Parks three step test

Author: s | 2025-04-24

The Parks 3 step test is also known as Parks-Bielschowsky three-step test, Park’s three-step test, or Bielschowsky head tilt test. The Parks 3 step test is also known as Parks-Bielschowsky three-step test, Park’s three-step test, or Bielschowsky head tilt test.

The Parks three - tests to detect squints - The Parks three-step

Right vs. left head tilt, the paretic muscle can be detected. Potential paretic muscle: LSO, left superior oblique; LIR, left inferior rectus; RSR, right superior rectus; RIO, right inferior oblique. Reprinted with permission from (22).It has been proposed to add a fourth step, namely, measuring the vertical deviation in upgaze and downgaze (14). For example, with a right fourth nerve palsy, given that the superior oblique depresses the eye, the right hypertropia will increase in downgaze and lessen in upgaze. There are 3 important caveats regarding the Parks–Bielschowsky 3-step test: spread on commitance, the test's sensitivity, and the test's specificity. With a longstanding fourth nerve palsy, the amount of vertical deviation may become similar in all fields of gaze (12). This usually occurs when the fourth nerve palsy affects the dominant eye. For example, in a patient with a right fourth nerve palsy, the right inferior oblique (antagonist of the right superior oblique) requires less innervation to move the eye into its field of action. Following the Hering law, the left superior rectus (yoke muscle of the antagonist of the paretic muscle) also receives less innervation and will seem paretic. This will, in turn, diminish the amount of vertical misalignment. This has been referred to as inhibitional palsy of the contralateral antagonist. An alternate explanation for the spread of comitance may be found in the study by Suh et al (15). Using high-resolution orbital MRI, these investigators demonstrated that displacements in the pulley systems of the rectus muscles can alter motility patterns in superior oblique palsy. The Parks–Bielschowsky 3-step test lacks both sensitivity and specificity. In a series of 7 patients, Kushner (16) suggested that a number of other entities might simulate a fourth nerve palsy with the Parks–Bielschowsky 3-step test including paresis of more than one vertical muscle, dissociated vertical deviation, myasthenia gravis, and previous vertical muscle surgery. Using superior oblique atrophy on MRI as evidence of a fourth nerve palsy, Manchandia and Demer (17) performed the Parks–Bielschowsky 3-step test on 50 patients. They found that the test was diagnostic in only 70% of cases. By reducing the test to 2 steps, the sensitivity increased to 76%–84% but diminished the specificity. Lee et al (18) measured the sensitivity of the 3-step test, depending on the presence or absence of the fourth nerve using high-resolution thin-section MRI. Testing sensitivity was 78% in patients with a fourth nerve and 72% in those without a fourth nerve. There was no statistically significant intergroup difference. Taken together, these reports demonstrate that the Parks–Bielschowsky 3-step test is insensitive in 22%–30% of patients with fourth nerve palsy: CYCLOTORSION Because the primary action of the superior oblique muscle is incyclotorsion, detection of a torsional component of diplopia is helpful in establishing the diagnosis of fourth nerve palsy. In obtaining the history, the clinician should not only elicit the vertical orientation of the diplopic images, but also inquire if one of the images seems “tilted” or “slanted.” For confirmation and quantitation of cyclotorsion, a valuable technique is

Parks–Bielschowsky three-step test

Toward the side of the palsied muscle, there was an increase in the vertical deviation, while tilting to the contralateral side caused either a decrease or resolution of the deviation. This became known as the Bielschowsky Head Tilt Test. Parks expanded on these observations and proposed a stepwise diagnostic schema in patients with vertical strabismus (13). As he pointed out, head tilt because of cyclovertical strabismus does not necessarily indicate binocular vision nor that the palsied muscle is an oblique. For example, head tilting may accompany a vertical rectus muscle palsy. In Parks' schema, the first step reduces the possibility from 8 to 4 cyclovertical muscles, the second step from 4 to 2, and the third step will determine which of the remaining 2 muscles is weak. Figures 4 and 5 illustrate the results of the Parks–Bielschowsky 3-step test for a right and left hypertropia, respectively. The first step determines that the paretic muscle is either one of 2 depressors in 1 eye or 1 of 2 elevators in the other. With the second step, one determines if the vertical deviation increases in right or left gaze. At this point, the 2 suspected muscles are in different eyes, both are always superior or inferior muscles and both are either incyclotorters or excyclotorters. In the third step, the paretic muscle is unable to perform its torsional and vertical actions. Yet, the muscle of the same eye that is able to perform the appropriate torsional movement will also move the eye vertically, thus increasing the vertical misalignment. For example, in a patient with a right fourth nerve palsy and the head tilted to the right, excyclotorsion will occur in the left eye because of contraction of both the left inferior oblique and left inferior rectus muscles. However, the paretic right superior oblique cannot balance the torsional and elevating activity of the right superior rectus, and the right eye will move upward leading to an increase in the vertical deviation (right hypertropia). With head tilt to the left, the paretic right superior oblique is not involved, and there will be either no increase in the vertical misalignment or it will diminish or no longer be detectable.FIG. 4.: Results of the Parks–Bielschowsky 3-step test are shown for a patient with a right hypertropia. In primary gaze, the vertical deviation may be due to paresis of 1 of 4 muscles. Increase in the deviation in right vs. left gaze reduces the possibility to 2 muscles and with measurement in right vs. left head tilt, the paretic muscle can be detected. Potential paretic muscle: LIO, left inferior oblique; LSR, left superior rectus; RIR, right inferior rectus; RSO, right superior oblique. Reprinted with permission from (22).FIG. 5.: Results of the Parks–Bielschowsky 3-step test are shown for a patient with a left hypertropia. In primary gaze, the vertical deviation may be due to paresis of 1 of 4 muscles. Increase in the deviation in right vs. left gaze reduces the possibility to 2 muscles and with measurement in

Parks Three-Step Test - Yumpu

Rosa Parks is best known for refusing to give up her seat on a segregated bus in Montgomery, Alabama, in 1955, which sparked a yearlong boycott that was a turning point in the civil rights movement. However, there was much more to Parks' life. Born in Alabama in 1913, she grew up in a segregated world that constantly exposed her to discrimination. Before her defiant act on that bus, she'd already fought back against injustice by joining the National Association for the Advancement of Colored People (NAACP) and investigating crimes committed against Black people.After the bus boycott, Parks continued to participate in the civil rights movement. She attended the March on Washington in 1963 and in 1965 witnessed the signing of the Voting Rights Act. Her later years saw Parks' work recognized with the Presidential Medal of Freedom and the Congressional Gold Medal.The following timeline covers notable events and achievements in Parks' long and remarkable life:February 4, 1913: Rosa Louise McCauley born in Tuskegee, Alabama to James and Leona McCauley 1919: A six-year-old Parks begins picking cotton alongside her grandparents. She also starts attending a segregated school in Pine Level, Alabama.1924: As there is no local school for Black children to attend after the sixth grade, McCauley goes to Miss White’s Montgomery Industrial School for Girls in Montgomery, Alabama.1929: Parks leaves school in the 11th grade to care for her ill grandmother and mother.1931: While Parks is working as a housekeeper for a white family, a white neighbor attempts to rape her.1931: Parks is introduced to Raymond Parks, whom she later described as being the first activist she encountered.December 18, 1932: Rosa weds Raymond ParksA photograph of Raymond Parks; Photo: Matt McClain/ The Washington Post via Getty Images1933: Parks returns to school and obtains her high school diploma, a notable accomplishment at a time when very few Black people in Alabama held this degree.1941: Parks starts work at Maxwell Air Force Base, which has an integrated cafeteria and trolley system.December 1943: Parks joins the Montgomery branch of the NAACPAs the only woman at her first meeting, she is named secretary of the group. Parks' work for the NAACP will also include investigating crimes against Black people such as murder, assaults and police brutality. Parks attempts to register to vote but is told she failed the literacy test required of Black voters.September 1944: Recy Taylor, a Black woman, is gang-raped by six white men. The Montgomery NAACP dispatches Parks to investigate the case. Parks helps establish the Committee for Equal Justice for the Rights of Mrs. Recy Taylor to advocate for legal action against Taylor's assailants. The case becomes national news but the rapists are never convicted.Recy Taylor; Photo: ©HBO Documentary. The Parks 3 step test is also known as Parks-Bielschowsky three-step test, Park’s three-step test, or Bielschowsky head tilt test.

Parks Bielschowsky three-step test

& Hoty's Clinical Neuro-Ophthalmology. Vol. 1, 6th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. Cited Here 2. Joo W, Rhoton AL. Microsurgical anatomy of the trochlear nerve. Clin Anat. 2015;28:857–864. 3. Nathan H, Goldhammer Y. The rootlets of the trochlear nerve. Acta Anat (Basel). 1973;84:590–596. 4. Agarwal N, Ahmed AK, Wiggins RH, McCulley TJ, Kontzialis M, Macedo LL, Choudhri AF, Ditta LC, Ishii M, Gallia GL, Aygun N, Blitz AM. Segmental imaging of the trochlear nerve: anatomic and pathologic considerations. J Neuroophthalmol. 2021;41:e7–e15. 5. Nan YS, Park Y, Kim I-B, Shin SY. Detailed anatomy of the trochlear nerve in the superior oblique muscle. Graefe's Arch Clin Exp Ophthalmol. 2019;257:2173–2178. 6. Hendrix P, Griessenauer CJ, Foreman P, Shoja MM, Loukas M, Tubbs RS. Arterial supply of the upper cranial nerves: a comprehensive review. Clin Anat. 2014;27:1159–1166. 7. Kono R, Poukens V, Demer JL. Superior oblique muscle layers in monkeys and humans. Invest Ophthalmol Vis Sci. 2005;46:2790–2799. 8. Lee JJ, Chun KI, Baek S-H, Kim US. Relationship of hypertropia and excyclotorsion in superior oblique palsy. Korean J Ophthalmol. 2013;27:39–43. 9. Demer JL, Miller JM. Magnetic resonance imaging of the functional anatomy of the superior oblique muscle. Invest Ophthalmol Vis Sci. 1995;36:906–913. 10. Akbari MR, Nejad MK, Askarizadeh F, Pour FF, Pazooki MR, Moeinitabar MR. Facial asymmetry in oculr torticollis. J Curr Ophthalmol. 2015;27:4–11. 11. Velez FG, Clark RA, Demer JL. Facial asymmetry in superior oblique muscle palsy and pulley heterotopy. J AAPOS. 2000;4:233–239. 12. Von Noorden GK. Burian-Von Noorden's Binocular Vision and Ocular Motility. 2nd edition. St. Louis, MO: CV Mosby, 1980. Cited Here 13. Parks MM. Isolated cyclovertical muscle palsy. Arch Ophthalmol. 1958;60:1027–1035. 14. Brazis PW. Palsies of the trochlear nerve: diagnosis and localization—recent concepts. Mayo Clin Proc. 1993;68:501–509. 15. Suh SY, Le A, Clark RA, Demer JL. Rectus pulley displacements without abnormal oblique contractility explains strabismus in superior oblique palsy. Ophthalmology. 2016;123:1222–1231. 16. Kushner BJ. Errors in the three-step test in the diagnosis of vertical strabismus. Ophthalmology. 1989;96:127–132. 17. Manchandia AM, Demer JL. Sensitivity of the three-step test in the diagnosis of superior oblique palsy. J AAPOS. 2014;18:567–571. 18. Lee JE, Yang HK, Kim JH, Hwang J-M. Diadnostic utility of the three-step test according to the presence of the trochlear nerve in superior oblique palsy. J Clin Neurol. 2018;14:66–72. 19. Olivier P, Von Noorden GK. Excyclotropia in the nonparetic eye in unilateral superior oblique muscle paralysis. Am J Ophthalmol. 1982;93:30–33. 20. Roh Y-R, Hwang J-M. Comparison of subjective and objective torsion in patients with acquired unilateral superior oblique muscle palsy. Br J Ophthalmol. 2011;95:1583–1587. 21. Muthusamy B, Irsch K, Chang H-YP, Guyton DL. The sensitivity in diagnosing acquired bilateral superior oblique paresis. Am J Ophthalmol. 2014;157:901–907. 22. Kline LB, Foroozan R. Neuro-Ophthalmology Review Manual. 7th edition. Thorofare, NJ: Slack Inc., 2013. Cited Here 23. Brodsky MC. Pediatric Neuro-Ophthalmology. 2nd edition. New York, NY: Springer, 2016. Cited Here 24. Girkin CA, Perry JD, Miller NR. A relative afferent pupillary defect without any visual sensory deficit. Arch Ophthalmol. 1998;116:1544–1545. 25. Ozkan

Parks–Bielschowsky three-step test - Wikipedia

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Park's Three Step Test - Eye Patient

Films/Courtesy Everett Collection1945: After taking the required literacy test for a third time, Parks becomes a registered voter. Yet before she can cast a ballot, she must pay a retroactive poll tax of $1.50 for every year since she reached the voting age of 21.1948: Parks becomes the Alabama state secretary for the NAACP.1949: Parks steps back as NAACP secretary to take care of her mother.1952: Parks returns to the Montgomery NAACP and once more becomes a branch secretary.August 1955: Parks attends a two-week training session at the Highlander Folk School in Tennessee. Alongside other civil rights activists, both Black and white, she discusses how to integrate schools following the Supreme Court's Brown v. Board of Education decision of 1954.December 1, 1955: In Montgomery, Parks defies a bus driver's order to let a white man take her seatThe driver, who had treated Parks rudely and evicted her from his bus in 1943, contacts the police and she is arrested.Fingerprint card for Rosa Parks; Photo: Universal History Archive/Getty ImagesDecember 5, 1955: Though Parks was not the first Black woman arrested for defying segregation on city buses, news of her case spurs the Black community to begin a boycott of Montgomery buses.Parks' trial takes place. She is found guilty and fined $10, plus $4 in court costs. Her lawyers file an appeal.January 7, 1956: Parks is let go from her job as a tailor's assistant at the Montgomery Fair department store.January 1956: Raymond quits his barbershop job after discussion of his wife and the boycott is forbidden.February 21, 1956: Along with dozens of other civil rights leaders, including Martin Luther King Jr., Parks is indicted for violating a Montgomery law outlawing boycotts.February 22, 1956: Parks is among a group of indicted boycott leaders who present themselves for arrest. She is quickly released. The case against Parks is eventually dismissed.1956: During the boycott, Parks serves as a dispatcher to coordinate carpools. She also travels across the country to speak about the boycott.December 21, 1956: Following a Supreme Court ruling that segregated buses are unconstitutional, the 381-day boycott ends. Parks is photographed sitting at the front of a bus for Look magazine.Photo: Getty ImagesAugust 1957: Unable to find work in Montgomery and still facing threats for her role in the bus boycott, Parks and her family depart for DetroitOctober 1957: Parks becomes a hostess at the Holly Tree Inn, part of the Hampton Institute in Virginia, but leaves after the fall semester in 1958 to rejoin her husband and mother in Detroit.1959: Parks begins doing piecework for Detroit's Stockton Sewing Company, a job she holds through 1964.July 1960: A Jet magazine article reveals that Parks and her family have been struggling financially, due in

Parks–Bielschowsky three-step test - Wikiwand

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Bielschowsky parks three step test presentation

Apartments has 3 shopping centers within 1.2 miles, which is about a 2-minute walk. The miles and minutes will be for the farthest away property. Parks and Recreation Distance Parks and Recreation Distance Moody Planetarium Drive: 5 min 2.8 mi Lubbock Lake Landmark Drive: 7 min 4.2 mi Science Spectrum Museum Drive: 9 min 5.0 mi Morocco Apartments has 3 parks within 5.0 miles, including Moody Planetarium, Lubbock Lake Landmark, and Science Spectrum Museum. Property Ratings at Morocco Apartments How Is This Rating Determined? Share details of your own experience with this property You May Also Like 19West 7117 19th St Lubbock, TX 79407 1-3 Br $935-$1,499 6.5 mi The Hudson at Orchard Park 3901 114th St Lubbock, TX 79423 1-3 Br $1,127-$1,781 6.7 mi Dakota Arms Apartments 6703 82nd St Lubbock, TX 79424 1-3 Br $967-$3,717 7.4 mi Frequently Asked Questions What neighborhood is the property located in?Morocco Apartments is in South Overton in the city of Lubbock. Here you’ll find three shopping centers within 1.2 miles of the property. Three parks are within 5.0 miles, including Moody Planetarium, Lubbock Lake Landmark, and Science Spectrum Museum.

Park's Three Step Test - Children's Eye

Part to her health problems.August 28, 1963: Parks attends the March on Washington for Jobs and Freedom. No women are invited to speak at the event, but Parks is among those singled out for a "Tribute to Women" in the civil rights movement.March 1, 1965: Parks takes a job in the Detroit office of newly elected Congressman John Conyers, where her tasks include answering phones and aiding constituents. She stays in this position until her retirement in 1988.March 25, 1965: Parks joins the march to Montgomery for equal voting rights. Many of the marchers do not recognize her but in the end she is acknowledged and invited to speak at the capitol building.August 6, 1965: Parks is among those present to witness President Lyndon Johnson's signing of the Voting Rights Act.July 23, 1967: Parks is in Detroit during five days of rioting. Amid the upheaval, her husband's barbershop is destroyed.August 30, 1967: A "People's Tribunal" is held regarding the deaths of three young Black men during the Detroit riots. Parks serves on the jury, which finds the police who were at the scene guilty (the officers faced no such repercussions in the legal system).August 19, 1977: Parks' husband, Raymond, dies.August 1979: The NAACP presents Parks with its highest accolade, the Spingarn Medal.January 14, 1980: Parks is given the Martin Luther King Jr. Nonviolent Peace Prize1987: Parks establishes the Rosa and Raymond Parks Institute for Self Development, intended to help young people better understand the past and prepare for their futures.1992: Rosa Parks: My Story, an autobiography for younger readers, is published.August 30, 1994: Parks is robbed and beaten by a mugger inside her home.October 16, 1995: At the invitation of Nation of Islam leader Louis Farrakhan, Parks attends the Million Man March in Washington, D.C.1994: Another book by Parks, entitled Quiet Strength, is published.September 15, 1996: Parks is presented with the Presidential Medal of Freedom by Bill Clinton.Bill Clinton with Rosa Parks during the Congressional Black Caucus dinner on September 15, 1996, in Washington, D.C. Earlier Clinton presented Parks with the Medal of Freedom.; Photo: RICHARD ELLIS/AFP via Getty ImagesJune 15, 1999: Parks receives the Congressional Gold Medal, the highest legislative honor in the United States.April 14, 2005: Parks and the hip-hop group Outkast reach an out-of-court settlement regarding their 1998 song "Rosa Parks."October 24, 2005: Parks dies at the age of 92Her body is brought to lie in honor at the U.S. Capitol Rotunda, the first time for a woman to receive this recognition.Watch “Rosa Parks: Mother Of A Movement” on History Vault. The Parks 3 step test is also known as Parks-Bielschowsky three-step test, Park’s three-step test, or Bielschowsky head tilt test.

Parks-Bielchowsky Three Step Test – EyeCalc

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