Hjernerystelse og syn

Om langvarige foslashlgevirkninger efter hjernerystelse

- med saeligrlig fokus paring synsforstyrrelser

Torben Helstrup neurooptometrist FCOVD (Slideshare Download)

Den der ler sidst - taelignker langsomst

1 Hjernerystelse og syn Helstrup 2014

Perspektiv og udvalgte pointer bull Indkredsning og paradokser bull Al tings ophav og rumtiden bull Optometrien i landskabet bull Synshjernens virke bull Fiksation og binokulaeligre lidelser bull Undersoslashgelser bull Sammenfatning

Aftenens program

Hjernerystelse og syn Helstrup 2014 2

Resten maring i selv Goggle

Hjerneskade Akut og laeliggelig fase Fokal skade og specifikke symptomer Mild hjerneskade mild traumatisk hjerneskade let hovedtraume mTBI) Ingen synlige skader men alligevel bestaringr udtalt mistrivsel og alvorlige symptomer hos en mindre gruppe (maringneder aringr) PostCommotionelle Syndrom (PCS) Global skade og staeligrkt aeligndret sensivitet


Snarligt kommende rdquoFysioterapeutenrdquo Behandling af en patient med dobbeltsyn og balancebesvaeligr i akut og subakut fase efter en apopleksi - et samarbejde mellem fysioterapeut og neurooptometrist ndash en case rapport Eriksen K udviklingsfysioterapeut1 Helstrup T neurooptometrist fcovd2 Meden P overlaeligge 3 1 Fysio- og ergoterapiafdelingen Bispebjerg Hospital opg 10 Bispebjerg Bakke 23 2400 Koslashbenhavn NV 2 Koslashbenhavns Private Synsplejeklinik Roslashdovre Centrum 247 2610 Roslashdovre 3 Apopleksiklinikken Bispebjerg Hospital Bispebjerg Hospital opg 1 Bispebjerg Bakke 23 2400 Koslashbenhavn NV


De usynlige skader

PCS Helstrup 2014 5

Konsensusrapport om Commotio cerebri (hjernerystelse) og det Postcommotionelle syndrom (langvarige foslashlgevirkninger)

httpshopsocialstyrelsendkproductscommotio-rapport

Langvarige symptomer efter hjernerystelse udstiller sundhedsvaeligsenets kollektive

uforstand

Tilgangen og raringdgivningen burde vaeligre meget ydmyg ndash men alligevel fremhaeligves ofte

bull Ro og hvile ndash i det uendelige (afmagtsraringdgivning) bull Psykologiske lidelser (ondt i livet) bull OK til det alternative (som garingr i selvsving)

Paradoks 1


httpwwwprivatsyndkklinikkenklinikkens-medarbejderecv-torbensprogforbistring-synslidelser


Cirka 15000 hjernerystelser aringrligt Beskue helingsproces for langt flertallet ndash dage uger

Men for cirka 1500 kikser det helt (PCS) Skolebarn kan sortere rdquoDuer ikkerdquo

Paradoks 2

Ingen systematisk tilgang til diagnose og behandling i Danmark httpwwwhjernerystelsedkavisartikel_jan2008pdf

Paradoks 3 Sygdom versus lidelse

bull En uheldig virkning af sygdomsbegrebet er at naringr der ikke stilles en medicinsk diagnose (og behandling) - saring opfattes tilstanden ikke som saring alvorlig

bull Det er helt forkert

bull Funktionsforstyrrelser kan afstedkomme meget alvorlige symptomer Personer kan vaeligre meget forpinte og uarbejdsdygtige


Optometrien i

landskabet


Daghoslashjskolen i centrum (neuropsyk)

NEUROLOGISK Nakkesmerter Hovedpine Svimmelhed Taringge eller dobbeltsyn Lysfoslashlsomhed Lydfoslashlsomhed Soslashvnproblemer Traeligthed

KOGNITIVT Daringrlig koncentrationsevne Opmaeligrksomhedsproblemer Hukommelsesvanskeligheder Generel forvirring Overbliksvanskeligheder Strukturproblemer Nedsat laeligseevne Ordfindingsvanskeligheder

ADFAEligRD Irritabilitet AEligngstelser Depression Aggression Indlaeligringsvanskeligheder Stressfoslashlsomhed Impulsivitet Humoslashrsvingninger Personlighedsforandringer

httpwwwdhicdkyderligereLangtidsfoelger_efter_mild_traumatisk_hjerneskadehtm

Langtidsfoslashlger efter mild traumatisk hjerneskade



Sanseindtryk Hyppigt forekommende langtidsfoslashlger er nedsat evne til at integrere sanseindtryk Personen bliver lyd- og lysfoslashlsom Endvidere ses en hoslashj frekvens af synsforstyrrelser dobbeltsyn flimren taringgesyn samsynsproblemer og fokuseringsvanskeligheder samt cerebral astenopi (3) Synsproblemerne vil fremkalde mental udtraeligtning og kan forstaeligrke hovedpine og svimmelhed

L a n g t i d s f oslash l g e r e f t e r m i l d t r a u m a t i s k h j e r n e s k a d e



Center for hjerneskade

Hvad er hjernerystelse Ved hjernerystelse kan der opstaring skader paring nervebanerne og i stoslashttevaeligvet hvilket paringvirker de kemiske systemer og blodgennemstroslashmningen i hjernen Forandringerne er ofte ikke synlige ved scanning eller neurologisk undersoslashgelse

httpcfhkudkGenoptraening-_voksnehjernerystelse



Commotio-enheden paring Center for Hjerneskade tilbyder ------- Ofte er den ramtes intellektuelle funktioner kun lettere paringvirket men foslashlgerne af hjernerystelsen betyder at de kun kan arbejde i kort tid ad gangen ------

Center for Hjerneskade samarbejder med en raeligkke eksterne fagpersoner (neurologer psykiatere optometrister mv) for at sikre at borgeren faringr det optimale udbytte af forloslashbet



Rumtiden (spacetime)


Big Bang Elektromagnetisk straringling tyngdekraft og tiden frisaeligttes

4 D verden Rumlig afstand betyder tidslaeligngde - og vice versa (ikke abstrakt - volumen omkring os)

137 milliarder aringr Vaeligsen med sanseapparat til afkodning ---


Fakta Rumtid I Einsteins relativitetsteori er tid og det tredimensionale rum slaringet sammen til en enkel firedimensional rumtid (4D)

Et punkt i rumtiden bliver benaeligvnt en haeligndelse

Enhver haeligndelse har 4 koordinater (t x y z) ndash en for hver dimension

Hjernerystelse og syn Helstrup 2014

Tid- hoslashjre-venstre- op-ned og naeligr-fjern dimensionerne

15



16

Al erkendelse af eget staringsted og al tings indbyrdes relationer - samt alt handling og faeligrden er baseret paring rumtidsanalyse og fremtidsfortolkning

4 D

Volumen

Synshjernens virke

PCS Helstrup 2014 17

Interface 1 Kontaktflade

mellem ydre og indre

verden (fiksationsfelt) Interface 2 Lysenergi til elektrisk impuls og

foslashrste processering

Signalmix og foslashlsomhedsregulering af interface 2 Opsplitning af egenskaber analyse og bevidsthed Samme aktivitet

fysisk elektrisk


De visuelle motorveje

Hvad

Hvor hvordan


X Orkestermodellen

80- 90 fra retikulaeligre formation og V1

Max 40 af retinale signaler transportes videre fra LGN

Interface

The binding problem - eller hvordan sammenflettes

og adskilles hjernecelleaktivitet


X Som et orkester ndash men uden dirigent

1 Signalforstaeligrkning (synkronitet) 2 Signal-stoslashj forhold optimalt (baggrundsaktivitet svag) 3 Forgrund ndash baggrund (filtrering af vaeligsentlighed)

20

Faeligrden og navigation


Online justering (transportstativ)

Minds eye Fremtidsfortolkning af rumtiden (txyz) - og masterplan for bevaeliggelse

Sanser til at afkode ydre og indre verden

Kumulerede hastighedsfordelinger for fritgaringende yngre (17-64 aringr) aeligldre (65 aringr+) og handikappede fodgaeligngere (med rollator stok) i signalregulerede kryds

Normal ganghastighed

Fremtidsfortolkning rdquoLaeligserdquo og handle



Faeligrden kraeligver at rumtiden fortolkes gt Kollisionskurs- og tid gt timing (ogsaring i rullestol)

Syn styrer bevaeliggelse og hastighed gt Masterplan



Scanning af information i rumtiden (txyz) - via saccader

Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7

Saccademotoren Fiksation Lokalisation Identifikation Ny saccade

Vis

ible

Ma

n B

rain

as

in F

ig 2

Corbetta M PNAS 199895831-838

copy1998 by National Academy of Sciences

htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm

l Frontoparietal cortical networks for directing attention and the eye to visual locations Identical independent or overlapping neuralthinspsystems


4-D fiksation sammenfatning og formaringl

bull Fiksation Visuelle

ankerpunkt i rumtiden

bull HVOR er det

(perifere syn) Global analyse

(M system) bull HVAD er det

(centrale syn) Lokal analyse

(P system)

X

Y

Z

bull Rumtidsanalyse analyse for beregning af kollisionskurs- og tid

bull Timing af bevaeliggelser

Trin 1


Figure 1 Eye movement scanpath (in red) of a person viewing a painting by Rein note the tendency to fixate on the faces Adapted from Yarbus (Eye Movements and Vision Plenum New York 1967)

Saccader i aktion

Afkodning af billede (scanningsmoslashnster)


Scanningsmoslashnstre er opgave relaterede


httpentirelysubjectivecomsaccades-we-see-what-we-are-looking-for

Godt bud paring efferente ruter fra V1 til LGN Hjernen opsoslashger og leder efter saeligrlige interessepunkter (POI) ndash afhaeligngig af opgaven (indefra gt ud)

Saccader i aktion

Kontaktsport og hjernerystelse

J Neurol Sci 2013 May 15328(1-2)28-31 doi 101016jjns201302008 Epub 2013 Saccades and memory baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players

Neurology 2011 Apr 2676(17)1456-62 doi 101212WNL0b013e31821184c9 Epub 2011 Feb 2

The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters


King-Devick Test httpenwikipediaorgwikiKing-Devick Test

bull The King-Devick Test (K-D Test) is

defined by Mosbyrsquos Medical Dictionary as a tool for evaluation of saccade consisting of a series of test cards of numbers The test cards become progressively more difficult to read due to variability of spacing between the numbers Both errors in reading and speed of reading are included in deriving a score[1] Saccades are quick simultaneous movements of both eyes

bull In 2011 researchers discovered a link between King-Devick Test and sideline remove-from-play concussion screening

J Neurol Sci 2011 Oct 15309(1-2)34-9 doi 101016jjns201107039 Epub 2011 Aug 16 The King-Devick test and sports-related concussion study of a rapid visual screening tool in a collegiate cohort Hjernerystelse og syn Helstrup 2014 30

Saccade-neurologien saringret

J Sports Med Phys Fitness 2014 Feb54(1)70-7

The King-Devick test as a concussion screening tool administered by sports parents

High levels of test-retest reliability were observed (intraclass correlation coefficient 090 [95 CI 084-097]) Additionally 6 boxers who participated in multiple bouts showed no worsening of their K-D times further supporting that scores are not affected by the fatigue associated with sparring Conclusion The K-D test is a rapid sideline screening tool for concussion that can be effectively administered by non-medically trained laypersons


Kommerciel hjemmeside httpkingdevicktestcom

Test af scanningsmoslashnster


httpswwwyoutubecomwatchv=hGcz0dQUZnw

Signalproblemer ved saringret saccade neurologi


Kan ikke saccadere normalt gt og kan ikke afkode txyz meningsfyldt gt kommer ud af synkronitet med rumtiden

Al bevaeliggelse baringde egen og i omgivelser bliver en trussel gt og kraeligver enorm mental anstrengelse at haringndtere (kognitivt load maksimalt) Afledte subjektive klager er ofte bull Konfusion Kan ikke se Tv film eller faeligrdes i centre ( for

mange bevaeliggelser og ligebyrdighed i signaler) bull Bliver let usikker paring eget staringsted og kan ikke bevaeligge hoved

eller krop hurtigt (svimler) Orientering tager tid bull Visuel aktivitet generelt meget kraeligvende og traeligttende og

har ofte opgivet laeligsning (isaeligr computer) bull Hvis man rdquosynderrdquo faringr man rdquotaeligskrdquo (let op til et doslashgn efter)

Det hele starter med Okulaeligr fiksation


Sigtemekanik til traringdloslashs online rumlig sansning

34

Spotlight = Fiksationsomraringde = Perceptionsfelt


Ankerpunkt og traringdloslashse perceptuelle kontakt i fysiske verden

Macula ca 1 grad Paramaculaeligre omraringde ca 10 grader (tommel i strakt arm ca 2 grader)

bullFiksation bullSmooth Pursuit bullSaccader bullOptokinetiske refleks bullVestibulaeligre-okulaeligre refleks

Fastholde eller skifte fiksationsfelt - mhp at opsoslashge og tolke rumlig information Fiksationsstabiliserende ved bevaeliggelse (hoved og krop)

Biomekanik til fiksation (et oslashje)

rdquoJaeliggerenrdquo Saccader og VOR gt OPSOslashGE information i omgivelser rdquoForfoslashlgerenrdquo Smooth pursuit og OKR gt FOslashLGE objekt ndash og stimulus kommer fra oslashjet selv (input-out drevet)

Sansekonflikt Transportsyge


Binokulaeligre ankerpunkt (fiksationsfelt) rdquoPoint of interestrdquo

Stereopsis (synsvinkelforskel)

Motorisk triangulation

(proprioception)


2

Signalforstaeligrkning

Rumtidsfortolkere af i signaler i t- og z dimensionerne

POI

POI Fiksationsfelt (Mindrsquos eye) Input-output drevet

Naeligrtriade Selvstaeligndige og gensidigt modulerende reaktioner bull Vergens version bull Akkommodation bull Pupil

Biomekanik til fiksation (to oslashjne) Binokulaeligre syn


Mindrsquos eye Paramaculaeligre omraringde daeligkker ca 10 grader af synsfeltet Oslashjenbevaeliggelser er klart hurtigere og mere praeligcise en hovedbevaeliggelser Saccader scanner synsfeltet

Ballistisk saccade til nyt objekt Bi-fiksation Smooth pursuitndash og

vergensfunktionen samarbejder (bi-fiksation indenfor Panums omraringde)

Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements

Disconjugate movements

Fast eye movements

Slow eye movements

Vestibular

Proprioceptive

Vergence eye movements

39

Ocular motor system in 3D space

XY Z(T)

Fiksations- og scanningsfelt

POI

Kredsloslashb

Sensoriske og motoriske systemer i samspil Input og output samtidigt


Signal sortering

Direktoslashren

Maskinrummet

Binokulaeligre synslidelser


General approach to diplopia

Danchaivijitr C Kennard C J Neurol Neurosurg Psychiatry

200475iv24-iv31 copy2004 by BMJ Publishing Group Ltd


Blikafhaeligngig skelevinkel

Dobbelt konturering

Posttraumatisk dekompenseret phorie PTDF

World Health Organisation ICD 2007

bull Diseases of the eye and adnexa (H00-H59)

bull H00-H06Disorders of eyelid lacrimal system and orbit

bull H10-H13Disorders of conjunctiva

bull H15-H22Disorders of sclera cornea iris and ciliary body

bull H25-H28Disorders of lens

bull H30-H36Disorders of choroid and retina

bull H40-H42Glaucoma

bull H43-H45Disorders of vitreous body and globe

bull H46-H48Disorders of optic nerve and visual pathways

bull H49-H52Disorders of ocular muscles binocular movement accommodation and refraction

bull H53-H54Visual disturbances and blindness

bull H55-H59Other disorders of eye and adnexa

Lidelser som afhjaeliglpes med optisk behandling ndash ogeller terapi

Medicin eller kirurgi har ingen eller begraelignset virkning

Portvagt problematik


Ortho

Basic eso (37841)

AF=NF ACA norm

(WHO H 503) Afst + naeligr problem

Divergens insufficiens

(37885) AFgtNF ACA lav

(WHO H 518) Afst problem

Konvergens insufficiens

(37883) NFgtAF ACA lav

(WHO H 511) Naeligrproblem

Basic exo (37842)

AF=NF ACA norm


Divergens Excess (37885)

AFgtNF ACA hoslashj (WHO H 518) Afst problem

Konvergens excess (37884)

NFgtAF ACA hoslashj (WHO H 511) Naeligrproblem

Udvidet Duane klassifikation

Eso

Exo

ICD 9 og 10 koder


Se konsensus testprotokoller AOA og AAO

44

Asthenopia (aesthenopia) or eye strain is an condition that manifests itself through nonspecific symptoms such as fatigue pain in or around the eyes blurred vision headache and occasional double vision Symptoms often occur after reading computer work or other close activities that involve tedious visual tasks

httpenwikipediaorgwikiAsthenopia

Asthenopia (WHO ICD 10 H 531)


Hovedpine og traeligtte oslashjne

45

Toslashrt oslashje

Asthenopi

Ergonomi refraktion Binokularitet

Ametropi Astigmatisme Akkomodation Presbyopi

Heterofori Fusion ACA Suppression

ICHD 1132 ICHD 1133

Indretning Synsafstand Blikvinkel Belysning

Aringrsagssammenhaelignge


httpjournalslwwcomoptvissciFulltext200311000Is_all_Asthenopia_the_Same_8aspx 46

httpwwwncbinlmnihgovpubmed14627938

The International Classification of Headache Disorders 2nd Edition (ICHD-II)

IHS WHO Diagnosis

ICHD-II Code ICD-10NA Code

1132 G 44843 Headache attributed to refractive errors (H 520 ndash H 527)

1133 G 44843 Headache attributed to heterophoria or heterotropia (latent or manifest squint) (H 503 ndash H 505)


Kompensationsbetinget hovedpine (11325)

bull Aringrsagen er meget kraftig anvendelse af akkommodationskonvergens ndash som kompensation for utilstraeligkkelig fusionskonververgens

bull Resultatet er en binokulaeligr hysterisk reaktion i akkommodationsfunktionen (Smertefremkaldende Mild - svaeligr)



Objektivt

bull Ofte paringfaldende lille pupil ved naeligrcovertest samt konvergensnaeligrpunktsmaringling

Subjektivt (stereopsis + visus normal)

bull Exoforie kombineret med lavt ACA forhold

bull Positive fusionsevne markant reduceret (tydeligst ved 6 m test)

bull Negative relative akkommodation beskeden (monokulaeligr visus bedst fra ca 125)


Gensidig Modulation ACA CAC

(Bi) fiksation Version Vergens (sigte)

Akkommodation Refraktion

(fokus)

Pursuit Fastholde Fiksation

(rdquoforfoslashlgerenrdquo)

Saccade Opsoslashge ny Fiksation

(rdquojaeliggerenrdquo)

Trin 1 Fiksation lokalisation og identifikation

Biomekaniske enheder for visuel perception


Offentlige sundhedsvaeligsen iagttager IKKE naeligrtriaden (anvender 1966 modellen) Optometristelever dumper med samme praksis UDLOslashBSDATO

Naeligrtriaden

Undersoslashgelser


Occurrence of oculomotor dysfunctions in acquired brain injury A retrospective analysis

Kenneth J Ciuffreda OD PhD Optometry (2007) 78 155-161

Table 3 Summary of the percentage of individuals in each subgroup (where for TBI n= 160 and for CVA n= 60) within a given category of ocular motor dysfunction and the most common anomaly present

Ocular motor dysfunction TBI () Most common anomaly CVA () Most common anomaly

Accommodation 411 Accommodative insufficiency 125 Accommodative infacility Versional 513 Deficits of saccades 567 Deficits of saccades Vergence 563 Convergence insufficiency 367 Convergence insufficiency Strabismus 256 Strabismus at near 367 Strabismus at far CN palsy 69 CN III 10 CN III

Note The ldquonrdquo represents the number of persons tested for accommodation which only included those under the age of 40 years (ie prepresbyopic) TBI = 51 and CVA= 8


Brain 2009 Oct132(Pt 10)2850-70 doi 101093brainawp181 Epub 2009 Jul 16 Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression malingering or intellectual ability Heitger MH Jones RD Macleod AD Snell DL Frampton CM Anderson TJ Author information Abstract Post-concussion syndrome (PCS) can affect up to 20-30 of patients with mild closed head injury (mCHI) comprising incomplete recovery and debilitating persistence of post-concussional symptoms Eye movements relate closely to the functional integrity of the injured brain and eye movement function is impaired post-acutely in mCHI Here we examined whether PCS patients continue to show disparities in eye movement function at 3-5 months following mCHI compared with patients with good recovery We hypothesized that eye movements might provide sensitive and objective functional markers of ongoing cerebral impairment in PCS We compared 36 PCS participants (adapted World Health Organization guidelines) and 36 individually matched controls (ie mCHI patients of similar injury severity but good recovery) on reflexive anti- and self-paced saccades memory-guided sequences and smooth pursuit All completed neuropsychological testing and health status questionnaires


1


Hjernerystelse Synsforstyrrelser og ingen psykiske vanskeligheder


Mean time post-injury was 140 days in the PCS group and 163 days in the control group The PCS group performed worse on anti-saccades self-paced saccades memory-guided sequences and smooth pursuit suggesting problems in response inhibition short-term spatial memory motor-sequence programming visuospatial processing and visual attention This poorer oculomotor performance included several measures beyond conscious control indicating that subcortical functionality in the PCS group was poorer than expected after mCHI The PCS group had poorer neuropsychological function (memory complex attention and executive function) Analysis of covariance showed oculomotor differences to be practically unaffected by group disparities in depression and estimated intellectual ability Compared with neuropsychological tests eye movements were more likely to be markedly impaired in PCS cases with high symptom load Poorer eye movement function and particularly poorer subcortical oculomotor function correlated more with post-concussive symptom load and problems on activities of daily living whilst poorer neuropsychological function exhibited slightly better correlations with measures of mental health Our findings that eye movement function in PCS does not follow the normal recovery path of eye movements after mCHI are indicative of ongoing cerebral impairment Whilst oculomotor and neuropsychological tests partially overlapped in identifying impairment eye movements showed additional dysfunction in motorvisuospatial areas response inhibition visual attention and subcortical function Poorer subconscious oculomotor function in the PCS group supports the notion that PCS is not merely a psychological entity but also has a biological substrate Measurement of oculomotor function may be of value in PCS cases with a high symptom load but an otherwise unremarkable assessment profile Routine oculomotor testing should be feasible in centres with existing access to this technology

2



httpwwwrehabresearchvagovjour2012497szymanowicz497html

J Rehabil Res Dev 201249(7)1083-100 Vergence in mild traumatic brain injury a pilot study Szymanowicz D Ciuffreda KJ Thiagarajan P Ludlam DP Green W Kapoor N Author information Abstract Vergence dysfunction in individuals with mild traumatic brain injury (mTBI) may have a negative effect on quality of life functional abilities and rehabilitative progress In this study we used a range of dynamic and static objective and subjective measures of vergence to assess 21 adult patients with mTBI and nearwork symptoms The results were compared with 10 control adult subjects With respect to dynamic parameters responses in those with mTBI were slowed variable and delayed With respect to static parameters reduced near point of convergence and restricted near vergence ranges were found in those with mTBI The present results provide evidence for the substantial adverse effect of mTBI on vergence function

Hjernerystelse og nedbrud i vergensfunktion


Optom Vis Sci 2012 Dec89(12)1740-51 doi 101097OPX0b013e3182772dce Concurrent vision dysfunctions in convergence insufficiency with traumatic brain injury Alvarez TL Kim EH Vicci VR Dhar SK Biswal BB Barrett AM Author information Abstract PURPOSE This study assessed the prevalence of convergence insufficiency (CI) with and without simultaneous vision dysfunctions within the traumatic brain injury (TBI) sample population because although CI is commonly reported with TBI the prevalence of concurrent visual dysfunctions with CI in TBI is unknown METHODS A retrospective analysis of 557 medical records from TBI civilian patients was conducted Patients were all evaluated by a single optometrist Visual acuity oculomotor function binocular vision function accommodation visual fields ocular health and vestibular function were assessed Statistical comparisons between the CI and non-CI as well as inpatient and outpatient subgroups were conducted using χ and Z tests

1


Samtidige synsproblemer


RESULTS 1 Approximately 9 of the TBI sample had CI without the following simultaneous diagnoses saccade or pursuit dysfunction third fourth or sixth cranial nerve palsy visual field deficit visual spatial inattentionneglect vestibular dysfunction or nystagmus 2 Photophobia with CI was observed in 163 (21 of 130) 3 and vestibular dysfunction with CI was observed in 185 (24 of 130) of the CI subgroup 4 Convergence insufficiency and cranial nerve palsies were common and yielded prevalence rates of 233 (130 of 557) and 269 (150 of 557) respectively within the TBI sample 5 Accommodative dysfunction was common within the nonpresbyopic TBI sample with a prevalence of 244 (76 of 314) 6 Visual field deficits or unilateral visual spatial inattentionneglect was observed within 296 (80 of 270) of the TBI inpatient subgroup and was significantly more prevalent compared with that of the outpatient subgroup (p lt 0001) 7 Most TBI patients had visual acuities of 2060 or better in the TBI sample (85 473 of 557) CONCLUSIONS Convergence insufficiency without simultaneous visual or vestibular dysfunctions was observed in about 9 of the visually symptomatic TBI civilian population studied A thorough visual and vestibular examination is recommended for all TBI patients

2

httpwwwncbinlmnihgovpubmed23190716 Hjernerystelse og syn Helstrup 2014

57

NeuroRehabilitation 2014 Jan 134(1)129-46 doi 103233NRE-131025 Oculomotor neurorehabilitation for reading in mild traumatic brain injury (mTBI) An integrative approach Thiagarajan P1 Ciuffreda KJ1 Capo-Aponte JE2 Ludlam DP1 Kapoor N3 Author information Abstract BACKGROUND Considering the extensive neural network of the oculomotor subsystems traumatic brain injury (TBI) could affect oculomotor control and related reading dysfunction OBJECTIVE To evaluate comprehensively the effect of oculomotor-based vision rehabilitation (OBVR) in individuals with mTBI METHODS Twelve subjects with mTBI participated in a cross-over interventional study involving oculomotor training (OMT) and sham training (ST) Each training was performed for 6 weeks 2 sessions a week During each training session all three oculomotor subsystems (vergenceaccommodationversion) were trained in a randomized order across sessions All laboratory and clinical parameters were determined before and after OMT and ST In addition nearvision-related symptoms using the Convergence Insufficiency Symptom Survey (CISS) scale and subjective visual attention using the Visual Search and Attention Test (VSAT) were assessed


1 Okulomotorisk rehabilitering



2

RESULTS Following the OMT over 80 of the abnormal parameters significantly improved Reading rate along with the amplitudes of vergence and accommodation improved markedly Saccadic eye movements demonstrated enhanced rhythmicity and accuracy The improved reading-related oculomotor behavior was reflected in reduced symptoms and increased visual attention None of the parameters changed with ST CONCLUSIONS OBVR had a strong positive effect on oculomotor control reading rate and overall reading ability This oculomotor learning effect suggests considerable residual neuroplasticity following mTBI

Okulomotorisk rehabilitering


Sammenfatning af undersoslashgelser med god belaeligg


bull Synsforstyrrelser er hyppige efter hjernerystelse bull Saccade neurologien saringres ndash og kan ret simpelt testes bull Synsskader er klart uafhaeligngige af psykologiske lidelser bull Det binokulaeligre syn kan skades (bifiksation) og

vergenslidelser blottes (mu kompensationadfaeligrd)

bull Reparation og genoptraeligning af vergenslidelser mhb normal (bi)fiksationsevne gt Laeligsefunktion (stabilt afkodningsfelt)

bull Goslashremaringlsbestemte aktiviteter dirigeret af masterplan mhb normal saccade funktion gt Faeligrden (strategisk afkodningsfelt)

En andel af PCS lidende kan ikke rehabiliteres fuldstaeligndigt hvis det optomotoriske apparat ikke inddrages Behandlingsplanen skal iagttage


Vores placering i

tvaeligrfaglig opgave

Haeligvde forstaringelse for synshjerne og

biomekanik

Perspektiv

Formaringl og budskaber


bull Oplysning til borgere Stort og smaringt bull Laeligngerevarende synsproblemer kan maringske lindres eller

afhjaeliglpes

bull Behandling er ikke for nybegyndere Der er mange faldgrupper

bull Henvis til en kollega med erfaring (foresposlashrg evt DO Saust) bull Hvis terapi bull Lokale svigt i det optomotoriske apparat og afledte

kompensationer skal adresseres foslashrst bull Genoptraeligning skal foslashrst og fremmest indeholde

goslashremaringlsbestemte aktiviteter i rumtiden (saringkaldt top-down aktivitet modsat bottom-up aktivitet)

Perspektiv og udvalgte pointer bull Indkredsning og paradokser bull Al tings ophav og rumtiden bull Optometrien i landskabet bull Synshjernens virke bull Fiksation og binokulaeligre lidelser bull Undersoslashgelser bull Sammenfatning

Aftenens program


Resten maring i selv Goggle





De usynlige skader

PCS Helstrup 2014 5




uforstand



Paradoks 1






Paradoks 2







Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes









De usynlige skader

PCS Helstrup 2014 5




uforstand



Paradoks 1






Paradoks 2







Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes







De usynlige skader

PCS Helstrup 2014 5




uforstand



Paradoks 1






Paradoks 2







Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





De usynlige skader

PCS Helstrup 2014 5




uforstand



Paradoks 1






Paradoks 2







Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






uforstand



Paradoks 1






Paradoks 2







Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes








Paradoks 2







Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes










Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Optometrien i

landskabet


































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





































15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






























15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes

























15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





















15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes
















15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes











15



16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes







16


4 D

Volumen

Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Synshjernens virke







fysisk elektrisk



Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes







Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






Hvad

Hvor hvordan


X Orkestermodellen



Interface






20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes










20
















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes




















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes















Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes











Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes







Spe

cial Issue

Saccade

Search

and

Orie

nt

Jun

e 2

01

1

Vo

lum

e 33

Issue 1

1 Pages 1

94

5ndash2

16

7


Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Vis

ible

Ma

n B

rain

as

in F

ig 2



htt

p

ww

wp

nas

org

co

nte

nt

95

38

31

F5

exp

ansi

on

htm






bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes








bull HVOR er det




(P system)

X

Y

Z



Trin 1



Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






Saccader i aktion







Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes









Saccader i aktion






























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes


































34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes
























34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes



















34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes















34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes








34














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes


















(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes














(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes








(proprioception)


2



POI








Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes












Vergens vinkel

POI

POI


Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






Version subsystem

Vergence subsystem

Conjugate movements


Fast eye movements

Slow eye movements

Vestibular

Proprioceptive


39


XY Z(T)


POI

Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Kredsloslashb



Signal sortering

Direktoslashren

Maskinrummet








Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes












Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes










Dobbelt konturering



















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






















Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Ortho

Basic eso (37841)

AF=NF ACA norm








Basic exo (37842)

AF=NF ACA norm







Eso

Exo

ICD 9 og 10 koder



44






45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes










45

Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Toslashrt oslashje

Asthenopi




ICHD 1132 ICHD 1133







IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






IHS WHO Diagnosis










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes










Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






Objektivt










(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes








(fokus)









Naeligrtriaden

Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes





Undersoslashgelser











1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes














1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes







1





2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






2








1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes











1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






1





2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






2


57






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes










2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






2












Vores placering i



biomekanik

Perspektiv




afhjaeliglpes













Vores placering i



biomekanik

Perspektiv




afhjaeliglpes






Vores placering i



biomekanik

Perspektiv




afhjaeliglpes








afhjaeliglpes





Healthcare

Hjernerystelse og syn