Equipment for Vision Rehabilitation

“What tools do I need to perform basic vision rehab interventions in my clinic?”

The first thing one needs is information. Understanding and Managing Vision Deficits-A Guide for Occupational Therapists would be a wise investment. Dr. Scheiman’s book explains assessing and treating basic binocular vision defects making the subject approachable for therapists. He also teaches a course by the same name that would be a good start.

Vyne Education also offers a course Vision Rehabilitation for Pediatrics-Seeing the Whole the Picture, taught by this author also introduces basic assessment and treating of eye movement disorders.

The Convergence Insufficiency Treatment Trial Manual’s Chapter 8 explains the in-clinic activities used in the CITT and would also be a worth while read.

You will need an optometrist

This may be the hardest thing to find. While the complete binocular vision assessment is the standard of care, frequently this assessment is neglected. Find the optometrist in your community that consistently performs these assessments and you will most likely find a partner. COVD and NORA doctors may be most receptive to working with a physical or occupational therapist that is training in binocular vision disorders.

The optometrist diagnosis is as important as the diagnosis a therapist would get before starting rehab on a shoulder. While we can perform basic testing on a shoulder, some results would indicate further assessment by the orthopedist. Same rules would apply concerning eye movements except that even poor tracking could be caused by a lack of visual acuity requiring glasses (or more accurate glasses).  Always insist that a child have a current eye exam before working on eye movement or even skills like visual motor integration or visual perception. Performance of these tasks requires best corrected visual acuity.

What about Equipment?

The Worth 4 dot   would be a wise first investment. With models starting at about $20, it it also very cost effective and gives great first clues to a eye movement problem.

Marsden Balls offer an easy to use moving target that requires good fixation to read letters. The handy therapist could probably make one on their own.

The Hart Chart is simple way to strengthen accommodation. Do it on a balance board and add in the challenge of balance.

The brock string is a must and its cousin the barrel card can be used to strengthen convergence.  Have the patient make their own brock string becomes a great fine motor activity too.

The Developmental Eye Movement Test is quick to give assessment that gives good data to reading ability and accuracy.

 

Prism and Lenses

The rules governing the use of prism and lenses vary greatly from state to state with the interpretation of the rules varying. Because of this, the author has chosen not to openly recommend these tools. They would generally require being under the supervision of an optometrist or ophthalmologist for there use and purchase.  They also require training to understand the appropriate therapeutic use of these tools.

Be a therapist!

The near-far axis is generally referred to as the Z-axis. When we turn our midline crossing tasks into the Z axis, we are now working the near far visual system.  Check out a previous post here. Be creative and have fun.

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Learn more about this subject in a live course and webinar presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education

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Convergence Tasks for Therapists

The Z axis

As therapists, we recognize the importance of mid-line crossing to help with primitive reflexes.  Reaching lateral outside of the base of support challenges balance and posture.

But to exercise convergence, the therapist must turn their favorite activity into the “Z axis”. This axis is the near-far axis, (referred to as the Z axis in vision) and challenges the convergence and accommodation system.  Many of our favorite activities can be modified just by turning them, to help strengthen the near vision system.

Simple convergence strengthening activities

Clothespins are great therapy tool, strengthening pinch for writing and other tasks. Having a child reach to a distance to retrieve the clothespin then hanging the clothespin on a near string can can help with convergence and divergence. The proprioceptive input of the hand hanging the clothespin on the string will cue the eyes to converge to a point.

The swing adds vestibular and proprioception to the convergence and divergence in this video.

In my clinic, I also use a cup with a straw that patients then put toothpicks in. This task can be graded by moving the cup closer to the child’s face.  This is task also made more difficult by not allowing the kiddo to touch the straw, removing the proprioceptive input,  forcing the eyes to guide the hand more accurately.

Amazing creative therapists

Cheerios on a Straw

In the task, the patient puts cheerios on a small coffee stirrer. The hand working at the end of the straw does a great job cuing the eyes to converge. Just make sure the straw stays in at mid-line.

Ball in a Tube

In this task, a 4 ft florescent bulb protector ($4 at Home Depot) is cut in half with a ping pong ball put inside. I then placed stickers on top of the tube. The patient has to align the ping pong ball under the the sticker. In standing? Even better. Balancing on a balance board? Even better!!!

As a bonus, the scrap end of the tube become a great “light saber” for popping bubbles to work on tracking and eye hand coordination.

Thanks to therapists that I have met

The weeks I spend traveling are exhausting but the energy of the people I met help me stay motivated. Thank you to all the therapists and teachers and others, that I have met.

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Learn more about this subject in a live course and webinar presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education

About the Author

Worth 4 Dot

Worth 4 Dot

The worth 4 dot is simple tool for assessing suppression and fusion. The results oworth4dotf the quick assessment can give us clues to the function of the eyes. The worth 4 dot (W4D) test is is made up of a pair of red-green glasses and light with 4 dots, 2 green, one red and one white.

The patient puts on the glasses and the light in placed near (40cm or less) and asked how many lights they see.  It is then moved to distance (1 M) and asked once again how many lights are seen.

W4D Responses

There are 4 appropriate responses. Other responses should be considered a failure of the patient to understand the instructions.

  1. 4 lights, near and/or far indicate using both eyes. I will ask if the lights are moving or not to see if the fusion is steady.
  2. 3 lights or two lights- three light indicates suppression of one eye. Which eye depends on the red green arrange of the particular test one is using. They may suppress at near or far or both, so an answer of 3 close and 2 far would be appropriate.
  3. 5 lights- a response of 5 lights indicates the patient is having double vision at the range. It may be near or far or both.

The W4D is usually the first test I do as it gives me early clues what to look for as I begin looking at eye movements. This test can also indicate how a patient may do on stereopsis testing as suppression of of an eye could me reduced stereopsis.

Getting a Worth 4 Dot

Worth 4 dot is available from Bernell.com. There are several version but the idea is the same for all.

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Learn more about this subject in a live course and webinar presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education

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Visual Processing Disorder

Visual Processing Disorder

Visual Processing disorder is broad term used to describe children that have difficulty with visual tasks. They may have problems with puzzles, mazes, handwriting or reading. The child may be clumsy and have difficulty remembering things like where toys are located. Visual processing problems can be different in each child. Here is a symptom checklist that might help.

Sensory Processing Disorders

Visual processing disorders are part of a larger group of disorders called “sensory processing disorders“. Sensory processing disorders can be linked to any sense (touch or hearing, vision, taste or smell) and are characterized by the brain magnifying or muting sensory information. This magnification or muting of the sensation can appear a child that does not like loud noises, or constantly likes to touch rough surfaces. They may be picky eaters because some foods “feel funny” in their mouths or they only wear their favorite super soft shirt.

These sensory difficulties can cause problems with fine and gross motor development as well as academic performance and cause behavioral issues as well.

Causes of Sensory Processing Disorder

Research continues to identify causes of these disorders but no real conclusions have been found. There are differences in brain structure noted in these children and environmental toxins have been linked to these disorders.

Treating Visual Processing Disorder

Children diagnosed with visual processing disorder should first have complete eye exam including a binocular vision exam. Children with visual processing disorders and other sensory disorders are frequently found to have eye movement and near vision focusing problems that only a binocular vision assessment can uncover. Treatment for the eye movement and near vision focusing problems can frequently reduce the symptoms associated with visual processing disorders.

Following resolution of the eye movement problems, we can ONLY THEN begin successful treatment of visual motor integration and visual perception problems.

Neurological Events and Visual Processing disorders

Recently, I have had several children referred to me recently with “visual processing problems” that also have histories of seizure disorder and concussion. These children also had significant binocular vision problems. Once their binocular vision disorder was correctly diagnosed (both had CI, accommodative dysfunction and saccade dysfunction) and treated, we then able improve visual processing for both of these children.

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Learn more about this subject in a live course and webinar presented by Robert.  Hosted by PESI Education

About the Author

 

Assessing Eye Movements

Assessing Eye Movements

Assessing eye movements should be a regular part of every therapists evaluation process. We get 75% of the information about our environment from vision and vision affects things like reading, handwriting and balance.

Before starting this evaluation, ask about the patients most recent eye exam. A patient not in best corrected visual acuity may have difficult time fixating and therefore show poor ocular motor skills. Every child needs a compete

Nystagmus

An involuntary movement of the eyes, called a nystagmus.  These are described as a congenital or acquired nystagmus and further described as jerky (faster in one direction than the other) or pendular (same speed in each direction).

Congenital Nystagmus

Assessing Eye Movements

Assessing eye movements is quick and easy and gives the therapist vital information on about the patient may be seeing the world . Its easy to do…just watch!!!

 

 

Learn More

Learn more about this subject in a live course and webinar presented by Robert. Hosted by PESI Education

About the Author