Miss Mary Mack.....

Remember the clapping games from elementary school recess? You had to clap a partner's hands in rhythm to the poem following a pattern. You had to cross the midline, remember the words to the rhyme, think ahead and respond to your partner. This little game builds bilateral coordination, laterality & directionality, visual motor integration, all of which are visual skills that contribute to a child's ability to succeed in school. If your child can't do a simple game of patti-cake without mixing up which hand goes where in the rhyme, don't allow them to forget about the game. Slow it down. Do it again and again. Simplify it by using just one or two elements in the sequence until they are mastered. This kind of game is really important especially if your child has trouble with reversals when reading and writing or gets confused about which side of the page to read first.

Rice, Tweezers, and Dot-to-Dot Books

One easy to do fun activity that helps individuals strengthen their lazy (or amblyopic) eye is to fill in the gaps between the numbers in a preschool dot-to-dot book with grains of uncooked rice.

Directions: Put about a tablespoon of rice into a small saucer. Tape a dot-to-dot page to the table so it doesn't wiggle. Put a patch over the better eye. Using a regular pair of tweezers, pick up one grain of rice at a time and place it carefully down between the numbers in order. Continue laying down grains of rice one at a time until the entire puzzle is complete.

Why is this an effective monocular activity?

1. Because the page is likely to be the same color as the rice, seeing where each piece of rice should be placed depends on good visual acuity
2. It also requires good visual-motor-integration skills to manipulate the tweezers, isolate just one piece of rice and maneuver it to the paper

Our Amblyopic Intern is Getting Better

This morning our 4th year optometry intern told me that yesterday she asked our senior doctor to refract her and guess what? After four weeks of doing vision therapy activities with our patients - she has been wearing red and green glasses to "wake up" her amblyopic eye when facilitating activities with anti-suppression targets and wearing a patch over her "good" eye when facilitating monocular activities....her best corrected visual acuity in her amblyopic eye has improved significantly. She is surprised and thrilled.

Jigsaw Puzzles Develop Visual Perceptual Skills

Children who hate doing simple jigsaw puzzles should be encouraged to do a simpler similar task so that their visual perceptual skills will improve. What visual skills are involved in doing a jigsaw puzzle?

1. Visual spatial relations is the ability to recognize patterns between the puzzle pieces. In a jigsaw puzzle you must recognize that some pieces have a straight edge, for example. Thus, they produce the outer frame of the puzzle. 
2. Visual closure is the ability to predict what an image will look like when you only see a portion of it. To solve a jigsaw puzzle you have to be able to visualize which pieces fit into openings made by the other pieces.
3. Scanning the array of unused pieces is an eye movement skill. People with saccadic deficits will have difficulty finding the right jigsaw piece.
4. Visual memory is the skill that allows a person to create a mental image and then refer to it. This skill must be in place when searching for pieces and when returning to the incomplete puzzle to place the selected piece.
5. Visual attention is a basic skill that must be in place before the simplest puzzle can be completed. People who do not value the information received by their eyes will not do well at jigsaw puzzles. They tend to try to locate things by touch instead of by sight.
6. The ability to transition between a central fixation with peripheral vision is necessary to complete any jigsaw puzzle. This skill is often very under-developed in individuals on the Autism Spectrum

Each of these visual skills must be developed and in place in order to enjoy and be successful at doing jigsaw puzzles. Academic success also depends on each of these visual skills. So, if your children do not like doing jigsaw puzzles, do not allow them to avoid them. Try using simple preschool puzzles and time how long it takes to complete them. Challenge your child to beat their previous time. Go to a teachers' supply store and purchase parquetry blocks or tangram workbooks. Even inexpensive dot-to-dot books will help to develop a child's visual closure and scanning skills while the hidden picture puzzles in Highlights or the I Spy book series will also improve a child's puzzle solving skills. 

Remember to schedule an annual eye exam with an eye doctor who incorporates vision therapy into their practice. These developmental optometrists routinely examine children's visual perceptual development and can prescribe in-office vision therapy activities to help.

In addition, the Eye Can Too! Read series of e-books contains helpful home-based activities and resources that you can easily adapt for any individual child or classroom.

Our Intern's Emerging Binocularity

Today I asked our amblyopic intern whether she has had any more results from doing simple binocular activities in our vision therapy room. Yes, she is aware of depth in a new and not terribly comfortable sense now that she can see two strings on the Brock string. She also had a terrific headache last week and attributes that to the emerging use of her right eye. Not only is she providing clear language about the disruption that becoming binocular is making for her otherwise reliable visual world-view, she is gaining empathy for all the patients for whom she will recommend vision therapy once she is a fully licensed board-certified optometrist. I hope to convince her to blog about her journey towards binocularity.

Can You Do This?

Hold your thumb out at arm's length in front of your nose. Look at it. It should look like a normal thumb. How do you have to change your eyes to make the thumb double? If you can make the thumb double, what do you need to do to make it single again?