DEVELOPMENTAL TESTING / DIAGNOSIS

CASE 8

A 6 year/6 month old patient enters your office. The parents want to know more about their daughter's development. They worry because she frequently reverses words/letters/numbers. They brought examples of her work:

 Based on the above work, what observations can you make about Caryn's:

-Laterality / directionality (link to notes)

-Visual organization

-Graphomotor skills (link to notes)

-Awareness of error

 What do these results imply? should we be concerned about significant learning disabilities?

History

Family Hx	Positive for ET in uncle (maternal side), sibling has no visual/developmental problems
OHx	Patient wears anisometrpic correction for 2.5 years
HRx	OD: +2.00 -2.00 x 065 OS: +0.75 -0.50 x 117
Birth Hx	Normal; no meds; delivered by non-emergency C-section; normal developmental milestones; high-normal I.Q., but teachers concerned about her eye movements, writing and visual planning

1. Any additional history?

Objective

Static retinoscopy	O.D.: +2.25 -2.00 x 065; O.S.: +0.25-0.50 X 120
Acuities	O.D.: 20/30; O.S.: 20/20
Cover test (entering)	No significant phoria/tropia
Stereopsis	40" of arc on Stereofly
EOM	4-5 fixation losses on one circle; FROM on double H test; + head turn; +motor support ; - motor overflow
Vergences/Phorias	Ortho/ 4D XP'; Normal ranges BI/BO @ Distance; BO' : 25/40/12 (seems a bit large!)

2. Why isn't FROM enough to record for EOM function?

3. What is meant by "motor support" and "motor overflow"?

4. There were no midline jumps on EOM testing. Is there any significance to that?

5. Any additional tests?

On a separate visit, you conduct a Developmental Vision Evaluation, combining standardized with non-standardized tests.

 NOTE: movies are best observed on the network because download times may be long!

NOTE: CLICK ON THE @ AND SEE A FRAMEPAGE WITH A DESCRIPTION OF THE TEST, TEST RESULTS AND THE MOVIE!

	TEST RESULTS / SCORE SHEETS	NORM TABLE	PERFORMANCE (movies)
Jordan RFT @	CLICK!	CLICK!	CLICK!
TVPS (notes) TVPS (examples)	TEST RESULTS SCORE SHEET	CLICK!	Vis. Discrim. @ Vis. Spat. Relat. @ Vis. Form Const. @
VMI @	Pg. 1 Pg. 2 Pg. 3 ScoringGuide * far right column: typical incorrect responses (correct responses in column to left)	CLICK!	CLICK!
3 X 3 Alt. Hop	Scoring Guide * far right column: age expecteds		CLICK!
Piaget Test @			CLICK!
TVAS @	Pg. 1 Scoring Guide
Puzzles @			Circus Split Form

6. Why incorporate non-standardized tests into the protocol? What value do they have? Why conduct a gross motor test like the 3X3 alternate hop? Aren't we EYE doctors?

7. Why are standardized tests extremely popular? What value do they have?

8. For each of the tests conducted: 

9. For each test conducted, please present an alternative test for that particular area of visual perception (with brief discussion of its merits).

10. Are there any tests that you feel are more appropriate for a 6.5 year old? (hint: look @ laterality / directionality for a good one!)

11. Are there any areas of non-motor or motor visual perception that have NOT been evaluated? How would you evaluate this area?

12. What are your overall feelings about this case? What specific areas of visual perception need the most work?