What does a math worksheet tell you about vision?

Many elementary school math worksheets are arranged in rows and columns. The expected approach is for the student to start at the top row with the first problem on the left and work across the row solving each problem in turn until there are no more remaining. Then the student should move onto the first problem at the left side of the second row, continuing in this manner until the last problem, located at the right margin of the bottom row, has been solved. Then, the paper is ready to be checked, corrected as needed, and handed in to the teacher. If, however, the teacher receives a paper that has a haphazard amount of problems solved and the student asserts that they, indeed, have been careful to do each problem, you can predict that the student may need to have an extensive eye examination by an eye doctor who is skilled in evaluating binocular vision development in children. A haphazard approach to this kind of worksheet is consistent with a saccadic deficit, a condition that relates to the child's ability to control their eye muscles and a problem that can be addressed in vision therapy and, as an extension of the same, with the Purple Book of the Eye Can Too! Read series of e-books that I wrote. Intervention should start with a thorough eye exam by an eye doctor.

PediaStaff Newsletter Article

Hopefully many therapists will read the PediaStaff newsletter article I wrote: http://www.pediastaff.com/resources-vision-therapy-what-it-is-and-how-and-when-to-refer-patients--featured-august-30-2010 and think about how and whether their patients will benefit from consulting a developmental optometrist.

Announcements

My postings have been fewer in the past months because I have taken a new position as the director for one of my nonprofit client's organizations and will be moving out of the area where I have lived for the past several decades within just a few weeks. Once my hectic life settles down again, I will become more consistent with this blog and with the other promotional efforts to get my Eye Can Too! Read e-books for homeschoolers and other people into the hands of the people who will use and benefit from them.

Meanwhile, yesterday I started writing the article I promised to do for the August edition of the Pediacare newsletter. The objective is to describe for providers of occupational, physical, and speech/language therapies etc. what vision therapy is, how it can benefit their patients, and how to find vision therapy providers to send referrals. I'm thinking that the best approach will be to give quick case studies of a cross-section of my typical patients. Hopefully this will be a great resource.

On October 9, 2010, the Eye Can Too! Read e-books will be available at the Colonial History Day for Homeschoolers at the Bolduc House Museum in Ste. Genevieve, Missouri, along with products from other venders and service providers who work with homeschooled students. More information about this event can be found at www.bolduchouse.com.

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.

Look!

When a person does not have good control of their eye movements they often do not trust, value, or rely on the visual system as a means of gathering information. The other day I was working with a nine year old boy in a vision therapy session. I had made a "map" on the floor using a length of clothesline placed so that every few feet the rope made a 90 degree turn. The boy, who is 100% accurate about identifying left and right on himself, was told to walk along the rope, stop before making a turn and say which way the rope led. If he correctly identified "left" or "right" I allowed him to progress. He was inconsistent and as I watched, I noticed that he never looked at the rope. At least guessing gave him a 50% chance! I began to say, "look DOWN at the rope." When he did, his accuracy rate improved. After more than 30 turns (we repeated the activity a few times), I still needed to cue him to "look DOWN at the rope" .... This boy cannot follow a slowly moving target like a Wolf Want nor can he successfully make short hops between two stationary targets without his eyes shifting suddenly away from where he is trying to make them point. Yet! Even though each week he has better control but now I realize that in addition to building the muscle awareness and automatic control of his eye movements, for this boy, I have to help him gain an appreciation and the habit of letting his eyes participate in gathering the information needed to navigate through life and the world.

After six years as a vision therapist....

It has been about six years since Dr. Doell recruited me to become a vision therapist in her optometry practice. At the time, I was a classroom teacher with a master's degree and I was also her patient - we had met when one of my own children suffered from a convergence insufficiency close to 20 years ago. She did about six weeks of vision therapy on Nancy and treated the whole family happily ever after.

We clicked - come from the same area of New York City and find the same things funny so we laughed through each appointment and even went out to lunch for fun a time or two. So, when she told me she was looking for people with masters degrees in education or OT to train herself, I was interested - besides single parenting (not by design) six minor children on a teacher salary was not cutting it so the few extra bucks looked good.

I observed the VT room in action and started working after school a couple of evenings each week. I already knew how to read a child's personality and make them feel at ease. It was easy for me to set up an activity and make it meaningful but it took a lot of practice to learn how to observe the eyes at work, how to match the right therapeutic activity to the diagnoses, how to decode the medical notes in the patient's file, and how to record and then apply what I observed.

Reading optometry books and articles made me feel illiterate at first - a whole new vocabulary had to be grasped - and I felt really slow at the task in spite of being an insatiable very competent reader. But I persevered, attended workshops and optometry conferences and asked the same questions a million different ways not realizing that it was the same question sometimes.

Now I find myself watching the eyes of people being interviewed on television and wondering if there is a strabismus or some other problem to explain anything other than aligned normal looking eye contact or eye movements. I find myself wishing I could do some simple activities with random colleagues and relatives because they display familiar ocular behaviors or postures that I know I could perhaps address and provide the means to greater visual efficiency.

I wish I could interest every classroom teacher in my e-books because a few carefully chosen lessons using the activities I present might just make a few more kids into more adequate readers who could do better on the dreaded standardized tests. Why don't the graduate level reading classes incorporate basic visual efficiencies or present the list of classroom behaviors that signal probable learning-related vision challenges which proper optometric attention could resolve?

I don't know how many more years I will be doing vision therapy a couple of days each week but I do know that my life and outlook has been forever changed because I have been introduced to the profession.

Helping special needs students accept and tolerate transitions

A special needs patient has been coming to me for vision therapy for much of the last year. His original skill set included eye movement deficits, convergence excess, delays in most subsets of visual perceptual development, and delays in visual motor integration. In other words, this kid's learning-related visual skills were severely messed up. The progress he has made on all fronts took a quantum leap once he began to see that he could control his visual system and that the strategies he has successfully used to resist frustrating tasks are no longer needed now that the tasks themselves are achievable.

However, like most special needs kids, he continued to struggle whenever he had to make a transition - in the vision therapy context this meant that it took us forever to get him to move through the flipper sequence for monocular and then binocular accommodation.

When I taught in the inner city classroom, the issue of helping children accept and tolerate transitions was one of my big goals especially when students with special needs were mainstreamed into one of my classes. So, I consider myself to be somewhat competent at fostering this skill. My patient, however, was one of the most resistant and I was working with him one on one so I could just imagine the issues he faced in the classroom at school.

Over the past six sessions, I have introduced yoked prism glasses - switching the direction of the prism every few minutes. The patient calls them "drunk glasses". At first he could not manage to walk a taped straight line with yoked six base anywhichway prism glasses. The other day, he tolerated - even enjoyed 20 base up, down, right, and left yoked prisms - he walked straight lines and manipulated a hoop to trap and release a marsden ball without missing a beat.

His father was observing the session and I realized that he did not understand what a huge achievement this indicated. So...... guess what I did?

I put the base 20 yoked prism on the dad and asked him to walk the line - he barely managed it base down. Then I shifted the prisms base right and the man nearly fell off the floor to the delight of his son, my patient. The purpose of the activity was achieved though, because the dad totally understood the huge progress that my patient had made - to handle quick transitions, adjust to them, and enjoy it. Now, to transfer that ability to other areas of his life....

Reading Focus Card

Joan emailed me after she read my website because we both come from St. Louis and we both have products to help students who are struggling readers. We had a great conversation the other night too and discovered that she has met the eye doctors I work for (I thought I recognized her reading focus card when I browsed her website- www.ReadingFocusCard.com) It is a tool that for anyone with deficits in the development of their saccadic eye movements- those short little hops that we make when moving from one word, line, or paragraph to the next. Of course, my perspective is that this condition can and should be resolved after a developmental optometrist provides a complete vision examination and prescribes the appropriate corrections, exercises, and vision therapy. Of course, my hope is that teachers everywhere become informed about learning related vision skills - how to recognize students who need intervention - and that they also will experiment with the learning activities in my series of e-books. The Purple Book deals explicitly with saccadic eye movements - by providing academic activities for students in grades K-8 which exercise and could improve these eye movements and at the same time promote more efficient reading skills as well. Go Joan!

What a privilege!

A former patient came into the office to day for a follow-up check by the doctor. When she first came to vision therapy she had no binocular vision. We started by doing lots of anti-suppression activities using polaroid lenses and red and green lenses. As she became more and more aware of what each eye was seeing, she began to be able to do a basic brock string. Although a sophomore in high school, she was delighted by the float that comes when we do some of the binocular activities - like the images of the strings, for instance, or the float of the quoits vectograms. After about 32 weekly therapy sessions, she was discharged - but we continue to watch her progress and give her things to do at home, checking up on her every couple of months. Today, the doctor was thrilled to report that our patient has developed randot stereo and was enamored with the fly's wings in the exam room. The patient blamed the results on watching Avatar, the movie in 3-D. Her original motivation included a desire to see Coraline. Here's a person whose life has been changed by the expansion of her visual function. What a privilege to have been part of the journey.