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.

Does Your Child Say Reading is Confusing?

Many children with learning related visual challenges describe reading as being confusing. I notice this time and again when working with younger elementary school students with whom I am doing in-office vision therapy. They don't understand how to explain the trouble using other words, perhaps because for them, reading has always been difficult. How inexplicable to be otherwise intelligent, curious, articulate, and wanting to learn but to lag seriously behind their peers in reading! While I have done no statistical survey to correlate the visual diagnoses of these children with their perception of "confusion", my sense is that it most often accompanies a severe delay in the development of the visual spatial skills of laterality & directionality. These children typically make frequent reversals when reading and writing, don't know their left from their right, and often have trouble crossing the mid-line. My theory is that they don't know which side of the page or word to read first - varying their approach without noticing it from line to line or word to word. Children also use the label, "confusing," when the words appear to wiggle or double on a page. This is a classic symptom of an eye teaming insufficiency or excess. Tutoring in phonics or reading comprehension strategies won't solve these problems. A comprehensive eye exam from a developmental optometrist may identify the problem. Once a diagnosis is in place, the options for treatment can be evaluated.

Poor Reading Fluency May Indicate a Learning-related Visual Challenge

Efficient readers move their eyes quickly across a page of text decoding words and processing meaning. The most efficient readers even scan and recognize familiar words by their shapes. It takes more than good phonetic skills and a good visual memory to read fluently though. People who have deficits of their saccadic eye movement skills can't usually do it. Because their eye muscles are not developed well enough for them to control where to point their eyes, they may not be able to maintain a fixation long enough to process the word or its meaning. When they lose the fixation, they also lose their place in the text.

Fortunately, saccadic eye movement skills are fairly straight forward to improve. Starting with monocular activities that exercise each eye by itself, the eye muscles get strengthened enough to become much more reliable within a few weeks. Like I tell my younger vision therapy patients who are struggling with saccadic eye movement deficits, "You are supposed to be the boss of your eyes but they are mocking you and saying, 'We don't have to do what you say. We can do anything we want." After several weeks of consistent practice, most patients gain significantly better skills.

Until they can manage quick and accurate saccadic eye movements while also doing a cognitive task at the same time, though, the optometrist typically will not discharge a patient from vision therapy.

While there are other learning related visual issues which can result in poor reading fluency like a convergence insufficiency or a visual perceptual delay, improving your student's saccadic eye movement skills will usually result in an increase in reading speed, fluency, and comprehension.

The good news is that even if you do not have a diagnosed deficit of your saccadic eye movements, anyone can improve their reading speed, fluency, and comprehension using the activities in the Purple Book of the Eye Can Too! Read series. (Click on the links at the right of the blog to preview the series at Home School Incorporated.) While written with the home school context in mind, the activities are appropriate for anyone and can even be adapted for use in a classroom learning center. The book contains graded academic activities that all also rely on and build saccadic eye movements.

Of course, every child should be examined by a developmental optometrist or other eye doctor once each year to make sure that their vision is developing normally, the eyes are healthy, and if they need glasses, they have the correct prescription. If you are concerned about the possibility that your child has a learning related visual problem, be sure to let the doctor know.

"I like the book...my eyes are not in pain anymore"

Let me tell you about a fourth grade home-schooled boy. We'll call him Charlie (not his real name but he is a real boy). When Charlie's mother first called me she was really concerned about the fact that despite her background and advanced degrees in teaching, Charlie could not read with any fluency. He took forever to do his assignments, made very frequent reversals in reading and writing, and was not advancing at a pace that should have been possible given his obvious intelligence and ability to handle advanced concepts whenever they were presented orally. Charlie's mother agreed to help review the material which would soon become the Eye Can Too! Read series of books because she was ready to try anything. After having Charlie attempt to do some of the activities, she realized that his visual skills were very poor indeed. We helped her to locate a developmental optometrist in her area who concurred, gave appropriate diagnoses, and began to supervise a program of vision therapy to address the various layers of Charlie's difficulties. These included eye movement deficits, convergence insufficiency, and visual spatial as well as visual perceptual developmental delays. Did I mention that Charlie HATED to read? Well, he, like many children with learning related visual deficits, hated to read.

So, here's the good news. Six months later, this week, Charlie's mother told me that she couldn't find him when she wanted him to do something last week until she looked in the living room. Charlie was curled up in a chair reading a Hardy Boy mystery book all by himself. It was the first time that his mother had ever seen him choose to read and also continue to read for an extended period so she left him alone. 40 minutes later she asked him why he was reading.

"I like the book," he answered. "The words do not disappear at the end of the lines [like they used to]. My eyes are not in pain anymore. It doesn't hurt. It's easier."

Once again I conclude that children who resist reading or who seem to find it excessively difficult may have learning related visual issues which can be addressed through a program of optometric vision therapy under the supervision of a developmental optometrist.

Even Adults Can Gain Better Learning-Related Visual Skills

Yesterday my editor for the Eye Can Too! Read series of books emailed this: "Today I was reading something and suddenly realized. . . I’d been reading!! I had been reading for a quite a while (5 minutes) without a break-off, and yet also unselfconsciously. After those five minutes I started my breaks again—but I believe I am seeing that your activities are working!! “Break” is my word for my kind of stop-start reading, going back and forth because I’m not comprehending—jumping all over. I think that before doing these activities I could only read for one minute before I started breaking. Maybe less than that."

By "your activities", she meant the activities in the first book in the Eye Can Too! Read series which give graded academic activities designed to give home school students experiences using saccadic eye movements and pursuits- the skills that help people move from word to word and line to line on a page of text without losing their place, skipping words, or getting lost...

When we began working on the book project neither one of us suspected that she had any learning-related vision challenges. She wears glasses- but lots of people do. Glasses correct a person's ability to see clearly at near or in the distance. However, when I took her to see the vision therapy practice in which I work under the supervision of a team of developmental optometrists, she had a huge amount of difficulty doing the most basic eye movement and eye teaming activities. Now, I am not qualified to diagnose anyone about anything, but I could suggest that if she did some of the basic activities in the Purple Book of the series, which became available in September 2008, she would gain ground. And I absolutely recommended that she locate a developmental optometrist in her local area who would be able to give her a comprehensive eye exam and follow up with a customized program of vision therapy.

As we have continued to talk about how she is doing, she has realized that she has never actually read an entire book straight through. Instead, she has developed all kinds of strategies to help her process the book's information - like note-taking and re-reading each paragraph three or four times- habits that make her a very excellent editor. The effort that she must have needed to earn a college degree and an MBA had to be huge. Now she can begin to envision a day when reading will be fun. I am so pleased to have been placed in association with her and I trust that many others who have a life-time of reading difficulties will find the same encouragement to have a comprehensive vision examination by a developmental optometrist no matter how old they are.

Even this morning on National Public Radio's "Morning Edition", Joe Palca reported about his difficulties with 3-d vision because of amblyopia. Amblyopia, or lazy eye, is another condition that responds to vision therapy activities especially when the patient is young. However, new research is demonstrating that even adults can be trained to achieve stereo vision. Palca's report gives a great example of what happens in a vision evaluation and at vision therapy sessions.(http://www.npr.org/templates/story/story.php?storyId=99083752).

Why Can't My Student Remember How to Read Simple Words After Lots of Review?

As frustrating as it can be for the teacher when a child seems unable to recognize the same easy word in the next sentence, it may be even more difficult for the student. Imagine knowing that you are a very smart person before being confronted with the need to learn to read, and then finding yourself stuck in the lowest performing reading group. How boring! How demeaning! The child cannot figure out how the other students can make the letters stand still on the page, or which of the double lines go with which letter, or which side of the page or word is the beginning, or why the letters and words seem to disappear - that is, if he has learning-related visual challenges. What is even worse, since he has never had any experience of normal vision with which to contrast his own, he cannot explain why he is having trouble. When teachers or parents decide that somehow the problem is related to his behavior or that he is just not trying hard enough or that he is being lazy, the student often responds with even less effort, overt anger, or becomes withdrawn and depressed.

Before assessing that your student is guilty of any of those things, consider that all of these symptoms correspond to a visual condition that can be addressed with simple activities during in-office or home-based vision therapy. Get your child tested by a developmental optometrist who is familiar with vision therapy. Then, follow through on the recommendations that the doctor suggests.

What? Your child passed the vision screening at the nurse's office at school, at the pediatrician's, and, besides, the local eye doctor says he does not need glasses. As the developmental optometrists are fond of saying, "vision is a lot more than 20-20 eyesight." There are ocular motility skills - how the eye muscles work together to point the eyes to a point in space; eye teaming skills - that keep the words single on a page and contribute to an appreciation of depth; accommodation skills - the ability to easily and comfortably change the focus from near to far and back again; a whole cluster of visual perceptual skills - how to interpret the information gathered by the eyes; and visual motor integration - how to use visual information to direct motion. Students can have difficulty with any of these skill sets without needing glasses.

If your student is having difficulty learning to read, if her academic performance does not "match" her expected potential, if school just seems too hard, get a thorough eye examination that considers more than just whether your child needs glasses.

Why do some people move their heads back and forth when they are reading?

If you have to move your head to follow the text when you read your ocular motilities may be deficient. When the six eye muscles in each eye move efficiently in coordination with each other, they can make very fine eye movements. The muscles coordinate to point the eyeballs to keep a visual image near and single. People who use their neck muscles to point their eyes don't realize this- it isn't a conscious failure, though. These people may have deficits of their saccadic eye movements, the short little hops that the eyes make from the end of one word or line of text to the beginning of the next. These same individuals may find it helpful to use a straight edge to keep their place while reading. They may also experience frequent loses of place and may habitually skip little words or even whole lines of text. Developmental optometrists often incorporate vision therapy in their practices. Simple activities and exercises can often promote the development of great saccadic eye movements over a period of several weeks.