VT Works

Build and Describe

In our Piece by Piece series, we spent a great deal of time exploring what can happen when a patient is given a collection of simple parquetry blocks and asked to create. We looked at organization, symmetry, spatial relationships, planning, flexibility, visual discrimination, and the integration of individual pieces into a larger whole.

Now, I want to put something between us – a barrier.

On one side sits the patient with a set of parquetry blocks; on the other sits the Vision Therapist with an identical set. The patient creates a design, but the therapist cannot see it. There is only one way to get that design from one side of the barrier to the other – with words.

It sounds simple enough.

“Put the red square next to the blue triangle.” So, I put it next to the blue triangle, and at first, I allow the patient to look over the barrier.

“No! Not there!”

Suddenly, we have something to talk about.

The Picture in My Mind

One of the things I love about parquetry is that a seemingly simple activity can reveal so much about how a patient processes information. In this activity, the patient already knows what the design looks like, since they can see it sitting directly in front of them. The challenge is no longer simply perceiving or constructing the pattern; the challenge is communicating that visual information accurately enough for another person to recreate it. That requires something very different. The patient has to look at the design, determine which information is important, organize that information into a useful sequence, select language that accurately describes spatial relationships, and monitor whether the listener is understanding what was intended.

“Put the triangle above the square” might seem perfectly clear to the person saying it.

Which triangle? Which square? How far above it? Is the triangle pointing up or down? Are the pieces touching? Are their edges aligned? The patient may have supplied an instruction that seems perfectly adequate because the missing information is already present in their own visual experience, and yet it is not present in mine.

That difference is where the activity becomes interesting.

Say What You Mean

The idea at this level is to develop and enrich the relationship between visual impressions and the ability to communicate those impressions verbally. To do this well, there is an important rule for the Vision Therapist.

Do not fill in the blanks for the patient.

If an instruction can reasonably be interpreted more than one way, the Vision Therapist should not automatically choose the interpretation that produces the correct design. Doing so may create a successful pattern, but it eliminates much of the opportunity for the patient to discover what was missing from the communication. Instead, consider a simple response:

“I need more information.”

I love that phrase. It does not tell the patient what is wrong, nor does it supply the missing information; instead, it simply lets the patient know that the message has not yet provided enough information for the listener to act confidently. This realization asks the patient to reconsider the message.

What did I leave out? What does the other person need to know? How can I say this differently?

Feedback Without Rescue

In the beginning, the patient can look over the barrier and watch the therapist attempt to construct the pattern. That immediate feedback can be incredibly valuable. The patient says, “Put the yellow triangle next to the blue square,” and then watches the Vision Therapist place it somewhere completely unexpected, which can cause an immediate reaction.

“No, turn it!”

Turn it which way?

“The point needs to face the square.”

Now we are getting somewhere. The patient is learning that successful communication requires considering what another person does not know, which remains an important distinction. The goal is not simply to produce more words; rather, the goal is to determine which information another person needs in order to understand the visual idea. As the patient becomes more successful, that immediate visual feedback can eventually be removed. The patient gives the complete set of instructions first and only then looks at the Vision Therapist’s construction.

Were the two designs identical? If not, where did the communication break down?

Now Switch

There is another piece of this activity that should not be overlooked, and that is the importance of eventually switching roles. The Vision Therapist builds the pattern and provides the instructions, while the patient must listen and construct, which completely changes the demand. Instead of converting visual information into language, the patient must take verbal information and construct a visual representation from it. The distinction gives us an opportunity to observe both expressive and receptive communication while still working within the same activity.

Can the patient create an organized verbal description of what they see? Can they listen to someone else’s description and construct an accurate representation of what they hear? Those are related abilities, but they are not necessarily the same ability. A patient who communicates beautifully when looking at a pattern may have much more difficulty constructing one while listening to another person’s description. Another patient may understand spatial language very well but struggle to organize their own thoughts sufficiently to explain a design to someone else. All of this is useful information for the Vision Therapist.

A Few Do’s and Don’ts

There are a few things for the Vision Therapist to keep in mind while working on the other side of the barrier.

Do be as literal as possible. If the patient tells you to place a piece “next to” another piece, place it next to it without supplying the orientation, distance, or relationship you think they intended. Remember, the goal is not for the Vision Therapist to figure out what the patient meant; the goal is for the patient to communicate what they mean.

Don’t rescue the patient. Resist the temptation to make a logical choice simply because you can see where the patient is going. If important information is missing, “I need more information” is enough.

Do avoid using “top,” “bottom,” “left,” and “right” whenever possible. Those words can provide an easy external reference rather than requiring the patient to describe the relationship between the pieces themselves. Encourage language that describes how the pieces relate to one another or establishes another meaningful reference: touching, separated, aligned, centered, closest to an object in the room, between, pointing toward, pointing away, and so forth.

Don’t correct an unclear instruction for them. If the patient says, “Turn the triangle,” turning it in the direction that seems obvious defeats the purpose. Turn it only as specifically as the instruction allows, or ask for more information.

Do let mistakes happen. A mismatched pattern is not necessarily a failed attempt. Sometimes the most useful moment occurs when the patient looks over the barrier and says, “That’s not what I meant!”

Don’t accept vague language too quickly. The patient may use words such as “there,” “like this,” “over here,” or “that way” because the meaning seems obvious from their own perspective. Remember that you cannot see what they see. Ask for enough information that you could reasonably follow the instruction without sharing their visual reference.

Do make mistakes when it is your turn to describe. When the roles are reversed, do not feel obligated to provide perfect instructions every time. Leave out an important detail, use an ambiguous description, or even give an incorrect direction occasionally. Give the patient an opportunity to recognize that something does not make sense, ask for clarification, or tell you that they need more information. Communication is a two-way process, and learning to question unclear information can be just as valuable as learning to provide it.

More Than Matching Blocks

Ultimately, the goal is not two identical arrangements of parquetry blocks; the blocks simply give us a way to make communication visible. When the two patterns do not match, we have tangible evidence that something happened between the visual idea, the words used to communicate it, the listener’s interpretation, and the final response. That gives both the patient and the Vision Therapist something they can examine together, and most days, this is what makes this activity so valuable. The patient begins with a picture that exists clearly on one side of the barrier. The challenge is to create that same picture on the other side.

Can you make someone else see what you see?

Over the next several posts, we are going to explore what happens Beyond the Barrier. We will look at spatial language, sequencing, ambiguity, receptive and expressive communication, feedback, increasingly complex patterns, and ways Vision Therapists can modify the activity as the patient’s abilities grow. All with the same handful of little colored blocks, only this time, we are going to have to talk about them.

And if, after all of that, you still aren’t quite sure what I mean…I guess I need to give you more information.

Stay Tuned for Part Two…