Good advice: Slurpee's are delicious

Week 2

THE CLINIC EXPERIENCE

The second week started of pretty much like the first, except there was little to no apprehension. We had a different trainer this week but I was looking forward to the appointment. Since O is timid of new people, I was invited into the session. Amanda had a vast array of activities for O to participate in. These activities are mostly centered on hand eye coordination and fixation. Fortunately they are also short in duration.

READING EYE Q

The first activity consisted of O looking at a screen. Amanda explained that the screen has a special sensor in which it utilizes biofeedback by detecting the movement of the eyes while the student is reading. The student is to quietly read a short story and then answer ten short questions pertaining to the plot of the story. These questions are then scored as a percentage to obtain a baseline of how efficiently the student can comprehend what they have read.

O struggled with this exercise. The results were immediate. In addition to the exact words O had read, a red squiggly line appeared on the screen marking the precise movement of O’s eyes while reading. The lines would jump from word to word, sometimes missing two or three words at a time. There was an instance where O completely missed an entire line of the story. She would fixate on one word then go to the third or fourth word prior then shift her eyes to the next line. Her eyes are all over the place like little plastic googly eyes used for crafting. O was having such a hard time, Amanda had to read the questions out loud for O to understand what was being asked. Even then she she mostly guessed. She honestly didn’t know the answers to these basic questions. Not surprisingly, her comprehension score was 40% but I am sure it would have been lower if she wasn't randomly guessing. The heart crushing reality is she really doesn't have any idea what she's reading.

ROSIE

Amanda introduced us to a new friend, whom O named “Rosie.” (sidenote, O names everything "Rosie" or "Lucy"). This particular Rosie is a purplish pink plastic monster that fits perfectly on a child-sized finger. Rosie is another tool used to evolve the game of steeple and keep the kids engaged in the activity so it doesn’t become monotonous. While the student has their fingers pointed in a steeple, Rosie goes along for the ride. Rosie also gives the child a sense of control as they are coordinating both hand and eye movements.

After putting Rosie in her new house (O’s pink eye kit that also contains her eye patch), Amanda brought out a balance board and showed O how to stand in the middle of the board to redistribute her weight to center the board in the middle. O tried to balance using very choppy and uncoordinated movements. O briefly managed to center the board in the middle so we both cheered her on to help gain confidence.

PALMS AND FINGERS

The final activity for the session involved a ball hanging from the ceiling from a string and was sized big enough for a child to grasp their hands around. This game is used mainly for fixation and tracking. The activity consisted of Amanda gently tapping the ball with alternate hands to O. O then had to mimic the motion by alternating with each hand while tapping the ball back to Amanda. When Amanda would randomly call out “palms” O would have to catch the ball in her palms of her hand then tap it back to Amanda. When Amanda would randomly call out “fingers” O would have to catch the ball with her fingertips and then tap it back to Amanda. At this point O had warmed up to Amanda and she was having fun. She started to casually chat while tapping the ball back and forth so she was forgetting to alternate her hands. With a little bit of reinforcement and praise, we got O back on track.

AND NOW WE PRACTICE AT HOME...

Home therapy was a lot like the first week with a couple of variations. We were instructed to continue playing snow angels and steeple for the next week. We would play steeple just like before except we were told to perform right eye-left eye-right eye to give that right eye a little more exercise. For the next week we would patch the left eye, then the right eye, and finally the left eye. Rosie was a nice addition to the game because O really doesn’t like the steeple game (and neither do I). Not only does she get to push the start/pause button on the phone timer, but she also gets to control Rosie. We were instructed to perform snow angels exactly like the week prior but when we call out multiple body parts O is supposed to move her extremities in unison without any forethought.

Andy has pretty much taken over home therapy because my late work schedule doesn’t correspond to optimal therapy practice. Practice should be completed as early as possible because once O becomes worn out from the day, her attention span is basically diminished. This results in a difficult practice session with an angry child (O) and frustrated parents (us). She seems to have incorporated therapy into her routine, sometimes practicing begrudgingly and other times excited to show off Rosie to her little brother.

I’m not sure if I have noticed this before but everywhere we go Olivia is trying to read everything. Whether it’s the white board at daycare announcing the weeks summer activities or words in a book detailing other title by the author she really wants to read. Although she is building more confidence with reading, she still hasn’t mastered the mechanics of reading. She is starting to be able to sound out letters with more skill but she continues to skip a large number of words. The fun thing to watch is when she sees a word and surprises herself. This is especially true when she realizes day care is planning banana split treats for the day.

On a side note, treats are becoming a regular occurrence after her therapy appointments. A week prior I mentioned to O’s best friend that I was taking O out for something special. Her friend asked me if I was going to take O out for a Slurpee. I replied by telling her that O has never had a Slurpee before and she looked at me with a look of shock on her face. She looked me square in the eye and said, “Slurpee’s are delicious, and I highly recommend them.”

Our first week of therapy

I began this written account for my eyes only, so everything is written retrospectively. Originally, I didn’t mean to share it. I wanted to document the types of exercises we were doing in addition to how we were coping through this long year of therapy. It wasn’t until a meeting between myself and O’s educators that prompted me to advocate for this little known (or talked about) diagnosis and educate people on the impact it has on learning. It eventually bloomed into an experiment (if you will) to see how and when it actually impacted O’s academics and other aspects of her life.

Throughout this endeavor, I have been asked many times what type of things do we do in vision therapy to make it successful. As you can recall, there are many tools in the proverbial toolbox that are used to manipulate the neuroplasticity in the visual fields of the brain. As I discuss these exercises, it is important to remember that every student in the program is going to have their own activities that fit their unique diagnosis. I have been warned that practicing exercises that are developed for a particular student can be detrimental for those not involved in the program. In other words, these activities are like medicine. We always tell people not to take medicine that is not prescribed to them because they can be harmful if not monitored by a doctor. Same thing. Don’t try this at home. Also, this is my family's experience and everyone is going to have their own unique perspective.

We finally started vision therapy in the middle of July. There were many mixed emotions and the stress level was high. We had sent O to summer school to help her improve her reading and writing skills over the summer. Unfortunately, it did not make much of a difference. O was nearing the end of her day of summer school so I ensured she had a good lunch with proper nutrition. The second we got into the car to go to her session, the clouds opened up and dumped a torrential amount of rain. In my mind I was hoping this wasn’t an omen on how the next year would go.

I anticipated not being able to attend the session but I was pleasantly surprised when I was invited to attend. We covered the usual housekeeping items consisting of paperwork and “rules” and “expectations.” Naturally when you hear the word “expectations” or “rules” a person would instinctively cringe, but it wasn’t that way at all. They introduced this in a more friendly and encouraging manner as “insider tips for the Visioneer journey.” This approach made it seem less overwhelming.

I will admit that I am an instant gratification person. I need to see results, now. After they practiced the activities, I found myself hoping that O will be instantly transformed. I have to put this out there… it won’t. This process is a gradual one and it's not going to happen overnight.

"Practice doesn’t make perfect, perfect practice makes perfect."- Visioneer insider tips

THE EXERCISES

Steeple

As silly as this may sound, I think of this as “eye yoga” because the movements simply stretches the muscles of your eyes in all of the directions to improve the eye’s ability to move around and focus on targets. Its not as “new agey” as it sounds and you don’t need a super cute outfit to practice them. You simply form your fingers in the shape of a steeple and move them in all directions of the cardinal gaze (for all of you medical folks out there) and hold each direction for at least twenty seconds and focus on a fixed point.

For you non-medical folks out there, the purpose of the cardinal gaze is to test how efficiently the six extraocular eye muscles are working with cranial nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens respectively.) They work against each other to control the movement of the eye in different directions. Normal vision perception requires the proper functioning of these muscles. These six extraocular muscles include:

1. The superior rectus muscle innervates upward movement of the eye

2. The superior oblique muscle innervates the downward and outward movement of the eye

3. The lateral rectus muscle innervates the outward movement of the eye

4. The medial rectus muscle innervates the inward movement of the eye

5. The inferior oblique muscle innervates the upward and outward movement of the eye

6. The inferior rectus muscle innervates the downward movement of the eye

Snow Angels

The eyes are connected to our entire body. In order for us to have control and coordination in our entire bodies, we need to possess that same control in our eyes. If a child is having difficulty with their gross motor skills (running, walking, etc..), the child would also manifest difficulties utilizing their fine motor skills (such as eye-hand coordination, messy writing, tracking objects, copying words from a board, etc..). Poor eye movements are intricately connected with these motor skills and results in poor performance in school or sports. This exercise allows the integration of the mind-body connection involving the top, bottom, and sides of the body in a coordinated manner.

The child is instructed to lie flat on their back with their arms at their sides and legs together. A command is then given to move a specific body part and the student is encouraged to visualize the movement before moving the specific body part. Once they are ready, they are to move the specified body part. Once this step is mastered, the exercise can be modified to increase the difficulty. This can be done by adding two step commands such as right arm, left leg, or left arm, left leg, etc.. etc…

Additional eye exercises

O was instructed to stand facing a wall covered in stickers different pictures consisting of rainbows, clouds, hearts, etc. She was instructed to take a yardstick and point at the different objects that were called out without moving her head. During this exercise the trainers evaluated her peripheral vision while wearing the eye patch. She was able to perform the exercise with a small amount of difficulty.

AND NOW WE HAVE TO DO THIS AT HOME....

After watching them perform the exercises, I left feeling confident that I could do this at home. However, once I got home that all changed. The first day of home therapy my husband was attending a work event in the evening so it was all up to me. I did not listen to any of the advice given to me the day prior so you can probably guess what happened. The first day at home performing therapy was an absolute FAIL…or at least in my mind it was.

Picture this:

I returned home late from work and the babysitter was giving both of the kids a bath. The bath was merely a plan to settle the kids down who were obviously riled up with energy. They were in the tub splashing the water outside of the tub yelling and screaming with glee and complete jubilation. Once they were dried off and ready for bed, they continued to run around with the energy of a rocket booster. Inside of my head I kept thinking over and over, “gotta get this done, gotta get this done.” My plan: Therapy. Bed. Therapy. Bed. What resulted was quite the opposite.

I figured since I watched the exercises during the therapy session that I could do something as simple as a modified cardinal gaze (I AM A NURSE, right?) and perform a few snow angels (I WAS A KID, right?). WRONG!!

First of all, my four year old wanted a “pirate patch” too. I couldn’t possibly even think of beginning therapy without him being able to play too. I spent thirty minutes searching for his “pirate patch” and was unsuccessful in locating it. I decided to proceed regardless. This was a bad choice. I started the steeple game with O sitting on the couch and I was crouched to her level. I tried to do it as close to how it was done in the office. Before I was able to proceed, M took this opportunity while I was sitting on the floor to climb on my back and start bucking his legs to start rough housing. I continued to practice the exercise. Needless to say, it was not a very good session.

The snow angels exercise did go a lot smoother. We practiced it the way we were taught in the office. Somewhere along the way we started to call it the “pencil game” which doesn’t make any sense at all because pencils don’t move their wings and legs in the snow. Whatever works.

The second day of home therapy I decided to break up the exercises so I could try to engage O in the activity. After getting O ready for school, we played the pencil/angel game. After school, we did the steeple game. Unfortunately I realized I wasn’t doing the steeple game correctly after I performed it. At this point O was mentally done and there was no way I was going to be able to salvage any extra time for therapy. The directions explicitly state to hold each direction for five seconds and let the eye steadily fix on the finger. I was performing the activity in a manner in which the cardinal gaze is traditionally tested.

The remaining days of the first week, we practiced the exercises first thing in the morning while O was fresh. Other than a few behavioral problems with her attitude towards therapy, it went off without a hitch. At this point I enlisted the help of her father to practice the exercise simply because of frustration. I knew if O saw my level of frustration with the exercises then she would perform them with the same level of enthusiasm.

Towards the end of this first week, my husband proved he is a lot more efficient with the training. Not only does he have O’s attention, he seems to do it effortlessly. The steeple game is not O’s favorite activity so he has learned to include her in the game to make her feel like she has a choice. His first tactic allows O to push the start button on the phone timer (who knew?). Then he will move his fingers slowly towards each direction and allow her to count to five. If she is not holding her gaze, then he will have her add a couple of seconds to that direction. The entire time he holds her head straight because she tries to tilt her head in the direction of their fingers instead of allowing her eyes fix on the gaze. She does have a tendency to try to move her head especially when her lazy eye is being stressed.

This first week has left me feeling overwhelmed. I am not sure how to keep this going for the next 51 weeks. I honestly don’t know how other families have the tenacity to continue this kind of therapy on top of their marriages, other children, careers, school, etc. How do they do it?

Destination... diagnosis

What is vision therapy? What types of things do you do during vision therapy to make it effective? I have frequently been asked these questions during the recent months from family friends. Its difficult to repeat the same thing over and over only to not be able to provide them with a sense of understanding. The only answer that can do it justice is, “it’s not one specific thing, it’s a lot of specific things.”That answer usually leads to even more perplexing and puzzled looks, but it's not something that can be explained over a matter of minutes. In order to understand vision therapy and the benefits, a person must have an understanding of the disorder behind it.

Vision therapy is a customized, progressive, non-surgical approach utilizing visual activities to correct visual problems or to enhance visual skills. Basically, it’s physical therapy for the eyes. Visual training is supervised by a doctor, usually a developmental optometrist and implemented by a vision trainer or therapist. The exercises are performed over a prescribed amount of time by the physician and are taught to the family so they can be performed at home.

The human brain has an innate ability to change its function and structure in response to external stimuli, known as neuroplasticity. Vision therapy can initiate neurological changes to optimize visual performance and correct visual problems. These exercises are applied to correct vision problems that interfere with efficient reading and learning-related vision problems. Sports vision training is designed to enhance visual skills related to improved sports performance. The exercises vary for each individual depending on their specific eye disorder.

As I was about to learn, the length of vision therapy is decided based on the age of the individual, the specific eye disorder, and the goals of therapy. It can be a relatively short period of time or completed over a long period of time. For serious disorders it can take awhile for the eye muscles to relearn skills and change the signals in the brain.

In our case, Dr. R. performed the same comprehensive eye exam as “the other guy” in the same systematic manner. Thankfully, we did not have to repeat the handwriting portion of the testing. We were able to use the results of the first exam that we were able to have faxed over. That did not come without its disadvantages. In this circumstance, Dr. R was not able to observe the mannerisms and behaviors O used during the writing portion. They were not able to observe how long it took O to perform certain tasks. Although I was present during her initial testing, I was not a reliable source because of a lack of specified training. The only reason we omitted it in the first place was to spare O from even more rigorous testing and delay treatment even further.

The eye disorders that are treatable with vision therapy include amblyopia, binocular vision problems, eye movement disorders, accommodative (focusing) disorders, visual perceptive disorders, and strabismus, to name a few. These disorders can result in a profound debilitating on reading comprehension and learning, fine motor skills, and gross motor skills. They can also interfere with a child’s confidence and social skills, making the world a much harder place to understand.

Unfortunately with our “second opinion,” O was diagnosed with all but the latter of these disorders. We have a lot of work to do in the coming year. Instead of 42 weeks of therapy, we have 52.

We started this journey by documenting the experience of how it has affected the normal daily dynamics of our lives. This project morphed into a tale of how it not only affects our family, but how it affects O’s ability to learn and comprehend the English language and learn the true art of how to read and write on her developmental level. Along the way we have come across ignorance from medical professionals and blatant disregard from educators. People have a hard time believing in something they know nothing about. Rather than listening, people act as though they are true experts in their respective fields without contemplating the future of a little girl.

What makes me an expert on vision therapy? I’m not. As any other parent, I would like to believe that I am an expert in the field of “My Child.” I am going to go through this next upcoming year with hope that this is the definitive answer into resolving O’s learning struggles and her disdain for reading. Although I may never reach my goal of being on the New York Times bestseller list or appearing on Oprah Winfrey’s book club list, (doesn'y Reese Witherspoon have an equally fabulous list, too? A girl can dream, right). I aspire to touch and educate at least one parent in the hopes to helping other children with “learning disabilities” learn how to read.

#becausewereadwithourears

#visualperceptualdelay

#visioneer