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Reading Series: Part 1

Part 1: External Factors

Are there factors that can cause vision problems without something being inherently wrong with a person’s visual system? Yes! These are a few simple ideas to take into consideration that may produce good results for little to no money. 

Slant Boards

  • When you see a picture of a school desk from the turn of the century, a few details may catch your eye. Many desks had bench seats attached, there was often an inkwell, a groove to set your pencil in, and a slight slant of the desktop. It makes sense that the desks of today don’t require most of those features, however one that students could still benefit from is the slanted desktop. This part of the ergonomic design was actually really good for a person’s overall posture and school performance. The eyes have an easier time focusing when the object of their attention is parallel to the face. A 22° slope seems to be the most comfortable slope to reduce visual and postural stress in the body. This can help with reading and writing too so that the eyes have an easier time focusing and a person can better track the lines of text/paper. The slant boards we use here in the office are from Visual Edge.

Reading Distance

  • There is no “one size fits all” distance a book should be from someone to read comfortably. What is recommended though is known as the Harmon Distance. To determine this for yourself, place the knuckles of one hand under your chin and lift your arm out in front of you. Wherever your elbow ends is where your reading/writing material should be placed. If you find yourself holding the book closer or further from that distance consistently you may need an update on your glasses prescription or possibly a visit with a developmental optometrist to assess other possible visual issues. 

Lighting

  • Don’t underestimate the power of proper lighting. I don’t know how many times I was told growing up to turn the light on when I was reading so I wouldn’t ruin my eyes. I grumbled about it then, but now I know lighting really can affect your vision. Your eyes need enough brightness to not strain when looking at text, but avoid sitting in an area with a glare as that can also disrupt visual processing. Try to utilize natural sunlight as much as possible and reduce reliance on fluorescent lights as that can also minimize head/eye pain.

Sometimes little changes are all you need to notice improvement in how you see, feel and learn. We hope these simple suggestions will help you on your way to better vision. If you have questions or would like to schedule an appointment reach out to us by phone 402-502-0043 or email us at [email protected]

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Christmas Gifts for Sensory Development

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Visual Processing Disorder & Vision Therapy

We play with blocks during vision therapy. Blocks of different colors, shapes, textures, symbols, some that allow us to make pictures, others to observe, some to build with, but all to help our brain process what we are looking at. Although the games can be fun, that isn’t the primary reason we play them. A visual processing disorder (VPD) exists when the brain is not correctly interpreting what the eyes are seeing. The diagnosis has nothing to do with visual acuity or how clearly the eye sees stimuli. This miscommunication can cause some misunderstood difficulties for those with this diagnosis. In this article we will explore skills that are difficult for children with a VPD, reasons why having a strong visual processing system is important, and how we help train the brain to improve these abilities here at our office. 

 

Difficult skills

A patient could have one, a combination or all of the following types of visual processing disorders. An article by the Optometrists Network¹ shares a quick description of skills that are difficult. 

  • Visual Discrimination–noticing similarities/differences between shapes, sizes, objects, colors and patterns. 

Ex: Confusing certain letters and numbers, loses place when reading aloud, struggles to notice details or differences

  • Visual Figure-Ground–noticing what is important amidst a busy background.

Ex: slow reading speed, difficulty with copying notes from board, trouble scanning for information/concentrating when page has many small words

  • Form Constancy–understanding that a shape stays the same regardless of its color, orientation, size or location.

Ex: can’t find missing items even if out in the open, difficulty recognizing known places or objects in a photograph, trouble reading unusual fonts

  • Visual Closure–predicting what a shape or picture looks like if only a portion of it is visible

Ex: words already learned require extra effort to sound out, piecing together a jigsaw puzzle creates tension, can’t find an item if the entire thing is not visible

  • Visual Memory–remembering something you saw after it is gone. 

Ex: individual letters and sight words are constantly needing to be relearned, struggles both with retaining information learned when reading and doing math, poor spelling

  • Visual Sequential Memory–recalling images or events in the order you saw them/they occurred

Ex: trouble putting shapes/pictures/letters in the order they saw them, switches around letters in a word, patterns are not easily recognizable

  • Visual Motor Integration–responding to visual information with an action

Ex: poor hand-eye coordination, often colors outside the lines, sloppy handwriting

 

The Power of Visual Processing

Did you know you have superpowers? I don’t mean the ability to time travel, have super strength or the all time favorite “flying.” A brain that is able to take in sensory information quickly and accurately gives us a tremendous boost in our overall quality of life. It allows us to explore our world so that we can seek, learn and achieve whatever interests us. Reading and writing aren’t the only areas impacted as some others include: recognizing faces and expressions, looking for a lost object, correctly interpreting road signs/billboards, seeing a story in your mind and planning ahead. 

 

Visual Processing Dysfunction at our Vision Therapy office

We have several different means by which we challenge visual processing at our office. At the start of this article we expressed the usage of a variety of blocks. Geoboards are also a great tool to construct pictures, plan ahead, and make proper use of space. You can even add in some memory work too! Visual memory style activities can be done most simply by hiding an image and covering it up again (think of a more age appropriate version of peek-a-boo), or in a more complex manner by noticing an image and creating it turned in a different direction, or even putting letters/words in the order you saw them. Not every patient has a visual processing disorder though we often incorporate these types of activities into their program to some degree because we want to challenge and grow all areas of the visual system. If you would like further information please reach out to us and we would be happy to answer any questions you might have! 

 

Resource

Signs of Visual Processing Information Dysfunction¹

https://www.optometrists.org/vision-therapy/guide-vision-and-learning-difficulties/guide-to-visual-information-processing/signs-of-visual-processing-information-dysfunction/

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Summary of “Vision and Learning” by Heike Schuhmacher M.D.

Do you remember how you first learned about Vision Therapy? It probably doesn’t surprise you that most people don’t know it exists until they or someone they know is participating in it themselves. So, what about all of the children who are suffering from learning difficulties and parents and schools can’t explain why? Dr. Heike Schuhmacher’s book titled Vision and Learning, gives a detailed yet reader friendly description of vision and hearing problems that do affect a population of students in negative ways. There is hope though as she shares her knowledge in this field that can affect the lives of these kids and those who care for them. 

Dr. Schumacher’s experience as a primary care and family physician who specializes in pediatric developmental disorders has allowed her to utilize different therapies with her patients. The emphasis of her therapies has been Vision Therapy.  In fact, she was the first German physician to become a Fellow of the American College of Optometrists In Vision Development (COVD). 

 

Visual and Auditory Systems Work Together:

Many of us take our senses for granted. Perhaps you have been blessed with outstanding functional vision and auditory skills as expressed by a pediatrician or from a school screening. Maybe you get by okay although words appear a little blurry from time to time or we mishear what someone says. Imagine a child trying to read a book if the letters look double, or trying to make friends but can’t understand what others are saying. What if that child also got headaches every time they had to read or write and couldn’t follow the directions spoken to him as was expected. This is usually the point where educators and parents become worried. Families are looking for answers but in many cases are altogether uninformed or under informed about the key roles the visual and auditory systems have on learning. 

Vision

“Vision is the brain’s way of touching the world” is the belief of the French philosopher Merleau-Ponty. So much of our abilities to learn, experience, perceive, and understand our world is through vision. With that being so, it is important that each part of the visual system can work optimally. Dr. Schumacher includes in her book the cybernetic model of perfect vision created by Arthur Marten Skeffington, the father of developmental optometry. This model showcases how four different visual functions need to work together to make proper vision possible. Those functions are: visual acuity/focusing, binocular vision, eye movements, and processing of visual perception. To simplify, here are a few real life struggles students may display with these functions plus body awareness and motor skills:

  • Visual acuity/focusing: focusing clearly when looking near or far
  • Binocular vision: fusing visual impressions from both eyes into one image, having optimal 3D vision at all distances, 
  • Eye movements: maintaining a steady fixation on a point, visually tracking an object in all directions with control, following a line of text accurately
  • Processing of visual perception: perceiving at one glance a number or letter combination or an entire word, successfully storing and recalling the combination and sharing it verbally and in writing 
  • Body awareness/motor skills: fine motor skills, graphomotor skills, eye-hand coordination, knowing where right and left is on his own body and on others

Hearing

When students are at the stage of learning to read and write they rely on their ability to process language as they hear it and also when they speak. This can induce reluctance and resistance in students who have Central Auditory Processing Disorder (CAPD). Phonological awareness and auditory working memory are 2 key skills that Dr. Schuhmacher mentions are impacted. She further gives a list of symptoms experienced by students with CAPD, some of those include:

  • Noticeable noise sensitivity
  • Asks questions for reassurance
  • Problems in following directions
  • Often looks to see what others are doing
  • Pronunciation errors persist for a long time
  • Confuses words that sound alike: them/then, fish/dish, head/bed
  • Actions do not correspond to the content of the task instructions
  • Poor auditory memory, both in duration and sequence (unable to recount sentences, stories, or task instructions or to spell out longer words)

Working Together

Without a doubt, children with visual disorders as well as auditory processing difficulties are going to struggle in school. Getting the visual and auditory systems thoroughly tested is the first step in identifying the child’s challenges. Dr. Schuhmacher encourages students who have auditory processing and speech disorders to get assessed by a developmental optometrist. Vision therapy can help those students and any student with learning difficulties to increase and enhance the connection between the eyes and the brain to help with many school subjects including: reading, writing, spelling and math. Neuroscience is now telling us that parallel sensory systems like the visual and auditory systems can have complimentary benefits on each other when one is being remediated through a therapeutic/treatment process.  

 

Conclusion 

“Comprehensive Testing of all relevant visual and auditory functions is essential for all school children with learning problems,” Dr. Schuhmacher states in bold print in her book. School screenings are not enough to make sure kids are equipped with the skills they need to succeed in school. Developmental optometrists, pediatric audiologists and speech/language pathologists can administer assessments to identify any problems and create plans to improve them. Doctors, teachers, and you with the knowledge you have of these struggles can change the trajectory of your child’s schooling.

If your child is experiencing troubles with learning we want to help! Contact us at Nebraska Visual Integration Center to help determine if a functional vision evaluation may benefit your child, to get more information, or simply to ask any questions you have about vision and learning. You can reach us by phone at 402-502-0043 or by email at [email protected] 

We look forward to hearing from you! 

 

Resources: 

Vision and Learning: A Guide for Parents and Professionals 

by Heike Schuhmacher M.D. 

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Dyslexia or Undiagnosed Functional Vision Problem?

The term “learning disability” is expressed frequently between concerned parents, educators, and anyone who feels they have one. You may know of a relative, a friend’s child, or even your own child who has been diagnosed during their school years. The LD Resources Foundation¹ states on their website that 8-10% of children under 18 have some form of a learning disability. One of the top 5 most common is Dyslexia, often thought of as a disability in reading. When looking for a cause of symptoms it is important to determine if the person has strong functional vision skills or if a deficit is causing learning problems mimicking Dyslexia.

What is Dyslexia?

What do you know about Dyslexia? Common knowledge leads us to understand it is a problem with reading. While that is true there is a little more to it than that. This definition posted on the Edublox Online Tutor Website² brings to light visual dyslexia. 

“Dyslexia is considered to be a neurological disorder in the brain that causes information to be processed and interpreted differently, resulting in reading difficulties.

The terms visual dyslexia and auditory dyslexia are often used by scholars to describe two main types of dyslexia. Visual dyslexia, also called surface dyslexia, dyseidetic dyslexia, or orthographic dyslexia, is a subtype of dyslexia that refers to children who struggle with reading because they have problems remembering and discriminating visual gestalts.”

 

What are common symptoms of Dyslexia?

Not every person with Dyslexia will present with symptoms identically, though they often have symptoms that affect 3 skill sets. Someone with Dyslexia typically struggles with phonological awareness, verbal memory, and verbal processing speed. The Optometrists Network³ wrote an article giving a detailed description of what Dyslexia is and how it presents in different age groups. This is not an exhaustive list, but it does demonstrate how the person is impacted by the 3 symptoms mentioned above.

  • Under Age 5 
      • Recognizing letters and their sounds
      • Getting the letters confused when saying a word
      • Learning frequently used word progressions (ex. Days of the week)
  • Age 5-13
      • Saying a word backwards/switching letters when reading (ex. saw vs. was)
      • Incorrectly saying/writing letters and numbers that look similar (ex. p vs. q and 2 vs. 5)
      • Remembering math facts
      • Remembering spelling rules
      • Following directions in the correct order
  • Age 13 and Above
      • Reading out loud and/or below grade level
      • Recalling the main ideas of a story/comprehension
      • Understanding jokes
      • Managing time

Can functional visual problems present similarly to Dyslexia?

Before beginning a formal assessment to determine if someone has Dyslexia, it is recommended they undergo a specialty vision examination to evaluate the 3 areas of visual functioning: integrity of the visual pathway, visual efficacy, and visual information processing. Oftentimes binocular vision problems (especially convergence insufficiency) can be confused with Dyslexia or may accompany the diagnosis. Those symptoms, taken from Dyslexia and the Vision System⁴, are listed here:

  • Reversing letters like “b” and “d”
  • Skipping words or entire sentences when reading
  • Struggles to copy off the board
  • Words look blurry or move
  • Has trouble spelling
  • Low reading comprehension
  • Reading slowly
  • Becomes easily tired and eyes feel strained when reading

Can Vision Therapy help?

Yes! In many circumstances where the person is diagnosed with a vision issue they can work on various skills in Vision Therapy to improve the brains’ ability to coordinate the eye muscles and the connection between the eyes and the brain. Several patients begin therapy citing struggles with reading. We know the importance of reading, writing, memory work and being able to plan ahead as well as several other life skills. A few activities that may help get the eyes into the proper alignment and help the person know where they need to look include: reading charts in a certain way, using a set of special blocks moved in different patterns to form words, and using specific glasses to fuse 2 images together to create 1 image with clarity and depth. It can be a life changing experience to receive Vision Therapy amidst school, work, or life struggles.

If you or someone you know would like to schedule a functional vision exam feel free to contact us by phone at 402-502-0043 or send an email to [email protected]. 

 

Resources:

The Top 5 Most Common Learning Disabilities and their Symptoms¹

https://www.ldrfa.org/the-top-5-most-common-learning-disabilities-their-symptoms/#:~:text=The%20top%20five%20most%20common,dyscalculia%2C%20dysgraphia%2C%20and%20dyspraxia.

Visual Dyslexia: What It Is and How to Treat It²

https://www.edubloxtutor.com/visual-dyslexia/ 

Does My Child Have Dyslexia³

https://www.optometrists.org/childrens-vision/vision-for-school/dyslexia/ 

Dyslexia and the Visual System⁴

https://www.optometrists.org/childrens-vision/vision-for-school/dyslexia/dyslexia-and-the-visual-system/

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Convergence Insufficiency Treatment: Vision Therapy vs. Neurolens

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A Teacher’s View on Vision Therapy Conclusion

 

Conclusion: More to School than Meets the Eye

There is more to school than reading a book, writing a paragraph, or solving a math equation. What about all those sometimes forgotten skills that help us to be successful as we take notes, follow directions, play a game, take a test or interact with classmates? These abilities cannot be ignored no matter if the student is primarily an auditory, visual or kinesthetic learner. I have learned that since the eyes take in the information and the brain makes sense of what it sees, the visual system is of high importance. 

 

General School Difficulties

  • Having efficient speed/accuracy/ memory needed to copy from the board to their paper
  • Forgetting which way was right or left when playing games
  • Mixing up cardinal directions
  • Following multistep directions
  • General ability to process information and remember it
  • Wearing shoes on the wrong feet
  • Proper organization of school supplies/work
  • Needing to touch everything to know how it feels

 

 

Education and Vision Therapy

I am sad when I think of my students who lost confidence to do their work correctly and retreated into themselves. I also had students do the opposite, who acted out behaviorally because doing the work was so hard for them. Staying at either end of the spectrum for too long is not a place we want a child to be. Something that vision therapy offers is the chance to be in an environment where making mistakes is okay. During vison therapy we learn and grow in multiple ways at each session. While working on eye focusing skills we learn patience. We teach our eyes to work as a team, while being a part of a team that encourages each other to do our best. Our eye tracking abilities improve while we push ourselves. We gain spatial awareness and appreciate the body God gave us. A positive attitude helps foster and encourage our visual thinking skills. As a former classroom teacher and current vision therapist, I am blessed to continue my work of helping others learn more than classroom skills, but life skills as well. 

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A Teacher’s View on Vision Therapy: Math

Part 4: Math is More than just Numbers

Math is usually one of those subjects you absolutely love or totally despise. Although math was never one of my favorite subjects when I was a student, as a teacher I grew to appreciate the various processes, tools, songs and hands-on ways to make learning more fun. Visually it can be cumbersome to understand how mathematical concepts work and are related. This doesn’t even include the act of reading, interpreting, and correctly writing the problem to find a solution which is a more advanced skill. Since the basic levels of math require number recognition, some students who struggle with math have difficulties starting at this level. Perhaps their difficulties begin when they have to use spatial awareness to write the numbers down in a certain way, or draw a visual representation of the mathematical work they are doing so that it makes sense. Math is a subject where you need to master one skill before moving onto the next level. In third grade this was made obvious as we progressed from mastering multi digit addition and subtraction, to learning how to multiply, to introducing division. 

 

Common Math Difficulties

  • Writing numerical answers in the correct order/place value (ex. Understanding 123 is very different from 321)
  • Recognizing patterns in numbers, counting
  • Skip counting
  • Lining up numbers correctly to solve problems
  • Following the appropriate steps to solve a problem
  • Clockwise/Counter clockwise
  • Symmetry of geometric shapes (ex. Drawing the rest of the picture so the sides match)
  • Memorizing math facts
  • Being able to read a word problem, understand what it is saying, and find a way to solve
  • Drawing a visual to solve a word problem 
  • Concepts of measurement such as weight/size/ distance/ length

 

 

Math and Vision Therapy

I have done several activities so far as a vision therapist that help promote visual awareness, memory, processing speed, seeing things from a different perspective, and patterns. Spatial awareness activities can include orientation, number order, and require a person to solve any problems that come up while working. One activity we use to promote visual logic is a version of tic-tac-toe where the patient cannot see the board and has to plan and visualize each move in their head, much like planning for how to solve a math problem. Working through these vision therapy exercises could promote mathematical growth as well as numerous other brain skills. While vision therapy doesn’t strive to teach math skills, it helps improve the child’s conceptual understanding of math through numerical literacy and visual thinking. It’s exciting to know so many areas of the brain can be enhanced at the same time. 

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