VT Works

As we continue upon our journey in understanding the benefits of the Space Fixator, there are a few points which are worthy of revisiting. The most important of which is remembering periphery occurs on all meridians, not just on the X-axis. Many times in Vision Therapy, we stress peripheral awareness to the left and right of the patient, but equally important is the awareness of space vertically (Y-axis), as well as the space near and far on the Z-axis which is building an awareness of the space between the patient’s face and the target, as well as the space behind the target.

The other point work mentioning here is an understanding that, much like learning, peripheral awareness may not be a continuous forward motion – there will be ebbs and flows. Some habits can be hard to to break, so if people tend to visually ‘tunnel’, it is important to remind them frequently that maintaining peripheral awareness is key. Under stress, we will tend to revert back into old familiar patterns, making those reminders all the more valuable.

Levels Six and Seven – Change Eye Movement – Homolateral and Contralateral

Our setup for this level is to have our patients comfortably situated in front of the space fixator, preferably standing, at a little less than arm’s reach. The Vision Therapist will need some type of clicking device, or can snap their fingers if needed.

As we continue to build this skill level, our patients are encouraged to work in a homolateral pattern while alternating hands. When our patient hears the clicker, or the Vision Therapist snaps their fingers, the patient should continue and complete the sequence for the target currently being viewed. For the subsequent target, the patient should be asked to reverse the direction of their eyes. In other words, if the patient was moving his eyes in a clockwise direction, when the Vision Therapist snaps their fingers, the patient should reverse and travel into a counter-clockwise pattern.

For this exercise, it becomes important to keep the clicks (or snaps) unpredictable to help build in flexibility of visual processing an peripheral awareness. This also creates a situation where the patient will need to attend to, and process, auditory information along with the visual task at hand.

If our patient feels a bit of stress with this activity, or the Vision Therapist senses the patient is pushed into a place of higher visual processing demand, it becomes crucial for the Vision Therapist to remind and encourage the patient to remain peripherally aware. This includes working to maintain an awareness of the space to the right and left of the Space Fixator, the space between the patient’s nose and the Space Fixator, as well as the space behind the Space Fixator. Doing this will both help the patient to build their central/peripheral integration, but also to build an overall awareness of the space. Many times, it works well to ask the patient some variation of these questions:

• How do you feel this is going?
• What does the world look like when you try to keep your periphery open?
• How is this different from how you see the world every day?
• How is your sense of space affected by this activity?

Once the patient is strong in this activity, they can be asked to continue, but this time using a contralateral pattern. Remember, though, with each increase in difficulty and/or demand, the patient’s tendency may be to fall back into old patterns thereby closing down their peripheral awareness. This is where the Vision Therapist may offer gentle reminders of the importance and value of keeping peripheral awareness, as well as asking the patient to maintain the feeling associate with the increased sense of space.