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



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.


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.


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.


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.


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.


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!”


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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