VT Works

As was the case in Part Five, we will be combining levels in this post since to help maintain clarity for how the activities will interact and build on each other. As with most activities, the building blocks each level creates are crucial to a patient’s success on subsequent levels, so understanding and appreciating the these interactions remains an important piece to administering the activities effectively and well.

Levels Eight – Homolateral and Contralateral

Our setup for these two levels remain the same – standing, arm’s reach from the target – our patient should be encouraged to maintain peripheral awareness all around, including on the Z-axis between them and the target as well as beyond the target.

For level eight, our patient should continue the activity in a homolateral pattern while traveling clockwise on the Space Fixator. When indicated, either with a clicker, snap of the fingers, or other type of signal is offered, our patient should complete their current pattern sequence. In subsequent fashion, our patient should change their movements to contralateral patterning and continue this way, until it is indicated for them to reverse – again, with a clicker or snap of the fingers, etc. Important to note on this level, it is not necessary for the patient to change the direction of their eye movements; rather, only the patterning movement of their body. As the activity proceeds and signals are given to change the patterning, it is important to remember each dot sequence should be completed prior to a switch from homolateral to contralateral, or vice versa.

For the Vision Therapist, it is important to work our patient towards a level of unpredictability by altering the time between each shift in direction. This will both require our patients to maintain an awareness of their surroundings and process the world around them, but also keeps their processing “in the moment” while not allowing them to get too far ahead of themselves in terms of planning.

This activity can be achieved in a counter-clockwise direction, as well. Our patient’s ultimate goal at this level is to maintain continuity and accuracy without being affecting by the shift in direction or auditory interference.

If we need to up the level, jamming (causing distractions) may be considered, such as adding sounds or movements in the room for the patient to ignore, asking the patient to answer simple questions (2+2=?) while working through this pattern, or even adding a gravity challenge through the use of a balance board. Being creative, working to find the best way to help our patients work through their filtering mechanisms while they maintain full concentration, is the name of the game.

Level Nine – Changing Eye Direction While Homolateral and Contralateral

Ok, friends – things are getting serious!

Our setup for this level is the same – standing at a comfortable distance from the Space Fixator and is to be encouraged to maintain awareness of their peripheral vision as much as possible throughout the activity.

Begin the activity as in level eight with the patient listening for the clicker and/or a snap of the fingers PLUS the verbal commands to the Vision Therapist.

For this level, when the clicker is sounded or fingers are snapped, the patient is to change the direction of their eye movements only. Since this reaction is different from the needed patient response in level eight, a strong instructional set is needed here.

For the remainder of the activity, the Vision Therapist will offer the patient verbal cues to indicate when the patient should change between homolateral and contralateral patterning. When the “opposite/contralateral” command is offered, the patient should change into contralateral movements. When “same/homolateral” command is offered, the patient is two change into homolateral patterning.

If the “same/homolateral” command is given while the patient is in a homolateral pattern, no change is to be made. The same is true for the “opposite/contraleral” command if the patient is in a contralateral pattern. Changes should only be made IF the command is different than what is currently being done.

In order to keep the patient working at a high level, it is incredibly important the patient analyze the commands to determine if changes are needed. For this reason, it is also important the Vision Therapist offer the commands in an unpredictable timing pattern, which will require our patient to maintain awareness and to be prepared to execute a required change at any moment.

Ideally, as our patients progress through these two levels, their goals might include executing the requested changes without challenges, or disruptions in performance.

Stay tuned for the finale!