Introduction to Learning and Vision Therapy: Clinically Speaking Part VIII

Visual Neurorehabilitation 1: Eye Movements

Gross visual motor integration: Notes

Orderly development of a child evolves from sensory dominance in proximoceptive inputs (tactile, gustatory, kinesthetic) to telereceptive control (audition and vision). Vision is the king of the hill and requires proximoceptive awareness and facility to be in place first before fine visuomotor control is attainable. To this end, the therapist will first ensure that the child shows strong gross motor control, in particular balance, bilateral integration, and laterality awareness (the physical awareness of motor dominance including manipulation with hands and locomotion). It is also worthwhile at this early stage to reinforce concepts of directionality (left-right) awareness (cognitive and symbolic awareness, i.e. a child prefer the right hand for reaching without being aware of handedness or the sense of left vs. right as a direction). In order to keep the therapy visits to a minimum, both low-level and higher-level skills can be developed simultaneously, with emphasis at the on low-level activities in the case of DOMD (developmental dysfunction), while moving more quickly to higher cognitive and fine motor activities for FOMD (functional concerns). The activities presented in this Part emphasize techniques for developing more advanced fine visuomotor skills.

About the VT Short Course

The American Academy of Optometry has prepared an introductory training document for optometrists interested in pursuing behavioural practice. The document “A System for Vision Therapy in Primary Care Practice: A Systematic Approach to Optimal Patient Care.” (American Academy of Optometry. 13 October 2011. David A. Damari, O.D., FCOVD, FAAO Marc B. Taub, O.D., M.S., FAAO, FCOVD Janette Dumas, O.D., FCOVD). The ‘short course’ on VT provides some guidelines, sample activities, and multiple other resources for the new initiate to visual neurorehabilitation. This document is summarized in this and the next three sections and is included as a downloadable VT Workshop.

The goal in offering this material here is to provide an overview of some concepts and activities and should serve as means of opening discussions with visual rehab specialists. Some terms will be unfamiliar by necessity as they relate to clinical optometry and optometric vision therapy. The activities are not always suitable to out-of-clinic care because some specialized equipment is occasionally required. This course reviews these activities in spite of this limitation because the equipment can be ordered, or is available through developmental optometry clinics. Untrained professionals are encouraged to investigate to learn more, but only formal training and experience can yield meaningful results. You are encouraged to contact local providers to learn more about the tools and techniques of visual neurorehabilitation. My own personal view is that in most cases, something is better than nothing, and that OTs are ideally suited to learn more and become excellent vision therapists.  If you suspect a child is having difficulty with vision-based concerns, it is prudent to refer to a behavioural vision specialist for assessment and possible co-management of care.

About the Sample Activities

It is impractical to provide detailed commentary on these activities in such a short space, so I have decided to include more breadth than depth in this part to expose the reader to a more representative notion of what Optometric Vision Therapy (OVT) provides. Behavioral vision specialists spend 4 years studying diagnosis and management of diseases of the eye and the visual nervous system, physiological optics, human development, and multiple aspects of diagnosis and treatment of vision-based behavioural concerns. This is followed by ongoing work, training, and research into the field. It is, in other words, simply impossible to offer anything but a cursory overview of the domain in 10 Parts.

What is presented here and in Clinically Speaking Parts IX and X will be elaborated over time, so I’ve taken the liberty of splitting it up into three sections by theme. You can also search the site for ‘Activity’ for a general list of activities, or search for a specific activity name to learn more. The online library will continue to evolve over time, so feel free to send us your comments / requests.

Note that the activities and information given refers only to the remediation of vision concerns, some of which will affect learning and behaviour. The activities and notes presented in the VT Workshop document do not specifically relate to Learning therapy as discussed in this program. Finally, some activities will address concerns not discussed in the course, or perhaps only mentioned in passing.

General Notes: Download the VT Workshop

9-10: Testing Eye Movements / NSUCO Scoring – Notes

10-12: DEM / Eye Movement Recording Systems – Notes

Activities for Developing Rapid Automated Eye Movements

12-15: Eye Movement Therapy

  • Wall Saccades
  • Hart Chart Saccades
  • Pegboard Rotator
  • Hart Chart Rows and Columns
  • Monocular Prims Jumps
  • Michigan (Ann Arbor) Tracking

See Appendix pp 39 “Letter Chart Techniques” for

  • Jumping Eye Movements
  • Near-Far Letter Charts (Sample chart provided pg 41)
  • Rows and Columns


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