There are times in pediatric practice when we have exhausted all our screenings, standardized evaluations and treatment implementations for children with special needs; however, our patient/student has plateaued in progress. We instinctively know that there is more progress to be had along the rehabilitative journey but we are at a roadblock. If vision difficulties are suspected, there is another avenue to explore-collaborative treatment with qualified vision therapists and vision therapy optometrists.
According to Judy Hughes, OD, of the Austin Eye Gym, vision therapy is a "sequence of activities individually prescribed and monitored by the doctor of optometry to develop efficient visual skills and processing." Hughes recommends commencing the program after a comprehensive eye examination using standardized tests yielding results that may indicate the child's use of compensatory lenses, treatment lenses and/or vision therapy.
As a behavioral optometrist, Hughes may utilize lenses, prisms, filters, occluders, specialized instruments and computer programs. She often collaborates with occupational therapists in both clinical and school settings, broadening treatment intervention.
Information gathered from this optometry practice relates research that has demonstrated vision therapy effective for such conditions as ocular motility dysfunction, non strabismus binocular disorders (inefficient eye teaming), strabismus, ambloyopia (poorly developed vision), accommodating disorders (focusing problems) and visual information processing disorders. The collaboration of vision therapists and occupational therapists takes place in the integration of visual skills with other sensory systems. Integration then provides automatic effective responses to visual tasks, alleviating symptoms that inhibit developmental or academic progress.
Pediatric practitioners have been utilizing sensory modalities facilitating sensory integration for forty years now. We know the sense of vision is the most important of the senses, taking into the brain more information than any other sensory system. We dutifully review records for results of eye exams and remind parents of the importance of ruling out impaired eyesight before we select our own battery of visual motor tests or develop treatment plans for visual motor difficulties. But when a child complains of dizziness, nausea or headaches during or after OT and progress is at a standstill with all known treatment strategies having been used only to result in the child and her family becoming increasingly frustrated, we may consider researching the availability of behavioral optometry and vision therapy.
The key concept for comprehensive and efficient vision is the differentiation between eyesight and vision. Eyesight refers to the 20/20 standard of being able to see accurately and clearly at a distance of 20 feet.
Vision on the other hand is the concept of identifying what is seen, processing or interpreting the information and responding to that information appropriately. As therapists utilizing sensory processing strategies, this concept of input-process-output is included in the foundation of sensory integration intervention. Since "vision" happens in the brain, not in the eye itself, a child or adult who has experienced sensory difficulties secondary to traumatic brain injury, post concussive syndrome or cerebral palsy may pass an eye examination using standard eye charts but continue to experience visual impairment. Consequently, the strong connection to developmental or academic delay is noted when vision is impaired in this context.
Vision therapists with a background in occupational therapy refer to the Self Assessment Checklist for Vision Problems compiled by the Parents Active for Vision Education (www.pavevision.org/visionproblem.htm). OT practitioners might find it useful to be aware of these "vision stress indicators." This checklist includes avoiding a task by doing as little possible; experiencing pain or other symptoms (visual aches and/or overall body fatigue), and falling asleep while reading; suppressing the sight of one eye at the cost of reduced efficiency and understanding; myopia or astigmatism or any combination of the above. Eye discomfort, headaches, blurred vision, lowered visual performance, blurred vision, sensitivity to light, reading difficulties, comprehension difficulties, attention and concentration difficulty, memory difficulty, double vision with visual tasks, or loss of the visual field are additional symptoms children may experience while in occupational therapy. Being aware of alternatives in evaluating and treating these problems benefit these children and expand our horizons as practitioners.
Not all optometrists are trained in vision therapy. The Baltimore Academy for Behavioral Optometry offers Clinical Curriculum Courses for both graduate optometrists and therapists. This course certifies the optometrist and interested therapists in behavioral optometry and vision therapy respectively. There are, in fact, occupational therapy practitioners across the nation who have applied their knowledge of sensory integration to the area of vision therapy, attended and graduated this intensive course and are now practicing as vision therapists under the supervision of behavioral optometrists. These therapy practitioners expand the practice of behavioral optometrists by blending their knowledge and experience in cognitive therapy, sensory processing and optic studies. Practicing together, functional comprehensive vision is facilitated, thus providing meaningful experiences in school, at play and in the home.
Carolyn Cantu, MS, OTR, is currently a consultant and trainer for Austin Families Inc. of Austin, Texas, and a curriculum writer for the OTA program at Austin Community College. She has been in the profession for 34 years and has worked in pediatrics since 1985.