Neural Visual Postural Posttest, Level 3-2017 Neuro-Visual Processing Optometric Rehabilitation and Visual Postural Dysfunction Following a Neurological Event Posttest, Level 3 This Posttest consists of 93 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. Assessing and Designing NVPR for a wheelchair bound patient requires:a. Understanding posture and its relationship to spatial vision processingb. Biomechanicsc. External controls used to support postured. The use of yoked prisms to affect postural alignment with and withoute. All of the above2. Prescribing prisms for the wheel chair bound patient requires that the clinician:a. Establish visual spatial processing (ambient visual process) as a foundation together with motor through postural organization and the base of support (BOS)b. Consult with the inter-professional rehabilitation teamc. Always evaluate postural tone first and assess the support of the chair for postured. a, b and ce. None of the above3. Creative techniques for refraction for a patient who is in constant flexion with head down and seated in a wheel chair might include:a. Using a mirror placed on the lap of the person and refracting through the mirrorb. Asking the patient “which is better one or two?”c. Inhibiting extensiond. Patching one eye at a timee. All of the above4. Dynamic near retinoscopy:a. Is the same as vision therapyb. Is the method of choice to evaluate the balance of the focal and ambient process when having the patient develop fixation at a near rangec. Is the 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 goal of the Neuro-Visual Processing Evaluation is:a. To improve the acuityb. To balance the state of bi-modal visual processing in relationship to the proprioceptive base of support (BOS) and/or the state of postural tonec. Dilate and give a cyloplegic refraction to all patientsd. a and ce. All of the above7. A head tilt or turn often is the result of or influences:a. Strabismusa. Sb. Torticollisc. Visual Midline Shift Syndromed. Cyclotorsione. All of the above8. 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 spino-tectal tracte. All of the above10. The neocortex is:a. Innermost layer of the cortexb. 2.5 mm. thickc. Composed of six layersd. 0% of the human braine. a, b and c11. Neuro-Visual Postural Therapy (NVPT) is:a. A series of exercises for the eyesb. A means of facilitating neuro-visual processing in conjunction with the proprioceptive base of support (BOS)c. Physical therapy for optometristsd. a, b and ce. a and c12. NVPT always includes:a. Visual fixation in the neutral or centered positionb. A saccadic fixation toward the direction of elongation of the body with weight transferc. Maintainting an upright posture against gravity with capital flexiond. Maintaining capital extension with flexion on the side of weight transfere. a, b and b13. The clinician should facilitate visual-postural movement upright against gravity for the patient by placing their hand(s) on the:a. The clinician should never touch the patientb. Place one hand on the proximal key point of controlc. Place one hand on the distal key point of controld. b and ce. None of the above14. A key point of control refers to:a. Having the patient balance on one footb. The positions of hand placement by the clinician to facilitate postural organization upright against gravity and with movementc. A list of factors involving using the local process to drive neo-cortical responses to the stimulusd. Acupressure for the visual systeme. None of the above15. The Neuro-Visual Processing Evaluation should always begin with:a. Having the patient in the best supported postureb. Over-stimulating the focal visual processc. Disregard of the patient's postured. b and ce. None of the above16. When there is a head turn or rotation by the patient to fixate, consideration should be made for:a. Base in prismsb. Yoked prismsc. Base end in the direction of the rotation or turnd. Base end opposite the direction of rotation or turne. b and d17. If there is a strabismus always:a. Prescribe the compensatory prism to correct the eye deviation before assessing anything elseb. Consult with the physical, occupational therapist and/or physician about neuro-postural imbalancesc. Assess for postural alignment and imbalance in weight shift first before prescribing compensatory prismsd. Assess for Visual Midline Shift and design a strategy for prism prescription that first includes yoked prisms to affect postural alignment before compensating prisms.e. b, c and d18. Spatial neglect is:a. A function of right parietal – occipital dysfunctionb. A focal visual processing dysfunctionc. An ambient or spatial visual processing dysfunction in relationship to the proprioceptive base of support (BOS)d. a and ce. b and c19. A spatial neglect demonstrates:a. A visual sensory dysfunctinb. An ambient or spatial visual processing dysfunctinc. A Visual Midline Shift opposite the neglected fieldd. A mismatch of motor and spatial visual processing yielding to 'focal binding'e. b, c and d20. When assessing the posture of a wheel-chair bound patient relative to Visual Midline Shift the clinician should evaluate:a. If there is a lateral weight shiftb. If there is a posterior or anterior tilt of the pelvisc. If the Paradoxical shift is the same as the VMSd. a and ce. a, b and c21. The visual neocortex is:a. 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 b22. 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 above23. If there is a tissue restriction that limits facilitation to the upright position:a. There is most likely a biomechanical restrictionb. Consult with the physical, occupational therapist and/or physicianc. Consider yoked prisms prescribed to affect postural alignment of the pelvisd. Include a lateral component of the yoked prisms to affect the lateral shift of visual midline more to centere. All of the above24. If there is a biomechanical restriction always:a. Position the prisms to reduce the effort of alignmentb. Position the prisms to force the person to sit straighterc. Place the base end of the prisms base downd. Make the patient work to overcome the yoked prisms so that they build up muscle strengthe. Disregard the direction of their posture and concentrate on the binocular dysfunction, fixations and accommodation25. Focal binding:a. Causes difficulty with the disengagement of focalizationb. Causes the focal process to over-ride the ambient preconscious anticipation of the spatial domainc. Can cause postural bindingd. Postural binding can reinforce focal bindinge. All of the above26. 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 above27. For the wheelchair bound patient if there is no bio-mechanical restriction and the patient demonstrates low postural tone with lower lumbar elongation in a slumped posture:a. The clinician will be able to facilitate the patient to an upright postureb. Consideration for lumbar support in conjunction with referral for physical and occupational therapy should be madec. Prescription of Base Down yoked prisms should be consideredd. Prescription of Base Up yoked prisms should be considerede. a and b28. In general, the greater the amount of weight shift:a. The more binocular dysfunction will be foundb. The more the angle of a strabismic deviation will be presentc. The greater the amount of yoked prisms will be needed to affect the VMSd. a and be. None of the above29. Asymmetrical yoked prisms are effective when treating:a. Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS)b. Prescribing for VMS and strabismusc. Affecting strabismusd. Only ocular motor restrictionse. a and b30. The most important consideration for developing NVPT is:a. Having the patient in a balanced refractive correction with appropriate yoked prismsb. Considering if the patient needs to be referred for a Neuro-Visual Processing Rehabilitation evaluationc. Considering if an inter-professional referral for physical and/or occupational therapy is neededd. All of the abovee. b and c31. The nature of the ‘excitation/inhibition ratio’ typifies the balance between:a. Input and output of the visual processb. Input and the motor responsec. The bi-modal visual processd. The cortex 'top-down' control over the motor processe. c and d32. Visual processing requires inhibition and excitation to be modulated by:a. A temporal sequence in order to maintain proportion between Feed-forward and Feedbackb. Attention and concentrationc. A normal sleep cycled. a and ce. None of the above33. ‘Focal binding’ is:a. A visual processing isolation on detailb. Focalization with an inability to releasec. Change in ‘weight’ between excitation and inhibition causing compensatory shifts in inhibition to preserve excitationd. Represented by multiple peaks on the VEP P-100 cross pattern reversal analysise. All of the above34. 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 above35. PTVS is affected by:a. Bright lightb. The ratio between GABA and Glutametergic principal cells as well as the imbalance in the interneurons which have reduced inhibitory effectc. Too much sugar in the dietd. All of the abovee. None of the above36. Graphical analysis of Visual Midline Shift requires:a. Observation of posture and balanceb. Plotting coordinates as a function of weight shiftc. Determining the axis of the yoked prisms as a function of weight bearingd. a, b and ce. a and b37. When plotting VMS coordinates the following is correct:a. The horizontal axis represents lateral weight shiftb. The vertical axis represents anterior/posterior weight shiftc. Postural analysis is given a value of 12 being the maximum weight shift ind. The unit of 12 signifies the limit of center of gravity within or beyond the boundaries of the base of support (BOS)e. All of the above38. The axis of the yoked prism prescription can be determined by:a. Intersecting the coordinates on the graph between the ‘x’ coordinate (value of lateral weight shift) and the ‘y’ coordinate (value of the anterior/posterior weight shift)b. Extending a line from the zero coordinate located in the very center of the graph outward bisecting the intersecting coordinate from the ‘x’ and ‘y’ axesc. Project the line outward to determine the axis of the yoked prismsd. a, b and ce. a and b only39. The axis of the yoked prisms designates:a. The relative position and orientation of the yoked prismsb. The position of the apex end of the yoked prismsc. The position of the base end of the yoked prismsd. a and be. a and c40. A lateral right weight shift of 10 and an anterior weight shift of 4 would yield a degree axis plotted on the graph of:a. 340 degrees for both the OD and the OSb. 300 degrees for both the OD and the OSc. 220 degrees for both the OD and the OSd. 315 degrees for both the OD and the OSe. None of the above41. A score or value of 12 represents the maximum weight shift relative to:a. Center of Gravityb. 'Risk of Fall'c. Variable weight shiftd. Posterior weight shifte. Anterior weight shift42. Parallax is:a. A dysfunction of the focal and ambient visual processb. A relative motion perceived between the focalization point and the foreground or background when the person shifts positionc. Only observed when viewing astronomical bodies in outer spaced. All of the abovee. None of the above43. Parallax representsa. A disassociation between the ambient and the focal visual process when the focal process is engagedb. A distortion of the central visual processc. An imbalance in the visual process and should be suppressedd. None of the abovee. All of the above44. Parallax provides monocular and binocular cues to depth:a. Due to disassociation between the focal and the ambient visual processb. Is natural to our visual processing in a 3 dimensional worldc. Demonstrates plasticity between the ambient and focal visual processd. None of the abovee. a, b and c45. A lack of plasticity within visual processing between the focal and ambient process may cause:a. The person’s movement to be projected into the visual fieldb. Spatial disorientationc. Symptoms of dizzinessd. Motion sicknesse. All of the above46. Postural binding may be due to:a. Lack of growth in infancyb. Constant repetitions of abnormal movementsc. Muscle sequential deformitiesd. Tissue restrictionse. b, c, and d47. The BOSa. Is determined by birthb. Depends on the ability of the body to keep biomechanical alignment while movingc. Changes with mental attituded. Is always the same, no matter the supporting surfacee. Is organized by the motor systems48. Neuro-Visual Postural Therapya. Is a Vision Therapy approachb. Is a Physical Therapy Approachc. Is a Speech and Language approachd. Is an interdisciplinary problem solving approach that is patient centerede. Is a pediatric approach49. Brain injurya. Affects postural toneb. Prevents expression of efficient postural reactionsc. Challenges stability in postures against gravityd. Is related to the extent of injury and location of the brain insulte. All of the above50. A brain injurya. Will often cause the person to experience functional deficiencies in both sensory systems and action systemsb. Only affects learning abilitiesc. Is an acquired conditiond. Affects the first two years of developmente. Is independent of environment demands51. The BOS:a. Is the same to all posture and movement requirementsb. Is the launching platform for body performancec. Refers to the body sized. Dependents on cognitive controle. Is a primitive reflex52. Balance over the BOS:a. Is required to be upright against gravityb. Does not affect quality of posture/movementc. Is independent of postural toned. Is refined through the developmental processe. a and d53. 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 c54. 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 b55. 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 movements56. Postural mal-alignment:a. Is present only in orthopedic conditionsb. Is present only in neurological conditionsc. Is only evident in static posturesd. Is only evident during movemente. None of the above57. Postural mal-alignmenta. Is a feature of individuals with neurological damageb. Is a characteristic only found in orthopedic patientsc. Is a feature that can be observed in both neurological and non neurological involved individualsd. Occurs only in seated posturee. Is a result of bad posture58. Postural mal-alignment:a. Does not affect efficiency in action systemsb. Changes with developmentc. Is growth dependentd. Is a result of bad sitting habitse. None of the above59. Postural mal-alignment:a. Can be changed through cognitive controlb. Can be changed through verbal instructionsc. Is changeable through specific techniques of physical handling, verbal and visual cuesd. Is a permanent condition.e. Is a reflection of IQ.60. Correcting trunk alignment:a. Is essential before starting NVPT proceduresb. Can be obtained by cognitive controlc. Unchangeable through optical elementsd. Changes postural tonee. a and d61. Facilitation of trunk alignment:a. Refers to alignment of trunk in the vertical axisb. Is obtained with external controlsc. Refers to alignment in all planes of body movement.d. Is a technique that requires strength from the facilitatore. Is practiced under no gravitational conditions62. 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. b and c63. The NVPT Approach:a. Is a multidisciplinary 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 patient64. In NVPT it is important to understand:a. Developmentb. Development of Posture/movementc. Focal Bindingd. Postural Bindinge. All of the above65. In NVPT:a. Prisms are use to change the relationship between the position of the body upright against gravityb. Lenses are used to balance the acuity needs of the patientc. Gymnastic equipment is used to challenge balanced. Changes of the organization of the BOS is expected through the use of prismse. All of the above66. NVPT consists of:a. Facilitating vision and posture in order to influence the quality of the patient’s responsesb. Repetition of the same procedure until the patient learns itc. Improving postural organization while performing a visual taskd. Improving visual skills with or without movemente. a, c and d67. Key points of control:a. Refers to specific sites on the body from where a movement is facilitatedb. Do not need to be integrated to respond efficiently to environmentc. Are organized according to body side preferenced. Depends on cognitive controle. Are processed at a cognitive level68. Key points of control:a. Are a substitute of prescribed yoked prismsb. Are sensory receptorsc. Depend on the BOSd. Restrain movemente. Are painful69. Key points of control:a. Are always used with the patient lying in prone positionb. Are always used with the patient in a standing positionc. Locations change according to the patient's own control of movementd. Depend only on visual cuese. Depend on cognitive control70. Key points of control:a. Are used to facilitate movementb. Require that the patient has cognitive controlc. Depend on visual statusd. Depend on verbal commande. Are used to inhibit movement71. Postural organization:a. Is always observed in standing postureb. Depends on cognitive controlc. Is a non-changeable conditiond. Influences movement efficiencye. Depends on weight and stature72. Postural organization:a. Is a guide to prescribing prismsb. Is practiced using specific spectacles for each individual patientc. Takes in account development status of the patientd. Has no influence on movement readinesse. Is the same in all individuals of the same age73. Functional categories of movement:a. Are based on functional characteristics of posture and movement regardless of the origin of the brain damageb. Uses concepts of learning theoriesc. Are established according to IQ measurementd. Depend on visual acuitye. All of the above74. Functional categories of movement:a. Identify patient's posture and movement statusb. Are not changeable regardless of posture and movement improvementc. Are determined according to clinical testingd. Are determined through clinical observatione. a and d75. Functional Category 1:a. Corresponds to patient's ageb. Corresponds to patients that are indepent walkersc. Corresponds to patients that have mild postural imbalancesd. Corresponds to patients that function with mild inefficienciese. All of the above76. Patients who are classified as Category 1:a. Under sudden balance demand will show a TLRb. Limit their movement repertoire to avoid fallingc. Avoid moving over a narrow BOSd. Position themselves with a wide BOSe. All of the above77. Patients who are classified as Category 1:a. Do not have functional inefficienciesb. Tend to be focally boundc. Have high amplitudes in both accommodation and vergencesd. Use physiological energy in an efficient mannere. Can only be diagnosed with an MRI78. Patients who are classified as Category 1:a. Can be helped through NVPTb. Need extensive training in readingc. Need auditory trainingd. Only need vestibular therapye. None of the above79. Patients who are classified as Category 1:a. Show shift in both visual and body midlinesb. Maintain Postural alignmentc. Do not have visual acuity errorsd. Are always under 5 years of agee. Biomechanical alignment is symmetrical80. Patients who are classified as Category 1:a. Do not suffer headachesb. Show functinal visual difficultiesc. Develop their cognitive potentiald. Are always identifed by the pediatriciane. Outgrow their inefficiencies81. Patients who are classified as Category 2:a. Are semi-independent walkersb. Can walk small distances with an external aidc. When walking tend to drift in a combination of spatial planesd. Show body mis-alignmentse. All of the above82. Patients who are classified as Category 2:a. Show discrepancy in functional efficiency between upper and lower body or right and left sideb. Antigravity postural adjustments lack refinementc. Hand use is more efficient in sittingd. Shoulder and pelvic girdle have reduced movement rangese. All of the above83. Patients who are classified as Category 2:a. Are in persistent postural binding as a result to avoid fallingb. With movement demands increases risk of fallc. Often have binocular problemsd. Lack flexibility and amplitude in accommodation and vergencese. All of the above84. Patients who are classified as Category 3:a. When seated depend on external controls to maintain upright alignmentb. Need help to do transitional movementsc. Are unable to take steps independentlyd. Are dominated by abnormal postural reactionse. All of the above85. Patients who are classified as Category 3:a. Have an inability for vision to lead motor performanceb. Vision is focally boundc. Posture and movement are boundd. Have binocular problemse. None of the above86. 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 above87. When examining the patient with significant involvement neuro-motorically:a. Have the patient use the prism Rx or therapeutic prism prescriptionb. Have the patient in the best possible supported chairc. Assess changes in balance, (between ambient and focal process), eye alighment, quality and amplitude of version and vergences. Identify which Visual Skills the patient needs to establish or refine.d. None of the abovee. a, b and c88. Vertical prisms may be effective:a. To disassociate the visual spatial process from the proprioceptive BOSb. To incorporate facilitated movement and reinforce proprioception when there is focal and postural bindingc. Should only be used with the person seatedd. Should always be used with caution and safety of the patient in minde. a, b and d89. In Neuro-Visual Processing Rehabilitation the clinician should always:a. Treat the condition diagnosed and not the patientb. Treat the patient and not just the condition diagnosedc. Treat the convergence insufficiency before the visual postural dysfunctiond. None of the abovee. All of the above90. In Neuro-Visual Processing Rehabilitation the clinician should always:a. Treat the strabismus before the Visual Midline Shift Syndrome affecting balance and postureb. Treat and affect the Visual Midline Shift Syndrome before prescribing prisms to affect the strabismusc. Treat the neuro-visual postural imbalance before treating the binocular dysfunctiond. All of the abovee. a and c91. A strabismus as well as binocularity and visual skills can be affected by:a. Poor postural alignmentb. Poor postural supportc. Capital extensiond. Torticollise. All of the above92. The following is correct:a. Balance the organizational process that is interfering with binocularity as well as with posture, balance and movement in spaceb. Developmentally the ambient visual process precedes the focal process in organizationc. NVPT should always be preformed with the properly prescribed yoked prismsd. None of the abovee. a, b and c93. Neuro-Visual Processing Rehabilitation and NVPT are:a. Inter-Professional in serviceb. Using lenses to improve acuityc. Exercises to improve strength of eye musclesd. Coordinated eye exercises that do not need a treating clinician