How Hopscotch Helps Vision

One of the games I remember playing at recess was hopscotch. My school had a cement playground between the brick building and a twelve or fifteen foot high fence along the back yards of the neighboring houses. There was also a sand lot that did not belong to the school but which we were allowed to use during recess but no girls were welcome on that part of the playground in the early 1960s because the rough wild boys were always playing soccer or softball. And, of course, we were wearing dresses so that wasn't an option for us even if the boys would have tolerated our presence. Since boys have cooties, we didn't mind being excluded because who wants to get cooties. The girls tended to dominate the black-top part of the school yard. We also often played hopscotch - especially if someone remembered to ask the teacher for a piece of chalk from the black board to draw the board. It is too bad that recess is being marginalized because even a simple game of hopscotch relies on and improves the learning-related vision skills that make academic progress easier.

Even drawing the hopscotch board takes a combination of visual skills. First, using the visual perceptual skill of visual memory, the chalk artist checks the mental image of the board. Then, using visual spatial relations, another visual perceptual skill, and visual motor planning, the chalk artist arranges the lines - oops- don't forget to apply good visual motor integration so that the lines meet at good perpendicular corners and the numbers in the boxes are legible.

Applying visual attention and good saccadic eye movements, the kids scan the yard until they locate a rock that won't roll too much, is colored so that it contrasts with the pavement enough to find after tossing it, and is small and light weight enough to pitch.

Again, it takes good eye movements, visual attention, and the ability to team both eyes on a location in the distance as well as great visual motor integration to make an accurate throw so that the rock lands in the next box.

Next, the vestibular system has to coordinate with the visual system with good bilateral integration skills to hop through the board without stepping on any lines.

Finally, visual memory has to remain at work between turns so that the players can keep track of their next goal.

So, if anyone tries to take away your recess - try challenging them to a game of Hopscotch. And, please, post a comment to share what was your favorite recess activity when you were in grade school.

What's So Good About Recess?

Recess, that endangered but kid's favorite part of the school day, could be key to a child's academic success. No, not because they need a break - but they do! And, not because it's fun - but it is! Recess is where the gross motor bilateral coordination building laterality & directionality eye movement visual perceptual and visual motor integration skills all get exercised on a daily basis without anyone realizing it. That's the problem. So many educators insist that the reason children are not making more consistent progress learning to read and write is because they don't spend enough time in the classroom that many (especially inner city) schools are doing away with recess. My next Eye Can Too! Read book will be about recess games that actually will make it easier for children to learn to read. These include hopscotch, jump rope, ball games, aiming/tossing games, running games, and clapping games. I'm going to provide the directions and then explain the learning-related visual skills involved as well as connect those to how they are critical to developing adequate reading and math skills. Want to help? Add a comment here or on FaceBook or Twitter about your favorite recess game when you were a kid. If there was a type of recess game that you just never were able to do well, let us know that also. And, more than anything, make sure that the children you know, love, and work with have plenty of opportunity to be outside playing the games that build the skills they need in the classroom.

For Teachers About Learning & Vision

Teachers should be the first line of intervention when one of their students has a learning-related vision problem since they get to see the children at work every day. When a student covers one eye or puts their head down so that only one eye points towards the text or paper, the teacher should recognize that this child needs to see an eye doctor to rule out amblyopia, or problems teaming the eyes to keep a word or other image single. When a student squints or complains of having a headache often during school - especially when asked to copy work from the board or smart-board to a piece of paper on their desk, the teacher should suggest that the student's parent make an eye appointment to make sure that the child knows how to accommodate i.e. switch their focus from near to far and back again efficiently. When a student cannot line up the digits in a math problem or appropriately space words on their paper, the teacher should first offer some practical hints but if these do not seem to help, it is time for a referral to an eye doctor to make sure that the child's eye movements and visual perceptual skills are developing on schedule. When a student makes frequent reversals when reading or writing - especially after the second grade, this may be a visual spatial delay in the skills of laterality and directionality. Finally, when a student has trouble in PE or on the playground catching or aiming balls or, in general, has under-performing gross motor skills, the root of the problem could the visual-motor-integration. While each of these symptoms can make success in school very difficult, all of them can be addressed by a few weeks or months of in-office vision therapy under the supervision of a developmental optometrist. No child should be left behind in school because of addressable learning-related vision problems.

Hope for an amblyope

We have a new intern in our office, a fourth year optometry student who, as I am fond of saying to the therapy patients, is just a minute away from becoming an eye doctor. As I was introducing her to the various activities that we use in therapy, she disclosed that she is not binocular. In other words, she does not see in three dimensions because her eyes do not team properly together. She is also an amblyope. One eye has an acuity that is at least two lines on the Snellen Eye Chart worse the other eye. This is probably why she is not binocular - she opted to pay attention to the information coming into her brain from just one eye - actually, she did not do this on purpose, it just happened and therefore she does not experience double vision. You need two eyes to point to the same place in space AT THE SAME time in order to experience three-D vision. Since we deal with binocular dysfunctions a lot in VT (vision therapy), she and I began to talk about what her goals were for this rotation. Binocularity has been an abstract concept for her, not ever having experienced it and she hopes to understand it better. As I showed her patient histories that demonstrated how we can stimulate the emergence of binocularity in patients with similar conditions as her own, she became more and more intrigued with the possibility that she, like "Stereo Sue" Barry, could actually achieve a different visual outcome. That was last Monday. I only work on Mondays and Saturdays so when I saw her today she greeted me with the news that she is beginning to be able to do very simple binocular tasks. Later this morning, she was wearing a patch over her better eye to make the amblyopic eye work. I love when people unexpectedly gain hope for what they thought was a forever condition to change. I'll keep you posted.

Can't cross the midline - Rake my yard, please!

Children who cannot cross the midline have lots of problems in school. They don't easily form letters like X, V, W, M, N, or Z because these letters require them to draw a line that moves across a diagonal. These kids have trouble finishing worksheets where they have to connect a selection on the left side of the page by drawing a line to its match on the right side even when they can demonstrate mastery of the information orally or in other kinds of written assessments. Regular playground activities like skipping are also very difficult and the most delayed children may not be able to alternate their feet when climbing up or down a flight of stairs. These same children probably do not know their left from their right and may become confused about which side of a word or line of text to read first. By providing lots of gross motor experiences that require a child to cross their physical midline during a program of in-office vision therapy, we can often help them to form the neural pathways that allow them to understand where they are in space. Then we can assist them to apply that knowledge to directions outside of their body. So, it's fall. I spent much of the afternoon raking leaves. It is a perfect chore to give to a child who needs to learn to cross the midline. You hold the rake with both hands and sweep it across your body again and again. Of course, the satisfaction of creating a huge pile of crispy leaves to jump in and hide beneath provides most of the motivation needed. Even very small children can rake if you buy them rakes with shorter handles.

If you suspect that your child may have delays in the development of laterality & directionality, make an appointment for a comprehensive eye exam with a developmental optometrist who incorporated vision therapy into the practice. The doctor may decide to administer a series of normed tests to learn whether your child's visual perceptual skills are developing on schedule.

If you would like to have a set of original activities that assist children to grow in the development of the visual spatial skills of laterality & directionality, consider buying the Yellow Book of the Eye Can Too! Read e-book series by Lesley Barker

Before you Medicate, Investigate- ADHD & Vision

Clinical research has established that there is a link between a diagnosis of ADHD and certain vision deficits or delays in children. Many children with ADHD also test positive for a saccadic eye movement deficit. This means that they have difficulty moving their eyes efficiently and accurately from one fixed visual target to another as in going from one word or line to the next on a page of text. Many children with ADHD also test positive for a convergence insufficiency (CI). This means that they are unable to cross their eyes or team them appropriately and may experience words moving, blurring, or doubling on a page. They may get headaches when reading or they may, without ever being aware of it, suppress the vision in one eye. Many children with ADHD also test positive for accommodative infacility (AI) which means that they have trouble adjusting their focus when looking from a near image to a different image in the distance.

The good news is that all three of these visual diagnoses can be addressed with a program of in-office vision therapy under the supervision of a developmental optometrist. So, if your child has been diagnosed or if you are being encouraged to obtain a diagnosis of ADHD, don't stop there. Arrange an appointment for your child to receive a comprehensive eye exam by a developmental optometrist who incorporates vision therapy into their practice. If the eye doctor finds that your child has any of these visual problems, follow through with the program of vision therapy. To find a developmental optometrist in your area, plug your zip code into the search box at www.covd.org.

You can read more about this in: Borsting, Eric; Michael Rouse, and Ray Chu. Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. "Optometry", Volume 76. Number 10. October 2005

Learn to Be the Boss of Your Own Eyes

A first grader came to his 15th in-office session of vision therapy today. His parents brought him to the developmental optometrist in the first place because they noticed one eye shifting in whenever he got tired. They feared he would be teased for having crossed eyes and wanted to try to avoid surgery. Not only did the doctor concur that he has a strabismus- an eye turn, she discovered that he did not use both eyes as a team. Like many other children, he suppressed the vision in one eye to avoid seeing two images when his eyes were not aligned at the same time on the same visual image in space. This unconscious strategy made him unaware of any visual problem. He had good grades, was a good athlete, and had no intrinsic use for coming to see me every week. It has taken all sorts of monocular, and binocular activities disguised as games to coax him to begin to experience binocularity. Last week it started to make sense TO HIM. I asked him to watch a bead approaching his nose on a long string (the Brock String - magic to many patients but key to learning to use two eyes together). Whenever the bead got within about six inches of his nose, his left eye swooped in towards his nose and he reported seeing two balls. Had his eyes continued to be teamed on the in-coming bead it would have remained single. Finally he was able to connect the feeling of that eye moving in with the sensation of double vision. "You need to be the boss of your own eye," I suggested, "but it keeps saying: 'I don't have to obey you - I can do anything I want.'" That apparently was enough motivation to make the child take charge. Today I could push the bead within two inches of his nose without the eye wigging out and he could switch between that bead and another bead about eight feet away on the same string without any problems at all except that it made him very tired. By next week he should be able to do more repetitions without fatiguing. As long as he is the boss of his own eyes, he will make them mind. Of course, this activity correlates with the ability to read for extended periods of time without fatigue, double vision, headaches, or the words wiggling on the page. It also solves the cosmetic problem that his parents were so (justifiably) worried about.  I can't wait for his re-evaluation appointment with the doctor who will be thrilled at the emerging binocularity and independent control of his eye movements both when using one eye and two.