Surprises

Between patients at the optometry office where I work as a vision therapist, I browsed through the most recent edition of the COVD Journal. Imagine my surprise when I came across a link to my blog - this one! - in the last article. Here are the other optometry related blogs that you might be interested in following:

• http://covd.typepad.com/visiondevelopments/
• http://covd.typepad.com/visionu/
• http://mainosmemos.blogspot.com
• http://brighteyesnews.com
• http://wowvision.typepad.com/the_wow_vision_blog/
• http://petesaoablog.wordpress.com
• http://janetsjournalblog.com
• http://blogs.psychologytoday.com/blog/eyes-the-brain/feed

I also discovered that www.homefieldadvantage.org, a great home school resource also decided to link to my website.

If you are a homeschooler, a member of a home school support group, or an optometrist with a vision therapy practice that services homeschoolers, let me know, please. Follow me at @eyecantooread on Twitter or "fan" the Eye Can Too! Read page on Facebook.

Do You Have Good Eye Movement Skills?

A very common learning related visual problem is poor eye movements. The six eye muscles in each eye should work together to point the eye to a visual target such as a word on a page or a baseball coming towards a bat or glove. There are actually two types of eye movements facilitated by these muscles. Pursuits are the movements the eyes make to follow a moving visual target smoothly. When I am helping a patient develop good pursuits, I often characterize this skill as "ice skating for your eyes." The other type of eye movement is called saccades. Saccades are the short hops the eyes make between two fixed visual targets such as when going from the end of one line of text to the beginning of the next line.

Both pursuits and saccades are developmental eye movements. Like learning to swim or ride a bicycle, once a person knows how to do them, they continue to improve. With experience, the person can coordinate the movement automatically and fluently enough to do other things at the same time like carry on a conversation, for example. However, for patients whose developmental eye movements are delayed, basic tasks like reading, lining up digits in a math problem, or hitting a baseball can be very difficult.

There is a simple test that optometrists use to test a child's eye movements called the Developmental Eye Movement Test (DEM). It is available exclusively from the Bernell company (www.bernell.com). Bernell provides an assortment of tools for optometrists and vision therapists. The DEM can be used for children as young as first grade. First the child is asked to read a column of 80 single-digit numbers arranged vertically. The examiner times the child with a stop watch. Then the child must read the same 80 numbers arranged in rows horizontally with random gaps in the rows. By the time a child is twelve years old, the speed with which they read the vertical numbers should match their speed reading the horizontal numbers. The test has been validated over a period of years so norms for a child's performance scores have been established according to both age and grade. Besides comparing the vertical and horizontal reading speeds, the DEM also measures the number of errors made by the child. It only takes about three minutes to complete the entire DEM but the results may explain why a child is having difficulty in school in spite of having 20-20 vision.

If your child scores poorly on the DEM, vision therapy may be indicated. Your child may also be helped by the activities in the Purple Book of the Eye Can Too! Read Series. While I wrote the series for home-schooling families, anyone can implement the activities which are similar to what we use in in-office vision therapy to address eye movement deficits.

Does Your Child Stand With One Leg or Arm Wrapped Around the Other?

Many of the children whom I see for in-office vision therapy have more than one learning-related visual issue that makes it difficult for them to succeed in school. Sometimes a child presents with a severe laterality and directionality delay. Laterality is the ability to tell left and right accurately on yourself. Directionality is the ability to project the knowledge about left and right away from yourself into space. Both are visual spatial skills, i.e. processing skills or visual perceptual skills. We discover the extent of a child's delays using a combination of tests: the Piaget Test of Left/Right Awareness, either the Jordan or the Gardner test of letter reversals, and a dyslexia screener. Children who cannot cross the mid-line or who make frequent reversals when reading or writing letters and numbers often score poorly on these tests, all of which have age/grade level expected normed scores. Then we use a series of activities in therapy to address any laterality and directionality delays. (The Yellow Book in the Eye Can Too! Read series provides parents and teachers with similar activities and information about how to understand a child's behavior when doing them.) I have recently noticed that many of the children with the most severely delayed laterality and directionality skills stand or sit with one leg wrapped around the other. They often twist their bodies when standing, and seem to be holding themselves together with the right hand grabbing their left side and the left hand grabbing their right side. I think that this postural habit exacerbates the problem by making it difficult for the child to know which body parts belong to the right side and which to the left. I have begun to coach parents to discourage their children from using these positions as another way to address the child's visual spatial problems which they sometimes express as being "confusing." I'd love to know whether others see the same correlations. Feel free to add your comments. Thanks.

Eye Hand Coordination as Demonstrated by Kindergarten Students 100 Years Ago

These are three scans taken from kindergarten albums from my family members. The first is carefully woven paper. It was made by Mary Edwards at Froebel Kindergarten in St. Louis City in the 1907-1908 school year. The other two scans were done by a boy, Albert Edwards, who attended kindergarten in the 1899-1900 school year, also in a St. Louis public school. The portrait of George Washington is a printed picture over which Albert has sewn very tiny neat straight stitches - the blue is a coarse thread and the white is a very fine thread. The holes are different sizes denoting that the needles were too. The third scan shows a series of folded origami.


Why did I include these scans in the Eye Can Too! Read blog? I wanted to make a statement about what kinds of activities were done at the reading readiness, preschool level in the eras before television, plastic playgrounds, and Game Boys. The eye-hand coordination required to do any of these crafts is far more mature than we expect from fifth graders today, let alone from five year olds. Not only did these children have to demonstrate very fine motor control, this kind of close work would have strengthened their eye movements so that they could gain experience converging on near point images long before they were expected to use those eye movements to decode the meaning of text.

How I Got Interested in Vision & Learning

I grew up with great vision - well, I didn't need glasses and was an avaricious reader from early on, loved school and always wanted to be a writer and always wrote stuff I hoped other people would read.

The first place I taught was a tiny church-based school in Santa Ana, CA - in around 1978. I taught first grade. A developmental optometrist pioneer in vision therapy did an inservice training workshop for us teachers and I learned how to recognize when a child's vision problems were at the root of their academic difficulties. We toured his amazing vision therapy clinic. I ended up referring about four students to this doctor and all of them benefited by either a prescription for glasses or a series of in-office vision therapy sessions. Then I forgot all about it.

Until....perhaps fifteen years later. Now I was a home-schooling mom with seven children who also taught students from a total of six families over the course of a 17 year period. One daughter struggled with penmanship and resisted any form of written work in spite of being a very fast reader with great comprehension way above her grade level. Another daughter struggled to learn to read and write, made frequent reversals when writing, and could not progress past the primary readers in spite of an obvious ability to comprehend what ever I read aloud to her, and who had an uncanny gift for organizing people and things.

I took the girls to an optometrist at a major store outlet. Both passed the vision examination as far as acuities and ocular health. So they did not need glasses. Fortunately, the doctor had been a student of Dr. Gail Doell at the UMSL -School of Optometry in St. Louis. She taught binocular vision and owned her own optometry practice where she provided in-office vision therapy. The first daughter was diagnosed with a convergence insufficiency which resolved in about 8 weeks. She went on to be an air traffic controller in the US Air Force. The other daughter's problems were more related to visual perceptual developmental delays - they also resolved enough for her to make the dean's list at college every semester and to become a successful accountant. Of course, Dr. Doell became our family's eye doctor forever.

Fast forward another twelve years to 2004. I was in Gail's office for a regular eye exam. My marriage had failed leaving me the single parent of six (my oldest was grown already). This meant that my home-schooling days were ended. The children, enrolled in public schools, all thrived as top students earning scholarships and awards every year. I went back to teaching - in the St. Louis City public schools. I had also earned a Masters in Teaching. Gail and I were laughing over funny stories about my classroom experiences when she happened to mention that she was hiring a new vision therapist. She wanted someone with a graduate degree either in education or occupational therapy to train in-house. Was I interested? After observing several times, I started working for her as a part time vision therapist. Six years later, I still do that in her pediatric office, the Center For Vision & Learning in Creve Coeur, MO.

Most teachers are never told about how fundamental the development of the visual system is to a child's academic success. Many students who are intelligent and excited about learning but who also have undiagnosed learning-related visual problems lose motivation, engage in deteriorating behavior, and become discouraged about their potential success. It begins in kindergarten for many. In fact, many academic challenges could be avoided if every teacher knew how to incorporate activities to improve eye movements and to build visual perception. Even more students would do better at school if every teacher knew how to recognize the symptoms of convergence insuffiencies or excesses and accommodative disorders so they could refer the students to a developmental optometrist who specializes in binocular vision. Special education teachers could help many of their students who have Autism or Asperger's Syndrome by understanding the visual issues these individuals often face and by collaborating with developmental optometrists and skilled vision therapists.

IT IS NOT ENOUGH FOR A CHILD TO PASS THE VISION SCREENING IN THE SCHOOL NURSE'S OFFICE - THIS JUST DEALS WITH DISTANCE VISION AND WITH OCULAR HEALTH - EFFICIENT READING RELIES ON SEVERAL OTHER VISUAL SKILLS

As I participated in optometry training workshops and conferences I discovered that as much as teachers don't know what optometry has to offer, optometrists don't know how classrooms work either. I have experience in the classroom, the homeschool, and the vision therapy contexts. That's why I wrote the Eye Can Too! Read series of curriculum activities for homeschoolers. Of course, they can be adapted for classrooms too. I'm working on a big book of learning related vision activities for the primary classroom learning center now.

Besides finding it personally rewarding to see my patients advance several reading levels within a few months of starting vision therapy and gain self-confidence so that they can begin to enjoy school, I am passionately convinced that the more than 40 years of optometric research about addressing learning-related visual problems through vision therapy activities should be made more widely available. That's why I write this blog and hope to be a resource to parents and teachers for the sake of the kids.

Please feel free to share the links to this blog. Follow me (@lesleybarker) on Twitter and become a fan of the Eye Can Too! Read page on FaceBook. Leave your questions on one of these sites and I'll get back to you with some kind of response that I hope will help.

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.

Teaching Students Visual Memory Skills

Do any of your students have difficulty identifying or properly sequencing letters or numbers even though they have been given plenty of instruction and guided practice and seem otherwise bright, articulate individuals? Over the years, several of my vision therapy patients have had this problem and I have discovered that when they learn how to access their visual memory, they begin to have a strategy to solve the embarrassing dilemma.

Here is an activity that can help teach students how to overtly access their visual memory.

1. Have the student close his eyes and describe from memory the items in the classroom.
2. Ask whether there is an alphabet chart posted anywhere in the room.
3. Ask the student to tell you from memory what color the chart is and what color the letters are. If the student does not know, give them an assignment to find out the next time they are at school.
4. Ask whether your student can see a picture of that chart in their mind. Then ask how many "w's" are on it.
   
5. Ask if the student can read the chart by looking at the mental image and find the letter that comes two before "q".

Note that many students who have difficulty remembering visual material have not been assisted to look carefully and analyze the visual images. These students may prefer to learn using an auditory or kinesthetic mode but they can still develop more visual competence with help.

Here is a spelling activity to help students put visual material into their visual memory.

1. Take any word on the spelling list. Perhaps you want to learn to spell picnic.
2. Write picnic in neat manuscript letters as a model.
   
3. Direct the student to trace the word with a pencil five times.
4. Next tell the student to imagine that it is a very damp cold day. There is moisture on the car window. Tell the student to use her finger to write the word picnic on the window.
   
5. Ask her if she can see the word on the imaginary car window. Then ask her to spell it by reading the letters from the window in her mind. Next, ask her to spell it backwards.

Notice that this method does not rely on any phonetic skill at all. It is a visual activity. The most efficient readers mix their ability to remember visual cues with their ability to sound out words. In English, especially, because there are so many equally correct ways to write a single sound, we have to use both our auditory and visual memory to become good spellers and readers.