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.