Optokinetics (OPK or OKN)

• Testing requires a full visual field stimulus

– At least 90% of vision field
– If using a light bar you are testing smooth
pursuit and OPK/OKN but not OKN alone
• May get normal results when not normal
– If the patient can see any visual marks in the
room they may not be able to be tested
accurately
• The optokinetic system is evaluated by both
nystagmus during visual stimulation (OPK/OKN
testing) and after (OKAN- the optokinetic after-
nystamus)
– This indicates a normal functioning central vestibular/ velocity
storage mechanism
 Optokinetics (OPK or OKN)
• Need full field to also trigger the sense of
rotation known as circular vection
– OPK is centrally mediated
• Basford et al. 2003 found 4 of 10 TBI
patients did not generate OPK and none had
circular vection
 Optokinetics (OPK or OKN)
• Instructions to the patient influence the results!
– If instructed to follow the dots you get
prolonged slow phases with large corrective
saccades
• Look nystagmus
– If instructed to stare straight ahead you get
small quick phases that are frequent
• Stare nystagmus
– Best Instructions are none
• If patient is falling asleep…
– Have them look for the “ red heart”, or “ the
star shape”, etc.
Abnormalities: Optokinetics
• Low Gain
– Both directions
– CNS Lesion
• Examples: floccular lesion, parietal lobe
lesion
– Rule out
• large or multiple visual field deficits
• Inattention
• medications
Abnormalities: Optokinetics
• Asymmetric OPK/OKN
– Vestibular end organ
• If reduction opposite of spontaneous
nystagmus
• If acute
• IF there is no spontaneous nystamus and not
acute
– Then it is supra-tentorial
– Likely parietal lobe lesion
– Rule out
• Visual field deficit (one hemifield)
 Supratentorial
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Analysis – OKN (OPK)
 Analysis – OKN (OPK)
• % to remove segment ends
– Removes a % from each end of a test segment.
• Increasing the % causes more data to be
deleted from each end and less to be used
for calculation.
• The result is based solely on the data
remaining between the green cursors.
• Stimulus Noise Filter:
– Same function as sine filter (remove high
frequency component of the
signal), but to the OKN feedback signal.
• Make sure it is always on.
 Analysis – OKN (OPK)
• Segment:
– Moves the green
cursors along the
data
– Selects each
segment in turn
– The results are
shown for the
current segment
selected
 Analysis – OKN (OPK)
• Avg Eye Vel
– average SPV
• StDev
– standard deviation
for average SPV
• Validity
– The percentage of
the total SPV data
that matches the
best fit line.
– As this number
approaches 100%,
the results will
become more valid.
• Avg Stimulus vel –
– Velocity of the
OKN, norms