infancy
- b. Constant repetition of abnormal movements
- c. Muscle skeletal deformities
- d. Tissue restrictions
- b, c and d
53. The Cerebral Palsy infant
- a. Is born with tissue restrictions
- b. Develops tissue restrictions through the use of abnormal movement patterns
- c. Learns abnormal movement patterns that interfere with development of postural reactions postural reactions
- d. Can spontaneously arrest primitive reflex patterns
- b and c
54. Body alignment refers to:
- All body segments in all postures in static and in motion
- Only to the standing posture
- Only to sitting posture
- Only in static postures
- Only during movement
55. Biomechanical misalignment:
- Affects postural tone
- Prevents expression of efficient postural reactions
- Challenges stability in postures against gravity
- Is related to the extend of inefficiency in Posture/Movement
- All of the above
56. Human Performance:
- Takes place in a gravity bound environment
- Is not influenced by gravity
- Relates only to motor learning
- Requires only cognitive control
- Is independent of environment demands
57. The BOS is:
- The same to all posture and movement requirements
- The launching platform for body performance
- Refers to the body size
- Dependents on cognitive control
- Is a primitive reflex
58. Balance over the BOS:
- a. Is required to be upright against gravityLateral extension on the affected side
- b. Does not affect quality of posture/movement
- c. Is independent of postural tone
- d. Is refined through the developmental process
- a and d
59. The BOS:
- a. Is always the same regardless of the performed movement
- b. Can be organized through external supports
- c. Can be organized through different relationships of body segments
- d. Remains the same through motor responses
- b and c
60. A narrow BOS:
- a. Requires precise trunk adjustments
- b. Elicits balance and equilibrium reactions
- c. Does not involve participation of distant body segments
- d. Is always present at birth
- a and b
61. A wide BOS :
- Provides stability against gravity
- Is only used in a standing posture
- Is always the same regardless of environmental demands
- Does not restrict expression of balance and equilibrium reactions
- Is only used in stressful movements
62. Postural observation:
- Is done only in standing
- Is done only in sitting
- Is done only in static postures
- Is done only during movement
- None of the above
63. Head and neck misalignment:
- Is a feature of persons with neurological damage
- Is a characteristic only found in orthopedic patients
- Is a feature that can be observed in both neurological and non-neurologically involved individuals
- Happens only in sitting
- Is a result of poor posture
64. Shoulder tilt is a result:
- Poor nutrition
- Slow growth during childhood
- Postural imbalances
- Poor sitting habits
- Only happens to individuals with brain insult
65. Efficiency of performance depends:
- Only with intensive practice of movements
- Cognitive control
- Verbal instructions
- Observation on how the movement is performed
- Organization of the Neuro-Postural Base of Support
66. Vision is a:
- Sensory response
- Sensorimotor response
- Dependent only on acuity
- Can be affected by cognitive control
- Unchangeable through optical elements
67. “Vision is Motor” is a statement from:
- Developmental clinicians
- AM Skeffington
- Teachers and educators
- Pediatricians
- Ophthalmologists
68. Body ‘Key Points of Control’:
- Are always used to keep the body stable
- Are used to facilitate movement
- Can be proximal or distal
- Are only used in sitting
- Are only used in lying prone
69. The NVPT Approach:
- Is a mulidisciplinary approach
- Is practiced only by Neuro-Optometrists
- Is only practiced by Physical Therapists
- Is used only with severely involved patients
- Is only used to position the patient
70. In NVPT it is important to understand:
- Development
- Development of Posture/Movement
- Focal Binding
- Postural Binding
- All of the above
71. In NVPT:
- Prisms are use to change the relationship of the body to ground
- Lenses are use to responds to the acuity needs of the patient
- Gymnastic equipment is use to challenge balance
- Changes of the organization of the BOS is expect through the use of prisms
- All of the above
72. Goals in NVPT are:
- a. Practice of vision skills to perfect them
- b. Repeat the same procedure until the patient learns it
- c. Improve Postural control while performing a visual task
- d. Improve visual skills with or with out movement
- c and d
73. Poprioception, auditory and visual inputs:
- Integrate at different levels of the CNS
- Do not need to be integrated to respond efficiently to environment
- Are organized according to body side preference
- Depend on cognitive control
- Are processed at cognitive level
74. Requirements for efficient perceptual postural control:
- Muscle skeletal structures free of deformities and restrictions
- Sensory receptors free of structural damage
- Secure BOS
- Freedom to move in organized symmetry and asymmetry
- All of the above
75. In a normal standing posture:
- All body segments are aligned in relation to each other
- Alignment depends on body strength.
- Alignment is maintained without any trunk adjustments
- Alignment depends only on visual cues
- Alignment depends on cognitive control
76. Postural shifts:
- a. Occur in only one body plane
- b. Occur in all body planes
- c. Depend on the activity to be performed
- d. Depend on verbal command
- b and c
77. The NVPT approach:
- Is protocol dependent
- Is a problem-solving approach
- Is practiced only when the individual can follow verbal instructions
- Is practiced only when the patient can assume standing independently
- Is practiced only on a sitting posture
78. The NVPT approach:
- a. Is practiced using lenses to solve acuity problems
- b. Is practiced using specific lenses and prisms for each individual patient
- c. Takes in account development status of the patient
- d. Initial posture of the patient is crucial to start visual procedures
- b, c and d
79. The NVPT approach:
- Uses concept of the Bobath approach
- Uses concepts of Developmental theories
- Facilitates normal alignment through positioning of the patient
- Facilitates normal postural reactions
- All of the above
80. The NVPT approach:
- a. Is used only with young patients
- b. Can be use with patients of all ages
- c. Can be use with patients of different diagnosis
- d. Can only be used with verbal patients that can answer “which one is better, one or two?”
- b and c
81. The NVPT approach:
- Uses central and distal Key Points of Control to facilitate movement responses
- Uses different stable and moving surfaces according to the patient potential of response
- Design the visual tasks according to the individual identified visual inefficiencies
- Uses different optical elements to influence the relationship of the patient to space.
- All of the above
82. 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 VMS
- b. Design asymmetrical yoked prisms after the alignment of prism is determined for the VMS
- a and b
- d. None of the above
83. Asymmetrical yoked prisms for treatment of strabismus and VMS requires:
- Assessing posture first
- Design yoked prism first to affect the VMS
- Align the asymmetry of the prisms not based on the deviating eye but on the abnormal weight shift
- Design the asymmetrical prism accordingly for the deviation using the yoked prism carrier as the base for both eyes
- All of the above
84. The vestibular system has:
- a. A central component of four vestibular nuclei
- b. A peripheral component of the sensory nerves and the ascending and descending tracts
- c. The 3rd nerve or oculomotor nerve
- a and b
- a, b and c
85. Without proprioception:
- a. We would have much difficulty listening to voices
- b. Both the ambient visual process and the spatial vestibular process would be rogue, uninhibited systems taken over by focal processing
- c. There would be no difficulty because the ambient process can function by itself
- a, b and c
- None of the above
86. The Reflex Heirachy Theory:
- a. Associates segmental static reactions of more than one body segment
- b. Involves changes in position of the whole body in response to changes in head position
- c. Is the same as the patellar reflex
- d. None of the above
- a and b
87. The reflexes responsible for orienting the head in space are:
- a. Optical righting
- b. Labyrinthine righting
- c. Body-on-head righting
- a, b and c
- None of the above
88. The following are correct:
- a. Reflexes are present in early development to set the postural organization to be up-right against gravity
- b. Become latent with the organization of the ambient visual process of vision, the vestibular process and the proprioception system
- c. Spontaneous reflexes occurring in movement that re-occur later in adulthood are considered pathological
- a, b and c
- a and c
89. The Systems Model of Reflexes:
- a. Demonstrates that vision maps spatial information to the muscles and proprioceptive system
- b. The visual system will elicit organized postural responses in standing infants at an earlier stage than the somatosensory system
- c. Shows that the eyes, ears and smell must work together
- d. All of the above
- a and c
90. Abnormal Reflex Responses can occur:
- a. When the ambient visual process is no longer grounded in the proprioceptive BOS
- b. Over-focalization occurs
- c. If music is played too loud
- a and b
- e. None of the above
91. Facilitation refers to:
- Eliciting postural movement responses by using the clinicians hands to apply proprioceptive cues to specific sites on the body called ‘key points of control’
- Determining the method of aligning the prisms
- Methods of patterning
- All of the above
- None of the above
92. Proximal ‘key points of control’ are:
- Used to elicit a movement response
- Used to give the feeling and direction of a movement
- The head
- The upper and lower trunk
- All of the above
93. An efficient neuro-postural base requires:
- Normal postural alignment
- Equal distribution of weight
- Ability to weight shift in all directions with graded control
- Efficient righting and equilibrium reactions as an underlying foundation for volitional movement
- All of the above
94. NVPT is a treatment approach is:
- Only for the pediatric population
- Only for normal intelligent children
- For all TBI patients and persons with neuro-visual-postural imbalances
- For treating only non-degenerative neurological disorders
- Performed at hospitals
95. A Paradoxical VMSS is:
- a. A shift of the visual midline toward the non-affected side
- b. A shift of the visual midline away from the affected side
- c. A shift of the visual midline toward the affected side
- a and b
- None of the above
96. Pusher’s Syndrome is a VMSS where the person shifts their weight:
- a. Away from the affected side
- b. Toward the affected side
- c. Toward the non-affected side
- a and c
- None of the above
97. When considering treatment for a person with a Paradoxical Visual Midline Shift the clinician should:
- Wait one year and what ever the patient is left with is what they have to live with
- Wait one month after the event and prescribe yoked prisms
- Prescribe yoked prisms as soon as possible and confer with the neurologist, physiatrist, physical and occupational therapist
- Refer for physical therapy before prescribing yoked prisms
- None of the above
98. Vertical ocular motilities (sursumduction):
- Are paired with head extension
- Are paired with head rotation
- Are paired with head flexion
- Are independent from head movements
- Occur only with head movements
99. NVPT should always be performed with:
- Good lighting and the eyes open
- With the appropriate yoked prisms
- In prone position
- In supine position
- None of the above
100. The ambient visual process is:
- Proactive
- Preconscious
- Oriented to posture and balance upright against gravity
- Faster in processing speed than the focal process
- All of the above
101. NVPT and Neuro-Visual Processing Rehabilitation is:
- A patient-centered approach
- Incorporates the use of yoked prisms and facilitation of movement
- For the purpose of organizing the ambient spatial visual process with the proprioceptive BOS
- All of the above
- None of the above