we include the anatomy and neurophysiology of the visual system.the functions and how its importance. assessment of processing disorders is also included. we include clinical features and management of visual processing disorders. A recent advance related to management of visual processing disorder has been attached at the end.

1. Visual Perception
SUSAN JOSE

2. Introduction
• Visual perception is defined as the total process of the
reception (sensory functions) and cognition (specific mental
functions) of visual stimuli.
• Visual receptive component is the process of extracting and
organizing information from the environment.
• Visual-cognitive component is the specific mental functions
that provide the capacity to organize,and interpret visual
stimuli giving meaning to what is seen.
• The vestibular -proprioceptive and tactile integration is the
base on which the visual and auditory systems start to mature
and integrate.

3. Receptive systems
M and P ganglion cells
on and off center cells bipolar cells

5. Visual PATHWAYS
• 1 Pathway-
Parvo and
magnocellular pathways- starting
from the Lateral Geniculate Nucleus
Functions-
Magnocellular pathway- spatial
orientation
Paarvocellular pathway- colour ,
shape and size
Dorsal stream – visually guided
movements , to know the
orientation of objects
Ventral stream- concious
identificaion of the object

6. 2 pathway-
• Superior colliculus (SC)
Function- map the visual space around us in terms of visual and
somatosensory cues.
Afferents- some fibers from the optic nerve, LGN, primary and
association visual areas(17, 18, 19),spinotectal pathway
(somatosensory input)
Efferent –
• tectospinal pathway, (reflexive movt of head and neck to visual
stimulus)
• occulomotor nuclei (saccades)
• Tectopontine – for cerebellar processing of head and neck
control.

7. 3 pathway-
• Accessory visual pathway
• Function- detects self-motion and generates corrective eye
movements
• some fibers from optic nerve  medial vestibular
nuclei,eldinger west pal  inferior olivary complex Floculo
nodular lobe cerebellum  medial vestibular nuclei 
III,VI,V CNN
4 pathway-
• frontal eye field- is connected via association fibers to
occipetal lobe.
• Function- Voluntary eye movements.

8. Receptive functions
• Visual fixation and conjugate eye movts are controlled by
occulomotor nerve which receives inputs from SC. Fixation
is prerequisite for scanning.
• Pursuit- it is important for visual fixation on a moving
object. Slow conjugate movements of the eyes.
• Saccades- rapid change of visual fixation. It may be
voluntary or involuntary.
• Acuity- discriminate the fine details of objects in the visual
field.

9. • Accommodation- the ability to focus on an object at varying
distances. 3 steps are involved in it-
– Convergence or divergence
– contraction of ciliary muscles
– pupillary dilation.
• Binocular fusion-
Motor fusion - both the eyes should be in the same position . By
equal action of the extra ocular muscles .
Sensory fusion – image formed on both the retina should be of
same size and characteristics.
• Stereopsis- depth perception, peripheral vision is important in
depth perception.
• crude steropsis at- LGN
• fine - occipetal and posterior parietal centers
• Convergence and Divergence.

10. VISUAL COGNATIVE
FUNCTIONS
VISUAL
ATTENTION
ALERTNESS VIGILANCE
SELECTIVE
ATTENTION
DIVIDED
ATTENTION
VISUAL MEMORY
WORKING
MEMORY
LTM
VISUAL
DISCRIMINATION
OBJECT
PERCEPTION
SPATIAL
PERCEPTION
VISUAL IMAGERY

11. ROTATION IN VISUAL IMAGERY

12. OBJECT PERCEPTION
FORM CONSTANCY
FIGURE GROUND
PERCEPTION
VISUAL CLOSURE

13. SPATIAL PERCEPTION
POSITION OF OBJECT IN
VISUOSPATIAL
ENVIRONMENT
DEPTH PERCEPTION
TOPOGRAPHICAL
PERCEPTION
d , b
Saw, was

14. VISION AND BODY SCHEMA
• It is an unconscious internal representation of the body
providing a postural frame of reference.
• It is always updated during movements.
• The coordinates of the body and the coordinates of the
environment should match for an efficient and coordinated
postural and movement control.
• It is important for interpreting self-motion, and to calibrate
motor actions.
• The proprioceptive-tactile-visual system contribute for
formation of Body schema.
• When in a new environment or learning new actions vision is
used to constantly update body positions until the
proprioceptive and tactile can take over the function once it is
learnt.

15. VISION AND BALANCE
• Vision-vestibular-prorioception important for
balance and postural control.
• Visual gives the sense of verticality with respect
to the vertical objects in the environment.
• During reactive response peripheral vision is of
particular importance. As the person holds or
places his foot during the holding or placing
reaction dependants on the ergocentric visual
map.

16. Age Movement
Gestational 5TH
month
eye movements are produced by vestibular influences
1 week Attentive to Human faces
2nd month Visual fixation, accommodation,
convergence, and saccades and pursuits, stereopsis
4 months Categorise objects, visually directed reaching and
downward gaze established
1 yr Body schema develops, lateralisation, bilateral
coordination
3 -7 years Figure-ground perception , good eye hand coordination
6 and 7 years Form constancy , ability to regulate attention
7 to 9 years Position in space
7-10 years of age directionality
18 years Visual acuity is best
Developmental changes in visual system

17. • Developementally control develops from horizontal eye,vertical
movements ,diagonal, and circular directions.
• Visual perception develops completely- 9 years of age
• Until that age child prefers to learn via tactile, proprioceptive systems.

18. Visuoperceptual
defects

19. SENSORY MODULATION
• REGISTRATION –
• fails to attend to and register relevant environmental stimuli.
When CNS is working well, it knows when to “pay attention”
to a stimulus and when to “ignore" it automatically and
efficiently.
• Failure of registering life saving inputs can be dangerous.
• Because of reduced sensory inputs the child lacks the inner
drive.
• Unless there is sensory registration there will be no adaptive
behavior.

20. Hyporesponsive and problems with
discimination
Seeks out visual stimulation
Effects a child’s visual tracking, discrimination, and
perception
Difficulty with visual discrimination – b and d, q and p for
example
Reversals when reading – now for won, no for on, was, for
saw
Difficulty telling the differences between colors, shapes, and
sizes
Difficulty copying from a chalkboard
Inconsistent sizing or spacing when writing, doesn’t write on
the line

21. Hyperresponsive
Complains about bright lights, covers eyes
frequently, or may get frequent headaches from
light
Sensitive to florescent lighting
Easily distracted by visual stimuli – distracted by
movements in their periphery
Enjoys playing in the dark
Rubs eyes frequently
Decreased eye contact

22. Summary of Functions Visual
Perception-
• Balance and postural control along with vestibular and
proprioceptive systems.
• Ergocentric map of the environment.
• Along with other senses involves in building the body
schema.
• Navigate the environment along the integration with
other sensory systems.
• Ability to locate a sound source accurately along with
the visual-auditory-vestibular integration.
• Accurate reaching process.
• Higher cognitive process- writing reading.

23. Assesment
Ayers Sensory Integration And Praxis Test
Praxis on Verbal Command:
• 1-2 step verbal direction
Sequencing praxis:
• 6-step process.
Post rotary Nystagmus :
• spinning the child on a spin board 10 times over
a period of 20 seconds. Look for nystagmus
reaction. Even if present it should stop is 10
secs.
Manual form perception:
• Part I – involves identifying the visual
counterpart of a geometric form held and
manipulated in the hand.
• Part II – involves feeling a shape with one hand
and finding the matching shape among a line of
blocks manipulated with the other hand,
without the aid of vision and visual cues.

24. • Scoring is software mediated

25. Other Types-
• Bruinenski Osestery Test – 2 (BOT-2)
visuomotor test
• Test Of Visual Analysis (TVAS) - non motor
• Developmental Test Of Visual Motor
Integration.(DTVMI)

26. Management

27. Management
• Attention
• If the child has reduced arousal to perform a task then, start
with a sensory input that arouses the child and then give a
meaningful task to the child.
• Organize the workspace- if under responsive child use high
contrast colors for making and give a visually attractive
workspace.
• If hyper-responsive- organize workspace into categories.
• Give less no. of letters per page.

28. Memory-
• Repetition and constancy of learned items at home and school.
• When learning new items associate it with older memories and
let them know why it is different.
DISCRIMINTION-
• Use tactile and proprioceptive system for academic learning.
• Maps for topographical identification.
• Practicing imitation, identification of letters.
• For improving body schema or spatial orientation- imitation
games, holding positions and R-L discrimination games.
• Provide various positions to work so that the eyes have a
stable head and body.

29. ARTICLE
 Reem M. Alwhaibi, Reham S. Alsakhawi & Safaa M. ElKholi
(2019)
 Augmented Biofeedback Training with Physical Therapy
Improves Visual-Motor Integration, Visual Perception, and
Motor Coordination in Children with Spastic Hemiplegic
Cerebral Palsy: A RCT
 Physical & Occupational Therapy In Pediatrics,
10.1080/01942638.2019.1646375

30. • Children with spastic hemiplegia have impairments in visual-motor
integration (VMI) that affect the interaction of motor, visual perceptual, and
visual skills.
• Specific disorders of visuoconstruction, evidenced by limitations in
activities, such as reproducing spatial configurations with square blocks,
drawing from a model, and spontaneous drawing, have been demonstrated
in children with right- and left-side hemiplegia .
• Augmented feedback is defined as external information about a
performance that supplements internal sensory feedback. Theoretically,
when learning happens the controlling process changes gradually from a
closed-loop system to an open-loop system using explicit or implicit
learning.
Introduction

31. Inclusion
1. 5to 8yrs spastic hemi with MAS in upper limb flexor muscle
group between 1 and 1+
2. ability to handle objects independently as described for
levels I and II of the Manual Ability Classification System
3. able to understand and follow verbal commands and
instructions.
Exclusion Criteria
1. presence of visual or auditory impairments (using eye
glasses or hearing aids)
2. moderate to severe contractures; fixed deformities in the
upper limbs
3. severe spasticity
4. autism
5. severe cognitive impairment
6. epilepsy; botulinum toxin A upper extremity treatments
within the previous 6 months

33. Methodology
Six games were selected – each game was performed for 10 min
Biofeedback games

34. Conventional therapy

35. OUTCOME MEASURES
Beery-Buktenica Developmental Test-
• VMI section, consisting of 30 geometrical shapes that the
subject is instructed to copy with a pen and a paper
• VP section, which requires the subject to match visual shapes
within 3 min
• MC section, which requires the subject to trace the shapes with
a pencil without leaving the doublelined paths in which the
designs are presented and has a 5-min time limit

36. RESULTS
• Visual motor integration,Visual perception and
Motor coordination
• Comparison between pre- and post-treatment
scores within each of the three groups revealed a
higher mean standard VMI scores at post-
treatment for each group.
• MANOVA between the 3 groups showed that
group C has a higher mean age equivalent score
compared with children in groups A and B. There
was no significant difference between groups A
and B.

37. Discussion
• The optimal outcome of the training is that children could
use feedback to improve manual actions performed with the
affected hand, specifically actions involving fine motor
skills.
• Biofeedback has been reported to enhance treatment
programs and facilitate motor learning by engaging sensory
inputs, and it may enhance compensatory strategies
required to overcome functional losses.
• The improvement noted in the group who received
combined therapy could be related to timing of feedback
received,(i.e) within milliseconds of the movement
accomplishment.
• The children in the biofeedback group relied more on the
visual and auditory systems to process information.

38. • Preliminary evidence suggests that interacting with
games that are associated with visual feedback
improves the accuracy of motor actions compared
with performing the same exercises with limited
feedback or from memory.
• The use of feedback during the execution of specific
movements helps in motor skill acquisition.
• The improvements could be related to neural
plasticity and remapping of the cortical areas.

39. REFERENCES
• Sensory integration in children by: Anita
Bundy
• Case-Smith/O’Brien: Occupational Therapy
for Children, 6th edition