VT Works

We have reached the end – the last level! The great part about reaching this point, aside from your patients building excellent peripheral awareness, is we already know the directional set. We now will need to help our patients tie things together.

Hopefully, by this point in the activity sequence, our patients have a good sense of maintaining peripheral awareness while attending to central information. This skill is fully tested in the final level, as we are about to bring everything together and load their cognitive processing, while they work to put their new found skills into practice!

Level Ten – Peripheral Touch

Our setup remains the same – standing at a comfortable distance and centered on the central target/dot.

For this level, we will ask our patient to repeat most of the previously learned skills while working through the “Look, Ready, Touch, Back” patterns.

Step One – “Locate” – while the patient is keeping their focus on the center dot/target, the patient should discover the first dot in their sequence (usually the 12 ‘o’clock dot), essentially achieving simultaneous awareness of the central and peripheral targets.

Step Two – “Touch” – with their eyes fixated on the center target, the patient should touch the the target they are giving attention to in their periphery, in this case the 12 o’clock dot. This step, when completed correctly, demands the patient integrate their central fixation with their peripheral awareness through localization and proprioceptive feedback.

Step Three – “Look” – the next step in this process is for the patient to visually verify the accuracy of their localization by moving their eyes to the dot they have touched. Before moving their eyes, our patients can be reminded to maintain awareness of their own finger and to move their eyes directly to that spot.

Step Four – “Back” – with full peripheral awareness of all dots on the pattern, in particular, the center dot, our patient returns their arm to their side and their eyes back to the center dot.

From here, the activity is continued with all the dots in the pattern – 1 o’clock, 2 o’clock, etc.

In terms of adding to this activity, consider having your patients work through this activity monocularly and binocularly, clockwise or counter-clockwise, as well as in a homolateral or contralateral pattern. We might also consider adding in a metronome to help with the rhythm and timing aspects, give the patient a “hold time” between each dot (one Mississippi, two Mississippi…) to help maintain a slower pace, we may also repeat our snapping technique asking our patients to reverse direction. We could also ask our patients to stand on a balance board, offer them verbal and visual interference, and even conduct some other distracting activity while they are working.

Remember, the number one goal here is to build peripheral awareness while maintaining central fixation – be that on the X-axis, Y-axis, or the Z-axis. When you get your patients to this point, sit back and watch the changes!

Cheers!