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?