VT Works

My experience and training in Vision Therapy has mostly been a  “build from the ground up” approach which attempts to address all levels of development in which vision is affected.  In most cases our therapy programs begin with a body mapping assessment of the patient’s relationship with gravity.  We ask the patient to perform activities such as those a 6 to 12 month old baby would perform in the normal course of their development.  These activities may include pushing up from a prone position, rolling over from back to front and back again, and a combat crawl, just to name a few.  During these activities, we are observing the patient to assess the level of difficulty these activities present.  Many patients, who may have had some interruption during the 6 to 12 month stage of development, seem to have difficulty performing these tasks, no matter what age they may currently be.  An example of this would be a 7 year old boy, who is struggling with a first grade curriculum. While discussing his life to this point, our patient’s mother reveals during his first year of life, he did not crawl; however, on his first birthday, he pulled himself up and began to walk.  When asked to perform a combat crawl type activity during his first Vision Therapy session, our patient struggles mightily.  The simple coordination of a contralateral movement becomes an overwhelming proposition for this young man. The information this process provided was invaluable.  The very foundation of this individual’s gross motor development, his relationship with gravity was unstable and under developed; therefore all subsequent development of his motoric systems were suspect.  His subconscious understanding of the space his body occupied, or his “mental map” is inadequate.  He had not had the experience of moving around on the ground on hands and knees, understanding gravity’s pull in that manner before rising to his feet, nor had he passed through that stage of development which would help him feel or locate his center of gravity or his core.  Identifying and understanding one’s core is very important for all subsequent stages of development.  Laterality and directionality begin with the core or center of one’s body.  My right side is my right side relative to my core, and my left is my left relative to my core.  Often times people who do not solidify their core identification through development of a mental map of their own body, struggle with laterality and directionality in childhood and even adult life.

In Vision Therapy, we design our activities to rebuild those connections which are responsible for the mental map.  We may start by having patients perform body resistance activities to help them subconsciously identify that the sides of their body are different and as such require different degrees of attention for any given task.  As the therapy progresses, the patient may commence creeping and crawling, followed by laterality and directionality techniques that are designed to properly identify the sides of one’s body, and help them gain a further understanding of the differences between left and right.  Laterality and directionality is continued up through the concepts of mirror image, bilateral integration, objects relationship to each other in space, and object manipulation through visualization. Our doctor might also emphasize therapy procedures aimed at achieving better bilateral integration, which is the coordinated use and interaction of the two sides of the body.

Another area of development that can be greatly impacted by a poor body scheme, or body map, is spatial relationships.  As humans, we tend to identify items or places in the world, as well as calculate distances, relative to where we are standing or sitting.  For instance, this computer screen I am looking at is approximately 16 inches in front of me.  I calculated the 16 inches based on my subconscious understanding of where my core is, and determined how much space there is between my core and the computer screen.  People, who do not possess a strong understanding of their core, may have more difficulty with this process.  Subconsciously understanding where my core is, or having a strong mental map of my body, provides me with a starting point for my calculation. When we identify a child or adult that does not possess a strong mental map, we will be sure to address all other areas that may have been affected along the way including visual motor integration.  It would seem hard to coordinate a visually driven motor exercise, such as writing with a pencil, when your brain does not have a firm understanding of where the “starting point” is for your gross motor systems.   Also the auditory-visual integration can be affected because the foundation of the visual system, which is fine motor, is weak and thereby creating a mismatch between the two modalities.

Our Vision Therapy program attempts to assess and address all the aforementioned areas and continue into high level activities such as visualization, visual discrimination, auditory-visual integration, visual memory, and visual closure. Visual processing style also becomes an important component to Vision Therapy in these areas.  A patient’s processing style, be it the “quick to closure” impulsive type, or the reflective “think things through to the nth degree” type, needs to be considered.  No matter which style the patient employs under normal circumstances, Vision Therapy must force the patient into the processing style that they are not used to and most uncomfortable with in order to be effective in making new perceptual connections. Once the gross motor and fine motor areas are addressed, the patient usually will begin to realize the complexity of the high level activities that they are doing with such ease, as compared to when they entered Vision Therapy.  A fun game we use to prove to patients how expansive their visual skills have become is a visualized Tic-Tac-Toe.  This game draws on their visualization skills, their visual memory skills, their visual sequential memory skills, their visual processing skills, among other areas.  This game also gives us, as therapists, an insight into the patient’s thinking in terms of their ability to plan and strategize, as well as how they may processing when asked to do so at a high level.  This activity, as with all other activities, has the potential to uncover other areas of difficulty that will need to be addressed as well.

As for the Vision Therapy room, invariably patients or parents will ask “what this has to do with my eyes” when we begin addressing body work, which is a perfectly valid question. My “go to” explanation has become two-fold:

First, we will be checking for the motor skills necessary and valuable to visual development, and second, it’s important to gather more information to help our doctors determine if a referral to Occupational Therapy is warranted. As an aside, for the latter, my hope is always that the inverse is true of our counterparts in Occupational Therapy.

With all of this in mind, it’s important to remember Vision Therapy cannot, and will not, solve anything and everything with respect to body development. Many Developmental Optometrists have a strong working relationship with Occupational Therapists in their respective areas, and with good reason. Occupational Therapy is wonderful at addressing muscle and body coordination within the body and should be utilized and referred to prudently when assessing the overall needs of a patient. In a perfect world, a cross-referral type network can be established whereby a patient’s needs are addressed well, and by the most qualified professional in each modality.

Cheers!