EXPERIMENT NO. 7 OBJECT: Demo ae mstrate the superficial reflexes on the human subject REOQUIREMENTs: Human subject, coton, key PRINCIPLE: i Bee SOON: It defines as involuntary response and action of effectors, like ee particular stimulus applied, without person will or wish, sa et lve owe ses Senge eg Sn ei gai ficial ae Superficial reflexes are plantar, abdominal, poe aaron light 1) PLANTAR REFLEX: a: Stimulate slightly the outer/lateral edge of the sole of foot by scratching gently with the key/atick from heel to little te, then repeat the same medially across the mciaarss. ‘That slight stimulus in a normal beslthy adult person produces a contraction of the adductor muscles of the thigh and of the sartorius . __b: Slight stronger stimulus causes flexion of outer four toes, which increases with increasing the strength of stimulus till all the toes are flexed on the metatarsus and drawn together, the ankle is dorsiflexed and inverted called the dorsal planar reflex/response. The spinal cord segments involved in this reflex after fifth lumbar and first sacral segments ij...) - Babinskis extensor planlar response that is dorsifexion/eatension of the great toe and out and extension of the other toes. By dorsiflexion of the ankle and by flexion of the hip and knee is the abnormal plantar response. It is observed in patients with corticospinal tract lesion /upper motor neuron lesion. ripple f contractions of the abdominal muscles found. These reflexes can’t be toa ne HPP paliens, elderly obese persons and inpregant women, ‘The seventh to twelfth spinal segmeats arc involved in these reflexes a aearr ai scratching the inner part of thigh which ae Ae ceva of es ‘on ape side, First and’ second lumber spinal coments ae involved in this reflex 36a4 lateral edge of a ihly oven te "8° at a distance. AE reflex is 5 ‘ Decne SEX inco ane ever, the pupils pee Se a light reflex. It is of two types a direct! indirect of tone ‘eon coe ata parasympathetic nerves supplying to the sphincter en a ‘The essential factor Prihe superer tone ofthe sphincter ofthe pupillae Cre) pesbve oneal Flantow, Kel Suped ei 16 denies iS wx > , postive tes ass rig sehen => Le tive Gan e nta wy vi UTV-2, ‘ : Light da flex > Basile a {; Ask the paienv/ubjest 8 relaxhishher lower limb while eliciting planter reflex. Pe ee oe ape tie dill ee beeincl at tonon on ie comea 2 et ee eet should not be wiped with cotton and central part RELEVANT VIVA QUESTIONS; Q.1. Wht tisial information can be obtained Q.2. Define babinskis si; by eliciting : z 1 sign with its si he oo ielalaeerand oa UPeto'cal LH lexos pane pet ft X@s One hel J \p Aaliarnnnrd he Oa ts Petkanhy he CobedLaal Lallee® 40Us duslem BY elie!. "EXPERIMENT NO. 8 ‘OBJECT: Demonstrate deep tendon reflexes in human beings REQUIREMENTS: Patellar hammer and human subject. ° If, : i : sof niion of a tightly sweiched muscle is struck ie. a single, sharp blow with a e This irae Hamme, the muscle contracts esky and briefly, a Mondsynaptic stretch reflex; itis a test of the integrity of the affereat segment ong 24 he exciublty fhe aor Hor alsin he pial *_ The main deep/tendon ref i i icep j Riek ineketecees ne ee Bee es ii) Pass your left hand under the knee to be tested and place it on the opposite .., _ _Kitee ,the knee to be tested rests upon the dorsum or your wrist. iii) ‘Strike the patellar tendon, midway berween its origin and insertion with the lar hammer, Following the blow, there will be brief extension of the knee from contraction of the q iv) This reflex can sometimes be more easily elicited/produced with the patient ” Me trike apy oft aes ek veeohangoa fa deca advan ‘ Sometimes it cannot _elicited/produced without applying reinforcement/stronger force. For doing this, ask the patient to make some strong voluntary muscular effort with the upper limbs) for example to hook {| the fingers of the two hands together and then to pull them against one “This reflex is exaggerated/sctivatd in upper motor neuron lesion and sluggish/slowed down’in lower motor neuron lesion. A pendular kneo jerk is observed in cerebellar disease; . | ‘The spinal segments involved in his reflex are 2", 3° and 4 lumbar. JERK: Pe ; i that the Achilles’ tendon js stretc! » fae let a patellar hammer on the posterior surluce of the tendon. Aveniently eficited when the patient it kneeling fii) ‘The reflex can also be cOnvSNTN CO chair, (supporting body/standing op Kne=s) TARA neeeh gon ewe re ee TRICEPS JERK: forearm to rest along his chest Fi bow of the patient and allow the : i) Tw da triceps ofthe Pet above tha olecranon. The triceps muscle Sonar This reflex depends upon 6" and 7 cervical segment BICEPS JERK: and pl i) Flex the elbow ata right angle snd ‘The examiner will hen place his thu o Eee i) strike it with the patellar The eter dogeite upon pro 6° cervical segments of the spinal cord, SUPINATOR JERK: , i) Ablow upon the styloid process of the radius stretches the supinator. | ii) _ Itcauses supination of the elbow. Reflex depends upon 5® and 6* cervical segments of the spinal cord. | ‘the spinal cord. \ Jace forearm in a semipronated position, ‘or index finger on the biceps tendon JAW JERK: ; i) Ask the patient to open his mouth slightly, not too wide. ii) Place your one finger firmly over his/her chin and then tap it suddenly with the other hand as in percussion/musical instrument. : iii) ‘The contraction of jaw muscles closes the jaw. The jerk is sometimes absent in healthy individuals and is increased in upper motor neuron lesions above the 5" (trigeminal) nerve nuclei. ANLKE CLONUS: i) Blend the patient's knee, slightly and support it with one hand. Grasp (seize/catch the seat wih ree te fore/front part of the foot with other hand and li) A sudden stretch causes a reflex contraction of the calf muscles, which then relax. lit) But the continued stretch causes relaxation, which is called clomis, The sega tion oF contraction 6 Shows the sgn of upper motor ney ee costed slonus is abnormal OBSERVATIONS/RESULT:the Patient js kneetin eg tal cord, PRECAUTIONS, While demonstratin t along his chest, 'PS muscle contracts, ronated position, the biceps tendon tracts. cord. Q4. What are the causes of hyper reflexia? Q.5. Explain different abnormalities of tendon reflexes? lator, Q6. Name the spinal cord segments involved in, knee jerk, triceps jerk and biceps jerk? Nat nat be boflevs- SPrasEXPER = NT NO. 10 EXAMIN, i ee ATION oF CEREBELLUM Lesion in the cerebelluy ia". "Ang0, rhythm and ff musla Gontsac features: alfect its functions, ao ee the Riswme eet Asthenia Ataxia Abnormal posture Rebound 1, 2 3. 4. 5. 6, 7. 8. ° emors This means loss to execute repeated altemate movernu..is. Test a i his elbows at right angle to pronate and supi- i Ask the at el alas mover wile slow and incomplete. « ; | si. Ask the palen wo tap your palm wit is fingertip as fas as possible will not be able to do this. ) 444. Asynergia This,means inco-ordination. Test In Upper Limb i Finger - Nose test : Ask the patient to touch your index finger ( which ia at a distance of about two’ feet from the patient) with his index finger and then to touch his nose. He is asked to do this rapidly. He will fail to do this. ii, Finger - Finger test: Patient is asked to touch the tips of his twa index fingers with extended arms bringing them from a distance rapidly. He will not be able to do this. ‘ fii ‘Ast he patient to make ange cce inthe af with hs forefinger. He, will fail to do this. Ifthe result of the above tests is doubtful then ask the patient to repeat them 5 while his eyes are closed. Irregularity in the movements will become more ‘marked indicating the presence of Asynergia. In Lower Limb i. Towalkalong a straight line: This has been described tinder the heat = ing of “ataxia ———— === fi. Heel-dnee test Patient lies inthe bed in supine position. Ask him '0 pt the heel of his foot on the Ime of the other leg and rub it dow" Fong the shin. Then he should raise the leg ithe air and again pst the heel on the knee. He will fail to do this. fi Patient is asked to make a large circle inthe air by his toe. He will no ™ be able to make it ; sign: This is done forthe differentiation between lesion of cefeber erior column. This sign is elicited as follows:‘and its tracts are intact otherwise thizy. hhim to close his eyes (while the feet are are intact he would neither » & Atonia This means loss of muscular tone. Test for the muscular tone has already been 7, Rebound phenomenon ‘Make the patient flex his elbqw slightly. Now aak him to flex it firmly against the resistance (Le. you hold his arm) then suddenty release it. The patient will slap his own face due to rebound phenomenon. In normal person this phe- ~_nomenon is absent. a -Pendular knee jerk Ree. The after extension will fall down in a pendulous HB the ke nang nthe bed wit eps hanging Sow. §. Nyptagmus rhythmical and oscillatory movements of _ are inrlee - he tal, vertical or rotatory. Eyes move faster eyeballs. These i 46Beg rect ta We oie Se of hen GS eames se aa. Sings im ang Test : : pole! ‘Ask thie patient to look straight infront of hii and observe whether the eyes | - : remain steady. Now puta pencil (or even your index finger) in front of the Seu\y patient at the level of his eyes at a distance of 11 / 2 feet. Move the object to the extreme left, then to the extreme right, then upward and downward gradually and keep it therefor some time, The patient is asked to movers | 9 eyeballs along the object without moving his head. 10. Scanning speech J walle Patient will speak lowly and deliberately syllable by syllable. Ask himtosy | - Wer artillery’, he will pronounce as: “ar-til-ler-y" i — It. Drunken gait Voki Patient wil walk a if he is drunk. Detailte given in "Types of gait Ye 12. Intentional tremors’ E : Sle * Patient is asked to pick up a certain object. Tremors will appear in hishands |‘ 13. Pastpolnting = ‘ s Hold some object.in front of the patient and ask him He ree see ee : FINDINGS ofa Se ees Af‘the response of alr, subject closes is har eyes. 5) Coujumetival reflex: itis also related to the ophthalmic divisiee of s* nerve Take a wisp of cotten, apply on subject’s cyes in response of touch Sloseseyes. 9 gin 0 | 2 5) Examination of facial merve(VI): |) 0950. | | a) Sensory fumction: Aaterior two thirds of the tongue is tested for different solutions having sweet, salty sour aad bitier tastes. Subject is ask to protrude his /her tongue, and after cleaning it with gauze piece, glass rod dipped in solution is applied on the tongue, the subject is asked to tell the taste sensation which he or she feels, after each (est mouth is washed with water. The sweet taste is felt at thetop of tongue, sour at the sides and bitter on hinder or pofrior part of the tongue. b) Motor function: ‘Sidipest is ated to shut his Mer eyes tightly, if paralysis he she can not do so. Ask the subject to whistle to swal hs ex check, then sppy the Up of finger to check paralysis or not. in parlysis he is unable to It is composed of two sets of bearing and the other“ id is the nerve of 5 “apples th vesibule (tle and seule and th emleelar ana is eof ; ect is asked to shut his or her eyes, 3) For the performance of the test iC hearing, uber fuera sei ‘normal ear. ‘keeping one ear closed with a fingertip normal ey, Exc eg commined: In thin way voice teat or tuning fork tests are also performed. » Fee Pectnuler part ofthe nerve Is tested by calorie test and barany chair test to test subjects equilibeium. n ‘a) Sensory function: It is sensory supplier of posterior one third of the tongue, ) ‘Some solutions are applied there, ask the subject to recognize the taste. b) Motor function: It is motor function for the middle pharyngeal constrictor end styl ‘muscles in the posterior wall of the pharynx. Ask the subject to open his /her mouth then depress the tongue with tongue depressor, see the reflex contraction of soft palate; also called palate reflex. 8) Examlnavion ofVanus nerre( it mot ot bor for ropinary palate) the and the Tt is also the sensory and motor for respiratory passages, the alveoll, the heart and the most of the abdominal viscera. 'a) Ask the subject to open his her mouth and see the movement of soft palate, when normal then by swallowing flulds do not regurgitate through nose. ) is tsb reese Ot ns O0eS ve comptes lant fe nasopharynx. €.g.... paralysis then he/she: pronounces eng : then normal fom taboo lel ene u ) Check the voice, normally the nerve helps to tighten the vocal cords, if paralysis vocal cords relax, the subject’s voice becomes hoarse and deep and also having longer tis motor and supplies to the a. Ask the subject to lift his/her shoulders 1 it hel ee houh | Bow moma inna of up equally, if he/she elevates shoulders, M subject to rotate the chin towards the opposi 10) functioning of sternomastoid muscle. ie side tae the ncaa | It is the motor and supplies the tongue and its muscles. The nerve is tested by asking the Paralysis tongue deviates de 1B the subject to produce the tongue, in. smaller on the side of lesion eam to the paralyzed side and will be RESULT: Fon E tie aiotcanca isk ti, Temboth ye sepantely rvsRELEVENT VIVA QUESTION? “Qi. Whiat is anosmia and its causes? Q.2. What is parosmia? Q.3. What is the nervous pathway for the sensation of smell? ).3. Name the extra occular muscles? - . aa Which of the extraocular muscles are involved in abduction, elevation, depression and rotational movements of the eye ball? Q.5. What do you mean by squint or strabismus? Q.6 What is piosis and drooping of eyelid? Q.7. What is Argyll Robertson pupil? Q.8. What are the divisions of trigeminal nerve? Q9. What are the different skin areas on face supplied by each division of the trigeminal nerve? Q10. Which of the sensation of face are perceived by the trigeminal nerve? Q:11. What symptoms are found due to the lesion of the whole trigeminal nerve? Q.12, What is meant by facial palsy? Q.13. What do you mean by the term bells palsy? Q.14. What is the difference between the upper and lower motor neuron paralysis of facial nerve? Q.I5. Which of the cranial nerve are involved in carrying the sensation of taste? Q.16. Which of the cranial nerve elicit the palatal reflex? nerve? Q.17. Which of the muscles are controlled by the accessory pea: are the untowards (inconvenient) effects seen by the lesion of the vagus ni Q.19. Which muscles are supplied by the hypoglossal nerve? Q20, How will you differentiate between a supranuclear lesion from the infranuclear lesion? Q.21 What are the signs of lesion of hypoglossal nerve? ANEMIO.- Ine ae 4 (me). Couses:- —Sinuselis ahd olan bum H sl a Mu) ireneiv) Donot use v) Use the ar, Much hot water, ) probe (rod) for the pharyngeal reflex. CLINICAL IMPoRTancp. 1: Olfactory nerve:The loss 2 f 7 sinusitis and allergy or tance? Of smell called anosmia may be temporary due to spud Nemontage and heady 27 Brooves, meningiomas, meningitis, 3. Oculomotor nerve: visual acuity, color sense and vis fields. Fssion causes the eye to daplace dona and outwards 6. Abducent nerve: Paralysis causes inability i squint and the subject has diplopia ia looking ya thar dieeeiee ert. 4: Taste may be lost on the anterior two third of the tongue b: There is drooping of one side of the face and that side is expressionless &: The furrows of the brows are smoothed out and the eye on the affected side is more widely open than the other normal eye d: The patient is unable to whistle ¢: The food may collect betweea teeth or cheeks on the affected side and food or saliva escape out of the affected side etc bee ai, 8. Vestibulocochlear nerve: Leisoa causes deafness and disequilibrium ; 9. Glossopharyngeal nerve is rarely paralysed alone as it functions along with tenth. - «> SABE aa la es se 0 stewing du to he pany of soft ~a: Regurgitation of the palate words which required complete closure of b: The patient is unable to [pronounce and rush as rum Bilateral paralysis nasophary for example ea is UNO on ea et dente ¢ {ysis in the muscle supplies, The paralysis of muscle towards chin to the opposite fer if trapezius is weak hed towards the paralysed side and the—_———————_$__$__ EXPERIMENT NO. 4 Elect : TO Introduction encephalograms (EEGs) In this laboratory, you wil + YOU will record and analyze el explore the electri ivi it f and | et trical activity of the brain. il interfering signals, and ate (EEGs) on a ne Oe eat and shutting the eyes, auditory ee on alpha and beta waves by opening ies. Background The cerebral corts i is to some oer an huge numbers of neurons. Activity of these neurons Electrodes placed in pairs nized in regular firing rhythms (‘brain waves’). tential that derive from ney the scalp can pick up variations in electrical affected by the state of is underlying cortical activity. EEG signals are changes In different sta arousal of the cerebral cortex, and show characteristic fom the external jet ts of sleep. EEG signals are also affected by stimulation stimull. Ele SS aaa aT payers can become entrained to external epilepsies and the diagnosis of brain van” Bier ines in ihe cies 4 Recording the EEG EEG recording Is technically difficult, mainly because of the small size of the voltage signals (typically 50 pV peak-to-peak). The signals are stall because the recording electrodes are separated from the brain's surface by the scalp, the skull and a layer of cerebrospinal fluid. A specially designed amplifier, such as the Bio Amplifier built into the PowerLab, Is essential. It is also important to use electrodes made of the right ‘material, and to connect them properly. Even with these precautions, recordings may be spoiled by a range ‘of unwanted interfering influences, known as ‘artifacts’. In this labora’ u will record EEG activity with two electrodes: a frontal electrode on inet forehead, and an oceipital je on the scalp at the pe a the head (Figure 1)- A third (ground of earth) electrode is also aia he reduce electrical interference. In clinical EEG, itis usual to record ay ¢ ane of activity from multiple recording electrodes in an array over the heac.Equipment setup (with PowerLab 157). Origins of the EEG signals The EEG results from slow changes in the membrane potentials of cortica| neurons, especially the excitatory and inhibitory postsynaptic potentials (EPSPs and IPSPs). Very little contribution normally comes from action potentials propagated along nerve axons. As with the ECG, the EEG reflects the algebraic sum of the electrical potential changes occurring from large populations of ceils. Therefore, large amplitude waves require the synchronous activity of a large number of neurons. The rhythmic events that these waves reflect often arise in ~ in turn affected by a variety of inputs including the thalamus whose activity i ‘structures in the brainstem reticular formation. Components of the EEG waveform _ The EEG waveform contains component waves of different frequencies. Thes¢ can be extracted and provide information about different brain activities. The LabTutor software is set up so that the raw EEG signal is displayed in channel '. Digital filtering allows this to be analyzed into the component frequencies interest that are displayed in other channels. Each these waves (or rhythrs) _ Provides information about different brain states. These waves are: . Alpha (8 to 13 Hz; average amplitudes 30 to 50 u1V) thythm is seen when the eyes are closed and the subject relaxed. !t '§ d by eye opening and by mental effort such as doing calculations a rating on an idea. It is thus thought to indicate the degree of corti the greater the activation, the lower the alpha activity. Alpha We" gest over the occipital (back of the head) cortex and also over fronBe rae er ine eg in awake, alert individ ’ ‘ay be absent or reduc’ with py sedative-hypnotic drugs nich a as by 3, Theta (4 and 8 Hz; <39 Ww) their ey sie ae the dominant rhythm is beta. It enzodicel damage and can be accentuated ‘azepines and barbiturates. Theta rhythm is said not to awake children up to eee in awake adults but is perfectly normal in powever, that some os 'tis normal during sleep at all ages. (Note components, low theta (4 - 5 4a frp) eParate this frequency band into. two arousal and increased drowsiness”, ah Pa et rete Milt Sectoneed claimed is enhanced during tasks invoimnocan een oe i ea jory. 4, Delta (between 0.5 and 4 Hz; up to 100 - 200 yw) ita rhythm is th te aaeae edt Tenant thythm in sleep stages 3 and 4 but is not seen in component EEG ee is to have the highest amplitude of any of the a necks rnaraies . Note that EEG artifacts caused by movements of jaw . can produce waves in the same frequency band. 4, Gamma (between 30 and 50 Hz) Some people also recognize gamma waves but their existence and importance is, more controversial. It may be associated with higher mental activity, including perception and consciousness and it disappears under general anesthesia. One suggestion is that the gamma rhythm reflects the mental activity involved in integrating various aspects of an object (color, shape, movement, etc) to form a coherent picture. Interestingly, recent research has shown that gamma waves are enhanced in Buddhist monks during meditation and are absent in schizophrenics. It is not presently possible to relate the EEG waves to specific underlying neuronal activities. In general, the more active the brain the higher the frequency and the lower the amplitude of the EEG. Conversely, the more inactive the brain the lower the frequency and the higher the ‘amplitude of the signal. The EEG during sleep m provides an indicator of the sleep state. 5 Sao ee di ‘ltemating stages, non-REM and REM (rapid Sieg consists of wo very ser eS en dscibed four stages that are a in jin sensory thresholds, an increase in in EEG wave cy. Stage 1 is ‘of consciousness, This is followedthen 4. Sleepers then mi pee sane fn stage 1, REM sleep occure S* ouch the Whole in § ‘90 minutes so that, over the course of an g hour sie SY lasts, Pe FOO aD to 6 times. In the later cycles, the REM Sioa he oes No . ad stages 3 and 4 become shorter. longer vas These stay can be correlated with EEG activity. Stage 1 is associated wit, miceaenn vad activity, alpha activity that becomes less obvious and the T emergence of theta activity. Stage 2 has irregular theta activity, short bursts o waves of 12 - 14 Hz called sleep spindles, and sudden increases in wave € plexes). e arenes ene K-Komplex i b t t i 100 nV 100 pV] c ‘ 1 sec Lsec - Sleep spindles. Stages 1 and 2 are relatively “light” stages of sleep. In stages 3 and 4, dele jastivity predominates with the distinction between the two being that in Stage jere is delta activity for less that 50% of the time. In stages 3 and 4we al@ ‘sleep. In REM sleep, which can last from 20 to 60 minutes or more, similar to that in Stage 1. REM sleep is the stage most associated Wi" gh the EEG shows significant activity during REM sleep, moto brain : and nor-epinephrine alter duti"? HOn-REM sleep stages 1 to 4, serotonin levels &° EM sleep, nor-epinephrine, corticosteroids and EM sleep Is characterized by di ) respiratory rates. In REM sleep, there is mark’ Pressure and irregular breathing.tudies, EG, sere and Nor state an pastorate? 8° toy weg Tepid, coordinated eye se BENS iecodniee aie onc on ‘eflectng the active ive nh ments (hy Tien Spe tone, whereas REM sleep fal lt i ‘and a little EMG activity ten aoe inh ths “t a ren Sleep stages. The EEG and changes in intracranial metabolism Changes in the EEG can be a x environment of the neurons, One cai jesPense {0 changes in the chemical tory is. to obs 'y Way to demonstrate this in a student laboratory eve the effects of hyperventilation. Hyperventilation lowers blood. Peoz. Since CO2 , being lipid soluble, readily crosses the blood-brain barrier and cell membranes, this in tum results in decreased Poo. (hypocapnia) in the brain interstitial fluid and within the neurons and glial cells. Thus extracellular and cellular pH is elevated - acute respiratory alkalosis. In addition, blood vessels in the brain constrict with reduction in brain blood flow. The consequences are a change in neuronal activity with slower rhythms and higher amplitudes (increased delta and theta activities) as well as some decrease in alpha activity. There is still debate about whether these EEG changes are a consequence of the metabolic changes or- of hemodynamic factors. One possibility is that they arise from depressant effects of the hypocapnia on the brainstem reticular formation and are analogous to the EEG changes seen in the transition from wakefulness to sleep. The EEG and the functions of the cerebral hemispheres Efforts have also been made to use EEG Kieariings (9 ese ot Contributions cee hemlet a ees with (searing, the left hemisphere is the etl the right hemisphere is the more intuitive, Problem solving and Se ‘and spatial processing rather than with eave ede concamed wih THES rare reve the, 8 ak language. Corel reading |r nizaton mn realty, there {is litle publi! °versimplification cortical organization, this hypothesis. évidence to lend credence toThe EEG and personality ‘Attempts have also been made to relate personality to EEG patterns, perhaps the most famous example being Eysenck’s Cortical Arousal Model of Introversion and Extraversion. Eysenck argued that there is some ‘optimal’ level of electrical activity in the cortex. If we fall below this we tend to be bored and fall asleep; above this we are unable to deal with the activity and feel overwhelmed. In this Construct, extraverts need additional mental stimulation (people around them, Joud music, etc) to reach this optimal cortical activity whereas introverts avoid such additional stimulation as their cortical activity is already in the optimal region. There has been considerable debate about the extent to which EEG findings support this hypothesis. Questions: 4. Under what conditions did you see alpha waves more clearly? 2. What are alpha waves thought to indicate? 3. What effects did the different types of music have on the alpha wave activity?EXPERIMENT NO. 13 OBJECT: Demonstrate and record (test) visual acuity (VA) REOUEMENTS: PRINCIPLE: ‘D.Vigual Acuity; © Its the degree / visual power to which details & the contours of the objects are Perceived / differentiated from one another. ° Visual acuity is usually in terms of minimum separable that is the shortest élauance by wile two Glas can be separsad and sil be perceived as two © Clinically visual acuity is determined by the use of familiar snellen’s letter charts viewed at a distance of 20 feet (6 meters). . © In this chart, series of letters of varying sizes constructed that top letter is visible to the nonmal eye at 60 meters and Subsequent lines at 36, 24,18, 12,9, 6 and S meters respectively. ‘© The patient reads down the chart as far as he / she can, if only the top letter of the chart is visible the visual acuity is 6/60. Normal person should be able to read the chart up to 7™ line, that is, the visual acuity is 6/6. ‘* Visual acuity of less than 1/60 is recorded as by counting fingers, hand movement or perception of light by the patient. © Ask tho subject (tested) to be seated at a distance of 20 feet away from snellen’s chart and tries to read the smallest line distinguishable loudly. Snellen's chart is designed so that « normal individual can read the leners in the smallest (7) line at 20 feet or 6 meters. ° Subject Is asked to read the chart at the distance of 20 fect, because person’s visual acuity Is stated as V=d/D, where'd’ is the distance at which patient can read the letters; and D is the distance st which a normal eye can read the lenters. Hence normal visual acuity 1s 20/20 or 6/6. . Ifthe patient's vision is recorded 10/20, it is subnormal because he is able to read Jetters within 10 thet, thar one is readable at 20 feet by the normal eye. ® For knowing the glasses (lena) forthe patient to wear, the leas is held up and Patient Is asked to look at an object through it. Then the lens is moved fro) side to side and the object is watched. If the object moves in the same direction to the tens the lens is cancave; used for myopic (dstant Vision) or shonslghedness.siiisoe in aeseseed by using reading Meased on the printer's polnt system," * Visual acuity at the ordinary readin} types of varying sizes, the notation being + The smallest isNS. . The rea a Or ae the smallest type which the patient can rag comfortably. tient to wear, the lens is held up any * For knowing the glasses (lens) for the pati It, Thom the lens is moved from sid ee hel te beck ame oie oe in the opposite drweion’s to side object the rarigrelpal is convex; used for Hyperopia (near vision) or long-sightedness, ‘© Forthe patients antigmatism, in which patient is unable to form the image on the niagle foul poln, because of the oblong (ega) shape ofthe cores, of rarely an oblong shape of the lens. © The cylindrical lenses are used to set the proper axis and to focus the image on the single focal point. RESULT: PRECAUTIONS: 1) The examiner must have his / her own 6/6 vision, with or without glasses; and no colour blindness. fi) Each eye should be tested separately, in the manner that one eye should remain close while the other, is being examined. iti) For illiterate patients visual acuity is tested by ‘E” letter test. iv). Lightening should be proper. Gilnical Importance; : ‘The visual acuity gives the degree to which details and contours of objects are perceived. lineal visual caty is often determined and used for the diagrone, and renee of Mon nee testing visual acuity? Q3. What are those factors which affect visual acuity? Q.4. What do you mean by short sightedness/myopia? How it is corrected and whit ‘causes the eye to be short sightedness or myopic? Q.5. What do you understand by the visual acuity of 6/6, 6/12, 1/607 ‘Q.6. What do you mean by the term fir sightedneshyperopia? How it can be comected? hyperopia? : . What causes the eye to be far sightedness or