WEBVTT

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Words appear ocular motor dysfunction ,

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smooth pursuits and cicadas testing

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procedures . Rendered 3d model of the

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human brain and eyes appears more than

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40% of the brain is dedicated to vision

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and any damage to the brain can affect

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several different visual and eye motor

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pathways including indirect trauma .

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The model rotates 360 degrees . It is

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important for eye care providers to

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screen patients who have a possible

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history of TBI as neurologic injuries

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sustained from concussion , blast

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exposure and other head trauma can lead

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to vision dysfunction in an examination

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room . A practitioner moves her finger

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from side to side and up and down in

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front of a patient . Three of the most

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common manifestations are problems

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focusing difficulty converging the eyes

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and issues visually tracking objects .

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The screening for ocular motor

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dysfunctions following traumatic brain

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injury . Clinical recommendation is

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available for download from the vision

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center of Excellence website . A QR

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code appears V ce dot health dot m

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slash providers slash clinicians ,

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hyphen and hyphen and researchers slash

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clinical hyphen practice hyphen

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recommendations slash ocular motor then

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pages from the V ce website . This

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video is an addendum to the clinical

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recommendation and will demonstrate the

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proper testing procedures to detect the

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presence and type of ocular motor

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dysfunction in patients diagnosed with

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or suspected of having a TBI I . If

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your patient does not have a formal TBI

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diagnosis , refer them to their primary

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care provider for an evaluation . The

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practitioner holds up her finger in

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front of the patient's face . Smooth

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pursuits is the ability to track a

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moving target smoothly . TB is can

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affect pursuit eye movements which use

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a different neurological control system

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than cicadas and may include the

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tendency to introduce psychic eye

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movements during a smooth pursuit . The

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practitioner holds up two fingers , 3

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ft apart . Cics are when our eyes move

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between two targets . Following A TB I

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affected individuals may over or

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undershoot a target when attempting to

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jump from one point of regard to

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another accurately . This is

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particularly problematic when reading

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the following ocular motor dysfunction

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tests will help identify those

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individuals that have a dysfunction of

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smooth pursuits and or cicadas perform

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this test on patients of any age .

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Begin by performing the procedure for

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smooth pursuits . Tests , sit facing

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the patient and have the patient look

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straight ahead , instruct the patient

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to perform this test by only moving

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their eyes and not their head , hold

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your index finger , 3 ft away from the

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patient . While the patient focuses on

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your fingertip , smoothly , move it 1.5

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ft from the patient's midline to your

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left , then move your fingertip 1.5 ft

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from the patient's midline to the right .

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It should take two seconds to move this

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3 ft distance . Do this twice as the

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practitioner moves her finger . The

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patient follows with his eyes , with

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the patient focused on your fingertip ,

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raise your finger 1.5 ft above the

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patient's eye level , then lower your

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fingertip , 1.5 ft below the patient's

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eye level . It should take two seconds

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to move this 3 ft distance , do this

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twice . She moves her finger up and

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down here , you see a patient

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demonstrating normal results for a

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visual pursuit , his eyes move up and

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down smoothly . If a patient is

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unable to follow a pursuit visually and

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or they substitute CCAS for the smooth

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pursuit eye movements , the results are

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abnormal . Here's an example of what an

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abnormal result looks like the

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patient's head moved slightly , record

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the results . The practitioner makes

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notes now begin the CCAS testing

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starting with horizontal cicadas sit

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facing the patient and have the patient

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look straight ahead , instruct the

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patient to perform this test by only

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moving their eyes and not their head .

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Hold your right and left index

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fingertips , 1.5 ft away from the

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patient's midline about 3 ft from the

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patient . So that the angle of gaze is

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30 degrees left and 30 degrees right at

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the level of their eyes , ask the

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patient to move their eyes from one

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fingertip to another as quickly as

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possible 10 times . She gives the

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patient instructions that his eyes move

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quickly from side to side .

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Here , you see a patient demonstrating

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normal results for horizontal cicadas .

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If ccas are dysmetric , such as under

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shooting , over shooting excessive head

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movement or unspecified subjective

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complaints , the result is abnormal .

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Here's an example of what an abnormal

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result looks like . The patient's eyes

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move jerkily demonstrating abnormal

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jerky horizontal cicadas

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record your results and proceed to

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vertical cicadas , sit facing the

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patient and have the patient look

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straight ahead , instruct the patient

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to perform this test by only moving

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their eyes and not their head . Hold

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your right and left index fingertips ,

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1.5 ft above and below the patient's

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midline with both fingertips held about

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3 ft away from the patient . So that

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the angle of gaze is 30 degrees up and

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30 degrees down from the level of their

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eyes , ask the patient to move their

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eyes from one fingertip to another as

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quickly as possible . 10 times here you

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see a patient demonstrating normal

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results for vertical cicadas , his eyes

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move up and down quickly and smoothly .

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If cicadas are dysmetric , such as

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undershoot , overshoot , excessive head

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movement or unspecified subjective

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complaints , the result is abnormal .

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Here's an example of what an abnormal

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result looks like jerky , up and down ,

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eye movements ,

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record your results . The practitioner

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writes notes any abnormal results

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increase in visual symptoms , headache ,

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dizziness , nausea , and or fogginess

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from the baseline during this testing

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are indications for referral for a more

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comprehensive TBI ophthalmic

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examination . She hands the patient a

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referral document words appear I CD 10

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coding guidance for visual dysfunction

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following traumatic brain injury ,

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proper and accurate coding is very

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important for data quality and analysis .

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The accuracy of the reported diagnoses

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affects many variables , clinical care ,

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proper allotment of resources and

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research and education . Just to name a

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few scenes of military personnel

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working in offices , warehouses and

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labs . Higher quality data leads to

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better evidence based clinical

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decisions on assessment and management

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of conditions and diseases . This is

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how we can improve the readiness and

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total health of the force for the

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purposes of this video . Only primary

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symptom codes or diagnostic position

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two from the clinical recommendation

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are covered in this coding guidance . A

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list of diagnostic position , two

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primary symptom codes appears . This

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list of diagnostic codes are the most

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commonly reported ocular motor

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dysfunctions associated with TBI

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symptoms and vision related complaints .

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Diagnoses . In bold indicate grouped

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coding sets for certain variables of

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condition . The three codes in bold are

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blindness and low vision , nest , stama

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and irregular eye movements and visual

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field loss . For more detailed

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information . A full list of codes is

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available for download at the URL

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displayed on screen V ce dot health dot

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m slash providers slash clinicians ,

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hyphen and hyphen researchers slash

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clinical hyphen practice , hyphen

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recommendations slash ocular motor .

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The most important thing to remember

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when screening for ocular motor

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dysfunction is to examine the patient

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treat and refer accordingly and code

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accurately for best results . For more

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information on the coding guidelines

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and or to download this and other

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clinical recommendations . Visit the

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Vision Center of Excellence online .

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Thanks for watching . A QR code appears

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V ce dot health dot mail slash V CE

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home

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produced by Visual information

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directorate Naval Medical Leader and

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Professional Development Command .

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Bethesda Maryland .