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Vision Therapy

What is it, why do it and what are our aims and expectations?

The aim of vision therapy is to help your child explore new ways of specific eye related learning and thinking.

For example, if a child is having difficulties with reading, vision therapists will not practice reading with a child rather they will do exercises and activities with a child. These activities are ones that are important in creating a firm foundation for the skills that underpin the reading process. By helping a child explore different ways to perform an activity or exercise, we aim to provide transferable skills that they can use when they read.

How does the vision therapy program work?

Your child will have recently performed a visual perceptual assessment with the optometrist. From this assessment, we will know the specific areas that require assistance. The optometrist will tailor a vision therapy program for your child based on the perceptual assessment results. This program should be practiced 15-20 minutes per day at home.

In house training visits with our vision therapist are 30-45 minutes in duration. During this appointment, your child will practice and demonstrate the previous sessions exercises and learn new exercises for home practice.

Vision therapy usually lasts 3-4 months, although some programs can be shorter or longer depending on your child’s individual needs. Your optometrist will be able to give you a better idea of timeframe after assessing your child.

Explanation of Vision Therapy by Dr Paul Harris, Behavioural Optometrist (reproduced in part with permission of Dr Paul Harris)

The Toolbox Analogy

Imagine that we have delivered to a plot of land all of the necessary raw materials needed to build a house. Piles of wood, nails, screws, plumbing supplies, doors, windows, roofing materials, etc. are all present in abundance. The child brings to that work site each day their toolbox. The tools in that toolbox have been acquired over the years based on the life experiences that child has had. Some children enter the worksite with a rather complete set of tools to cover most needs, while others have only the essentials or may in fact be missing even a core or fundamental tool. Fundamental or required tools might be considered to be a hammer, a saw, a screwdriver or a tape measure.

In general, schools assume two things. The first is that most children enter with the set of tools that will carry them through their academic career and that the fundamental set of tools that a child brings to school is fixed. The child is placed into a series of courses such as Carpentry 101 and Plumbing 101. In Carpentry 101 they may begin with the simple tasks of measuring and marking lumber to be cut to length, how to start, drive, and set a nail, and making a cross-cut saw cut safely, accurately, and square. To a child coming to the workplace with a basic framing hammer, a handheld crosscut saw, and a Stape-measure these beginning classes may come rather easily. To a child missing one or more of these basic tools, failure to achieve basic “educational” goals may become evident rather early on.

Generally in the education system a child comes to the attention of their teacher before testing for a problem is initiated. To qualify for services their performance must have fallen to a certain measurable amount.

Many resourceful and smart children who are missing fundamental tools may find ways to get the job done although they are not using the proper tool. They might find a rock to use as a hammer or they might use a monkey wrench to hammer in the nails. The job gets done but it takes longer, the job isn’t done as well and there may be some wear and tear on the child that would not have been present had the child used the proper tool for the job. However, the child, due to a lack of the appropriate developmental experiences is/was lacking the tool. This degree of compensating can often serve to mask the discovery of a missing fundamental tool for quite a while in a resourceful child.

Once the teacher realizes the child is having a problem, the school system will initiate a series of tests to identify the problems. Psychological educational testing often correctly identifies the general category of the problems, such as carpentry or plumbing but may fail to recognize that the lack of a tool may be the problem. Here is where a false assumption dooms the child to an intervention program that will actually work to embed the problem even more. How?

A hammerless child is labelled as “hammerless” or “hammer compromised.” The system then looks for special education materials that have been shown to be able to be mastered by those without hammers. The idea has been that the child who does not have a hammer should not be penalized for not having a hammer and we should not ask them to do things that require hammers. Therefore a program has been conceived and produced in, for and by the school, which addresses hammerless children’s needs.

The hammerless child will be given activities, which will not require them to use a hammer. Either they will now use screws and screw guns for everything or they will switch to learning to assemble prefab home kits. The child will advance through the rest of their courses but a fundamental tool and basic skill necessary to nearly any home building project will be missing, the ability to use a hammer. The false assumption was that once hammerless, forever hammerless.

The education system is not in the business of tools. They are in the business of tool usage. “Missing tool? Oh well you’ll just have to learn to accept your hammerless condition and arrange things differently so that you don’t encounter hammering demands in school life.” Real life then becomes another matter.

The key factor in behavioural vision care is that our assumption is that the presence of a missing tool is only evidence of not having had the appropriate meaningful experience to have developed or acquired that tool. We are in the business of identifying the missing tools and then putting together treatment protocol. The purpose of which is to provide the child with the necessary meaningful experiences to acquire the tool.

In essence, we take the child shopping. We know that hardware stores exist. We know the fundamental classes of tools. We know the order which people generally acquire tools. One would not start their saw collection with learning how to use a compound mitre saw. One starts with a basic handheld crosscut saw and learns by cutting lumber to length. More complex sawing techniques are then introduced in the correct order so that each experience is built on the prior knowledge base. This process of tool acquisition and attaining fundamental competence in the use of the skill is the domain of optometric behavioural vision care. We turn over to the school system a child who now possesses the correct array of tools to perform the tasks required of them.

Behavioural vision care optometrists do not teach carpentry or plumbing. Behavioural vision care optometrists do not teach reading, writing or mathematics. Behavioural vision care optometrists do identify missing tools and take the child shopping to acquire and gain competency with the new tools. Then, and only then, will the school system find a child who is ready to be taught using conventional methods and who will achieve in a variety of educational settings and following a variety of teaching methods.

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