Neural Visual Postural Posttest, Level 3-2017 | Optometry Continuing Education

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.

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1. Assessing and Designing NVPR for a wheelchair bound patient requires:
- a. Understanding posture and its relationship to spatial vision processing
- b. Biomechanics
- c. External controls used to support posture
- d. The use of yoked prisms to affect postural alignment with and without
- e. All of the above
2. 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 team
- c. Always evaluate postural tone first and assess the support of the chair for posture
- d. a, b and c
- e. None of the above
3. 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 mirror
- b. Asking the patient “which is better one or two?”
- c. Inhibiting extension
- d. Patching one eye at a time
- e. All of the above
4. Dynamic near retinoscopy:
- a. Is the same as vision therapy
- b. Is the method of choice to evaluate the balance of the focal and ambient process when having the patient develop fixation at a near range
- c. Is the 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’
- e. 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
- e. a, c and d
6. The goal of the Neuro-Visual Processing Evaluation is:
- a. To improve the acuity
- b. To balance the state of bi-modal visual processing in relationship to the proprioceptive base of support (BOS) and/or the state of postural tone
- c. Dilate and give a cyloplegic refraction to all patients
- d. a and c
- e. All of the above
7. A head tilt or turn often is the result of or influences:
- a. Strabismusa. S
- b. Torticollis
- c. Visual Midline Shift Syndrome
- d. Cyclotorsion
- e. All of the above
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
- d. a and c
- e. None of the above
9. The brain stem:
- a. Provides the proprioceptive base support for the spatial sensorimotor organization
- b. Includes the Abducens Nerve (6th cranial nerve) important for innervation of the lateral rectus muscle
- c. Provides trunk stability
- d. Receives input from the spino-tectal tract
- e. All of the above
10. The neocortex is:
- a. Innermost layer of the cortex
- b. 2.5 mm. thick
- c. Composed of six layers
- d. 0% of the human brain
- e. a, b and c
11. Neuro-Visual Postural Therapy (NVPT) is:
- a. A series of exercises for the eyes
- b. A means of facilitating neuro-visual processing in conjunction with the proprioceptive base of support (BOS)
- c. Physical therapy for optometrists
- d. a, b and c
- e. a and c
12. NVPT always includes:
- a. Visual fixation in the neutral or centered position
- b. A saccadic fixation toward the direction of elongation of the body with weight transfer
- c. Maintainting an upright posture against gravity with capital flexion
- d. Maintaining capital extension with flexion on the side of weight transfer
- e. a, b and b
13. 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 patient
- b. Place one hand on the proximal key point of control
- c. Place one hand on the distal key point of control
- d. b and c
- e. None of the above
14. A key point of control refers to:
- a. Having the patient balance on one foot
- b. The positions of hand placement by the clinician to facilitate postural organization upright against gravity and with movement
- c. A list of factors involving using the local process to drive neo-cortical responses to the stimulus
- d. Acupressure for the visual system
- e. None of the above
15. The Neuro-Visual Processing Evaluation should always begin with:
- a. Having the patient in the best supported posture
- b. Over-stimulating the focal visual process
- c. Disregard of the patient's posture
- d. b and c
- e. None of the above
16. When there is a head turn or rotation by the patient to fixate, consideration should be made for:
- a. Base in prisms
- b. Yoked prisms
- c. Base end in the direction of the rotation or turn
- d. Base end opposite the direction of rotation or turn
- e. b and d
17. If there is a strabismus always:
- a. Prescribe the compensatory prism to correct the eye deviation before assessing anything else
- b. Consult with the physical, occupational therapist and/or physician about neuro-postural imbalances
- c. Assess for postural alignment and imbalance in weight shift first before prescribing compensatory prisms
- d. 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 d
18. Spatial neglect is:
- a. A function of right parietal – occipital dysfunction
- b. A focal visual processing dysfunction
- c. An ambient or spatial visual processing dysfunction in relationship to the proprioceptive base of support (BOS)
- d. a and c
- e. b and c
19. A spatial neglect demonstrates:
- a. A visual sensory dysfunctin
- b. An ambient or spatial visual processing dysfunctin
- c. A Visual Midline Shift opposite the neglected field
- d. A mismatch of motor and spatial visual processing yielding to 'focal binding'
- e. b, c and d
20. 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 shift
- b. If there is a posterior or anterior tilt of the pelvis
- c. If the Paradoxical shift is the same as the VMS
- d. a and c
- e. a, b and c
21. The visual neocortex is:
- a. 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
- e. a and b
22. 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
- d. b and c
- e. None of the above
23. If there is a tissue restriction that limits facilitation to the upright position:
- a. There is most likely a biomechanical restriction
- b. Consult with the physical, occupational therapist and/or physician
- c. Consider yoked prisms prescribed to affect postural alignment of the pelvis
- d. Include a lateral component of the yoked prisms to affect the lateral shift of visual midline more to center
- e. All of the above
24. If there is a biomechanical restriction always:
- a. Position the prisms to reduce the effort of alignment
- b. Position the prisms to force the person to sit straighter
- c. Place the base end of the prisms base down
- d. Make the patient work to overcome the yoked prisms so that they build up muscle strength
- e. Disregard the direction of their posture and concentrate on the binocular dysfunction, fixations and accommodation
25. Focal binding:
- a. Causes difficulty with the disengagement of focalization
- b. Causes the focal process to over-ride the ambient preconscious anticipation of the spatial domain
- c. Can cause postural binding
- d. Postural binding can reinforce focal binding
- e. All of the above
26. The superior colliculus is important for organization of:
- a. Conscious focal processing
- b. Temporal organization for control of the trunk
- c. Vertical saccades
- d. None of the above
- e. All of the above
27. 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 posture
- b. Consideration for lumbar support in conjunction with referral for physical and occupational therapy should be made
- c. Prescription of Base Down yoked prisms should be considered
- d. Prescription of Base Up yoked prisms should be considered
- e. a and b
28. In general, the greater the amount of weight shift:
- a. The more binocular dysfunction will be found
- b. The more the angle of a strabismic deviation will be present
- c. The greater the amount of yoked prisms will be needed to affect the VMS
- d. a and b
- e. None of the above
29. Asymmetrical yoked prisms are effective when treating:
- a. Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS)
- b. Prescribing for VMS and strabismus
- c. Affecting strabismus
- d. Only ocular motor restrictions
- e. a and b
30. The most important consideration for developing NVPT is:
- a. Having the patient in a balanced refractive correction with appropriate yoked prisms
- b. Considering if the patient needs to be referred for a Neuro-Visual Processing Rehabilitation evaluation
- c. Considering if an inter-professional referral for physical and/or occupational therapy is needed
- d. All of the above
- e. b and c
31. The nature of the ‘excitation/inhibition ratio’ typifies the balance between:
- a. Input and output of the visual process
- b. Input and the motor response
- c. The bi-modal visual process
- d. The cortex 'top-down' control over the motor process
- e. c and d
32. Visual processing requires inhibition and excitation to be modulated by:
- a. A temporal sequence in order to maintain proportion between Feed-forward and Feedback
- b. Attention and concentration
- c. A normal sleep cycle
- d. a and c
- e. None of the above
33. ‘Focal binding’ is:
- a. A visual processing isolation on detail
- b. Focalization with an inability to release
- c. Change in ‘weight’ between excitation and inhibition causing compensatory shifts in inhibition to preserve excitation
- d. Represented by multiple peaks on the VEP P-100 cross pattern reversal analysis
- e. All of the above
34. 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
- d. a and c
- e. All of the above
35. PTVS is affected by:
- a. Bright light
- b. The ratio between GABA and Glutametergic principal cells as well as the imbalance in the interneurons which have reduced inhibitory effect
- c. Too much sugar in the diet
- d. All of the above
- e. None of the above
36. Graphical analysis of Visual Midline Shift requires:
- a. Observation of posture and balance
- b. Plotting coordinates as a function of weight shift
- c. Determining the axis of the yoked prisms as a function of weight bearing
- d. a, b and c
- e. a and b
37. When plotting VMS coordinates the following is correct:
- a. The horizontal axis represents lateral weight shift
- b. The vertical axis represents anterior/posterior weight shift
- c. Postural analysis is given a value of 12 being the maximum weight shift in
- d. 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 above
38. 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’ axes
- c. Project the line outward to determine the axis of the yoked prisms
- d. a, b and c
- e. a and b only
39. The axis of the yoked prisms designates:
- a. The relative position and orientation of the yoked prisms
- b. The position of the apex end of the yoked prisms
- c. The position of the base end of the yoked prisms
- d. a and b
- e. a and c
40. 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 OS
- b. 300 degrees for both the OD and the OS
- c. 220 degrees for both the OD and the OS
- d. 315 degrees for both the OD and the OS
- e. None of the above
41. A score or value of 12 represents the maximum weight shift relative to:
- a. Center of Gravity
- b. 'Risk of Fall'
- c. Variable weight shift
- d. Posterior weight shift
- e. Anterior weight shift
42. Parallax is:
- a. A dysfunction of the focal and ambient visual process
- b. A relative motion perceived between the focalization point and the foreground or background when the person shifts position
- c. Only observed when viewing astronomical bodies in outer space
- d. All of the above
- e. None of the above
43. Parallax represents
- a. A disassociation between the ambient and the focal visual process when the focal process is engaged
- b. A distortion of the central visual process
- c. An imbalance in the visual process and should be suppressed
- d. None of the above
- e. All of the above
44. Parallax provides monocular and binocular cues to depth:
- a. Due to disassociation between the focal and the ambient visual process
- b. Is natural to our visual processing in a 3 dimensional world
- c. Demonstrates plasticity between the ambient and focal visual process
- d. None of the above
- e. a, b and c
45. 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 field
- b. Spatial disorientation
- c. Symptoms of dizziness
- d. Motion sickness
- e. All of the above
46. Postural binding may be due to:
- a. Lack of growth in infancy
- b. Constant repetitions of abnormal movements
- c. Muscle sequential deformities
- d. Tissue restrictions
- e. b, c, and d
47. The BOS
- a. Is determined by birth
- b. Depends on the ability of the body to keep biomechanical alignment while moving
- c. Changes with mental attitude
- d. Is always the same, no matter the supporting surface
- e. Is organized by the motor systems
48. Neuro-Visual Postural Therapy
- a. Is a Vision Therapy approach
- b. Is a Physical Therapy Approach
- c. Is a Speech and Language approach
- d. Is an interdisciplinary problem solving approach that is patient centered
- e. Is a pediatric approach
49. Brain injury
- a. Affects postural tone
- b. Prevents expression of efficient postural reactions
- c. Challenges stability in postures against gravity
- d. Is related to the extent of injury and location of the brain insult
- e. All of the above
50. A brain injury
- a. Will often cause the person to experience functional deficiencies in both sensory systems and action systems
- b. Only affects learning abilities
- c. Is an acquired condition
- d. Affects the first two years of development
- e. Is independent of environment demands
51. The BOS:
- a. Is the same to all posture and movement requirements
- b. Is the launching platform for body performance
- c. Refers to the body size
- d. Dependents on cognitive control
- e. Is a primitive reflex
52. Balance over the BOS:
- a. Is required to be upright against gravity
- b. Does not affect quality of posture/movement
- c. Is independent of postural tone
- d. Is refined through the developmental process
- e. a and d
53. 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
- e. b and c
54. 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
- e. a and b
55. A wide BOS:
- a. Provides stability against gravity
- b. Is only used in a standing posture
- c. Is always the same regardless of environmental demands
- d. Does not restrict expression of balance and equilibrium reactions
- e. Is only used in stressful movements
56. Postural mal-alignment:
- a. Is present only in orthopedic conditions
- b. Is present only in neurological conditions
- c. Is only evident in static postures
- d. Is only evident during movement
- e. None of the above
57. Postural mal-alignment
- a. Is a feature of individuals with neurological damage
- b. Is a characteristic only found in orthopedic patients
- c. Is a feature that can be observed in both neurological and non neurological involved individuals
- d. Occurs only in seated posture
- e. Is a result of bad posture
58. Postural mal-alignment:
- a. Does not affect efficiency in action systems
- b. Changes with development
- c. Is growth dependent
- d. Is a result of bad sitting habits
- e. None of the above
59. Postural mal-alignment:
- a. Can be changed through cognitive control
- b. Can be changed through verbal instructions
- c. Is changeable through specific techniques of physical handling, verbal and visual cues
- d. Is a permanent condition.
- e. Is a reflection of IQ.
60. Correcting trunk alignment:
- a. Is essential before starting NVPT procedures
- b. Can be obtained by cognitive control
- c. Unchangeable through optical elements
- d. Changes postural tone
- e. a and d
61. Facilitation of trunk alignment:
- a. Refers to alignment of trunk in the vertical axis
- b. Is obtained with external controls
- c. Refers to alignment in all planes of body movement.
- d. Is a technique that requires strength from the facilitator
- e. Is practiced under no gravitational conditions
62. Body key points of control:
- a. Are always used to keep the body stable
- b. Are used to facilitate movement
- c. Can be proximal or distal
- d. Are only used in sitting
- e. b and c
63. The NVPT Approach:
- a. Is a multidisciplinary approach
- b. Is practiced only by Neuro-Optometrists
- c. Is only practiced by Physical Therapists
- d. Is used only with severely involved patients
- e. Is only used to position the patient
64. In NVPT it is important to understand:
- a. Development
- b. Development of Posture/movement
- c. Focal Binding
- d. Postural Binding
- e. All of the above
65. In NVPT:
- a. Prisms are use to change the relationship between the position of the body upright against gravity
- b. Lenses are used to balance the acuity needs of the patient
- c. Gymnastic equipment is used to challenge balance
- d. Changes of the organization of the BOS is expected through the use of prisms
- e. All of the above
66. NVPT consists of:
- a. Facilitating vision and posture in order to influence the quality of the patient’s responses
- b. Repetition of the same procedure until the patient learns it
- c. Improving postural organization while performing a visual task
- d. Improving visual skills with or without movement
- e. a, c and d
67. Key points of control:
- a. Refers to specific sites on the body from where a movement is facilitated
- b. Do not need to be integrated to respond efficiently to environment
- c. Are organized according to body side preference
- d. Depends on cognitive control
- e. Are processed at a cognitive level
68. Key points of control:
- a. Are a substitute of prescribed yoked prisms
- b. Are sensory receptors
- c. Depend on the BOS
- d. Restrain movement
- e. Are painful
69. Key points of control:
- a. Are always used with the patient lying in prone position
- b. Are always used with the patient in a standing position
- c. Locations change according to the patient's own control of movement
- d. Depend only on visual cues
- e. Depend on cognitive control
70. Key points of control:
- a. Are used to facilitate movement
- b. Require that the patient has cognitive control
- c. Depend on visual status
- d. Depend on verbal command
- e. Are used to inhibit movement
71. Postural organization:
- a. Is always observed in standing posture
- b. Depends on cognitive control
- c. Is a non-changeable condition
- d. Influences movement efficiency
- e. Depends on weight and stature
72. Postural organization:
- a. Is a guide to prescribing prisms
- b. Is practiced using specific spectacles for each individual patient
- c. Takes in account development status of the patient
- d. Has no influence on movement readiness
- e. Is the same in all individuals of the same age
73. Functional categories of movement:
- a. Are based on functional characteristics of posture and movement regardless of the origin of the brain damage
- b. Uses concepts of learning theories
- c. Are established according to IQ measurement
- d. Depend on visual acuity
- e. All of the above
74. Functional categories of movement:
- a. Identify patient's posture and movement status
- b. Are not changeable regardless of posture and movement improvement
- c. Are determined according to clinical testing
- d. Are determined through clinical observation
- e. a and d
75. Functional Category 1:
- a. Corresponds to patient's age
- b. Corresponds to patients that are indepent walkers
- c. Corresponds to patients that have mild postural imbalances
- d. Corresponds to patients that function with mild inefficiencies
- e. All of the above
76. Patients who are classified as Category 1:
- a. Under sudden balance demand will show a TLR
- b. Limit their movement repertoire to avoid falling
- c. Avoid moving over a narrow BOS
- d. Position themselves with a wide BOS
- e. All of the above
77. Patients who are classified as Category 1:
- a. Do not have functional inefficiencies
- b. Tend to be focally bound
- c. Have high amplitudes in both accommodation and vergences
- d. Use physiological energy in an efficient manner
- e. Can only be diagnosed with an MRI
78. Patients who are classified as Category 1:
- a. Can be helped through NVPT
- b. Need extensive training in reading
- c. Need auditory training
- d. Only need vestibular therapy
- e. None of the above
79. Patients who are classified as Category 1:
- a. Show shift in both visual and body midlines
- b. Maintain Postural alignment
- c. Do not have visual acuity errors
- d. Are always under 5 years of age
- e. Biomechanical alignment is symmetrical
80. Patients who are classified as Category 1:
- a. Do not suffer headaches
- b. Show functinal visual difficulties
- c. Develop their cognitive potential
- d. Are always identifed by the pediatrician
- e. Outgrow their inefficiencies
81. Patients who are classified as Category 2:
- a. Are semi-independent walkers
- b. Can walk small distances with an external aid
- c. When walking tend to drift in a combination of spatial planes
- d. Show body mis-alignments
- e. All of the above
82. Patients who are classified as Category 2:
- a. Show discrepancy in functional efficiency between upper and lower body or right and left side
- b. Antigravity postural adjustments lack refinement
- c. Hand use is more efficient in sitting
- d. Shoulder and pelvic girdle have reduced movement ranges
- e. All of the above
83. Patients who are classified as Category 2:
- a. Are in persistent postural binding as a result to avoid falling
- b. With movement demands increases risk of fall
- c. Often have binocular problems
- d. Lack flexibility and amplitude in accommodation and vergences
- e. All of the above
84. Patients who are classified as Category 3:
- a. When seated depend on external controls to maintain upright alignment
- b. Need help to do transitional movements
- c. Are unable to take steps independently
- d. Are dominated by abnormal postural reactions
- e. All of the above
85. Patients who are classified as Category 3:
- a. Have an inability for vision to lead motor performance
- b. Vision is focally bound
- c. Posture and movement are bound
- d. Have binocular problems
- e. None of the above
86. The most appropriate model of learning and performance theory to be applied to the bimodal model of visual processing is:
- a. Response-stimulus-response
- b. Stimulus-response
- c. The function model of vision
- d. The medical-pathological model of vision
- e. None of the above
87. When examining the patient with significant involvement neuro-motorically:
- a. Have the patient use the prism Rx or therapeutic prism prescription
- b. Have the patient in the best possible supported chair
- c. 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 above
- e. a, b and c
88. Vertical prisms may be effective:
- a. To disassociate the visual spatial process from the proprioceptive BOS
- b. To incorporate facilitated movement and reinforce proprioception when there is focal and postural binding
- c. Should only be used with the person seated
- d. Should always be used with caution and safety of the patient in mind
- e. a, b and d
89. In Neuro-Visual Processing Rehabilitation the clinician should always:
- a. Treat the condition diagnosed and not the patient
- b. Treat the patient and not just the condition diagnosed
- c. Treat the convergence insufficiency before the visual postural dysfunction
- d. None of the above
- e. All of the above
90. In Neuro-Visual Processing Rehabilitation the clinician should always:
- a. Treat the strabismus before the Visual Midline Shift Syndrome affecting balance and posture
- b. Treat and affect the Visual Midline Shift Syndrome before prescribing prisms to affect the strabismus
- c. Treat the neuro-visual postural imbalance before treating the binocular dysfunction
- d. All of the above
- e. a and c
91. A strabismus as well as binocularity and visual skills can be affected by:
- a. Poor postural alignment
- b. Poor postural support
- c. Capital extension
- d. Torticollis
- e. All of the above
92. The following is correct:
- a. Balance the organizational process that is interfering with binocularity as well as with posture, balance and movement in space
- b. Developmentally the ambient visual process precedes the focal process in organization
- c. NVPT should always be preformed with the properly prescribed yoked prisms
- d. None of the above
- e. a, b and c
93. Neuro-Visual Processing Rehabilitation and NVPT are:
- a. Inter-Professional in service
- b. Using lenses to improve acuity
- c. Exercises to improve strength of eye muscles
- d. Coordinated eye exercises that do not need a treating clinician