Howard Engel, author with alexia

In other words, this professional writer suffered brain damage that destroyed the part of the brain that recognizes written language. The feature article in the January 28, 2010 issue of The New Yorker Magazine by Oliver Sacks explores the problem and the disciplined approach that Engel took to cope. He depended on the brain's plasticity to relearn reading by another modality. He traced the letters with his fingers finding that that movement inputted the information into his mind so he could decode the words on the page. As his proficiency improved he switched from tracing letters with his fingers to using his tongue, a faster method. The saga is also described in a recent NPR interview: http://www.npr.org/templates/story/story.php?storyId=127745750. Like the process Oliver Sacks explains, vision therapy also depends on the brain's plasticity and on a whole body approach to developing visual skills. Everyone can learn to read better, faster, more efficiently, with better comprehension and without getting confused. It is the premise of my Eye Can Too! Read series of e-books.

Look with your eyes, not with your hands.

When my children were little and we went into a shop or a home belonging to someone with many visually attractive items within reach I had a saying that I repeated ad infinitem: "Look with your EYES, not with your hands." It was a familiar reminder of the etiquette required in such places. For some children, however, this instruction would be tantamount to blindfolding them because they do not value their eyes as efficient gatherers of information. Some children have poorly developed visual attention, responding more to auditory or tactile clues. These are the people who can never "find" anything that they are looking for even when it is right in front of them - not because of being distracted - they really don't see what they are trying to find. Other children have not developed adequate control of their eye movements and may even be mis-labeled with an attention hyperactivity disorder. These children cannot hold a visual fixation for long enough for the image to register - they may have deficits of pursuits (the ability to track a moving object) or of saccadic eye movements (the ability to make short accurate visual shifts in focus such as a reader makes when transitioning from one word, line, or paragraph to the next). If yourchild does not seem to LOOK where he or she is going, do not make the excuse that they are an auditory or kinesthetic learner (of course they may prefer to obtain new information through these channels but that does not mean they should not be assisted to develop the visual skills that will allow them more efficiency.) If it seems that your child does not gain new information by means of their eyes, schedule a comprehensive eye exam with a doctor who evaluates children's developmental visual skills. Then begin to incorporate visual challenges into every day situations - for example, draw a picture or write instructions for a task that the child must do with a reward for accomplishing it. And, consider purchasing a good resource like one of the Eye Can Too! Read e-books. Everyone can learn to use their eyes more efficiently no matter how they learn best.

Playing Croquet takes a combination of highly developed visual skills

All you have to do is aim a wooden ball with a clumsy wooden mallet to roll through a wicket the size of a clothes hanger. Of course if you bump into a competitor's ball you can advance a bit faster and if you get bumped you may be driven far off course. Suppose you lack the ability to discriminate between left and right on yourself or to project the knowledge of left and right into space? You'll have trouble sending the ball in the correct direction. Suppose you lack the visual perceptual skill of visual memory so that you can't create a mental image of how the ball will respond when you tap it from a certain side? You'll have trouble planning the next moves. Suppose you have delays in the development of visual-motor integration? You'll miss the ball or, if you are bumping another person's ball out of the path you might hit your foot instead. Suppose you have trouble transitioning from a central to a peripheral focus? It will be very difficult for you to judge how to strike the ball in relationship to the wicket yards away. It is needless to conclude that playing the game of croquet requires a combination of highly developed visual skills. So, if you have been playing that game with your children and one of them consistently quits in frustration, you might consider asking a developmental optometrist to do a comprehensive examination of their visual skills. Like optometrists are fond of saying, vision is much more than 20-20 eyesight.

Vision therapy - analogous to Ear training?

Vision therapy is a lot like the ear training musicians go through. First the person has to become aware that the eyes can be tools for gaining information about the world. Some kids miss this idea preferring to touch everything or talk their way through life. Often these kids have not developed good intentional control of their eye muscles - this is what the activities in the Purple Book of the Eye Can Too! Read series helps. After they build automatic eye movement control, then it is time to work on eye teaming - skills that require the assistance of lenses, prisms, and other specialty equipment that eye doctors keep around. Kids who display dyslexia type symptoms like frequent reversals of letters and words when reading or writing, who can't easily cross their physical mid-lines. and who confuse left and right need to have an eye exam so that the eye doctor can rule out any deficits or delays in ocular motilities or eye teaming. Then they can work on the visual spatial skills of laterality and directionality - these are the topics of the Yellow Book of the Eye Can Too! Read series. At last it is time to consider the visual perceptual skills - discrimination, memory, figure ground, sequential memory, closure, and spatial relations. These are more analogous to ear training. What did you see and can you recognize it again or more specifically in another context or after it is slightly modified? These skills are the subjects of the Green Book of the Eye Can Too! Read series.

Helping a parent process through what the eye doctor said

Last week I received a call from a home-schooler who found my Eye Can Too! Read website and wanted to know which book she should order for her son. She recently took him to a developmental optometrist who diagnosed a cluster of visual diagnoses which do indicate a need for vision therapy. But the mother had not been given enough information to understand what had been found or what the therapy would accomplish. We talked for more than an hour. While the doctor did not use any of the normed diagnostic tools with which I am familiar, I could tell by the description of her assessment activities what she had done. The therapy assignment for the first several weeks was to use a Marsden Ball to introduce appropriate control of Pursuits, one of the two ocular motility skills we address in therapy. The therapy is only done at home facilitated by the parent - the mother was instructed to swing the ball three times in each direction for each eye once per day. She was to do nothing more for now. We concluded that her son would benefit from using either the Purple Book or the Yellow Book and since the activities are academic in nature, designed with home-schoolers in mind, they could be used without compromising the therapy prescribed by the doctor.

It's Developmental

Eye movements, eye teaming, visual perceptual skills, and eye-hand coordination are all developmental skills. This means that they typically emerge given the right opportunities and experiences like learning to walk, ride a bicycle, or swim. There is a range of normal vision development which can be tested and measured against standard age/grade norms. This is how developmental optometrists determine and diagnose any delays or deficits of normal visual development. What we do in vision therapy is help trigger a child to acquire and maximize their visual developmental skills. I can't tell you the number of times a parent has asked me whether their child will need to return to vision therapy in the future. My usual answer is that it is very like learning to swim but then not swimming all winter. Can you still swim when the pool opens in the spring? Yes, and what good swimmer hesitates to dive into the pool's deep end even if they haven't been swimming in ages? Unless the visual problem involves a diagnosis of amblyopia, or some other non-developmental condition or brain injury, once a child's visual skills have developed, they tend to keep improving.

Toes Matter

 In our vision therapy room we pay attention to our patients' toes as well as to their posture in general. Toes matter. Every ballet dancer knows that the eyes follow the toes.When a patient habitually stands with one toe pointed in or out and tries to do the Brock String, for instance, they typically find it easier when their feet are parallel to the string. If they twist their hips or stand with one shoulder raised, a head tilted, or a shoulder tipped back or forward, we notice that they often also have a problem performing the therapy activities that require them to team their eyes efficiently. So, if you have poor posture, walk toes in or out, or tilt your head, I suggest that you make an appointment to see a developmental optometrist to learn if your posture might be due to a binocular vision problem - besides, even if you have perfect posture, you should get a comprehensive eye examination once a year.