It's always fun in the clinic.. not so much at home

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.

Please, anything but steeple

Week 4

THE CLINIC EXPERIENCE

We arrived at the clinic for O’s session and were immediately greeted by Amanda’s smiling face. This week I was invited into the therapy room. The first game was steeple. Have I mentioned how much I hate steeple? I don’t think it’s O’s favorite game either. Amanda told me it’s usually not a favorite among most kids, but we have to continue playing it until we master it. Generally speaking, once Olivia’s eye muscles are strong enough that she can fixate normally, we can move on to the next step. Every exercise is a building block to the next so it’s important to become proficient with the foundation first.

PEPPER TRAMPOLINE

The purpose of this exercise is to help the student recognize spatial awareness, while simultaneously incorporating sequencing, timing, and rhythm. Basically, O has to figure out where her body is in space, and understand where it is when it changes position. Spatial awareness is important for young children to learn early on in life becuase it helps with dexterity, balance, flexibility, and body strength. It also helps the body to learn to manipulate objects and interact within the world. This activity also has the added benefit of promoting attention and memory recall.

As it’s name implies, the activity utilizes a trampoline. If we were to do this activity at home, the child can simply jump on the floor. The student can also use different variations such as naming four sides of the room using colors, animals, etc.. During this particular exercise, the trampoline is placed at the center with four different colored discs that are laid out in a north- east- south- west pattern. This vaguely reminded me of the 80s handheld memory game Simon, in which the color patterns would start off easy then gradually become more difficult. A sequence of three colors would be called out and the “jumper” would jump in the direction of that randomized pattern. They would begin a regular jumping pattern then perform 2 jumps in each of the three directions. This requires them to twist their bodies in the air until they come down facing that direction. As the exercise continues, a sequence of 3 to 4 to 5 colors would be called out to evaluate how much the student can effectively retain.

This particular pattern was laid out as green-red- blue- purple. Amanda would call out the colors at random and O’s feet would have to land facing the direction of the specific disc. Amanda started out easy by announcing two color names then advanced to a more difficult pattern. Os performance was satisfactory except she had some difficulty with jumping in a 180* circle from green to blue or red to purple. We were able to successfully complete a four-color pattern. Towards the end of the exercise, Amanda included me in the game and let me call out a five-color pattern. O made it through the first four colors but was unable to add in the fifth color. In retrospect, I could barely get five colors when I played the handheld version so my daughter is a rock star.

HOT LAVA VARIATION

Afterwards, O was intent on leading the therapy session. She laid out the balance beam and announced that she wanted to get out of the lava. She did the forward heel to toe without any difficulty but had some trouble walking backwards. She was cooked in the lava several times. O took a few cues from her previous session and asked if she could tap the ball as she jumps off the balance beam into the lava. Amanda was pleasantly surprised at this request and was very accommodating.

ZAP IT!

Amanda took control after that. O said she wanted to play the memory game, but Amanda had a much better idea. She brought out a card game called Zap! The game of Zap! had letters that closely resemble each other such as a lowercase b, d, p, and q. The letters had a line underneath so the participants can distinguish the correct letter of the alphabet. The game of Zap! is a combination of a letter game and the game Uno. The letters are helpful in identifying letter reversals and laterality. Laterality refers to the preference humans tend to show for one side of their body over the other, such as handedness or the primary use of the right or left side of the brain they predominantly use. Letter reversals are common letters a child would often write backwards or upside down such as b, d, p, and q.

The idea is for the student to identify the correct letter and come up with a word that begins with that particular letter. Once the player correctly identifies both the letter and a word, they win the card. The elements from Uno are “skip” and “reverse” cards to make the game more fun and challenging. If the player draws a Zap! card, they lose the card. The player with the most cards wins. Occasionally we had to help Olivia come up with a corresponding word but she was the clear winner, 13-2.

I SPY

The final game for this week’s therapy was the game I SPY. Amanda brought out a copy of their garage sale copy that included a bell, a deck of cards, and four cardboard playing boards. The deck of cards had several images on both sides of them similar to a Where’s Waldo? book. At least one of those images on the playing cards matched up to the images on the playing boards. Once the player identifies an image that matches up to their playing card, they ring the bell and win the card. Amanda included me into the game so I could join in the fun. I know O really enjoyed having me a part of the game. I really want her to enjoy this time even though it’s a lot of hard work.

THE HOME EXPERIENCE

This week home therapy is going to be up to me since Andy will be working a lot of long hours at the hospital. I am really dreading having to play steeple more than anything. I really want to fast forward through and have a different activity. I have found that I would rather do anything, ANYTHING to get out of doing the steeple game. This includes dirty dishes and other menial tasks that do not include practicing steeple. We now have a routine that I would do every other exercise but steeple. Andy would do steeple.

I cheated this weekend. Andy was working the entire weekend so it was the kids and I. I took Amanda’s advice and purchased I SPY off of Amazon Prime the second we got home from our therapy session. She also suggested Spot it so that was added to the cart. Don’t you just love Amazon?

Do you remember how I mentioned I would do anything but play steeple? I took a little bit of nursing discretion and replaced it with I SPY. Whether or not that was the right thing to do is another story.

“I SPY” and “Spot it” arrived shortly before the weekend Andy was supposed to work. I saved the special unopened Amazon box just for the weekend. The kids had seen it arrive on the doorstep that Thursday evening and magically knew the special box contained something for them. We opened the game and M automatically went for the bell. DING! DIIIIING! DIIIING! Over and over and over... I should mention he kept ringing that blessed bell the entire time we were playing. It did not take long before the bell disappeared

Technically, I SPY is not a game for four year olds. Interestingly but almost expectantly, M was successful in spotting every single car that was on his cards. It’s all about a frame of reference right?? “Spot it” was a little more suited for his age. “Spot it” is similar to “I SPY” in which every card has a matching picture when it is next to another card. Since I was trying to play the game on M’s level so he doesn’t feel left out, we modified the rules a little.

M is now interacting with our therapy exercises. It’s important to remember this advice: not all of the exercises should be done with the other child, because an eye specialist prescribes these exercises specifically for O. Some of these activities can cause more harm than good if the person does not have a specific need or diagnosis.

Therapy is becoming a little bit monotonous. Olivia is beginning to dread performing these exercises at home. Sometimes trying to find time to work it in the evening routine is difficult. I have found that it’s easier in the morning on our days at home or right before dinner on work nights. I often find myself trying to rationlaize that we need a night off form therapy unitl I am reminded how much we have spent and more importantly what is at stake.

We need some Hot Lava in our life

THE CLINIC EXPERIENCE

This week I wasn’t invited to the third session. O’s main trainer, Amanda was on vacation this week so I wasn’t surprised to not see her. This week we had a trainer we never met before. O was scared to go back with her and begged for her to allow me back. I compromised by walking O to the classroom. She became distracted long enough for me to quietly slip away without noticing so she could participate in this week’s activities. I patiently waited in the waiting room listening to my audiobook on loan from the library and closed my eyes. An hour later, I opened them to a bounding little girl proudly sporting two Pokémon cards, which she announced one was for her little brother.

Briefly the trainer told me O did great and she noticed the right eye was sluggish while performing the fixation games (no surprise there, right?) and she then explained our homework for the week. This week’s activities were the same games we already know with more variations. I was instruted to have O close her eyes and visualize the respective extremity we call out before moving them while performing snow angels. As a warm up we could have O practice visualization by having her close her eyes and have her tell us about her bedroom.

HOT LAVA

In addition to this we have a new exercise for homework this week. I was instructed to draw a straight line on the floor by using duct tape or something similar and have O walk on the line heel to toe. My reference to this activity is similar to what a police officer would instruct a suspected drunk driver to "walk the line." Since she's seven years old and doesn't understand what "walk the line" infers, we have to pretend there is hot lava surrounding the line to strengthen her balance. Hopefully she will never understand that reference.

During the therapy session the trainer utilized a balance beam and noticed Olivia would try to get through the activity quickly without properly focusing on the instructions. Olivia was to walk heel to toe forwards and backwards at a pace to maintain her balance without having to steady herself. They pretended the floor surrounding the beam was hot lava. In my mind I tried to brainstorm ways to accomplish this at home without putting duct tape on my beautiful hardwood floors.

I mentioned this activity to Andy the next morning. He suggested using the park across the street that featured inlaid wood timbers outlining the play area. It wasn’t necessarily a bad suggestion but my fear is we would never get the children off the slides long enough to finish therapy. I also thought about using the crack that separates the driveway into sections. At a later session, I was taught that something as simple as painter’s tape can be used and still protect the floors.

We are starting to get into a regular rhythm of incorporating therapy into our daily routines. O is already coming up with excuses not to do it but she is outnumbered. It's hard to do after a long day at work and school. It's even harder trying to give our boy child an equal amount of attention while we help O. It would be so much easier if there was some proverbial "hot lava" to help us balance everything and keep it in good working order.

#becausewereadwithourears #visioneer #visualperceptualdelay