REFERRAL CHECKLIST

NORA has prepared a checklist to assist rehabilitation professionals (doctors, therapists,
counselors, etc.) in determining the appropriateness of referring clients for neuro-optometric
rehabilitation and treatment.

EXTERNALDIFFICULTIES

  • EYESIGHT
    • focusing
    • aiming (double vision
    • clarity (visual acuity)
    • visual field loss
  • COMFORT
    • dry eye
    • visual perception
    • vertigo
  • SPATIAL JUDGMENTS
    • walking
    • depth perception
    • visual midline shift
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INTERNALSENSATIONS

  • BALANCE
  • PTVS
  • Post Concussive Syndrome
  • DIZZINESS
  • EYE MOVEMENTS
    • paresis & paralysis
    • nystagmus
    • convergence insufficiency

The treatment plan improves specific acquired vision dysfunctions determined by standardized diagnostic criteria. Treatment regimens encompass medically necessary non-compensatory lenses and prisms with and without occlusion and other appropriate rehabilitation. Behavioral observations during therapy sessions or medical examination, in-depth interviews and screening will provide information to rehabilitation professionals about potential visual and neuro-motor dysfunction, Following is a list of client symptoms and/or behaviors that may be reported or observed. If these symptoms are present, the client may be in the Post Trauma Vision Syndrome and/or the Visual Midline Shift Syndrome and should be referred for neuro-optometric rehabilitation.

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