Approaching Therapy

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At first, the idea of delivering therapy (especially to your own child) seems awkward, perhaps a burden or just simply confusing and daunting. As quickly as possible, you must get over this. You must learn to clear your mind and pay attention to performing exercises prudently and conscientiously, always paying attention to your interaction with the client/child on the one hand, and how the exercise is done on the the other. Always gear your efforts towards meeting the client where he is at (see Writing Style on this Site), tasks should neither be too easy nor too difficult. Let the client practice and succeed, then load the task as instructed. Always give the client a new step to reach that is within reach, and occasionally just beyond their reach. Allow them to succeed most of the time. Remember: No one wins if exercises are made to be too difficult or too easy.

It is your obligation to study the exercises and be prepared. Set a time when you meet with your client, but don’t use that time to learn what to do. There is no set pattern to the exercises or how they are used. Frequently, the same sheet might be used in different ways.

Most tasks and activities in the site are designed to find the client where they are and then move them forward. Some tasks even at their simplest levels are too advanced for some people. Later, when they are ready, they can move on to the more advanced items. Some activities are difficult to master, such as working with the non-preferred hand, and can be very frustrating for children especially. You need to acknowledge that it is difficult, but offer no excuses. You should remain firm in that the task should be at least attempted, and if you can, make it easier and easier until it can be successfully accomplished – then you move forward from there. Never scold a child for not doing well, but do not reward ‘non-performance’. A simple ‘you will try again the next time’ is often sufficient.

In general, you should expect to do activities from all categories at all times, though the emphasis may change throughout therapy. The categories are: Gross Motor, Visual Motor Integration/Fine Motor, Perceptual (Visual Signal Processing, or VSP), Oculomotor (Visual Skills Acquisition), and Reading. To simplify things, try to do something from each category at each session. Most clients should begin by emphasizing gross motor skills, and later once these are mastered, emphasize visual motor integration, perception, and reading.

These activities are geared towards mastery, and so if an activity is too easy to begin with (even after loading it appropriately), run through it once, then leave it. If the activity is too hard, then make it simpler or put it off to another time entirely. Never let a client become discouraged if they cannot complete and exercise.

Remember to always gauge the mood and level of motivation of the client. A child might want to do a few more of cycles of an activity if he is having some success, and it’s ok to do a few more if time allows. It can at times be better to forgo another activity to accommodate the few extra cycles if the child is well motivated. This is a good time to encourage the child to really push themselves while you load the activity, or they beat their best time, etc. The goal is to keep things moving with a good level of healthy ‘stress’ (get the bodies physiology working in a positive manner).

In the end, the child/client must do it for herself to become more efficient in managing daily affairs, and more skillful in dealing with all areas of academic life. Therapy should never be about pleasing the parent or therapist (though this is ok, it should not be the primary reason), but rather more about the child working to consciously build their own strengths and thus gain independence and self-assurance. This is the best reason for trying hard.

Regarding videos: The videos are produced to speak to you, the therapist. A child watching these videos will not likely understand well enough to do these activities effectively. The intent is to convey not only the action of the activity, but also the sense of it, that is, what the child should be feeling as she is doing the exercise. Your job is to learn the activity, and guide the client through it, ensuring that you are both paying attention to what is happening and not rushing things. Focus is the key, and possibly even more important for the therapist.

Glasses: Clients should wear prescribed glasses for all near-point activities, and for all other exercises except where indicated. Consult your optometrist should you have any questions or concerns regarding glasses, or the comfort of the client. Never push visual limits too hard as this can be very uncomfortable and even painful to the client.


130 Guidelines for Therapists

Guidelines For Home Assistants of Optometric Vision Therapy

It is very important that the patient be prepared in advance before introducing any of the home procedures.  The perceptual set of the patient must be such that he answer the demands of the task in way that the experience is both pleasurable and meaningful.  In this way, learning will be enhanced.  The following steps will help accomplish this goal:

1. The home procedures must not be approached on a right or wrong basis.

2. Don’t tell the patient how he/she performed on each procedure–let the patient tell you.  In other words, the patient should be allowed to assess his/her own performance.

3. Discuss how much progress has been made each time and let the patient figure out what must be done differently next time to accomplish the desired goal of a particular procedure.

4. Don’t emphasize the unaccomplished phase of the performance.  Instead, stress the part that was accomplished.  Being 75 percent right sounds much better than being 25 percent wrong.

5. Don’t supply too many answers.  Learn to ask the right questions so that the correct answers can be made.  Observe and ask questions.  Do not judge and label the patient’s performance.  This approach will help the patient begin to monitor his own processes.

6. If it is obvious that the patient is tiring, stop short of failure and try again next time.  If success is experienced on a given procedure, and the patient wishes to continue it awhile longer, encourage him/her to do so.  Challenge, but do not frustrate.

7. On the day of your office visit, the new home training activities should be done by the home assistant(s) to better understand what will be asked of the patient during the coming week, and to be better able to carry out your home assistant’s role, as described above.

8. If either the patient or the home assistant is not feeling well, overtired or cross, do not work that day.

9. Home training is best done without an audience.  If others are around, retire to a separate room.  When the training can be done with an audience, an improved level of performance is indicated.

10.  You should not have to nag to do this.  If there is a problem in this area, please let us know immediately.