Coping day-to-day

Our daughter has a level of determination of someone far older than her seven years. She wants Vision Therapy to work. My husband and I have been very open with her regarding her visual issues. We have reassured her that her struggles in school are not her fault, and certainly not because she isn’t working hard. Even so, her confidence isn’t where it once was, and while we believe that vision therapy will be a success, and she will regain her confidence, it’s the day-to-day that can sometimes be a struggle.

For example, this past weekend we were doing homework together (my daughter still has trouble completing some in-class assignments) and while I can see where she has shown improvement, especially with her reading, she doesn’t. As she put it, “I’m not really good at anything. It’s so hard, and I’m tired.” As a mother, this is very difficult for me to hear, and it breaks my heart to see my beautiful, bright, intelligent child think so poorly of her abilities.  But I don’t allow her to see my sadness. I am her cheerleader, and I reassure her that what she finds difficult now will eventually become easier.  I also remind her of the many things she is good at!

“Instruction does much, but encouragement does everything”

~ Johann Wolfgang von Goethe ~

Recently her teacher pulled me aside during school dismissal and said, “We need to find a way to get her ready faster, as we’re always waiting on her.”  Her teacher is understandably busy, and she sometimes forgets about my daughter’s visual issues and the behaviours it [sometimes] brings out.  (To her credit, the teacher has made some in-class modifications to help my daughter, and I am very grateful for that.)

Again I explain her diagnosis, and again I reassure those concerned that we’re working to correct it, and once again I explain that her behaviours can be similar to dyslexia or ADD, but it isn’t the same. Admittedly, some days I feel as though I’m talking to myself, but I will tell the story as many times as I have to for my daughter’s sake.

Do we have days where we wish we didn’t have to go through this? Of course we do! But it’s part of our reality for now, and here are some of the things we do to cope:

Open communication. School is where our children spend the majority of their time Monday through Friday. I have been an open book with my daughter’s teachers about what’s going on with her vision, the ways in which it impacts her learning, and why my daughter does some of the things she does. Communication is through face-to-face discussion, notes to her teacher, and articles that I have come across that explain CI and how it affects learning.  I am also looking into donating books on the subject to the Teacher Resource Centre at the school.

Plan ahead. The world will not stop and wait, just because my daughter is in Vision Therapy. Organization is important; we plan each day and incorporate our VT homework into the schedule.  Of course the unexpected can arise, and not much can be done about that, but with a general plan in place, it’s a lot easier to deal with surprises.

Acknowledge accomplishments.  We don’t have a big-band parade every time one of our children succeeds, but we do take the time to acknowledge when our children have done something well. Whether it’s during vision therapy homework, school homework, or just ‘regular stuff’ we stop to say “Thank you for …” or “I am so proud of you for …” or “I like how you…” (fill in the blanks with what’s appropriate).

Be inclusive. My daughter has vision issues, but we are committed to Vision Therapy as a family. It’s not all on her.  It’s not, “YOU have to do vision therapy homework” it’s, “WE have to do vision therapy homework.” It’s not, “YOU have a vision therapy appointment.” It’s “WE have a vision therapy appointment.”

Have fun. Vision Therapy is extra work, but it is fun. Our Vision Therapist, Helen, is awesome. She’s so positive, and really knows how to put a fun twist on some of the exercises that helps to keep my daughter interested. I try to do the same with our VT homework.

Three children play in a lagoon formed from hi...

Photo by Mike Baird

Take a break. Sometimes we just need to not think about school, the visual challenges, Vision Therapy, progress reports, research etc. So when the time allows, we take a break. Not from VT homework (as that’s still very important), but just from everything else. We find the time to live in the moment, and recharge.

My daughter has had some tough life lessons considering her youth, but we’re doing our best to assure her that we’ll get through this – TOGETHER.

Another great article from Dr. Dan Fortenbacher for The VisionHelp Blog. (If you haven’t already, The VisionHelp Blog is one worth following.)

The VisionHelp Blog

Behavioral and Emotional problems with CIA team of researchers have recently released the results of a new study that shows a strong connection linking Convergence Insufficiency (CI), a relatively common binocular vision problem, with ADD/ADHD behaviors and emotional problems.

Even though Convergence Insufficiency (CI) has been extensively researched over the last 10 years this additional research is an important piece in the research puzzle to help doctors understand the impact of Convergence Insufficiency (CI) on the quality of life of patient. Dr. Press and I have written on several previous VisionHelp Blog posts beginning with CI- The Private Eye Goes Public – Part 1, where the epidemiological research shows the prevalence of CI to be about 1 in 12 in pediatric populations. Additionally,  we know that CI is associated with eye strain, double vision, headaches, blurred vision and other symptoms that can be found on the Convergence Insufficiency Symptom Survey (CISS). And we have definitive research that shows the only mode of treatment…

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Expanding My Home Library

The kids are at school and it’s cold and snowing outside, so I decided to take this rare opportunity to enjoy some quiet in my day with a cup of tea, credit card in hand, and shopping in The Optometric Extension Program Foundation’s  online bookstore!

As I have mentioned in previous blog entries I am an avid reader.  These days my focus is on vision therapy, vision and learning in children and ways to keep my daughter motivated at school. As I have been researching I encountered a number of suggested book titles. I am looking forward to receiving my order of:

See It. Say It. Do It. The Parents & Teachers Action Guide to Creating Successful Students and Confident Kids by Dr. Lynn F. Hellerstein  

Eye Power: An Updated Report on Vision Therapy by Ann Hoopes and Stanley Applebaum, OD

Looking Differently at Nearsightedness and Myopia: The Visual Process and the Myth of 20/20 by Steven J. Gallop, OD, FCOVD

The Suddenly Successful Student & Friends: A Guide to Overcoming Learning and Behavior Problems – How Behavioral Optometry Helps, 4th Edition by Hazel Dawkins, E. Edelman, OD & C. Forkiotis, OD

When Your Child Struggles by David L. Cook, OD

I also ordered what looks like a fun game to play with both of my children. It’s called QWIRKLE.  From The Optometric Extension Program Foundation’s web site:

Combining well-thought strategy with quick-thinking challenges, Qwirkle is played by creating rows and columns of matching colors and shapes; since the simple play requires no reading, the whole gang can connect shapes and colors, making the strategic multiple-tile moves that earn maximum points. 108 wood blocks. 2 to 4 players.”

Qwirkle

Qwirkle (Photo credit: MeoplesMagazine)

Stay tuned for future entries on The View From Here ~ our family’s journey through vision therapy as I’ll be offering my reviews from the perspective of a parent for the above titles. (I am really looking forward to reading them.)  In the meantime, if you haven’t already, take a look at the OEPF’s online store – they have a lot to offer. And if you have other titles that you think would be helpful to our readers, please feel free to share them here.

Have a wonderful weekend!

Weeks 13 and 14 … circle, circle, JUMP!

We had our weekly Vision Therapy appointment and my daughter is doing extremely well.  I am so proud of her!

Last week we worked on Circle/Triangle Jumps, See 3 Coins and MAR (flipper/accommodation) using flipper lenses with a -3.00 lens (the week before she used a +3.00).

Circle/Triangle Jumps involves a taped line on the floor, and my daughter looking at a chart of circles/triangles positioned at different points of a line. As she reads each image, she has to jump to the appropriate side of the line, and tap her right or left hand on her leg, depending on which side the triangle lies. Confused? I’m not doing the description justice (Remember, I’m not an optometrist or a trained vision therapist), but my daughter thinks it’s a lot of fun! The challenge for her is tracking as she sometimes loses her place, limited awareness of the space around her and having to remember both right/left for her hand and body.  But she’s doing it!

See 3 Coins includes a card with a coin (a penny in this case) taped on either side.  My daughter uses a pencil as her focal point, bringing it close towards her nose. In the distance she holds the card with the coins. Eventually she goes from seeing 2 coins to 3, and she’s to hold her eyes in that position (seeing three coins) for as long as she can (we time how long). We’re able to see her eyes turn inwards, although her left eye lags behind a wee bit, while she holds her focus. My husband and I have tried this exercise and it isn’t easy. My daughter thought it was pretty funny that she could hold position longer than her Dad. And she was surprised that I couldn’t do it at all (likely related to my being amblyopic as a child – but that’s another story!)  See 3 Coins is a challenge for my daughter as convergence is an issue, but she is determined to make it work.

For MAR (flipper/accommodation), my daughter wears her reading glasses, we patch one eye, and she holds +/- flipper lenses against her glasses while she reads material at an appropriate distance. In this case we used -3.00 lenses. (Week before last, we used +3.00 lenses.) The plus lenses allow the muscles of her eyes responsible for focussing to relax; the minus lenses force those same muscles to work harder to focus. Our daughter is able to focus fairly quickly (unlike her father and I who need several seconds before the image comes into focus. Darn these middle-aged eyes of ours!), but we have noticed that her reading slows a little as we approach the 5-minute mark and her ability to focus slows, when her eye muscles tire.

This week we’ll continue with See 3 Coins, but my daughter no longer needs to use the pencil. We will continue with MAR, but we’ll be alternating between -3.00 lenses and +3.00 lenses. Our daughter has also moved on to the final level of Circle/Triangle Jumps called Double Circle/Triangle Jumps. She tends to race through it in an attempt to just get it done, so we’ll also be concentrating on slowing her down a little bit. Finally, much to my daughter’s amusement, we’ll be playing “Super Heroes”. We’ve decided that we’ll both do this activity together. It involves my daughter staring really hard at a focal point using her “super powers” to burn through it (*wink*), then we’ll relax, and stare at the focal point gently. The idea is for my daughter to acquaint herself with the sensation of her eye muscles as they are working to focus, and then compare how her eyes feel when she’s focussed on an object while relaxed.  This is in preparation for future activities in her VT program.

Eye patch, pencil, reading glasses, flipper lenses, coin card, circle/triangle jumps chart

Eye patch, pencil, reading glasses, flipper lenses, coin card, circle/triangle jumps chart

These homework exercises sound fairly simple, don’t they? You may be wondering how any of this could possibly help a child with visual issues. As a parent learning about vision therapy as I go (versus a trained professional in the field of behavioural optometry) I don’t have the knowledge to explain the intricacies of it, but I definitely see the difference. In between our weekly appointments we have five days of VT homework, usually by day 3 I’m able to notice an improvement in how my daughter handles the routines. Often times, it’s very subtle, but it’s there, and as far as I’m concerned it’s an indication that we’re progressing in the right direction. 

A fascinating read about the development of visual spatial knowledge from Dr. L. Press for The VisionHelp Blog.

The VisionHelp Blog

WachsDr. Wachs’s VT Manual, which we introduced in the prior post subdivides its headings as follows:  General Movement, Discriminative Movement, Ocular Development Control, Visual Acuity, Visual Thinking, Hand Thinking, Graphic Thinking, Auditory Thinking, Repetitive Expressive Communication, Logical Thinking, Representational Thought, Speed & Accuracy, and Math.  My purpose here is to be descriptive of what you’ll find in the manual when you obtain the book, rather than to reproduce the procedures.  It’ll be well worth the $65 investment.  We’ll begin with an overview of General Movement.

First up is Reflexive Control, which revolves heavily around the concept of therapy to help integrate primitive reflexes.  They are sometimes referred to as retained reflexes.  Harry notes that OT, PT, or a strengthening program may be advisable for children with low muscle tone on physiological inadequacy.  This is the part of the book that would have been aided significantly by…

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Another great article by Dr. Leonard J. Press for The VisionHelp Blog.

The VisionHelp Blog

In the prior blog I noted that “home therapy” is a bit of misnomer.  After all, the procedures we prescribe to be done out of the office are increasingly done at places other than home.  In some instances they are reinforced by professionals in school, such as OTs, PTs, or SLPs.  In other instances, particularly when a parent home schools a child, it is entirely appropriate to consider some of the procedures as home therapy.  The bottom line is that when we assign these procedures, it is vital to have the therapist ask the patient to demonstrate their ability with the activity or activities when they return to the office.  That way we can gauge how appropriately and how well the procedure has been internalized and applied.  It’s amazing sometimes to see what the patient’s interpretation of the procedure should be done, despite what we thought were clear-cut written directions…

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The VisionHelp Blog

As noted previously, home vision therapy is something that is engendering alot of discussion and opinion on the vision therapy doc’s listserve.

We know that home alone therapy isn’t likely to work much better than a placebo, at least in the context of the CITT study.  Yet we also know that the designers of home therapy systems put a great deal of thought and design into principles of operant conditioning, behavior modification and feedback as applied to vision therapy.  Perhaps some of those ingredients can be better adapted to the current environment in which home (or any out of office) therapy is to be conducted. One approach is to consider the scientific basis for optometric vision therapy as cited by Ciuffreda (Optometry 2002) regarding the three phases of perceptual and motor skill learning:

1. Verbal-cognitive phase: This primarily involves conscious thinking and planning of movement strategies…

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My 7-year old wears bifocals

What do you think of when you hear the word “bifocals”? If you’re like me, someone age 40+ holding reading material at arm’s length in an effort to focus immediately comes to mind. (I can joke about it, as being over 40, I too wear bifocals.) When it was suggested that my daughter wear bifocals for school I had a temporary moment of panic thinking her vision issues were much more serious than initially thought.

Recently, an article from Children’s Vision Information Network came to my attention, “Bifocals for Children: Stress Relieving Lenses for Help with Reading” and it clearly explains how bifocals can help.  Specifically,

Many children have not developed sufficient control over their focusing systems, the natural lens inside the eye that keeps images clear, especially up close. Some children lack the ability to sustain sufficient focusing over an extended time period, so after a while print begins to blur. Others can’t make fast focusing shifts from one distance to another, like from the board to their desks, so any time they look away, everything is blurry. Some children have a tendency to over focus, and the additional stress causes eyestrain and headaches. If they over focus too much, the additional tension on the visual system can make the eyes to turn too far inward, causing double vision. Finally, near work at school places much more stress on the visual system than distance viewing, and some young children respond by translating the visual stress into physical and emotional symptoms—back and neck tension, headaches, constriction of their perceptual fields and a reduction in their visual space, a tendency to develop nearsightedness, and avoidance of the reading tasks that are causing the physical and visual discomfort.

Prescribing reading glasses effectively treats many of these problems. A convex plus lens relaxes the child’s focusing system, relieving much of the visual stress. In fact, prescribing a low power plus lens is so effective in keeping children’s visual system comfortable during extended close work at school that they are often called “learning lenses.”

My daughter has been wearing bifocals at school for two months (she has reading glasses that she uses at home) and I noticed a difference within a week of her wearing them. Pre-glasses she could barely complete the task of copying notes into her agenda that her teacher had written on the board.  This is no longer the case since she’s started using her glasses.  She still has issues with focusing (one of several concerns vision therapy will help with), but her glasses definitely make a difference. I can tell when my daughter forgot to put her glasses on at school, just by looking at her daily agenda. (The letters aren’t on the line, and she’s missed words.)

If the optometrist is suggesting bifocals for your child (or you) please give it serious consideration as they can help. In the meantime, be sure to check out Children’s Vision Information Network by the Wichita Vision Development Center for more information about children and bifocals, as well as vision therapy. (They have a great article entitled, “Learning to See: How Vision Develops and what to know if there’s a problem”.)

Also, I have added more helpful links to the Resource section of this blog. Please take a moment to have a look, and if you have other suggestions, be sure to let me know.

Reading glasses

Reading glasses (Photo credit: Wikipedia)

Coping with the Crazy Days

When I decided to start this blog I promised myself that I would be candid and honest, as I hope by doing so I can help other families going through similar experiences. For us, the vision therapy journey is filled with peaks and valleys. We can have a steady flow of great progress where things seem to be falling into place, school is a little easier, and my daughter is feeling calm and confident. Then, we have days like yesterday where she’s completely overwhelmed, frustrated, procrastinating, and well … tired.  Once upon a time, not too long ago, every school day was overwhelming. Since beginning vision therapy we have good days, great days and less than stellar days. Yesterday was a less than stellar day.

It is assessment time for term one report cards in our little corner of the world. This means that my daughter is inundated with projects and assignments (yes, even though she’s only in second grade), as her teacher prepares her evaluations. Yesterday she had social studies homework that included writing and coloring; she studied for today’s social studies quiz; had extra reading from the special education resource teacher that also included journaling, and her daily reading that is assigned to the class. This doesn’t include the math test she has to study for, for Thursday or the project she has to complete for the end of the month that includes both written work, and an oral presentation. And somewhere amongst the crazy, we fit in our daily 20-minute vision therapy exercises.

As the grown-up in the picture I try to make things as easy as possible, but admittedly sometimes I feel like I’m flying by the seat of my pants without a clue as to what I’m doing – like yesterday. None of my usual incentives were working. We managed to get it all done (the benefits of planning ahead and offering lots of breaks. Not to mention a lot of deep breathing on my part). Being human, sometimes in those moments of crazy I have doubts and I ask myself if vision therapy is really going to work. I have written about the small successes we’ve seen thus far, but when trying to support my (at the time) frustrated daughter and guide her through her assignments those little successes can be forgotten. That’s why, after we make it over the hurdle, homework is completed, bedtime stories have been read and my children go to sleep, I turn to helpful resources to remind me that vision therapy will work, and we will get through this journey. (You may recall from an earlier blog post, reading is how I relax.)

Yesterday, I turned to EXCELerated Vision: The Wow Vision Therapy Blog by Dan L. Fortenbacher, O.D., FCOVD and his team at WOW Vision Therapy.  When I looked through this blog, I actually said the word “wow” more than once. It is full – no exaggeration – of video testimonials, articles, podcasts and personal stories about the effectiveness of vision therapy.

By the time I finished watching the video What Can Vision Therapy Do for You? (October 16, 2012), any doubts I had earlier in the day about vision therapy were long gone. The video testimonial, Audrey Walks Taller Thanks to Vision Therapy, is one I am likely to refer to on a regular basis. (Like my daughter, Audrey had issues with binocular vision.)

If you haven’t already, check out EXCELerated Vision: The Wow Vision Therapy Blog. You won’t be disappointed.

As for us, today is a new day. The sun is shining, my children were smiling when they left for school and after a good night’s sleep we feel better equipped to continue on our journey. We’ll make it over the hurdles. We always do – eventually!

Article: “The Visual Process and Learning” by Steve Gallop, O.D., F.C.O.V.D

Sincerest thanks to everyone who have visited my blog. I hope others will share their experiences as well. Strength in numbers, as the saying goes; the more we talk about the importance of comprehensive eye exams and the connection between vision & learning, the higher the likelihood of increasing awareness about this issue.

As I have been reading repeatedly through my research – and have witnessed first-hand with my daughter – there is much more to seeing than our visual acuity. (My daughter has 20/20 vision, and by now we’re all aware of her struggles.) Which brings me to the second point of this post, Dr. Steve Gallop’s article entitled, “The Visual Process and Learning.” While reading the article I was nodding my head and murmuring, “Yes, that’s us.” and “That sounds just like my daughter.”

Imagine

Imagine (Photo credit: Javier Q.)

The following excerpt reminded me of a conversation with my daughter’s teacher where she expressed her concern about my daughter’s seemingly limited attention span. She was understandably frustrated, but as I reminded her, my daughter wasn’t being intentionally disrespectful. She can’t help it:

“A significant percentage of students who struggle with school demands have visual conditions that lie at the root of their learning difficulties. The below-level performer is often mistaken for having an attention deficit disorder or other learning disability. Often children with visually related learning problems are thought to be lazy or indifferent, especially when they are known to have high IQs and are not performing up to their expected potential.”

The following excerpt clearly describes one of the challenges my daughter is dealing with:

“Imagine if your two eyes pointed in two slightly different directions. This would cause you to see two copies of everything, either next to each other or overlapping. If this persisted, the brain would try to eliminate one of the copies. It might succeed or it might only succeed intermittently. Now imagine that your brain can eliminate this extra image intermittently but it comes and goes unpredictably and it’s not always the same image that disappears. Sound outrageous? This is actually a fairly common type of visual problem. Now imagine trying to read this way. Normally, it is hoped that the two eyes move efficiently across the printed page as a team. In the picture just painted, you can bet that the eyes are neither moving efficiently nor working like a team. What you get is something like this: the child reluctantly sits down to read; he starts at the top of the page and, unknown to him, his right eye is leading the way – stumbling along the page; suddenly, without warning, the left eye takes over – the problem is the left eye was looking at a different place on the page so the child can’t immediately decide where he was meaning to look and has to start over again. Even if he finds a way to avoid constantly starting over, the effort the brain must expend to carry on this constant vigilance simply does not leave enough energy and mental focus to perform at anything like a high level.”

If you haven’t already, please read “The Visual Process and Learning”. I found its content very relatable, as well as insightful, and I am further encouraged that we have made the right choice in pursuing vision therapy for my daughter.