VT Works

As we continue our journey through space, it is important to recap a few concepts. First, nothing we see is real until we make it real. What do I mean by that? Well, we can tell our patients all day if the importance of periphery, as well as the integration with our central inputs, but until they see and believe its benefits, we haven’t yet helped them to reach their fullest potential. They must buy into the concept, see it as beneficial, and work to implement the additional peripheral awareness into their everyday to make it worth something. When that happens, we have helped to build something that they now see as real, and the benefits will also be just as impactful.

Although the next two sections – Homolateral and Contralateral – should be done separately, for the purposes of this writing, we will review them together.

Part Four – Homolateral

As we work to increase the level of demand on the visual system, we will begin to incorporate full body involvement, which accomplishes no less than two goals:

First, by adding extra tasks to the instructional set, we are requesting the patient work to integrate their central and peripheral vision while completing both a higher level and higher quantity of task. Secondly, it’s rare we are sitting in a chair completely devoid of visual input or the need to move our bodies. Even driving, where most times we are fully seated, requires a fair amount of body movement and coordination. Taking all of this into account, by adding a coordinated movement to the Space Fixator we are both adding stress to the system while also asking the patient to perform, which one might argue makes the demand more “real life”, which ultimately is where we want this new skill to become valuable.

For level four, the patient should be moving both their arm and leg on the corresponding side in the first step, and then the two body parts on the opposite side for the next phase.

On the “touch” command, the patient should touch their right temple with their right index finger, while at the same time, their right foot should “toe tap” the floor in front of them. On the “back” command, both the arm and leg should return to the starting position. During the next phase, the patient should use left index finger and left foot.

Part Five – Contralateral

For this phase of the activity, the patient should be instructed to use their right hand in coordination with their left leg; and then their left hand in coordination with their right leg.

Ideas for loading this activity might be adding a metronome add an element of timing to the activity, creating a peripheral distraction to pull the patient’s attention away from the activity, or even an auditory jamming distraction to create interference the patient will need to filter out while working. These, and other ideas, will help the patient to build their central/peripheral integration and learn to maximize its benefit while managing the many stresses and sensory inputs involved in the world around them.