Yes or no to vision therapy

[Storygirl]

I've read through other threads about vision therapy, so I know there are those who swear by it, and those who think it is total bunk. I'm not wanting to open up that kind of argument, because I already understand both viewpoints. What I really need is some insight into whether VT is something that has the potential to help DS's particular problems or not. I know that no one can answer that definitively, but those of you who have some experience with VT have much more knowledge than I do, and I value your opinions.

 

Background: This spring DS10 was diagnosed with NVLD and extreme impairment of visual perception, visual-spatial processing, visual-motor skills, etc. He scored in the less than first percentile for all the tests the NP ran to test these areas. DS has been going to OT this summer, and the OT brought up to me DS's vision on multiple occasions, saying that she sees things that she is attributing to visual problems. She's been eagerly looking forward to what we find out from the COVD.

 

DS10 had a regular eye exam and an initial screening by a COVD Fellow today. She is respected by our pediatrician. DS completely passed all of the eye exams -- acuity, convergence, depth perception, peripheral vision, tracking, teaming, etc. The COVD says his eyes are healthy and have no physical problems.

 

She did say that the OT may be seeing some things that did not show up in her own testing of DS, because in her office he was fully focusing his attention on doing the vision things well. When he is doing something with the OT that requires having his attention on another task, his ability to also keep his vision working optimally may be compromised. His eyes are able to do everything he needs them to, but they may not be doing it all the time. This makes sense to me, because DS also has ADHD and SPD, and I know he has multiple problems with sensory processing. She thinks his visual processing problems are not due to his eyes but are an integration problem in his brain. She said that anything the OT does will be good, and he should keep doing it. She also recommended doing puzzles and video games, specifically something like Tetris (I can see that this would be good for him, because it is exactly the kind of thing he had trouble with during the NP evaluations). She in no way pushed VT but said that if we are interested, she can do some things to help him.

 

I gave her copies of the NP report and OT report. She is going to read them and call me sometime next week to discuss her thoughts after she has some time to see what they say. The next step would be a more in-depth evaluation where she would run specific tests to determine what exactly DS needs from her. She will not run the same tests that the NP did already, so she needs to read the report to decide how to proceed with the testing.

 

After that, we would know more, I'm sure. After that, the VT would start. She does short sessions about twice a month and assigns homework for 10-20 minutes per day, five days a week, between sessions. She said that she would happily refer us to another VT in our general area who does more in-office work (maybe 45 minutes per week) but less homework if that model would work better for DS. She gave me a handout with prices and an idea of the length of treatment. I'm sure after the more in-depth evaluation she would have a better idea of how long she would need to work with DS.

 

These kind of visual perception troubles are part of the NVLD. He is not going to go from the first percentile to above average. I suspect he will never have even low average skills in these areas, no matter what we do, because it is just part of his disability. So I'm not expecting a miracle cure. But since he has such extreme weakness, I'm thinking that anything we can do to help him improve even slightly will be worth it. Right? Maybe?

 

OR do we think of it the other way -- that this is just a disability that he has, that VT will not overcome it, and would therefore not be a good use of our time and money. I doubt insurance will cover it (haven't checked yet). The time and the money are considerations.

 

Help, oh wise ones!! Have any of you used VT specifically for visual processing issues? Did it help?

[kbutton]

My son is doing VT for convergence and accommodating problems. However, he didn't have a lot of symptoms until very recently. Is this something that the COVD feels might become more of a problem in the future, or it is what it is? I would probably wait to see how much the OT can do, even if you go ahead with VT, but that is just me. I would want a specific problem identified by the COVD doc, or some specific therapy for brain integration. You may very well find a program that does that more efficiently and effectively than VT. 

 

I do think it's good that you had the COVD do an exam. 

[PeterPan]

Storygirl, I want to speak peace to you on this.  I also need to go to BED.  :D  What specific scores for his visual processing are low?  Your NP report should say things like visual memory, figure ground, etc. etc. 

 

Therapy for visual processing is much more iffy.  I appreciate that you want to do everything for him you can.  Sometimes it budges, sometimes it's doesn't.  The fact that your VT doc is reluctant is telling you something.  Also, don't underestimate the value of things like puzzles.  A lot of VT for visual processing can be done with stuff you already have at home (tangrams, puzzles, SET game, etc.).  They'll do things like do the task but add background noise with a radio so that he stretches his ability to use his skill with distractions. You don't need to pay somebody $100+ an hour to turn on the radio and do puzzles with your kid, kwim?  

 

There's more to it than that, but it sounds like this doc is wanting to give you things you can do to help him.  They could work much more than you realize.  Doing expensive sessions at the office won't be the only option.  My ds is in a similar position (visual processing weaknesses, no physical problems) and after we get our NP baseline testing I've got the VT at home book (not the title, I'm lazy) to start with him.  I haven't looked through it real closely yet.  (actually, I loaned it out to my SIL!) but I recall it having a bunch of things that would work well for visual processing.  

 

Regular VT for convergence, etc. is real wizardry.  I wouldn't want to go through that alone.  But visual processing, oh yeah, do the things your doc says and then re-evaluate in 6 months and see how you're doing.  Or do one therapy session a month and make a routine of working together 15 minutes a day.  Or...  But getting the correct words for what aspects of visual processing you need to target will help.  Sounds like you'll want to add distraction to his ability to use them.  It's really not as rocket science-y as it feels.  You've got SO much on your plate right now, it would be ok to do things the way the doc says.

[Lecka]

So -- my son went from below the 10th percentile, to between the 10th and 20th percentile, on areas of visual processing.  

 

Totally worth it.  Major improvement.  Yes, still worse than other kids his age.  But, so much less worse.  

 

He had greater improvement in some other areas, that are probably part of that.  

 

But -- yes.  Even with his results being pretty low, it has made a big difference for him.  

 

But also -- he may have been at a good age.  He is 9 now, and has really had about a year of these things being addressed... and he has blossomed.  But ---- how much of that is due to finally having some brain maturation?  Or, finally getting over some previous academic anxiety?  Having his confidence go up?  

 

I can't say that it is straight cause and effect.  But I do think that his scores are still pretty darn low but nonetheless he has had real, functional, noticeable improvement.  

 

But that is also -- totally my impression.  

 

I think it sounds like you are getting good information from the VT and OT you are seeing.  Sometimes you may be going back to the OT and saying "here is what the VT said."  Then the OT has that information.  

 

I think an important thing to me, is that you are not looking to VT to solve any other problem.  You are not describing a problem with reading or with poor focus, and wanting VT to solve that problem.  You are looking at very low vision scores and wanting VT to bring up those scores in some small amount.  It does not sound like a situation where vision therapy is being offered in a questionable way.  

 

For my son I think that some of his areas of visual processing did not make much progress.... but the couple areas that went up, helped him overall.  So even if a few areas do not budge too much, if a couple of areas go up, it could help him.  It could just be that little bit easier to where it makes a difference.  

 

Or -- it could turn out to have been a waste of time.  

 

But honestly -- I think almost anything can turn out to be a waste of time, but with going in trying to make an informed decision, this seems like an informed decision to me.  

 

If you haven't spoken with his OT yet, I would speak to him/her as well.  That person might have an informed opinion and with personal knowledge of your son.  

 

Oh, but my son never went back to VT, just OT, but the VT did not think VT would be better than OT for him.  Also, he did bal-a-vis-x at school which is considered, to some extent, a brain integration therapy.  

 

So -- really quite a few things going on, and I don't know what is best out of options.  

 

Mainly ---- I think that a tiny improvement could be a functional improvement.  But I think the VT and OT would be ones more able to answer this.  They may have seen similar kids in the past and know their outcomes.  

 

I do think my son is still below average in some associated areas... but he is so much less below average than he used to be, it is worth it.  If I wanted him to be average, I would not be satisfied.  But I think it was really good progress for him.  

 

When he was lower in speech articulation, he moved up a few percentages (from below 10th to showing progress but still very low) and it made a big difference then, too.  Sometimes there is a point where it is just nice to have that progress.  He did get up to average in speech, but I would think it was worth it if he had stalled after making his first bit of progress.  That was also an improvement in his life and his ability to communicate with others.  

 

But I am just being generic about thinking small improvements can be worthwhile, especially when it is below 10th percentile and can be raised.  It can be a dramatic improvement while still being extremely behind -- b/c it is the child compared to the child, in the child's life, not the child compared to a norm group.  Comparing to a norm group has a way of not really mattering sometimes.  Like -- so what.  

 

That is my opinion, at least.  

 

 

[geodob]

You wrote that your son was diagnosed with NVLD in spring.

Where NVLD is actually a disorder that effects Spacial processing.

 

While Spacial processing is a sense, equal to vision and hearing.

It presents a unique problem with a diagnosis?

With vision and hearing, they can be tested in isolation.

But with Spacial processing, it can't be tested in isolation?

Rather it is tested by its effect on Visual and Auditory processing.

Along with Motor control.

 

But a problem with this model of testing?  Is for example, that its effect on the way that Visual processing is used?

Is defined as a disorder with Visual processing, when in fact.  

The disorder with Spacial processing, has effected Visual processing.

Equally, what is termed as Visual-Motor skills?

Is in fact, Spatial-Motor skills.
So that I would question whether VT would be of any value?

 

[kbutton]

You wrote that your son was diagnosed with NVLD in spring.

Where NVLD is actually a disorder that effects Spacial processing.

 

While Spacial processing is a sense, equal to vision and hearing.

It presents a unique problem with a diagnosis?

With vision and hearing, they can be tested in isolation.

But with Spacial processing, it can't be tested in isolation?

Rather it is tested by its effect on Visual and Auditory processing.

Along with Motor control.

 

But a problem with this model of testing?  Is for example, that its effect on the way that Visual processing is used?

Is defined as a disorder with Visual processing, when in fact.  

The disorder with Spacial processing, has effected Visual processing.

Equally, what is termed as Visual-Motor skills?

Is in fact, Spatial-Motor skills.

So that I would question whether VT would be of any value?

 

This is an interesting distinction. I've wondered about all that since visual and spatial are often lumped together in discussions.

 

[Storygirl]

To answer Elizabeth's question about the areas that he struggles, according to the NP tests:

 

Average in visuomoto precision

 

Below average in color naming, inhibition/switching, imitating hand positions, delayed recognition rmemory  (not sure which, if any, of these is a visual processing thing)

 

Borderline to impaired in:

 

fine motor coordination

visual-spatial-construction skills

visual perception (motor and non-motor)

bilateral fine motor

copy and memory for a complex geometric design

visuospatial processing

motor planning

perceptual planning

visual-spatial reasoning

perceptual reasoning (2nd percentile)

 

He scored in the less than 1st percentile for the following tests:

WISC -IV coding subtest

Grooved pegboard test

NEPSY-II arrows

D-KEFS Trail Making, number-letter switching subtest

D-KEFS Tower test

Rey Complex Figure, copy and delayed recall tests

 

So he is significantly impaired in these areas :sad: . Going from being totally impaired to having some ability in these areas might be huge for him.

 

I'd like to be able to help him. I'm sure some of the activities would be simple things that I could figure out on my own. I do have an issue with managing my own time and the many needs of my other kids, which means that 1) Going to appointments eats into our time for other things, but 2) I don't have a lot of time to figure this out on my own, make a plan, or execute it consistently -- I already have a lot on my plate. So maybe having someone help us would ensure that it gets done??? But it is a lot of money to pay for someone to give us a list of weekly assignments.

 

I wouldn't say the VT was reluctant. She was definitely willing and interested in working with him, but she wasn't pushing her services on us. She obviously believed she would be able to help him, but she wasn't pushy or insisting that VT would solve all his issues. She works for a large hospital system, so she is not needing to drum up business. I'm not worried that she is trying to hook us in to get our money (I'm sorry to say that I've heard this about other VT places, which is why I mention it).

 

[Storygirl]

 

Mainly ---- I think that a tiny improvement could be a functional improvement.  But I think the VT and OT would be ones more able to answer this.  They may have seen similar kids in the past and know their outcomes.  

 

I do think my son is still below average in some associated areas... but he is so much less below average than he used to be, it is worth it.  If I wanted him to be average, I would not be satisfied.  But I think it was really good progress for him.  

.  

 

But I am just being generic about thinking small improvements can be worthwhile, especially when it is below 10th percentile and can be raised.  It can be a dramatic improvement while still being extremely behind -- b/c it is the child compared to the child, in the child's life, not the child compared to a norm group.  Comparing to a norm group has a way of not really mattering sometimes.  Like -- so what.  

 

That is my opinion, at least.  

 

Responding to the bolded:

 

I think that small improvements for him would be a big success, considering his current scores. Thanks for your perspective, Lecka.

 

I also think that asking the VT about her success with similar cases is a great point. I will be sure to talk to her about this when she calls next week after reading his NP report.

 

Actually, I think the OT will be extremely disappointed if we decide not to do the VT, because she seems to be totally into it. She talks about it every single week. Not saying that that will influence our decision about whether to do it. I'll just have to be prepared for her to express disappointment if we don't.  She is eager to have a VT give assignments that she can work on with him.

[Storygirl]

geodob, do you have any ideas of things that work on spatial processing specifically? I'm sure all the things the OT is doing (plus all the time he spends doing gymnastics) has an impact, but maybe there are some things we could be doing that we are missing.

[Pen]

...

DS10 had a regular eye exam and an initial screening by a COVD Fellow today. She is respected by our pediatrician. DS completely passed all of the eye exams -- acuity, convergence, depth perception, peripheral vision, tracking, teaming, etc. The COVD says his eyes are healthy and have no physical problems.

 

...

 

 

I would accept this. To me the COVD is telling you that he does not need VT.

 

I am thrilled to hear this since I was thinking COVDs always find something LOL.

 

My ds did exercises for amblyopia which helped tremendously, but it was a COVD found problem (which when he found it, the COVD was able to show me so that I could see what was happening too),  and given a specific finding there was an idea of what exercises would help.

 

I did VT, and while my scores in VT related exams improved immensely I did not seem to get real world benefits.

 

I dunno, to me asking for VT when nothing was found, is like asking for surgery when nothing has been found, KWIM?

 

I'd do all the things the COVD recommended might help and see if there has been any improvement before embarking on VT.

 

Some of the things I actually did in VT could have been done without it for a lot less money--things like doing mazes and puzzles, Braingym exercises and so on. They had me do things like play Rush Hour Safari...okay, fine, fun, but at 1000s of dollars ????   Well, if all the problems I had hoped would be alleviated had been, I guess I would have been happy. But they weren't.

 

ETA: I'd at least try to get more info on what she might do that she thinks might help, given no specific finding of any problem that VT tends to be used for, and see whether it is things you can find elsewhere for less expense and stress.

[kbutton]

A chunk of these things sound like possible OT things to me from a recent conversation I had with a school-based OT and then with an OT clinic (though I realize what an OT offers varies greatly from one place to another):

 

fine motor coordination

visual-spatial-construction skills

visual perception (motor and non-motor)

bilateral fine motor

copy and memory for a complex geometric design

visuospatial processing

motor planning

perceptual planning (maybe OT too--not sure what it is?)

visual-spatial reasoning

perceptual reasoning (2nd percentile)

 

I don't know if VT is going to help with any visual memory stuff. There are people out there with no diagnosis who literally can't bring up a mental picture of anything that isn't right in front of them. If you have an impaired ability to visualize something, and then you have motor planning issues, it seems like anything related to the two together isn't going to come together until you work on motor skills. And I don't know if you can MAKE a person see picture in their head. I have no idea if that is possible. I am fairly certain that my MIL has NVLD. I tried to give her directions once and run through the landmarks she might see. She couldn't picture interstate signs in her mind, and when I tried to refer to the green ones (roads) vs. brown ones (landmarks, museums, etc.), it became rather hairy. And this is a woman that has been driving for half a century cross country. She can, however, do artsty stuff if she is looking at something. She has pretty poor gross motor skills though. Very clumsy. And not so great spatial skills. None of that really hampers her though.

 

I agree with Pen that it sounds like the VT is saying she had no ace in the hole type of findings with his exam. I think I would be looking for therapies that target some kind of brain integration for motor planning, bilateral coordination, etc. I'd see what OT does. It's not like you have to do VT or that it won't be there in the future. Most insurances do not cover it, but if you are trying to stack things to meet a deductible, it may count toward a deductible anyway. You never know.

[PeterPan]

You wrote that your son was diagnosed with NVLD in spring.

Where NVLD is actually a disorder that effects Spacial processing.

 

While Spacial processing is a sense, equal to vision and hearing.

It presents a unique problem with a diagnosis?

With vision and hearing, they can be tested in isolation.

But with Spacial processing, it can't be tested in isolation?

Rather it is tested by its effect on Visual and Auditory processing.

Along with Motor control.

 

But a problem with this model of testing? Is for example, that its effect on the way that Visual processing is used?

Is defined as a disorder with Visual processing, when in fact.

The disorder with Spacial processing, has effected Visual processing.

Equally, what is termed as Visual-Motor skills?

Is in fact, Spatial-Motor skills.

So that I would question whether VT would be of any value?

I know someone diagnosed NVLD (and confirmed by later evals) who got TREMENDOUS benefit from VT , but it was with a really unusual doc who did lots of sensory integration and body work with it. They also did lots of puzzles. The doc wasn't just blowing you off when she said to do them. :)

[ElizabethB]

My MIL is going to a COVD doctor after a stroke for visual processing problems, there are things they can do and it has been very helpful for her. Her eyes were totally fine physically, just her brain needed retraining after the stroke.

 

I would try it for a month or two and see what you think, it sounds like they have good ideas and will work with you. She saw progress after a month or two, and could tell after the first few visits that they things they were having her do were challenging and had the potential to help. (They initially made things a bit worse, actually, but were helpful in the long run.)

[geodob]

geodob, do you have any ideas of things that work on spatial processing specifically? I'm sure all the things the OT is doing (plus all the time he spends doing gymnastics) has an impact, but maybe there are some things we could be doing that we are missing.

 

Storygirl, you asked if I 'have any ideas of things that work on spatial processing specifically?'

Perhaps you might like to participate in a clinical study, into spatial processing 'disorders'?

Where it will basically involve doing a series of activities/ exercises with your son.

Then reporting on his ability with each one. 

Accompanied by a discussion of each of them.

Also how they all fit together in the developmental process of spatial processing.

Though these same activities/ exercises, can be used to stimulate further potential development.

 

But 'discussion' is an essential part, firstly to make sense of the activities/ exercises, and their current and future implications.

 

Though this is pilot qualitative study, which will form the basis for a much larger quantitative study, with about 8,000 participants.

With 3 different universities so far.

Where this will be the first comprehensive study of Spatial Processing.

[kbutton]

I know someone diagnosed NVLD (and confirmed by later evals) who got TREMENDOUS benefit from VT , but it was with a really unusual doc who did lots of sensory integration and body work with it. They also did lots of puzzles. The doc wasn't just blowing you off when she said to do them. :)

 

The context of a doc doing unusual sensory stuff makes more sense. I would want to know where VT and OT overlap in that case to get either really targeted VT with the OT, or have both therapies tailored so I wasn't paying twice for the same things. I'd want the therapists to coordinate things if possible.

[PeterPan]

The context of a doc doing unusual sensory stuff makes more sense. I would want to know where VT and OT overlap in that case to get either really targeted VT with the OT, or have both therapies tailored so I wasn't paying twice for the same things. I'd want the therapists to coordinate things if possible.

It was an eye doc who trains olympic athletes (sports vision therapy).

[Storygirl]

geodob, the trial sounds interesting, but we are having a very busy week. Let me think about the questions I would have for you. Just wanted you to know that I'm thinking.

[kbutton]

It was an eye doc who trains olympic athletes (sports vision therapy).

 

That sounds perfect for folks with spatial issues to try. I bet a lot of it is off-the-grid. It would be interesting to see if the gains made by athletes could be replicated (not in achievement level, but maybe in percentile gains, etc.) by kids who have deficits in those areas. 

[wapiti]

That sounds perfect for folks with spatial issues to try. I bet a lot of it is off-the-grid. It would be interesting to see if the gains made by athletes could be replicated (not in achievement level, but maybe in percentile gains, etc.) by kids who have deficits in those areas. 

 

FWIW, in our area, googling "sports vision" will pull up the appropriate practicioners, though IIRC, our old OT place also worked with athletes.

[Hottater]

I just skimmed the prior post. Did you rule out irlen syndrome first? http://irlen.com/ you can do self tests to help see if it might correlate to what your may be experiencing matches. I have a audio clip from Helen Irlen about what Irlen is and what symptoms are like etc. I know, I know-- another test, but this one is pretty immediate, if it does help then great! It's not like VT which does take a 4+ week process most of the time, but VT solves for other issues. You can do what I did - use your own sunglasses and/or different transparent file folder dividers to see if it calms the processing of what your kid sees. Then, if it does, then you can research further on the site, there is a professional screeners and professional diagnosticians, and on facebook, a whole lot of facebook support groups of people willing to answer some of your questions. My kid has stereotopic vision issues which is a depth perception issue, don't know if that is similar to the spatial functioning. I have the same issues of schooling my other littles and not having the time to do both while affecting my other kids' educations. Hang in there! make sure to have a lot of audio materials in the car they can all listen to while on the way to xyz appointment. 

 

 

 

 

 

http://a.advancedbrain.com/events/episode.jsp?id=SB&type=17

 

 

 

[PeterPan]

That sounds perfect for folks with spatial issues to try. I bet a lot of it is off-the-grid. It would be interesting to see if the gains made by athletes could be replicated (not in achievement level, but maybe in percentile gains, etc.) by kids who have deficits in those areas. 

Yes, it's a specialty in VT, sports vision.  This guy just happens to be nationally known and trains olympic athletes.  Somehow my friend with the NLD dc found him and got really, really out of the box therapy.  It's all the same stuff, but he knew how to get the whole body doing involved while doing the tasks to get the wiring made.  The place where we did our VT has people trained in sports vision.