Research & Articles on Vision Therapy

Handwriting Headache – Keyboarding Techniques Might be the Answer

By Jennifer Nelson, MOT, OTR/L

The Basic OT Dictionary Motor Skills
Traditional fine motor interventions sometimes fall short of correcting handwriting issues. Keyboarding skills, as taught through an assistive technology program, can help build written communication skills in young students.

The importance of handwriting
Of the skills a child acquires during the first years of school, handwriting is one of the most essential. Written communication is a necessary life skill for completing school assignments, writing a letter to a family member, filling out an application or simply writing down someone’s phone number. Failure to achieve handwriting success during the school-age years may have a negative impact on a child’s academic success, as well as his overall self-esteem.

School children demonstrate their knowledge in all academic areas through handwriting. Therefore, when handwriting is poor, a child may be misunderstood or even given a bad mark on school work. Jane Case-Smith, OT, in “Effectiveness of School-based Occupational Therapy Intervention on Handwriting,” The American Journal of Occupational Therapy 2002, emphasizes that students who have trouble with handwriting are so fo- cused on correctly forming letters that they may lose attention to the subject matter or to the instructor. The need for neat and legible handwriting only becomes more important as children progress through school. Therefore, early identification and intervention are crucial in order to decrease a child’s difficulties with handwriting.

How assistive technology can help
Due to each child’s unique circumstances, not all children have the same handwriting difficulties; therefore, an individualized plan of care should be considered. However, if problems with handwriting persist and the child’s academic performance is hindered, alternatives to handwriting should be explored. This is where assistive technology becomes important in a child’s academic setting. As defined by the Technology-Related Assistance for Individuals With Disabilities Act of 1988 (Public Law 100-407), assistive technology is “any item, piece of equipment or product system…that is used to increase, maintain or improve functional capabilities of individuals with disabilities.”

Assistive technology ranges from low-to high-tech. Low-tech is defined as tools that are inexpensive, involve a minimal amount of training and typically do not require batteries or electricity. Mid-tech options, typically portable word processors, are explored if low-tech options do not improve the child’s handwriting. High-tech options, like word prediction software, are necessary when a child’s needs are not met by other assistive technology options.

Low-, Mid- and High-Tech Tools

Keyboarding 101
It is imperative that a child learn how to competently use a keyboard in order to utilize assistive technology tools efficiently. Keyboarding can be introduced in occupational therapy, as well as at home or at school, in order to ensure a child will be proficient at word processing. There are essential fine motor skills necessary for keyboarding including the ability to use isolated finger movements and complex hand movements with the arms in a stable position, preferably with the elbows at the student’s sides. For keyboarding success, a child must be able to coordinate finger and arm movements to strike the keys and make the right key choices on the keyboard. Often these fine motor skills will improve after keyboarding instruction and keyboard use. Initially, the fo- cus should be on accuracy, and then speed, when teaching children how to keyboard. In order for touch typing to be functional, the child’s typing speed should be at least equivalent to his handwriting speed. Occupational therapists Janet Rogers and Jane Case-Smith, authors of “Rela- tionships Between Handwriting and Keyboarding Perfor- mance of Sixth-grade Students,” in The American Journal of Occupational Therapy believe a child often begins to learn how to type using the “hunt and peck” style of typing until he is familiar with the layout of the keyboard.

Good, solid typing instruction is important. When choosing a typing program, parents should look for a match between the child’s cognitive and developmental age and the software program’s features. Some features to look for are:

• Large, onscreen keyboards that show both the keys and the correct position of one’s fingers
• Programs where preferences, such as font size and color, can be changed to fit the needs of the child
• Programs that track changes and progress
• Programs that provide a multi-sensory approach combining both visual and auditory input

An excellent typing program will keep the child moti- vated to use the computer while teaching keyboarding skills. An assistive technology trained occupational therapist is a valuable resource for parents who are trying to find an effective instructional keyboarding program.

Web sites with free typing instruction:

www.sense-lang.org/typing
www.bbc.co.uk/schools/typing
www.typingsoft.com for an extended list of typing tutors on the web

Software programs providing typing instruction:

Name of Software / Supplier
Type to Learn 4 / Sunburst Company www.sunburst.com
Jump Start Typing / Available at Target or www.amazon.com
UltraKey 5 / www.bytesofl earning.com

Many respected occupational therapists believe that while the introduction of keyboarding has been recom- mended as early as first or second grade, it should not take over as the primary means of written communication until fourth grade. Once keyboarding skills are achieved, word processing can be used as a means of written communication.

The road block that children with handwriting difficulties face is not insurmountable. There is a way for these students to take part in written communication and find success in school. Parents can turn to assistive technology to help their children improve their written communication skills. Keyboarding and word processing ensure that a child’s written communication is legible for others to read. Typing allows for children to easily correct typing and spelling errors. Being able to use the keyboard also has been suggested to improve a child’s interest in schoolwork and the child’s attitude toward learning how to write. It’s exciting to have assistive technology options that will allow the child to feel a sense of achievement and pride in his written work.

Jennifer Nelson, MOT, OTR/L has worked with Atlanta families for five years and currently is a team member in the assis- tive technology department at Children’s Healthcare of Atlanta. She can be reached at jen.nelson08@gmail.com or 404-785-3779.

Sources: The American Journal of Occupational Therapy AbilityNet website: www.abilitynet.org.uk. Physical and Occupational Therapy in Pediatrics GPAT: Georgia Project for Assistive Technology. www.gpat.org.

http://www.kidsenabled.org/articles/index.php/200812/handwriting-headache-keyboarding-techniques-might-be-the-answer/

This article came from Kid's Enabled Magazine.  This is a wonderful resource for parents of children with learning differences.                                                           www.kidsenabled.com

Six Surprising Reasons Why Children Hate School

For one in four children, the reason why they hate school goes beyond homework and tough math. Surprising vision problems that are often undetected by parents, educators and doctors can cause students to dislike and struggle in school.

  

There are some surprising reasons why some children hate school.

The root cause for this 'hates school' attitude continues to fly under the radar of parents, educators, and medical practitioners.  

Brookfield, WI (PRWEB) January 31, 2011

For one in four children, the reason they hate school goes far beyond too much homework and not enough recess.

Their dislike for school results in non-stop complaining at home, bad behavior in the classroom, and poor grades on the report card. What’s most frustrating to parents is the fact that these children are generally bright kids – a fact that stumps teachers, doctors, and school psychologists.

The root cause for this “hates school” attitude: Vision problems. These problems fly under the radar of parents, educators, and medical practitioners. Fortunately, these are issues that can be corrected.

Discovering the “hidden disability”

According to the American Optometric Association, one in four children has a vision problem that affects their ability to learn. These types of vision problems can’t be detected by a typical vision screening with a Snellen eye chart.

“In fact, many children and adults with 20/20 eyesight actually have a vision problem,” said Dr. Kellye Knueppel, a developmental optometrist at The Vision Therapy Center in Brookfield, Wisconsin. “That’s why it’s referred to as the ‘hidden disability.’ “

Knueppel believes there are six types of vision problems that can cause a child to struggle in school, and lead toward their sour disposition toward school:

1. A child has poor eye-body control.

Eye-body control is essential to our knowing where we are in relation to other people and our surroundings. It enables us to sit still, stay on task, and direct concentration. Children with poor eye-body control are often labeled as hyperactive or having an attention problem.

2. A child can’t track or locate words.

Tracking and locating is a visual skill that includes the ability to visually look at and sustain fixation on a target. Children who have problems tracking and locating will find it difficult to follow a line of print or catch a ball. They’ll lose their place when reading, reverse words, or substitute words into a story. When they read, they will have an uneven speech flow.

3. A child’s eyes won’t work together.

Eye teaming is a visual skill that involves the yoking and aligning of eyes precisely so that the brain can unify the input it receives from each eye. Eye teaming problems are often referred to as binocular problems, and are the root cause for double vision.

Children with eye teaming problems tend to be chronic daydreamers, who always look tired with droopy eyelids. They may also be klutzy, have little sense of rhythm, and are prone to spilling.

4. A child has a low visual span and volume of awareness.

Children who take an extra-long time to complete an assignment may be suffering from a low visual span and volume of awareness.

To understand this concept, think about times when you’ve driven a car while under stress. In those instances, the amount of things you see is actually restricted. That’s called your effective span and volume of awareness. It controls how much information you can process in a single “visual bite.”

A child’s awareness works the same way. If the amount of information children can process is restricted, it will impact their academic performance.

5. A child has poor visual unification.

Visual unification involves the ability to utilize past experience and correlate information from all areas of vision with input from other sensory systems. It’s a great example of how the human brain is such an intrinsic part of the visual system.

Children with poor visual unification skills may have problems remembering the name (verbal label) for a numeral or letter. They may have problems visualizing something in their head. This inability to “see” something in the mind’s eye often results in poor spelling.

6. A child has problems focusing.

The visual skill of focusing, or accommodation, involves seeing clearly from every distance. It requires the ability to shift from far to near or from near to far, all while sustaining focus.

Children with focusing or accommodation problems have difficulty copying from the whiteboard to their paper. They also have problems looking at something far away, and then shifting focus to something close at hand.

It’s no wonder some children hate school.

When you have any of the vision problems listed here, school can be difficult. “We don’t like to use the words ‘hates school’, but this is generally the case,” said Dr. Knueppel. She noted that many of the children who come to her encounter the same issues at school:

• They get reprimanded from teachers and parents alike for being squirmy or losing concentration. 
• They begin to under-achieve in class or sports, which harms their self-esteem and social standing. 
• They feel fatigued, mentally and physically, from struggling in front of a book or computer. 
• They get frustrated because school comes easy for others, but not for them. 

Frustration lies in not knowing what the problem may be. But once you’ve identified the problem, what can be done?

Vision therapy provides a non-invasive solution

In many cases, these problems can be cured through a process called vision therapy, which includes a series of non-invasive, visual activities. Vision therapy is a specialized form of optometry. It is practiced by developmental optometrists, who have received extensive training in this area.

Dr. Knueppel urges parents, teachers, and educators to keep a watchful eye out for vision problems. If symptoms occur, a developmental optometrist should conduct a functional vision test.

A functional vision test is much more extensive than a typical vision screening or eye exam. It must be performed by a developmental optometrist, and includes a wide range of visual tests. All of the visual skills mentioned earlier in this article are included in a typical functional test.

“Most of the kids we’ve helped don’t really hate school,” Dr. Knueppel noted. “When their vision problems are corrected, it’s amazing how quickly they’ll rekindle a love for learning.”

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Vision Rehabilitation for Traumatic Brain Injury and Stroke Patients

By Elizabeth Stannard Gromisch HERWriter February 28, 2011 - 12:54pm 

  Photo: Getty Images 

Vision problems after a traumatic brain injury or stroke can be of serious concern to patients. With a traumatic brain injury, in which the patient sustains an impact to the head that causes injury to the brain, vision problems, such as blurred vision, can occur even when the injury is mild. Patients who have a stroke, a neurological condition in which the blood supply in the brain becomes disrupted, can have various vision problems, include double vision, decreased vision or a loss of vision. In a booklet published by the Australian Government's Department of Health and Ageing, up to 30 percent of patients who have a traumatic brain injury or stroke have a visual impairment. These post-brain injury visual impairments can include difficulty recognizing objects, being unable to see on one side, blurred vision and increased glare sensitivity.

So how are these visual impairments associated with a traumatic brain injury or stroke treated? Patients may undergo different therapies to help increase their vision. Options include compensatory scanning training, prisms and vision restorative therapy. With compensatory scanning training, patients use equipment that teaches them “to systematically turn their head to look into their affected side, thus compensating for their vision loss,” according to the Australian Government's Department of Health and Ageing. Prisms can help shift an image into the unaffected part of a patient's visual field. Another treatment is vision restorative therapy, which uses a computer program to help treat the vision loss. One type of vision restorative therapy is from NovaVision, which is cleared by the U.S. Food and Drug Administration, according to a press release from the company. 

 

 

This type of vision rehabilitation uses a computer for neuro-stimulation, improving vision through neuroplasticity, which the University of Washington defines as “the ability of the brain to change with learning.” In the press release about the treatment, the company notes that about 88 percent of patients exhibit an improvement with at least one daily functional activity and that the time between the injury and the start of the rehabilitation does not impact treatment. But this treatment is not without its controversies. In a 2005 article published in the British Journal of Ophthalmology, author J.C. Horton noted several issues that arose in an earlier clinical trial with this treatment, including no information of false positives and negatives, and reported that the treatment was effective for two conditions: homonymous, post-chiasmal lesions and monocular optic nerve diseases, which are at different levels in the visual system. As with any new treatment, always talk to your doctor first.

National Institute of Neurological Disorders and Stroke (NINDS): Traumatic Brain Injury: Hope Through Research ( http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm)

MedlinePlus Medical Encyclopedia: Stroke ( http://www.nlm.nih.gov/medlineplus/ency/article/000726.htm)

The Royal Society for the Blind and the Australian Government's Department of Health and Ageing: Neurological Vision Loss, A Guide for People Who Have a Homonymous Hemianopia ( http://www.trinity.edu/org/sensoryimpairments/VI/RandR/Neurological%20Vi...)

NovaVision Press Release: Vision Therapy the “Unmet Need” for Stroke and Traumatic Brain Injury Rehabilitation ( http://www.biospace.com/news_story.aspx?StoryID=211484&full=1)

University of Washington: Brain Plasticity: What Is It? ( http://faculty.washington.edu/chudler/plast.html)

The British Journal of Ophthalmology; “Disappointing Results from Nova Visions' Visual Restoration Therapy”; J.C. Horton; January 2005 ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772467/)

http://www.empowher.com/stroke/content/vision-rehabilitation-traumatic-brain-injury-and-stroke-patients?page=0,0

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Medscape Medical News

Eye-Hand Coordination Affected By Strabismus, Amblyopia

Norra MacReady

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Accommodation’s 3-A’s…The Triple Play for Reading and Learning

How vision therapy is saving Stella’s toes, and then some.

 

The hardest working toes in the business (of running around)

Stella is a toe-walker.

She’s been tiptoeing around for as long as I can remember. Prancing, really. Her gait has been so bouncy and adorable, so evocative of a little ballerina, that her physical effervescence has charmed even sour onlookers. I’ve been kindling a small flame of worry about her overworked and constantly clenched toes, despite an inner voice that told me to stop looking for trouble where there was none.

Early last year, I met up with Stella’s occupational therapist–the OT who helped Stella overcome her feeding aversion–to check in and discuss ideas for an article about our feeding experiences. I couldn’t help but ask for her expert opinion on Stella’s toe-walking. And just as I’d hoped, she reassured me. She rightly noted that Stella could stand on flat feet, bend her legs and pick something up with eat. Stella walked flat-footed here and there, and when she stood still, it was often on flat feet. Clearly, Stella was not incapable of walking flat-footed. Besides, she was less than 18 months old at that time, and toe-walking is relatively common in such little ones. In my heart and soul, I agreed with this assessment. I mean, really, do we have to make every little kid quirk into a problem to be fixed? It made me angry to think that something so seemingly age-appropriate and harmless about Stella could be pathologized. Enough with the medicalization of childhood already! As my dad used to bellow, in Braveheart fashion complete with a raised fist before leaving to pick up our Friday night pizza, “Who is with me?!” So I stopped worrying about it. For a while.

Fast forward a few dizzying toddler months. Sail past the great eye-crossing incident of 2010 and whiz by the diagnoses of strabismus/accommodative esotropia, hyeropia, anisometropia and amblyopia. Jump to Stella’s first appointment with her developmental optometrist, Dr. Torgerson (“Dr. T”) of Alderwood Vision Therapy Center. (‘Bout time I named her–we’re very lucky.) Upon meeting Stella, having taken her hand in the waiting room and led her to the exam room, Dr. T noticed that Stella walks on her toes. (Note: Stella’s ophthalmologist never noticed, or at the very least never mentioned, this.) During that consultation, Dr. T placed yoked prism goggles over Stella’s regular specs. Stella’s toe-walking was completely eliminated. She walked flat, instantly. No. Joke. Stella seemed to be looking at everything with new eyes. Dr. T seemed interested but unsurprised and made a note that this was worth exploring. I was still a bit defensive, a bit reluctant. I tried to reason around it. As in, “Well, she was just walking very slowly and cautiously due to the weird distortion of the prisms and that’s probably why she wasn’t as bouncy or tiptoe-y.” Of course, while my focus at that time was beginning a course of vision therapy to address the aforementioned diagnoses, I did at least make a mental note about the prisms’ elimination of her toe-walking. In truth, I pushed it aside, not wanting to create another problem. Not wanting to accept that in addition to her feeding and vision challenges, Stella’s toe-walking was “an issue.”

Turns out that the toe-walking wasn’t so much a seperate issue as an unexpected (to me) extension of her visual one(s). Since that fateful day, Stella has worn the prism goggles many times during vision therapy sessions. After the first time Stella wore them under the guidance of our vision therapist, Bethanie, I was sold on their effect. There was no denying it! I was struck not only by how her gait instantly changed, but also her demeanor. With the yoked prism goggles (the stronger the prism, the more pronounced the effect), she not only walks “flat” but also seems more calm and able to focus. The stronger ones are pretty overwhelming, however, so we’ve scaled back to some less powerful ones with plans to work in the original stronger pair soon. It’s a mind-blowing work in progress, if you will.

 

Stella's first run with the uber nerd glasses--I mean, yoked prism goggles

In essence, yoked prism goggles help re-wire the brain, forcing it to re-map spatial relations. Every time she wears them, they help her gauge the world more accurately. The repercussions are stunning. This isn’t just addressing Stella’s vision. Changes are happening in her brain, in how she perceives the world and her place in it. And that dramatically affects how she feels and behaves.

When Stella leaves those vision therapy sessions (wherein she wears the prism goggle, of any strength, really), she is more outgoing. She is open. Allow me to explain why that fact is so incredibly huge. I don’t label Stella as shy. I don’t want to presume, at age two, that “shy” is who she is and I don’t want to convince her that it is. But I will say that she is often quite tentative. We do see flashes of wonderful social interaction and friendliness–she’s very attached to her best friend, Cooper–so I know her social self is in there. But most often, she shrinks back under even the friendliest gaze from a stranger, or is daunted by mere proximity to people.

On the playground, Stella’s crowd avoidance is overt. She rarely uses structures if anyone else is there already. If someone playful soul is on or near the slide, instead of waiting for a turn or walking up with the understanding that they’ll be down soon, she avoids it completely. If people step aside and watch her, with a smile and friendly encouragement or quiet patience, she refuses to go down. She’s protective of herself. At music class, when the basket of instruments is placed in the center of the room, every other child in the room just flat-out goes for it. They make a beeline for the basket, and grab what they want, carefree! Stella immediately takes a step or two forward, only to halt as everyone rushes by. She waits for a big opening instead of squeezing in willy-nilly like the rest. Part of me has long wanted to push her into the fray. To tell her that she’s just as entitled and doesn’t have to wait for everyone else to take first pick. I just chime in with lighthearted encouragement, and a hand on her back.

Qualities like patience and shyness seem almost beside the point when I think about her vision, and the effect of the yoked prism goggles. I’m now convinced that such reserved, cautious behavior is due, at least in part, to the effect of her visual field–not just her innate personality. Crowded places (especially new ones) and chaotic situations can be so, so anxiety-producing for Stella. Thankfully, at long last, I now believe I understand why. She has trouble gauging her place in relation to a crowd. Per Dr. T and our vision therapist, Stella’s peripheral vision is likely limited, creating a type of tunnel vision that makes life more stressful. She’s always on guard because she’s learned that objects in her proverbial mirror are closer than they appear. She can’t quite trust her visual system in those situations. How startling that would be! And how draining and frustrating to be startled so often. So she takes extra precautions. Her separation anxiety, viewed through this lens of understanding, makes much more sense to me now. I’m her anchor amid the unfamiliar and unstable.

The same visual issues that cause this sort of defensiveness also give rise to her toe-walking. It’s not so much a problem as a solution Stella has come up with to better orient herself in the world as she perceives it. I get it now–the details may be hazy, but I am starting to understand a bit better how Stella sees, and how it affects her way of being.

Back to those yoked prism goggles! Despite some difficulty in getting her to wear them for extended periods, they seem to somehow relax her, and the results are stunning. After her last vision therapy session, during which the goggles are now a prominent therapeutic fixture, Stella ran out into the waiting room and strode right up to a much older child, looking him in the eye and beaming! I was elated. A few sessions ago, in the waiting area following one of her first (“full-strength”) prism goggle trials in vision therapy, Stella started chatting with another family. The mother was gently encouraging her children to put away the toys, and put on their coats, because “we’re going home.” Stella walked up to her, looked her in the eye and said, “We’re going home too! I’m going home!” She kept engaging them, over and over, as they walked out. They smiled and acknowledged her, probably regarding it as typical little kid behavior, but to me? I had to hold back emotion. On yet another such occasion, in between those two examples, Stella walked into the play area of the waiting room after goggle-clad vision therapy, waltzed up to the small play table which was closely encircled by older and taller children, and she confidently and without hesitation joined them. She nudged right in next to a 6 or 7 year old boy. She looked at him, started talking, and reached for the toys on the small table as the others played as well. She was unphased. I was awed. Deeply heartened. That was Stella, freed! That was Stella, no longer feeling caged in by her vision. Her world had opened up. She seemed lighter, less stressed, and more engaged with everyone around her. She carried an innate sense of security. I want her to feel that secure all the time (hek, I wish I did!), or at least more often. My hope is that continued use of the yoked prism goggles will get her there–in tandem with our other vision therapy efforts.

Already, Stella’s toe-walking is fading away. She isn’t so high up on her toes, and she uses her heels more often when getting around. Also! She used to flap her arms, especially when happy and excited, but we just realized that she hasn’t done that in a long, long time! Bear with me: Based on limited but fascinating reading, I’ve gathered that autistic children and others with tunnel vision (or other related visual issues in which ambient vision and/or depth perception are compromised) use arm flapping and toe-walking in part to help gauge their place in relation to their environment. Stella is not autistic, but there are clear parallels between Stella’s vision challenges, and even her behavior in specific situations, and those of autistic kids. Many of them would greatly benefit (not just visually but socially and emotionally and in all kinds of ways) from vision therapy yet never get exposure to it. Hopefully that’s changing as awareness of vision therapy grows. So much needless suffering could be eliminated or at least significantly reduced. I am the wanna-be Gandhi of vision therapy.

My view of vision therapy has greatly expanded over the months, along with Stella’s vision therapy regimen. At first, back in the dark ages, I viewed this work as the remedy for Stella’s amblyopia and probable accompanying deficit of stereoscopy. Plain and simple, just like the initial exercises: catching balloons, stringing beads onto pipe cleaners, and the like. Now, her exercises are centered around yoked prism goggles and vestibular activities. She’s using her whole body. Her brain is re-configuring the world. This isn’t an effort to “fix Stella’s eyes.” It’s a campaign addressing the myriad of ways her vision affects her physical and psychological wellbeing. And mine. Our stress reverberates between us, and can be overwhelming at times. I try to take a tip from Stella and just step back and be patient as we work through this, but sometimes I fail. It’s okay. We’re both doing the best we can. I get cupcakes for myself too often, but that’s a small and delicious price to pay.

The goal as I now see it? Stella won’t feel the need to tiptoe through life–literally or figuratively.

 http://lifeandtimesofstella.com/2011/03/22/how-vision-therapy-is-saving-stellas-toes-and-then-some/

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November 15, 2010 

Objective Measurements of Reading Eye Movements Improve After Vision Therapy 

Filed under: Oculomotor Dysfunction,Vision and Reading — Dr. Barry Tannen @ 3:49 pm

Dr. Tannen’s Research Review and Commentary:  

In this retrospective study, 46 patients who were diagnosed with oculomotor-based reading dysfunction received an average of 29 sessions of vision therapy.  Statistically significant improvements were found for all parameters of eye movement recordings following completion of vision therapy.  In addition, 93% of the patients reported subjective improvement after the vision therapy, including a marked reduction in at least one or more of their primary symptoms.   

Objective measurements of reading speed and efficiency improve in children diagnosed with oculomotor-based reading dysfunctions following vision therapy: a retrospective analysis
Barry Tannen, Noah Tannen, and Kenneth Ciuffreda (COVD Annual Meeting 2010)  

Abstract:   

Purpose:   

   A retrospective analysis was conducted to assess objectively reading speed and efficiency with the Visagraph II Eye Movement System (Visagraph) following vision therapy (VT) in children with signs and symptoms of oculomotor-based reading dysfunctions. 

Methods:   

46 children between the ages of 8-17 years from the primary author’s private practice met the following criterion: symptoms of oculomotor-based reading dysfunctions (e.g. loss of place when reading, skipping lines, etc), and Visagraph recordings where both reading speed and grade level equivalent were below their grade level. To be included in the analysis, VT had to both be recommended and completed during the years 2007-2009. All of these patients had Pre and Post VT Visagraph recordings using an amended protocol (Tannen and Ciuffreda, JBO, 2007) which calls for two recordings taken at the patient’s Independent Reading Level (aIRL) with the second one being used for analysis, and one recording taken at least two grade levels below the patient’s Independent Reading Level (bIRL). VT consisted of standard optometric vision therapy procedures for remediation of accommodation, binocularity, and oculomotor function according to the patient’s individual status.

The average course of treatment was 29 (forty minute) sessions performed twice weekly.

Results:   

Pre and Post VT Visagraph recordings were analyzed to determine if significant improvements in the various components of reading eye movements occurred after VT, and whether there was a difference in the Post VT Visagraph recordings of the aIRL group vs. the bIRL group. All Visagraph eye movement parameters improved significantly (p<.01) on a percentage basis following VT. Average aIRL improvement: Reading speed (51%), Grade level equivalent (134%), Fixations (34%), Regressions (45%), Span of Recognition (37%), Duration of Fixation (9%). Average bIRL improvement: Reading speed (54%), Grade level equivalent (138%), Fixations (42%), Regressions (63%), Span of Recognition (43%), Duration of Fixation (7%).

Conclusions:     

The results demonstrate significant improvements in all Visagraph parameters, both aIRL and to a greater degree bIRL. The latter suggests a primarily oculomotor basis for the improvement, and this appears to be reflected in the improvement aIRL as well. The positive objective findings in Visagraph measurements correlated well with symptom reduction that occurred in 93% of the patients.

http://visionhelp.wordpress.com

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Vision therapy effective in children with convergence insufficiency

SAN FRANCISCO - In a large-scale study on children with convergence insufficiency and accommodative dysfunction, vision therapy was found to be effective in normalizing accommodative amplitude and insufficiency, according to a study presented here at Academy 2010.

"This is the first data from a large-scale randomized clinical trial that shows benefit from vision therapy," Mitchell M. Scheiman, OD, FAAO, FCOVD, reported at a press conference sponsored by the American Academy of Optometry.

The study compared an office-based vergence/accommodative therapy with home reinforcement, home-based computer vergence/accommodative therapy, home-based pencil push-up therapy and office-based placebo therapy with home reinforcement. The 221 study children 9 to 18 years old were part of the Convergence Insufficiency Treatment Trial, Dr. Scheiman reported. One hundred sixty-four also had accommodative dysfunction.

"Everyone received 12 weeks of treatment," Dr. Scheiman said. "There were key results in terms of accommodative amplitude. At 4 weeks there was little difference, but at 12 weeks the results for the office-based vision therapy group was significantly better than placebo, computer therapy was significantly better than placebo and pencil push-up was significantly better.

"At the end of the 12 weeks, about 92% of the office-based group no longer had decreased accommodation," he continued.

For accommodative facility, at 12 weeks there was significantly greater effect for office-based than placebo, he said. "The other two groups in vision therapy were no more effective than placebo. Decreased accommodative facility was no longer present in 87% of the office-based group."

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Is Vision Therapy Actually Effective? Children With Learning Disabilities 

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