7

First Day of School!!!

We didn’t plan this very well so here we are, the first day of school and week 7 of therapy in the clinic. Andy took the day off with me for our annual first day of school brunch. We skipped the normal plans in lieu of us having a day date. WE had to cut it short to make it to our 3:30 appointment. O was so excited to have both of us pick her up from daycare to go to her appointment. She exclaimed with pure bliss of excitement, “it’s the best day ever!!” In honor of Andy being present for the appointment, he was invited to join in the session to get his first hand experience with the clinic therapy. The girls didn’t disappoint!


But that left me completely in the dark with the home therapy….


We have a new exercise this week. This week they worked on accommodation. Accommodation is simply the mechanism in which the eye changes and adapts from near focusing to distance focusing. The mechanism of this is simple. The ciliary muscle (smooth muscle) in the eye is responsible for contracting just enough so the lens of the eye is able to focus light on the retina by changing its shape. This reflex is automatic and usually doesn't require too much active thought.


It took me a couple of days to figure out exactly what they were supposed to do especially since my work schedule keeps me away most evenings. I finally learned all three of the exercises the night before our next therapy session. Even some of the details are a little sketchy. I have also started a new routine in which I would play or simply snuggle with M while Andy is the therapy helper. I would play simple games such as “Spot it” or “Don’t spill the beans” because they can easily be played in the short amount of time before our bath time and bedtime rituals.


While playing with M, I would glance over to see Andy and O sitting at the dining room table facing each other in the chair. O has become to intensely dislike her patch so she would take her fingers and cover her eye instead. She was given a small patch that easily slides over her glasses but she hates that one too. The first game to test accommodation includes a big letter chart and little letter card. These are both laminated so they can withstand a careless seven-year old. First she would read the big letter chart with letters and numbers all the same size in a randomized sequence. She would be instructed to read a particular line while Andy holds the sheet while covering one eye. After that is completed, O is to read (with that same eye covered) another randomized row of letters and numbers from the little card that she holds. She is to repeat this exercise on the other eye.


The other exercise to practice accommodation includes a piece of paper with different shapes and symbols that are shaded a different color to help differentiate the different patterns. The purpose is to count the number of each shape or symbol without using her fingers.


The other two exercises we are to practice this week at home include our favorite “stick and straw” and “rhythm timing and sequence.” Andy has developed a more fun way to practice this one at home since we really want O to be an active participant without all of the moaning and groaning. At the beginning of the week I saw Andy trying to coach O to walk with her legs swaying out to the side alternatively. O was not buying it. I suggested Andy should coach her to use the tiles on the floor to use as a guide, but does he listen? No. Not. Ever.


Before I go on about how men don’t listen, he actually devised a way to get our seven-year old to cooperate, and surprisingly have fun while doing it. After all of the other exercises have been completed, O is instructed to go make her obstacle course. This results in several whoops of joy and then the stampede towards the playroom commences. She runs upstairs and takes several random toys, such as blocks, soccer cones, dolls, etc. and sets them in a pattern near her child-sized trampoline. Once on the trampoline, Andy claps out a beat and while she jumps to the beat, she calls out numbers. Andy has already predetermined the number prior to beginning. After she jumps the prerequisite number she jumps to the floor and jumps over the obstacles with alternating legs. M thinks this is a game so he joins in the fun.


One night at dinner, O made a comment to me that I had a hard time rationalizing. She told me at school she has to stay at her desk when the rest of her classmates get to sit on the carpet for certain activities. This made me wonder a few things. Is she being singled out from the rest of the kids? Is it because the school is actually taking Dr. R’s suggestions seriously and implementing them? Sometimes it’s hard to get information from her. When I asked her why, I asked her if it’s because it helps her see better and she nodded. I wasn’t able to attend the school orientation so I don’t quite understand the layout of the room. My husband tried to describe the new contemporary "pod" classroom where there are four classrooms seperated by a partition but open to each other. In the middle there is a common area for the kids to store their belongings. Instead of minimizing visual stimuli, there is a now an enormous amount. Not confusing at all.

Updated: Mar 10

THE CLINIC EXPERIENCE

This week Amanda decided to try to have O back in the classroom without me. I was a little surprised because I have become used to being a part of the therapy session, regardless if I am a distraction or not. At some point O is going to have to learn how to be independent so I walked her to the classroom and gave her a hug before I left. I went to the waiting room and popped my ear buds into my ear to listen to the audiobook borrowed from the library.

When they were done, I went back to the therapy room and there were all kinds of therapy equipment strewn all over the room. It looks like they had a really good time. Before we left, Amanda reviewed this week’s homework exercise. We have finally graduated from steeple (insert sigh of relief). I was so excited to finally hear Amanda utter those words. However, the new game has elements of steeple (insert groan here) but it has an interesting element to “spice” up our home activities.


STICK AND STRAW

The purpose of this exercise is to help with eye hand coordination. The materials used in this exercise include a pointer (the stick), a straw, and the eye patch. This is to be done without glasses. This activity utilizes three different axis’ in which the straw is angles. The straw is held by the helper in the “x” axis, “y” axis, and “Z” axis. The “x” axis is the axis in which the straw is held in the horizontal or longitude direction. The straw is in the “y” axis when it is held vertically or latitude position. The “z” axis is when the straw is pointing directly towards the student. Before each axis is performed, the steeple game should be incorporated to practice tracking. The first step is to cover one eye with the patch and repeat each axis 10 times. Then the action is to be repeated 10 times with the other eye.


It is important to remember when we this exercise O is to move the stick in a half rainbow motion. When the stick is in the “x” axis, her hand should move in a half rainbow to the side. When the stick is in the “y” axis, her hand moves the stick in a half rainbow over the top. When the stick is in the “z” axis, her hand should move in a motion that is similar to throwing a dart.


All three of the axis’ should be done for both eyes in one sitting. As the helper, we score the number of successful attempts completed. If O overshoots or undershoots, or comes in too high, she should be guided to redirect the stick on the next attempt. Her helper is encouraged to tell her what went wrong with each attempt. Her helper is to hold the straw in the appropriate axis that is prescribed. Then O is to repeat the technique in each gaze at different distances from the her eye. Each attempt is subsequently recorded as successful or unsuccessful.


In addition to this exercise we were told to continue with the rhythm timing sequence exercise and standing angels. My favorite part of these exercises is that these can be done relatively anywhere. They can be done at the grocery store, bus stop, etc.… We do get some raised eyebrows when we play them in public but it makes the experience more efficient rather than cramming everything into our home routines.


The other important factor involves identifying O’s favorite activities. It is easier to perform these activities in public if she enjoys them. Fortunately standing angels is one of her favorite games. However, the rhythm timing sequence game is not. This is surprising because I would have thought that jumping is any child’s favorite activity. I don’t know if this game is difficult for O because it requires too much that she can mentally handle. Without consulting Amanda we modified it to make the experience more enjoyable for all parties involved. I wouldn’t recommend this practice to everyone, but my child will shut down and stop interacting. Sometimes you do what you have to do to get by.


We modified this game by having her clap her hands together and spell her name the second her hands make contact. We will even incorporate other concepts such as simple arithmetic to make it more difficult. She seems to be more receptive performing the exercise in this manner so it’s like I said before. Sometimes you do what you have to do to get by.

Progress is slow. I am trying not to get frustrated but it’s that instant gratification thing. I feel as though God is trying to teach me a lesson on patience.


Speaking of which, I met with a friend who just happens to be the children’s minister at our local church. It was very encouraging because she is going through a different but very similar experience with her child. When I say that I infer her child has a different disorder that requires the same type of therapy. It was very encouraging to hear her story and hear how her progress is going. It’s very important for me to realize that she is several weeks ahead in therapy than O so her progress is significantly more recognizable than what we currently see. I need to stop comparing O to other children because they all have different problems and they are all very different people. Each child is going to develop and progress at a different rate. The affirmation is going to come with small successes.


Most parents I have interacted with at the clinics have all told me by week 6 they have noticed significant changes in their child’s progress, especially with reading. Although we have not seen considerable strides, O has made some small successes that need to be celebrated. We were on our way to a family gathering at our chosen family’s house for Labor Day when O announced a speed limit sign. She has never tried to read a road sign in a moving vehicle going 45mph before. We have never told her the significance of this sign either. Even though it was a small victory, it was victory nevertheless. My heart soared with pride.


Next week school starts and I have a lot of ambivalence about it. I have concerns about whether or not her teachers will accept Dr. R’s recommendations. I worry that they will take a look at this "new medicine" and silently roll their eyes about the validity about it. I don’t care if they think if I am a “crazy mom,” I just want my child to succeed and learn alongside her peers without fear of being singled out as "slow" or "dimwitted." My goal is for school to be easier for her. I wish I could predict the future.


I emailed O’s special education teacher right before the school orientation. I wanted to have a quick meeting so we could get our “best foot forward” towards the new school year. Unfortunately I had to work the day of second grade orientation so I had to rely on Andy to handle it. I remember asking Andy in great detail about how it went. All I got in return was a shrug as he said, “I handed them the paper with the print out results and they just took it all in…” Wonderful… I think I need to be a bit more proactive. Men….

I know I can’t complain too much since he has virtually taken over the practice time at home, but still….

Updated: Feb 19

5

THE CLINIC EXPERIENCE


We have a few new games this week, which is exactly what I have been asking for, right? Not exactly. We still have to do steeple (insert groan here). However, Amanda has heard my requests for new games so she gave me some fresh ideas to keep it interesting.

This week we worked on bilateral integration and tracking. Bilateral integration refers to an individual’s ability to coordinate both sides of the body in a controlled and organized manner simultaneously. This is an indicator of how efficiently both sides of the brain are communicating and sharing information with each other. Bilateral integration has a profound effect on activities of daily living, fine motor skills, visual motor tasks, and gross motor skills.


SNOW ANGEL VARIATION

This variation of snow angels allows the student to perform the exercise as the name suggests, while standing. This level allows for more difficulty with the extra practice in balance.


However, during the session we practiced the laying down version but on two different levels. I have already described levels one and two. Today we are advancing to levels three and four. Level three incorporates the limb movement with eye movement. While the student lies supine on the floor practicing the normal limb movements, they are to simultaneously utilize the muscles in their eyes to track a ball that is suspended from the ceiling. This exercise helps with bilateral integration and tracking.


The other variation of snow angels requires the student to lift their limbs upward instead of outward. The helper calls out the sequence “ ______ up” and the arms or legs should lift up from the sides, perpendicular to the body and points to the ceiling. This is the fourth level version of snow angels known as HANDS UP ANGELS.


Fortunately O likes all of the versions of Angels in the Snow. I am grateful there is one we can practice at home without a struggle.


MEMORY

Everyone should be familiar with the matching game from our own childhoods. There are hundreds of versions with different cartoon characters or drawings that everyone can relate to. This particular set was a Disney Cars matching game. Amanda and O both sorted out thirteen matches with different colors to simplify the game. Instead of placing them in neat little rows like I was originally taught to do, Amanda scattered the cards face down onto the carpet. O played this game with relative ease.


HOT LAVA VARIATION

It seems O’s favorite game is Hot Lava. At the beginning of every therapy session, her first instinct is to run to the folded up balance beam and carry it out for Ms. Amanda. Today was no exception.


CHALKBOARD CIRCLE TRACE


This activity was introduced in today’s session to improve bilateral integration. This is achieved by helping the student to determine the concept of a circle. This circle is maintained in an accurate direction of action. The task is done with each hand with an eye patched.


In the office a medium sized hula-hoop was hung on the door. Amanda dimmed the lights and gave O a flashlight. O was instructed to trace the circle with the flashlight using whole arm movements instead of wrist movements. The focus on these movements should involve more gross motor control rather than fine motor control.


The student is first encouraged to use the right hand and move the flashlight clockwise over the circle in a smooth, uninterrupted motion. This is repeated at least two more times before changing direction to the counter clockwise direction. After this is accomplished, the student is encouraged to switch to the left hand and repeat the exercise. The student is then instructed to switch the patch to the other eye and repeat the sequence.


For the home exercises, the tip sheet encourages the use of a chalkboard or a large piece of paper in which the student completes the exercise with crayons or markers. The circle should be a minimum of 10” in diameter or more to utilize the gross motor skills. The student is to trace over the same line carefully in a slow accurate manner.


RHYTHM TIMING SEQUENCE


The purpose of this exercise is to provide and develop an accurate sense of time from which movements and space can be accurately judged and directed. Simply stated, time and space have a direct relationship with each other. People who lack rhythm and spatial judgment are often lost in space and clumsy. This exercise helps the student develop body awareness and integrates the concept of bilateral integration.


The student is first encouraged to jump in the middle of a small trampoline. The observer is required to assess whether or not a regular rhythm is maintained. After the student is comfortable jumping in a rhythm, they are asked to add something when their feet make contact with the trampoline. This could be simply calling out a word, clapping the hands together, or both. Before advancing to the next level, the jumps should be well coordinated and rhythmic.


Once this is accomplished, the student is to call out or make coordinated movements at the top of their jump. Once they can do this, the observer is to repeat the second stage to assess how well the student can adapt to a change in rhythm. The goal is to get the student to repeat this every other jump once the previous step is mastered.


During our session, Amanda asked O to call out her favorite letter “O.” Once Olivia was able to understand she was to call out “O” when her feet hit the trampoline, the game became easy. Amanda then asked O to pick her second favorite letter “P” and call it out at the top of her jump.


“O! O! O! O! O! O! O! O! O! O! O-P! O-P! O-P!”


THE HOME EXPERIENCE

We had four exercises for homework this week. Our activities included steeple (ugh), rhythm timing sequence, chalkboard circle trace, and standing angels. Amanda told me that steeple is a priority (ugh again)


It is very difficult to get complaince at home with these activities (standing angels excluded). The reason for this is simple. These exercise requires her to concentrate and move her body in a controlled manner. She refuses to do anything that is deemed "hard" and she gives up easily. As a result, there are two just as frustrated parents. Vision therapy is hard work.

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