Vision Therapy

Boy, getting Madison to read is about as easy as asking someone to jump into shark infested waters.  As I mentioned before, everything was (and much still is) difficult for Madison.  Trying to teach her to identify the letters of the alphabet or numbers was painstakingly difficult.  We tried singing, coloring letters , tracing letters in sand and whipped cream, lacing letters, making them out of clay, stamping them, making them with our body, among many other activities that I did with students in my classroom that had difficulty with letter and number identification.  Many of these were useless activities that although were fun for Madison, had no lasting effect.  In the end, I'm not really sure how she retained this information, I just know that it took quite a few years.  And then after all that, she was expected to learn how to read...really?  That process was (and is) just as difficult as letter identification.   Her teachers in kindergarten and first grade continued to tell me that there was nothing to worry about, that she was "just a little behind".  However, they had no idea how much effort Madison was putting in to be "just a little behind".  I knew there was something more going on and decided to have her privately tested at the end of first grade.  That is when we learned that she had a visual processing disorder.  She is now in fourth grade.

 It was good to finally have a diagnosis.  We took her out of private school and put her back into public school where she could get the services she needed.  I also decided to get her a tutor so that I could spend more time being "mommy" and less time being the one that was always making her "do school stuff".  During this time, I tried all the reading programs I had used as teacher, as well as purchasing additional ones recommended by various educational specialists.  These are some wonderful programs, but Madison still had trouble retaining visual information and learning basic reading skills.  I was so frustrated for my daughter and would have done anything to make school easier for her.

 One day I was at lunch with our associate pastor, and she mentioned that her son had gone to vision therapy.  She said that his symptoms, or problems, were not exactly like Madison's, but that it might be something that we may want to look into.  So, we did a little research and decided, controversial or not, if there was a chance that it could help our daughter even slightly, we were going to try it.  Shortly after we made our decision, Madison told me that she could not focus on one word at time when she looked at words in a book or on a worksheet...that she saw many words at one time.  Imagine how difficult that must make it to read a word, a sentence, a paragraph, a page!  This seemed to validate our decision.

What is Vision Therapy?  Vision Therapy is a doctor supervised program that is customized to each client depending on their needs that involves visual activities designed to correct certain vision problems and/or improve visual skills.  Its purpose is to teach the visual system to correct itself.  Vision Therapy is l
 like physical therapy for the whole visual system and the parts of the brain that controls vision.
Many "tools" play a roll during vision therapy such as balance boards, brock strings, balls, metronomes and other items.  It can also include activities that use prisms, lenses, flip glasses and computer programs.  They have also recently developed a Wii activity to aide in vision therapy.
Vision therapy is a process that demands a commitment between the therapist, doctor, patient and in children's cases, the parent.

Problems that Vision Therapy can correct:

• Amblyopia- or "lazy eye" is a vision development problem where an eye fails to attain normal visual acuity
• Strabismus-misalignments of the eyes, such as crossed eyes.  The success of VT for strabismus depends on the direction, frequency and severity of the eye turn.
• other binocular vision problems-eye teaming problems that don't produce visible eye turns.  This can cause eye strain and problems with near vision and reading.
• eye movement disorders- accuracy of eye movement 
• Accommodative (focusing) disorders- near-far focusing skills
• other problems-visual-perceptual disorders, brain injuries,vision problems associated with developmental disabilities

The reason we decided to take Madison to VT was because she had been diagnosed with a learning disability that drastically affected her reading.  All the academic resources that she was being afforded were not making much of a difference.  There is a debate among optometrists and opthomologists about the relationship between vision problems and learning disabilities.  Many optometrists believe that the multidisciplinary techniques of vision therapy is a beneficial treatment for certain  types of  learning disabilities.  They feel that these children have underlying vision problems that are contributing to their learning problems which can be helped with vision therapy.  However, many opthomologists feel that it is an ineffective way to treat learning disabilities and that there is not scientific evidence that backs up the claim that VT helps with learning disabilities. 

So, let's define what the IDEA (Individuals with Disabilities Act) states a learning disability is: "...a disorder in which one or more in which one or more of the psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia."  IDEA also says LD does not include learning problems that are primarily due to vision, hearing, or motor disabilities.  But...there are learning-related vision problems.  As stated in an article by Rob Murphy, these include eye health (drastic sight problems), functional vision problems (includes eye teaming, fine eye movements and accommodations), and perceptual vision problems (visual perception-understanding what you see, identifying, deciding its importance  and relating it to previously stored info in the brain).  I feel that there are probably many children that are dealing with both and that both can affect their ability to read.  Therefor, I am on the fence with this debate.  I know that Madison had severe functional vision problems and perceptual vision problems.  The functional issues (eye teaming, fine eye movements, etc) have gotten much better.  She is still working on and still needs to work on perceptual vision (this includes recognizing words she has previously seen and using her eyes and brain to form a mental picture of the words she sees).

So, how does all this relate to Madison's visual processing disability and her vision therapy program?  Well, I guess the jury is still out.  She began this process in the spring of 2008 and was told it would take a year.  Here we are 2 years later.  It would be wrong to say I have seen no improvement.  Her eyes definitely are working better together (improved functional vision).  She is tested with a visograph, a device that allows us to see exactly how her eyes are working as she reads.  It tests 6 different areas of eye movement: tracking, saccadic movement, words per minute, peripheral scope, bilateral coordination and comprehension.  She is making progress in all areas, although comprehension has never been a real issue for her.  However, she still relies heavily on her auditory skills to compensate for her weaker visual skills.  Her fluency is slow and she still substitutes words that look similar to the one she is reading (poor perceptual vision).  The program has also helped her balance and coordination, skills that she has had difficulty with since she began walking.  The process starts with physical exercises and progresses to what we call more "eye" related exercises.  She attends an hour session once a week and has 20-25 minutes of VT homework each night.  At her last progress check, I asked if there was an end in sight.  We hope to be done by the end of summer.  Will she be reading at the same fluency and accuracy rate as her peers when she is done?  Will this have all been worth it?  Well, the simple answer is, if it has helped her even just enough to cut down homework time 10 minutes or give her an ounce more confidence when she is reading, yes, it has been worth it. Has it been the "miracle cure" we had heard stories about, well, maybe the results will not be all that we hoped, but it has not hurt her, and we are always willing to try anything that will help our children.

If you have had experiences with VT I would love to hear your stories, especially how your child progressed after the program ended.

If you think your child might have a learning-related vision problem here are some symptoms our doctor says to look for...I have highlighted each one that applied to Madison:

• losing place while reading, or using a finger to keep place
• headaches
• dislike or avoidance of reading or close work
• blurred vision or double vision
• turning or tilting the head to use one eye while reading, or covering one eye
• crossed eyes or eyes that appear to move independently of each other
• short attention span during visual tasks
• difficulty remembering what was read
• rubbing eyes or excessive blinking
• placing head very close to book or desk when reading or writing
• omitting or repeating words
• confusing similar words
• slow reading speed or poor reading comprehension
• persistent reversal or words or letters (after 2nd grade)
• poor eye-hand coordination
• evidence of developmental immaturity