1. You are confident that a six year old child has 20/20 visual acuity in each eye. During an alternate cover test cover test, you observe no movement. However, the Hirschberg test clearly shows a 22 pd right esotropia. How would you account for this apparent paradox?
a. eccentric fixation
b. anomalous correspondence
c. child's inattention
d. intermittent suppression
2. The particular term "dyslexia" today to many people indicates what type of reading problem?
a. significant reversal errors when reading
b. poor word recognition but good comprehension
c. better oral reading than silent reading
d. disabled readers who have difficulty with spelling
3. A 8 pd base-out prism is placed before the right eye of a 7 year old patient with 20/20 acuity and 20 sec stereopsis. After 2 seconds, you occlude the right eye. The left eye is observed to "flick" in. This suggests which ONE of the following?
a. the child has eccentric fixation
b. the child has anomalous retinal correspondence
c. the child simply failed to fuse the prism
d. this is a normal response in a binocular individual
4. Which one of the following describes the theory as to the impact of an M-pathway (transient channel) deficit on reading ability?
a. after a saccade, the P-pathway cannot inhibit the M-pathway
b. after a saccade, a defective M-pathway excessively inhibits the P-pathway
c. after a saccade, the M-pathway poorly inhibits the P-pathway
d. after a saccade, a defective P-pathway doesn't register the saccade
5. The M-pathway is thought to be important for normal reading for other reasons as well. Select one.
a. it "sees" the "details" of the words
b. it controls binocular processes
c. it provides association with language processes
d. it supplies preliminary information about word shape
6. As a result of an M-pathway deficit, the persistence model predicts which ONE of the following?
a. integration across saccades is facilitated because words are "seen" for longer durations
b. saccadic latencies are much shorter, in the express saccade range
c. words of the text are seen overlapping from fixation to fixation
d. errors in reading are made because the letter "M" cannot be seen
7. Which ONE of the following is the most important aspect to consider before enrolling a child in a visual perception therapy program?
a. the child must have identifiable perceptual deficits associated with learning problems
b. the perceptual therapy must be conducted individually and not in group sessions
c. the therapists must have an advanced educational degree to administer the therapy
d. the therapy is covered by the child's health insurance
SELECT ALL CORRECT ANSWERS
1. Which of the following, if present, would exclude a child from a diagnosis of learning disabled? (SELECT ALL)
a. mental retardation
b. hearing impairment
c. emotional disturbance
d. cognitive deficit
e. lack of opportunity to learn
f. poor reading but good math scores
g. reversal errors
h. cultural disadvantage
i. delay in visual memory skills
j. delay in visual-motor integration
2. In reviewing all the research data on the relationship between vision and reading a pattern emerges. Which of the following is correct?
a. distance VA is not related to reading skill
b. anisometropia occurs more frequently in the reading disabled
c. hyperopia appears to be associated with good reading performance
d. myopia is associated with slow progress in reading
e. astigmatism appears to be closely related to poor reading skills
f. there is a tendency for poor readers to be exophoric at near
g. poor readers have lower stereo thresholds
h. vergence anomalies are associated with poor reading skill
i. poor readers have a tendency to be esophoric at distance
j. correction of refractive error accelerates reading progress
3. Which of the following are commonly found in the reading eye movements of poor readers (SELECT ALL)?
a. longer fixation durations
b. smaller forward saccade lengths
c. greater number of regressions per line of text
d. greater number of fixations per line of text
e. shorter fixation durations
f. larger forward saccade lengths
g. fewer regressions per line of text
h. more return sweep errors
i. fewer return sweep errors
4. A 9 year old child has difficulty copying from the blackboard. She is slow, sloppy and makes many errors. Select ALL of the deficits that could in part account for the behavior.
a. uncorrected refractive error
b. form perception deficit
c. visual-motor integration deficit
d. divergence excess
e. ocular motor deficit
f. visual memory deficit
g. accommodative infacility
h. fine motor control deficit
i. hearing impairment
j. articulation difficulties
k. reduced stereopsis
l. generalized fatigue
m. poor body muscle tone and/or muscle weakness
n. attention deficit
5. Select ALL of the following correct statements concerning the Random Dot E Test.
a. the child has to recognize letters before being able to succeed on the test
b. a failure indicates a deficiency in global stereopsis
c. the stereoscopic demand increases as the card is moved away form the patient
d. the stereoscopic demand is approximately 180 seconds at 1.5 m
e. using a two alternative forced choice technique, two consecutive
correct responses indicates successful performance
f. The Random Dot E test is sensitive to the presence of amblyopia
and/or strabismus
g. can be used without polaroid lenses in apprehensive children
6. Which of the following are characteristic definitional behaviors of children with attention-deficit hyperactivity disorder (DSM III-R)? SELECT ALL
a. has difficulty remaining seated when asked to do so
b. impulsivity when answering questions
c. easily distracted
d. has difficulty with sustaining attention
e. has difficulty with word recognition when reading
f. frequent occurrences of purposeful oppositional behavior
g. often shifts from one activity to another
7. Parquetry blocks can be used in vision therapy to improve which of the following (SELECT ALL)
a. visual memory
b. form discrimination
c. laterality/directionality
d. visual-spatial relationships
TRUE-FALSE
_____ 1. Language delays are thought to be a cause of learning disability.
_____ 2. A discrepancy between potential ability and school achievement is part of the criteria for identifying a learning disability.
_____ 3. Potential ability is usually determined by measuring "intelligence" (IQ).
_____ 4. When doing diagnostic chalkboard circles, a 7 year old would be expected to perform symmetrical but not reciprocal circles.
_____ 5. There is a higher prevalence of significant against-the-rule astigmatism in school aged children than in infants.
_____ 6. Vergence testing can be performed in a preschool child by inserting a prism before one of the eyes and observing the vergence (eye movement) response.
_____ 7. When performing the Broken Wheel Test impulsivity can be controlled by performing the test at very close working distances.
_____ 8. In visual acuity assessment, Allen figures can be converted to Snellen equivalents by multiplying the stated size by a factor of 1.5.
_____ 9. The NSUCO system of evaluation of saccadic and pursuit eye movements uses a 4 part reporting system of accuracy, attention, head movements and body movements.
_____ 10. The SCCO oculomotor evaluation system uses a 4 point performance scale.
_____ 11. Visual perceptual development begins at birth. If in the early school years a deficit in visual perception is found, it can easily be traced to a lack of sensory input or stimulation.
_____ 12. If a critical ratio is exceeded on the Developmental Eye Movement Test (DEM), there is a suggestion of deficient oculomotor control.
_____ 14. Trunk control in the developing child is established before head control.
_____ 15. The ability to cross the midline in ball playing activities indicates a developmental lag regardless of the child's age.
_____ 16. A one year old comes to the office for examination and can sit provided that there is enough trunk support. This does not indicate a developmental delay.
_____ 17. Adequate sensory input requiring a motor response is one of the conditions required for development to proceed normally.
All was not happy at Club Babaloo. Rick Ricardo was attempting to teach Little Ricky, his five year old T.V. son, how to play the conga. Little Ricky would do O.K. with his technique and rhythm, but would fall apart when he faced his father and attempted to follow dad's directions. The senior Ricardo would say "hit the conga with your left hand when I hit the conga with my left hand". Little Ricky would get very frustrated and as an adolescent, he got back at his domineering father by joining a really talentless teen pop band (name the band and I'll give you an extra point....maybe!). Questions 1- 5 refer to Little Ricky.
1. Based on the information above, what basic visual perceptual skill does Little Ricky have problems with
A. laterality
B. eye-hand coordination
C. visual closure
D. directionality
2. Is this difficulty to be expected (ie. normal) in a T.V. character Little Ricky's age?
A. yup
B. nope
3. On the Piaget test, Little Ricky does fine on identifying left and right body parts on himself, but falls apart when asked to identify left and right body parts of the examiner. Knowing this test result, could the senior Ricardo have made an adjustment that would allow Little Ricky to follow his father's lead more effectively?
A. Little Ricky's problem is with laterality, and no simple adjustment would allow Little Ricky to follow his father's lead more effectively
B. Little Ricky's problem is with laterality, and his congo playing would improve if the senior Ricardo would face the SAME direction as Little Ricky when playing
C. Little Ricky's problem is with directionality, and no simple adjustment would allow Little Ricky to follow his father's lead more effectively
D. Little Ricky's problem is with directionality, and his congo playing would improve if the senior Ricardo would face the OPPOSITE direction as Little Ricky when playing
4. When drawing squares, Little Ricky has no problems. But when he tried to draw a vertically elongated diamond, Little Ricky had significant difficulty in making a proper corner (see below). What is this an example of?
A. homeomorphism
B. dog ears
C. superimposition
D. babalooism
5. The senior Ricardo is very concerned about his son's perceptual skills and wants to make sure that his child scores above the norms in a standardized test. A good standardized test for the visual perceptual skill answered in question #1 would be
A. the Jordan Reversal Test
B. the Lateral Awareness and Directionality Test (LAD)
C. the Circus Puzzle Test
D. the Detroit Motor Ability and Speed Sub-test
E. all are correct
F. A and B are correct
6. The major disadvantage to standardized tests is that they
A. do not have norms established for different age groups
B. do not allow for evaluating the process that the child used to reach an answer
C. do not have specific guidelines to follow, resulting in variations in test administration
D. A and C are true
Snydley Whiplash, ever the nasty cartoon villain of the sixties, gave up cartoons and settled down. He even bought a condo in Mansion Hill, ...yes; he turned into a regular YUPPIE! Snydley also got married and had a child named Snyder. Assume that Snyder is eight (and one month) years old and that offspring of cartoon characters have the same visual/motor developmental sequence as humans. Questions 7-9 deal with Snyder.
7. When Snyder is asked simple tasks like to hold a crate of dynamite in his left hand, he messes up. In this case, Snyder exhibits some difficulty in mastering what basic visual perceptual skill?
A. laterality
B. eye-hand coordination
C. visual closure
D. directionality
8. Is this to be expected (ie. normal) in a cartoon character Snyder's age?
A. yup
B. nope
9. You administer the Winterhaven (Gesell) Copy Form Test to Snyder. He seems to have a fair pencil grip and good posture. His pictures are well planned and organized....that is, until he reaches the "British flag" pattern (see below). He draws it in a segmented fashion, drawing eight lines from the border of the rectangle to the center. What does this indicate?
A. poor visual memory skills
B. difficulty in crossing the midline
C. poor visual closure skills
D. poor directionality skills
The next patient to greet you is a frustrated Bam-Bam. It seems that he is having difficulties in the Prehistoric Pre-School. Betty Rubble, his concerned mother, reports that Bam-Bam has difficulty creating letters correctly and is always erasing his little tablet . He is getting quite frustrated at school. Assume that Bam-Bam is six (and one month) years old and that offspring of cartoon characters have the same visual/motor developmental sequence as humans. Questions 10-15 deal with Bam-Bam. ON QUESTIONS 10 AND 11, PLEASE CHOOSE ALL THE CORRECT ANSWERS!! ON ALL OTHER QUESTIONS, ONLY CHOOSE THE SINGLE BEST ANSWER!!!
10. The entire TVPS battery was administered to Bam-Bam. He scored well above the established norms for his age in all the sub-tests. Which of the following visual perceptual skills are NOT tested with the TVPS? (Circle ALL Correct Answers)
A. visual sequential memory E. visual memory
B. visual figure/ground F. eye-hand coordination
C. visual motor integration G. directionality
D. visual form constancy
11. You decide (on a whim) to complete the Beery VMI test. Bam-Bam struggles through first few items, then gets bogged down on the triangle and messes it up horribly. He realizes his error immediately and yells, "BAMN! BAMN!!!!", in frustration. After reaching a ceiling level (3 errors), Betty takes her son to the rest room, where Bam-Bam got a mouthful of Brontosoap. His score on the VMI was in the lowest 5% for Bam-Bam's age. Based on the above results from the TVPS and the VMI, which of the following visual perceptual skills can still be involved in this case (Circle ALL Correct Answers)?
A. visual sequential memory
B. visual closure
C. visual motor integration
D. visual form constancy
E. visual memory
F. eye-hand coordination
12. While Bam-Bam struggled with the VMI test, you noticed that he would start to draw a figure, then attempt to erase his errors. At that time you
A. should let Bam-Bam erase his work, the test allows for that
B. should let Bam-Bam erase his work, but you should record each erasure
C. should not let Bam-Bam erase his errors, but encourage him to continue
D. should give Bam-Bam fifty dollars
13. When observing Bam-Bam complete a puzzle, you observe that he uses one hand to pick up the puzzle piece, then transfers it to the other hand as he crosses the midline. The other hand placed the piece into the space. This is consistent with what level of bimanual integration?
A. alternating unilaterality
B. bilateral symmetry
C. bilateral asymmetry
14. On the same puzzle, Bam-Bam tries to force an obviously inappropriate piece into a space. When it did not fit, he tried to force it in with his club. After this second unsuccessful attempt, Bam-Bam reports that the piece "does not go with the puzzle". This behavior best fits the term
A. false start
B. forced choice
C. form error
D. bimanual integration
15. If you wish to test for Bam-Bam's eye-hand coordination (only), a good test for that visual perceptual skill would be (one answer only)
A. the Jordan Reversal Test
B.the Wold Sentence Copy Test
C. the TVPS (Test of Visual Perceptual Skills (non-motor))
D. the Detroit Motor Ability and Speed Sub-test
E. the Beery Test of Visual Motor Integration (VMI)
F. B and E are true
You did such a bang up job with Bam-Bam that Betty Rubble recommended your services to their friend and neighbor, Wilma Flinstone. She comes to your office with her 23 month old baby, Pebbles. She is teaching Pebbles Latin and French and wants to make sure her daughter is developing normally. Assume that offspring of cartoon characters have the same visual/motor developmental sequence as humans. Questions 16-21 deal with Pebbles.
16. A good test to administer to Pebbles would be
A. the Jordan Reversal Test
B.the Denver Developmental Screening Test (DDST)
C. the TVPS (Test of Visual Perceptual Skills (non-motor))
D. the Detroit Motor Ability and Speed Sub-test
E. the Developmental Indicator for Assessment of Learning (DIAL-R)
F. B and E are true
17. During the test, Pebbles completed the tasks without any delays. A delay is defined as
A. an item (rectangle) is situated completely to the left of the age line is MISSED
B. an item is situated so that the age line crosses at the separation between the light and shaded area of the rectangle is MISSED
C. an item is situated so that the age line crosses at small vertical line extending from the top of the rectangle is MISSED
D. an item (rectangle)anywhere is MISSED
18. Tor F There are three sections to the DDST: Eye Movement Skills, Language Skills and Gross Motor Skills
19. On the DDST, a failure is recorded when
A. a tested item (rectangle) is situated completely to the left of the age line is MISSED
B. a tested item (rectangle) is situated completely to the right of the age line is MISSED
C. a tested item (rectangle) anywhere is MISSED
20. Pebbles saw your Marsden ball suspended from the ceiling (any optometrist worth their salt has at least one hanging from their ceiling) and went to play with it. She would "toss" the ball and then catch it as it came back to her. Having the ability to do this with the Marsden ball indicates that Pebbles has achieved which MOTOR BASE, as defined by Kephart?
A. balance and posture
B. locomotion
C. contact
D. receipt and propulsion
21. When attempting to complete a puzzle, Pebbles would take a piece and rotate it to it's proper orientation BEFORE placing it in the correct space. This indicates
A. impulsive behavior
B. good bimanual integration
C. an advanced (i.e. early) transition to visual inspection in the visual motor hierarchy (i.e. vision dominates)
D. an advanced (i.e. early) transition to tactual (motor) inspection in the visual motor hierarchy (i.e. motor system dominates)
E. motor support is present
22. T or F To both Kephart and Getman, the principal way a baby learns from their environment is by moving through it.
23. A child who has problems with discriminating similar forms (D from O or U and V) and who does not self correct will most likely have delays in which visual perceptual skill?
A. laterality/directionality
B. form perception/discrimination
C. eye hand coordination
D. visual closure
24. A two year old with a +4.50 O.U. dry subjective refraction
A. should receive spectacle correction as soon as possible (if condition is stable)
B. should be monitored. If an esotropia should develop, it may be necessary to prescribe spectacles
C. does not need spectacles because of the high amplitude of accommodation present in a child that age
25. In general, which of the following characteristics are positive signs when determining the prognosis of a congenital or early acquired ET
A. normal retinal correspondence
B. early onset
C. unilateral strabismus
D. prism adaptation
E. A and C are correct
26. Therapy for anomalous retinal correspondence may include
A. reversing prism
B. opaque pathcing
C. synoptophore work at the patient's objective angle using large, flashing targets
D. all are correct
27. Bruckner’s test is useful in
A. quantification of an subjective angle of strabismus
B. quantification of refractive error
C. presence of amblyogenic factors
D. A and C are correct
28. If a six month old child presented with hyperopic anisometropia (O.D. +1.00 DS; O.S. +2.50 DS) and an intermittent left ET at near (strabismus present 20% of the time).
a. What would be the best course of action for this patient as far as passive modes of vision therapy? Be specific as to type and timing of therapy.
b. What would be the best course of action for this patient’s refractive condition? Why?
c. What are your major concerns about patching in this case?
For questions 29-30 select the correct description for the two sub-test of the TVPS presented.
______ 29. visual spatial relations
______ 30. visual figure ground (which form is different?)
A. choosing a copy of the template that differs from other alternatives
B. finding a representation of the template from other alternatives; the representation of the template may be hidden or embedded in a complex visual presentation
C. finding a representation of the template from other alternatives; the representation of the template may be rotated, flipped, enlarged or reduced in size
D. the ability to remember characteristics of a template and select the exact copy from other alternatives
31. A child who has problems with discriminating similar forms (D from O or U and V) and who does not self correct will most likely have delays in which visual perceptual skill?
A. laterality/directionality
B. form perception/discrimination
C. eye hand coordination
D. visual closure
32. It has been discussed in class (and reviewed in your text-book) that before visual perceptual skills therapy is conducted on a patient, their peripheral visual skills (accommodation, oculomotility etc.) must be normalized. What visual perceptual skill(s) is the exception to this rule of thumb?
A. visual figure ground
B. form discrimination
C. laterality
D. directionality
E. visual closure
33. Chalkboard circles were demonstrated in class as a way to encourage visual motor integration, eye hand coordination and laterality skills. We defined symmetrical circles as __________ and reciprocal circles as _______________.
A. both hands go toward the midline at the same time/ both hands go clockwise or counter-clockwise together
B. both hands go clockwise or counter-clockwise together / both hands go toward/away from the midline at the same time
C. circles are drawn close to the same size and shape / circles change size and shape as child continues work
D. none of the above
34. Which of the skills mentioned in the above question is more difficult?
(SYMMETRICAL CIRCLES / RECIPROCAL CIRCLES)
35. Completing "map" (NOT a human maze) exercises is an
A. advanced laterality task
B. advanced directionality task
C. beginning directionality task
D. advanced visual closure task
E. advanced visual sequential memory task
36. There is a clear developmental trend in reading eye movement characteristics. Relative to an older, more experienced reader, a beginning reader has which of the following eye movement parameters? (Select All)
a. Longer fixation durations
b. Smaller forward saccade lengths
c. Greater number of regressions per line of text
d. Greater number of fixations per line of text
e. Shorter fixation durations
f. Larger forward saccade lengths
g. Fewer regressions per line of text
h. Fewer number of fixations per line of text