Vision and Neuro-development
Last and certainly not least in our series of Neurodevelopment Interventions is the category related to vision. Vision is more than the ability to see. The visual system also involves making sense of what is seen and that involves complex pathways in the brain. Problems and errors in vision can occur at three levels. These three levels are interrelated, meaning that problems in one area can effect functioning in other areas. The first level relates to the actual structure of the eye and visual system that may cause problems in being able to see clearly. The second level relates to the way the two eyes work together to see something clearly. Problems related at this level do not have to do with structural damage or irregularities of the eyes, but more in the way the muscles of the two eyes work in order to get clear vision. The third level involves the nerve fibers of the visual system in processing the information received through the eyes. Errors at any of these three levels can contribute to learning disorders, poor sports abilities, and the ability to enjoy life to its fullest.
The first level is often addressed through corrective lenses or glasses, and surgery where needed. With the second level, interventions rely mostly with exercises and sometimes surgery. The third level interventions almost always depend on exercises to develop neuro-pathways to improve visual processing. The bulk of this article will focus on exercises addressing problems in levels two and three as they relate to learning.
Most systematic approaches to overcoming learning disorders include a visual component with exercises designed to overcome problems. DORE, Structure of Intellect (SOI), Pace Tutoring or Rx Learning all have visual exercises to help participants overcome their learning related visual problems. However, the profession best equipped to identify and treat developmental vision problems are members of the American Academy of Optometry.
It is estimated that 20% of the population has enough problems with their visual system to cause problems in learning. This percentage is much higher (80 % or over) in children diagnosed with Attention Deficit/Hyperactivity Disorders, Reading Disorders and Autism Spectrum Disorders. Almost every child that is hyperactive and/or Autistic can benefit from vision exercises.
If you suspect that you or a loved one may have a vision problem and that a vision problem is interfering with learning, where do you go for help? To an eye doctor, right? There are three different types of eye doctors: Opticians, Ophthalmologists and Optometrists. Opticians test vision and recommend glasses, corrective lenses or contacts. They do not treat eye diseases. Most people who need glasses will visit an Optician or an Optometrist. An Ophthalmologist is a medical doctor who treats diseases of the eyes. These medical doctors will prescribe some exercises but primarily prescribe medication, special lenses, and surgery as a methods to correct eye problems. The group of doctors who have expertise in using neuro-developmental techniques to overcome learning problems are Optometrists. They have special equipment and procedures to diagnose developmental vision problems and have the procedures to correct the problems with exercises. Both Opticians and Optometrists will refer individuals to an Ophthalmologist if there is something significantly wrong with the structure of the eyes or eye muscles.
There was a time where individuals living outside of large cities would have to travel to a large city to be evaluated and treated by an Optometrist. Now they are very common and are in most cities large and small. To find a professional near you, visit the American Academy of Optometry at www.aao.org. They even have a list of symptoms of eye problems.
Assessing Visual Problems.
Optometrists usually make a very thorough evaluation of the eyes in the following areas: 1. Visual Efficiency: checking for acuity (20/20 vision) near and far, refraction, ocular mortility and alignment, accommodative-vergence function, and physical health of the eyes. 2. Visual Information Processing: visual spatial orientation skills, visual analysis skills, including auditory-visual integration, visual-motor integration skills, rapid naming and executive functioning related to visual skills. 3. Supplemental Testing: to determine reading disorder subtypes. The result of the comprehensive evaluation is to develop vision exercises and neuro-developmental exercises to correct problems identified which will allow the individual to do better in school, sports and other areas of interest in life.
One of the problems of doing so much testing is that as you increase the number of tests, you increase the likelihood of finding a problem when none really exists. Another issue is that the brain and body have ways to overcome deficits in a particular weak area. However most Optometrist s are good at demonstrating to parents and patients the problem that can be readily seen and explain how it is causing a particular problem in learning. Not every problem found may need to be addressed. However, problems that interfere with learning will need to be addressed.
No one has a perfect brain and few of us have a perfect visual system. Just because deficits are uncovered does not mean that problems in learning will occur. Some are able to compensate for those weaknesses and some are not able. A good intervention program will make sense to the parent, coincide with other areas of functioning of the participant and improvements should be observed within 30 to 60 days of doing visual exercises.
Few children with learning problems have just one deficit. For children with a vision problem and an attention problem, vision therapy will be helpful. Theoretically correcting the developmental vision problem will significantly improve attention skills and lower hyperactivity but may not completely cure the child with ADHD. In children with autism, treating their developmental vision problems may help in the child's social relationships, but it is not expected to address every symptom of autism. In both cases, vision therapy should significantly improve their ability to learn and function in school. Every child is an individual and usually unique in their strengths and weaknesses from a neurodevelopmental perspective. Treatment plans must be developed based on the unique characteristics of the individual. It is important to consider other areas of functioning as well as the visual system that may be contributing to the learning problem (inattention, muscle fatigue, motivation, coping skills, emotional well-being).
Treating Vision Problems with Neurodevelopment.
The best professionals to treat developmental vision problems are optometrists. Some Occupational Therapists also have training in treating visual perception problems. Dore also treats vision problems related to learning disorders. They use vision testing and balance testing to design their interventions. All of these professionals use principles of nuero-development. This article is not intended as a substitute for being evaluated by an Optometrist . If you are under the care of an eye doctor, please consult with your eye specialist to insure that these exercises will not cause disruption or negative consequences to your eyes or to the treatment you are receiving.
Below are some of our favorite vision exercises to overcome learning disorders. They are grouped according to common problems seen in learning disorders as related to vision.
Both eyes working together. The first group of exercises has to do with Binocularity. Binocularity describes how well the eyes interact with each other and how they send messages to the brain. Eyes should aim together and both eyes should see clearly. When eyes are working out of alignment with each other, it could cause problems with depth perception. Sometimes the information from one eye is used by the brain but the information from the other eye is lacking. A common example of this is a term called Lazy Eye. A lazy eye has been used for three different conditions: Amblyopia (one eye seeing things blurry and the other eye sees things in focus), Strabismus (one eye turned inward or out while the other eye is on the visual target) or ptosis (one eyelid looks droopy). Each condition has its own set of treatments. Neurodevelopmental exercises are not used on Ptosis.
For amblyopia and mild cases of strabismus, eye patches and the Brock String Exercise are often used. An eye patch is usually placed over the dominate eye (or the eye that does not turn inward or outward, or the eye that sees clearly) while the weaker eye is used for primary vision, thanks to the other eye being patched. A good exercise is to wear the patch for as many hours as possible but not for more than 14 hours. When the eye patch is taken off, it is recommended to do exercises with the Brock String so that the eyes have a chance to team together. The Brock String is also helpful for individuals with poor depth perceptions. To remediate most learning problems, the length of the Brock String is 10 feet. For some sports applications, the length of the Brock String should be 20 feet. The use of a long Brock String has the potential for improving a basketball player's ability to make free throw shots. The Brock String provides feedback to the participant of how well the eyes are teaming together at various distances. In adults, playing the video game Tetris has been shown to be effective for adults suffering from amblyopia. For adults the results of a study showed that playing Tetris without an eye patch was more effective than playing the game with an eye patch.
Focus Flexibility. Some children take forever to do board work. One problem that can cause excessive time to do board work is that the participant's ability to go from near point vision to far point vision is impaired. The Near to Far Exercise is designed to speed up a person's ability to write down assignments or copy things from the chalk board, white board, or smart board in class.
The Crazy Straws Exerice is an activity to help children see and follow things real close to their eyes. The activity involves drinking various colored liquids from a crazy straw. The participant sucks on a straw that has loops in it and watches the liquid get to their mouth. Having children play with soap bubbles is another great way to increase their ability to track things close up. Batting around a balloon or trying to keep a balloon in the air is another great near to far tracking activity.
Visual Tracking. Another common visual problem is the ability to follow a moving object. In reading, this is the ability to follow a line of words and then go to the next line. Many children will skip a line or not be able to read a line. Accommodations for this problem involve using their finger as they read to keep track of where they are reading. Another accommodation is to use a ruler or straight edge to read. These techniques usually help the reader to not skip lines while they read. Accommodations do not strengthen the eye's ability to track or keep its place while reading.
A quick way and rough measure of a tracking problem is to have the child follow a finger moved in a circle on a horizontal plain about 6 to 12 inches from the participant's nose. The test is usually performed twice around in one direction and then twice around in the opposite direction. A person with poor tracking ability will not be able to smoothly follow the finger.
There are many different ways to remediate visual tracking problems. Some of our favorite exercises include the Pendulum Ball Exercise, Bean Bag on a Balance Board, Finger Tracking and Object Tracking. Within 60 days of doing tracking exercises, you should notice a significant improvement in the child's ability to read without losing their place. It should also increase attention and focus skills.
Irlen Syndrom. For a few individuals the way light reflects off the page interferes with reading and reading comprehension. An accommodation for these individuals is to use a colored plastic to place over the words, thus effecting the reflection. Another technique is to used tinted glasses. Different individuals respond best to different colors of plastic. There are see through colored straight line edges and colored straight edges, paragraph size to help individuals with Irlen Syndrome as well as those who have trouble with visual tracking.
Visual Implusivity. Most hyperactive children have difficulty being impulsive with their eyes. Their eyes frequently move. It is a believed that every time the eye moves, a different thought is introduced into the mind. This contributes to the individual thinking of other things rather than what is being presented at school.
A simple test for visual impulsivity is to play the remedial exercise called the Pen and Pencil Game. Usually hyperactive individuals have a difficult time playing the pen and pencil game. However within 90 days of practice, most of them can master the Pen and Pencil Game. Theoretically when this is accomplished, the person has improved ability to concentrate and to focus. Combined with other exercises it can greatly improve a child's ability to focus and concentrate in school.
Imagery. Some children do not have good visual imagery. Visual imagery is the ability to obtain a representation of something in the mind's eye or to see something or imagine something with the eyes closed. For most people if you say "Don't think of a sail boat", they will automatically think of a sail boat. They will get a mental image of a sail boat. If they were to describe the sail boat, each person would have a unique image of a sail boat. Individuals with poor imagery ability will not be able to describe the sail boat. Two games presented in other sections that include visual imagery include Walk the Plank and the Grid Game. My Favorite Martian is another game to develop visual imagery. Good mental imagery can lead to better reading and listening comprehension.
Another skill related to imagery is the ability to imagine what something would look like if it has been turned. This is a skill often used in geometry. A great game to remediate a problem in this area is Tetris. In the game Tetris, objects can be turned so that the fit into spaces. Tetris is a great game for visual development.
Visual Motor Coordination. Some children develop slowly on visual motor coordination. A good exercise and fun game for children is the use of a bouncy ball on a string. As your child plays with the rebound ball, you should see improvements in visual motor abilities. Some teachers report that children who were had less communication skills improved their ability to communicate with other children after playing with the bouncy ball on a string. A related exercise is mentioned at the additional comments of the Pendulum ball Exercise.
In the discussion of balance in the Sensory Integration Section of Neurodevelopment, there are several activities that combine visual skills (e.g., tracking) with motor and balance skills. Balance Board Fun is one example. (link) Circles on the Board Exercise is another activity that combines visual skills with motor skills. Simply drawing letters in the air is another good exercise to improve motor coordination and visual skills.
,B>Figure Ground Discrimination. Some children have difficulty with the ability to notice subtle details in their visual field. Figure ground exercises are helpful in this area. As adults read, they do not look at all the letters of a word. Usually they notice the first and last letters of the word, the brain figures out what the word is and then moves on to the next word. Children with poor figure ground and visual integration have difficulty reading fast. They spend so much time and energy on each of the letters of the word. This makes reading laborious. SOI has several developmental modules to address this problem. Alternative exercises includes easy Dot to Dot book then harder Dot to Dot activity books, finding hidden objects books, and Where's Waldo? and similar activities. When you work with these books, do so in a neuro-developmental fashion. This involves starting with the easiest ones first and then working up to the more difficult activities. Always start at a level that the child can do. Next, progress slowly over time to really difficult or complex exercises that will lead to mastery of the skill (e.g., in connect the dots, the participant is able to guess what the dot to dot pattern will be before connecting the dots of a complex sheet). There are great "apps" for tablets and phones that have all of these exercises that are found in books. Most of these "apps" are free of charge.
Another Visual Processing Exercise. Figure Ground Discrimination does involve complex visual processing. It has to do with the brain interpreting what it sees to make since of it. In order to do efficient visual processing, the eyes should see clearly and the muscles of the eyes should work together well. Exercises like the Brock String, eye patches, tracking exercises are designed to give the brain a good image to work with. Another fun exercise that helps with visual focus and processing is the Say the Color Game. When used with a metronome it can increase visual processing speed. It is usually a fun game for participants to play.
Investigating the strengths and weakness of the visual system can provide valuable information for children with learning disorders. The results can generate a plan of action to improve visual functioning if needed. Improvements should be seen within 30 to 60 days and mastery in most cases should be within a few months for most cases. More severe cases such as seen in Autism, will need exercises to be broken down into easier components and continue to be worked with until the visual system reaches normal age levels. Improvements in the visual system will eventually lead to improvements in learning and other areas of functioning. It is certainly worth the time and energy put into the exercises. Hopefully some of the exercises will be fun for the participant. Overtime, as the participant sees improvement, they are more likely to be self motivated and will need less and less bribes or rewards to do the exercises often.
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