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Calgary Vision Therapy
  • Home
  • What Is Vision Therapy
  • Vision & Learning
  • What We Treat
  • Neuro-Optometry Exam
  • About Us
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  • Info For Parents
  • Vison Therapy References

Frequently Asked Questions By Both Parents and Teachers

Contact us at 403-242-1800 or calgaryvisiontherapy@gmail.com if you cannot find an answer to your question.

Many parents ask me to make a series of formal  recommendations to teachers to help their child, once I have identified a  visual development problem that is affecting their child’s ability to  learn. I resist this for several reasons. First and foremost is that the  professional educator is the best person to make decisions that  directly impact the instructional approach to the child. I am not  trained as an educator. Secondly, so many of the visual development  problems that I encounter respond quickly to treatment. Often by the  time a compensatory procedure or supportive activity is implemented, it  may already need to be modified.  It is also my experience that once a  compensatory technique is implemented, it tends to be held on to and  continued even after visual skills have been improved and that  compensatory technique is no longer required.  Once certain visual  skills have reached a certain level of improvement, it is crucial that  those new developing skills be allowed to be used (even if mistakes  continue to occur) to allow for further practice and development of the  improved skill.


With these caveats, I do feel that the following  might be found helpful in a combined approach to aid us both in helping  the children we serve.


NOTE: For any given child only a portion of this  FAQ may be applicable. However, I feel that by sharing this general  knowledge with you, the professional educator, it may empower you to  help your students in new ways.


The answer to this question certainly depends on a  number of variables, including what groups of children we are talking  about and at which aspects of visual development we are looking. A study  was done by the New York State Department of Education in conjunction  with the New York State Optometric Association, in which they did  testing on random samples of children in all socioecomic groups  throughout New York State. It was found that around 23% of the general  school population had visual development problems that were affecting  learning in a significant way.  In this study, when you looked only at  those children identified under public law 94-142 as needing extra help  in school, the percentage climbed to 93%.


In a study done in Baltimore with juvenile  delinquents at the Hickey School in the late 1980’s, Dr. Paul Harris  found the number of these 14-18-year-old boys with visual development  problems to be in the mid-90’s percentage wise. In another study in the  late 1990’s in several Baltimore City public schools, it was found that  over 80 percent of the children had primary visual development  problems.  Without the visual problems being addressed, simply reducing  class size, getting better text books, finding better teachers, or  changing the pay system to a merit system will not result in significant  gains. The visual problems need to be addressed so that the children  can then benefit from their education.


Due to the prevalence of visual dysfunctions in  children with learning difficulties, it is highly recommended that ALL  children who are placed on an IPP program should be evaluated for Visual  Information Processing and Oculomotor Dysfunctions to investigate if  there are any visual dysfunctions that are creating a roadblock in the  child's individual to learn..


There is no simple answer to this vital question.  Parts of it will be found in many areas and blaming one exclusively will  not lead to a resolution of the problem for large numbers of children.  The following is a list of some of the potential culprits and a bit about what types of problems they may be causing.


  • Not enough self-directed movement while young:  In our modern fast-paced society, families seem to always be on the go.  So we transfer our young child from the baby carrier to the car seat to  the stroller and we move them around for much of the day, rather then  having them exploring the world around them with their own visually directed mobility.
  • Too much screen time (including TV, smartphone, tablets)
  • Attention demands too short: So many of today’s television shows geared for children are so fast-paced that they seem to  flit from one thing to another almost like an MTV video, barely giving  the child the opportunity to learn to sustain attention. Thus, they seem  to come to school needing a "USA Today" version of school.
  • Too many pictures supplied rather than constructed by the child: When a child gets to listen to a reader who orates in an  interesting manner, using descriptive prose, the child gets the chance  to learn to make, modify and recall visualizations and visual imagery,  which will become the basis for spelling and reading later in life. When a child is given a steady diet of graphics and cartoons they become passive viewers of "interesting" content but they don’t get the opportunity to develop the necessary mental imagery skills.


The visual process is the ability to derive meaning  and direct action as triggered by light. The behavioral optometric use of the word vision or visual is very different than is seen by the  majority of eye-care professionals and the public. Most people, when  they think of what they do visually, think only of the clarity with  which they see. They think of a trip to the eye doctor as a time to be  reassured that their eyes are healthy and to allow for optical  corrections in the form of glasses and/or contact lenses to be  identified, prescribed and dispensed.


As a behavioral/developmental optometrist I do all  this, but I also look at much more! From moment to moment we have  things we are doing and things we want to accomplish. To do this we scan  our environment with all of our senses, but the visual process leads  this search and is responsible for building the spatial map of where we  are in space, where our body parts are one relative to another and where  the object or objects we are looking at, listening to or feeling are  relative to us and relative to other things.


We then use this updated construction of reality  to direct our actions. As seen from the perspective of a behavioral optometrist, when a clumsy movement or an inaccurate movement is made,  it generally is not the fault of the motor system but is the fault of  the guidance and control system, and is seen as a visual problem.


It has been said that most visual problems are problems of omission. This means that the information needed to properly  identify and locate objects in space was there but it wasn’t taken in  and used by the person. Due to a lack of inclusion of the necessary  information, an error in the instructions sent to the motor systems results.


To do this well requires several fundamental visual abilities which include:

•  The ability to move one’s eyes free of the rest of the body.

•  The ability to easily shift fixation from one place to another.

•  The ability to accurately point both eyes to the same place in space without excess effort and with a stable alignment.  Unstable alignment often leads to the complaint of words moving on the page or momentary jumbling of the letters, or misalignment of numbers in math problems.

•  The ability to sustain near-centered visual attention.


The primary method of treating a visual development  problem is to arrange conditions to provide the person with the  necessary meaningful experiences to acquire these needed skills and  abilities. The method whereby this is done is called vision therapy.


During the early phase we will be building  foundation skills and abilities, which may not translate immediately  into observable changes in the classroom. I view the course of a therapy  program to consist of three phases. The first third of the therapy  program helps the child acquire the fundamental visual skills and  abilities. During the first third most symptoms such as headaches or  blurred distance sight after doing close work are reduced or eliminated.

The middle third elaborates on those skills and  abilities, so that when different life demands are encountered that may  be similar but actually require slightly different skill sets, the child  has the ability to shift from one application to another with ease.


The final third of treatment has two major  purposes. The first is to automate the newly acquired skills and  abilities so that the new skills are simply called on when needed  without any conscious thought. The second is to help the child  generalize the new skills so that as life throws new challenges, they  can immediately call on what they have learned and make the necessary  adjustments, again almost without conscious awareness of having done so


In some instances your student is under a great deal  of stress trying to perform sustained near-centered visual tasks such as  reading. Besides the difficulty of the actual work you are assigning,  one of the factors contributing to this stress may be an inability to  focus their visual system at near. As we shift focus of our eyes from  distance to near we have to supply about 2.50 diopters of accommodation  ("focusing power"), a bit more so at the closer working distances that  are representative of most children. Stress-relieving lenses are glasses  designed to take some of the load off of the accommodative system. On  average, these lenses reduce the amount the eye has to change focus by  about 40%. This has the dual effect of helping the child stay on task  for a longer period of time before their visual concentration begins to  deteriorate as well as allowing them to stay further away from their  close work, thus reducing the on-going demand on the accommodative  mechanism.


During the course of treatment the role of the  lenses often changes. Whereas at first they helped to maintain a good  working distance and helped the child concentrate better, later on they  take on more of a role in the prevention of the development of  nearsightedness. You may have noticed that more of your excellent  students are nearsighted and wear glasses or contact lenses to see  clearly at distance. There are links between doing large amounts of  sustained close work in people who are goal-oriented and detail-oriented  and the development of nearsightedness or myopia. You may have also  noticed fewer of those children with learning problems wearing glasses.  Once the vision therapy has helped the child acquire the visual  abilities necessary to learn and once they begin applying themselves in  school they become at-risk to development of nearsightedness. The  stress-relieving lenses help to prevent this.


Visual therapy is a step-by-step developmental program  designed to provide patients with the necessary meaningful experiences  to acquire full use of their visual process. Visual therapy is based on  Piagetian principles of learning, in which a series of graded problems  are presented to a child under very controlled circumstances and then  practiced for reinforcement.


Therapy in my office (Calgary Vision Therapy) is  done on a one-on-one basis for 50 minutes. Each session consists of four  to five activities which are done for 8-10 minutes each. Then two to  three of them are assigned for home practice. The most difficult aspect  of being a therapist, as well as being a teacher, is to know exactly how  demanding a particular activity should be. Too intense and the child  may go into a "flight" pattern and avoid the activity or go passive and  not fully engage in the activity. Too little intensity, where a child is  asked to do something that they can already do, is a formula that  simply wastes everyone’s time, effort and energy. My therapists are  highly trained to adjust the demands of the activities to maximize the  speed of improvement, but not at the cost of putting the child under too  much stress.


A key aspect of therapy is the involvement of the  parents as home therapists. We require from 20-30 minutes of practice or  drill a day under the direct supervision of a home helper, who is most  often the child’s parent.


See What is Vision Therapy for additional explanations.


Reading is a complex process that is dependent on many  visual abilities as well as a host of other skills. Much of the early  emphasis in the visual therapy programs is aimed at the fundamental  visual abilities. These foundational skills are necessary to build on,  but often do not have an immediate effect on improving reading  performance. Early on, the major effects might be that the child can  stay on task for a longer period of time before tiring.


A major developmental hurdle, already discussed,  is learning to move the eyes only when shifting visual attention from  one place in space to another. Once this has been achieved we often see  renewed interest in near tasks that involve sustained use of vision for  deriving meaning. The fact that the child can now do this kind of task  often helps them feel better about themselves, and early changes in  reading may not be directly from the actual visual therapy, but  indirectly from the changes in the child’s self-image and feeling that  they are not dumb, that a real problem had been found and that it is  being addressed.


As the therapy progresses we often see a pick up  in the fluency of reading at their current instructional level.  Mechanically we see the child begin to take in a larger perceptual  chunk, resulting in them not needing to stop so many times with their  eyes per unit of text. Because less effort is needed to keep their  place, to keep the print clear, and to plan where to go next, as well as  keeping both eyes directed accurately so that their inputs are  complementary, more of the child is left to learn from the experience.


Over time we see a consolidation of gains at a  level of reading material followed by a non-linear jump to a new demand  level. When that happens there is a short period of time when the  mechanics seem to make a downturn. This is because it takes more  thought, reflection and some conscious effort to decode new words and to  find the appropriate meaning in more complex contexts at the new level.  Over time this too becomes consolidated, with a commensurate period of  time of improvement in the mechanics again. This continues cyclically  during the course of treatment as well as continuing for many months  after treatment has been completed. This can also be seen in normally  developing readers at the appropriate developmental time.


To recap, we first often see improvements that are  more secondary to attitude differences than to actual treatment  effects. Once the "eye movement free of the rest of the body" target has  been achieved there is often a new ability to sustain near centered  visual attention, which can be seen in renewed interest in close work.  Then begins a cycle of change; beginning with improved mechanics at the  current demand level and followed by a jump in the demand level that can  be understood. During the early part of the jump to the new level the  mechanics typically suffer for a finite period of time.


The time-frame for seeing change will vary with the  degree of the problem, the age of the child, the intensity and  regularity with which the home practice sessions are done , and many  other factors. Generally, by the eighth week of visual therapy changes  are beginning to be noticed by all. At first, these may only be that the  child is staying on task a bit longer or doesn’t have to be restarted  on homework assignments so many times. Often the child is beginning to  notice things in their environment, many of which may have been there  all the time but are just being recognized.


A major visual development step is the ability to  track and fixate with eyes only. In cases where this was not present, I  see this emerging by the 10-week progress evaluation. The visual therapy  begins in free space with real physical objects and moves to working in  the two-dimensional plane of paper or a blackboard at about this time.  Since visual development follows this course one of the early signs of  change is often in sports. The child with emerging spatial competency is  more aware of where they are in space in relation to others and to  objects and as a result of this they interact with these things more  accurately and more consistently.


We learn to use the visual process over time. Visual  abilities develop as a result of life experiences that children have  prior to entering school. We are a product of the environment we grow up  in. Many of the skills and abilities we have began with meaningful life  experiences as children. Visual skills and abilities are learned  primarily through movement and interaction with our three-dimensional  world. Novelty is critical for the emergence of a diverse set of skills  and abilities.


A child with a limited set of experiences should  not be expected to acquire skill merely as a result of surviving a  certain number of years on this earth. Time alone does not cause  development. Good development is the result of the appropriate  meaningful experiences occurring at opportune times in a person’s life.  Physiological maturity alone is not sufficient to guarantee proper  development.


We cannot expect children who have never heard  classical music to identify an oboe or a trumpet by their distinctive  sounds. To do so they need the life experience of listening to these  instruments in isolation and having someone properly identify the  instruments for them. This needs to be repeated more than once to become  a lasting skill.

Learning how to fixate on an object, shift visual  attention from one point in the visual array to another, precisely align  both eyes with ease for sustained periods of time, and shift attention  from distance to near and back again are all developed skills. A child  who has not had appropriate life experiences in meaningful ways may come  to school without these requisite skills.


A behavioral optometric evaluation can be compared  to taking an inventory of these visual abilities and skills and finding  which are present and which may not yet have emerged. The lack of the  emergence of these visual abilities no more represents a physical or  physiological or mental deficit than it does in the music example above.  In this situation, no one would diagnose a neurological music  processing brain center in need of medication. There would be  recognition that the life experiences necessary had not been  encountered. (Of course there are isolated instances of such problems  but these are few and far between.) The vast majority of what we see in  clinical practice are visual development problems.


If the only problem a child presents with is a pencil  grip and writing posture, we will often make a referral for occupational  therapy. However, many children that require visual therapy also  present with pencil grip and writing posture problems. If the parent  wants us to address this we will deal with the sensory motor aspects of  holding a pencil and sitting at a table early in the therapy. Towards  the end of therapy we then address how to apply these new sensory motor  skills to handwriting. In most instances the sensory motor skills need  to be practiced at a fundamental level for several months before they  can be applied directly to handwriting.

It is our experience that most children do not  learn an efficient pencil grip or are allowed to use an inefficient grip  as long as they are at least copying something down and doing their  work.  Frequently, individuals with poor grip abilities are instructed  to have a laptop or a scribe.  It is understandable why these  compensations are created as teachers have enough responsibilities and  challenges keeping their students attending to the task on hand and  dealing with multiple individuals with varying learning challenges;  however, we feel it is very important that each child develop these  skills properly as at some point in their career, they will be required  to do some handwriting for a length of time.

Many children who have developed poor pencil grips  are often found to lack the finger dexterity required for efficiently  using a pencil as a writing tool to express their ideas.  At Calgary  Vision Therapy, when this is shown to be an issue along with other  inefficient visual skills, our office will add finger dexterity  developmental procedures to their program.  As vision leads the hands  and directs where the pencil should be placed on the page, training in  this area can overlap.


Connection between Eye Tracking and Motor Coordination:


Eye Tracking can be thought of as a super-fine  motor coordination skill. If overall motor coordination skills are not  well developed, it is likely that fine motor (handwriting) and eye  tracking skills will be poor as well.  When writing, the eyes have to  lead the hands.  If the eyes don’t move accurately and reliably,  handwriting may become slow, messy and inconsistent. One approach to  training the eye tracking system includes training the overall motor  coordination system.


Difficulties in copying from the  smart/white board  come in two flavors. The first is problems secondary to clarity  problems. A child who is nearsighted sitting in the back of the room  without glasses or contact lenses may not be able to see the letters and  differentiate them well and therefore may make lots of mistakes or copy  the wrong thing entirely. Generally no amount of treatment will address  this. Some form of eyewear, glasses or contacts, are needed to address  this problem.


The second and more common problem affecting  copying from the blackboard is the problem with fixation and tracking  already noted. The child may be incapable of remembering where they were  as they shift from one place to another. So when they return to the  blackboard after writing down the last portion seen, they may be unable  to relocate where they were. This ability to leave a mental marker from  the last fixation point is taught in therapy and often comes in between  the 10th and 12th week of treatment and certainly should be present by  the 20th week. So problems related to fixation and tracking respond to  treatment rather quickly. In the meantime it might be helpful to give a  child with this type of problem a copy of their assignments so that they  can have it at their desk and they are not penalized for making copying  mistakes.


We learn to use the visual process over time. Visual  abilities develop as a result of life experiences that children have  prior to entering school. We are a product of the environment we grow up  in. Many of the skills and abilities we have began with meaningful life  experiences as children. Visual skills and abilities are learned  primarily through movement and interaction with our three-dimensional  world. Novelty is critical for the emergence of a diverse set of skills  and abilities.


A child with a limited set of experiences should  not be expected to acquire skill merely as a result of surviving a  certain number of years on this earth. Time alone does not cause  development. Good development is the result of the appropriate  meaningful experiences occurring at opportune times in a person’s life.  Physiological maturity alone is not sufficient to guarantee proper  development.


We cannot expect children who have never heard  classical music to identify an oboe or a trumpet by their distinctive  sounds. To do so they need the life experience of listening to these  instruments in isolation and having someone properly identify the  instruments for them. This needs to be repeated more than once to become  a lasting skill.


Learning how to fixate on an object, shift visual  attention from one point in the visual array to another, precisely align  both eyes with ease for sustained periods of time, and shift attention  from distance to near and back again are all developed skills. A child  who has not had appropriate life experiences in meaningful ways may come  to school without these requisite skills.


A behavioral optometric evaluation can be compared  to taking an inventory of these visual abilities and skills and finding  which are present and which may not yet have emerged. The lack of the  emergence of these visual abilities no more represents a physical or  physiological or mental deficit than it does in the music example above.  In this situation, no one would diagnose a neurological music  processing brain center in need of medication. There would be  recognition that the life experiences necessary had not been  encountered. (Of course there are isolated instances of such problems  but these are few and far between.) The vast majority of what we see in  clinical practice are visual development problems.


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