Vision Therapy assessment yesterday...

[mom22kids]

I took my daughter for her VT assess yesterday and they noticed a few things.

 

1) she had some minor improvements in a few areas from her last assessment.  She scored better in some depth perception stuff etc which I expected given how much we worked on it.

 

2) They noticed a big decline in her ability to see things close up. 

 

It was a 2 hour appt so I may be confusing some of the info/terminology but in a nutshell...when she looks off into the distance she has smooth fluid movements, she has a focus? of 1 diopter which is what they want to see.  Her distance looking skills are beautiful in the Dr's words.

 

But when she looks at things that are near she has some issues.  They like to see people use their eyes in the 4-6 diopter range and she is still only at a 1diopter.  So she is looking at only a small pinhole of the page and just moves that focus point all around to see the entire page.  She does this to block out the "mess" of the page which is perfectly in line with her personality and her OCD-ish tendencies.  She also has very jerky eye movements.  They are not smooth and fluid but more like the second hand of a clock.

 

They also checked 5 of her primitive reflexes and at least 3 gave evidence of being active.  They provided me with this feedback but the formal test results will be given to me at an appointment in Aug.

 

So there is no question I am going to start vision therapy.  I knew that before we went.  But...in terms of finding the right place... I looked at the website this morning to see if there was a bio for the lady who did the bulk of the assessment - we liked her and could request her to do the therapy - and there was only one person who is a certified vision therapist. 

 

Is that typical?  The girl we liked came to the company in 2009 as a receptionist and has worked her way up to this position but no mention of being certified?  Shouldn't someone certified in OT or VT be in charge of integrating primitive reflexes?

 

Just wondering what others experiences have been?  Thanks!

 

[OneStepAtATime]

Yeah, I would go with someone certified.  

[Lecka]

I would be fine with this if you can ask about her experience, and how she has been trained, and it seems good.

 

I think personality counts for so much.

[PeterPan]

What was the doctor's plan for treating the retained reflexes?  No, you should not do VT until you have worked on the reflexes or else made a plan that coordinates working on them with the VT.  Some eye docs will do it themselves and some will send out to an OT.  Those MUST be worked on to make progress.

 

It's not a problem that only one therapist is certified.  It's very involved and expensive.  Odds are they get their lead person certified and that person supervises everyone else.  That's fine.

 

That's great that you got a thorough eval and are getting some answers!

Edited July 13, 2016 by OhElizabeth

[mom22kids]

I would be fine with this if you can ask about her experience, and how she has been trained, and it seems good.

 

I think personality counts for so much.

 

Well my daughter didn't seem to care either way so it would be easy for me to just request the one person who is certified.  Which I will - see if she is a good fit at least.   The place was amazing.  Clean, bright, airy.  Huge open gym like space with trampolines, and equipment everywhere.  There were kids present doing therapy and it was a supportive, friendly environment.  I was really happy overall but was not that happy to see that most people are trained "in house" with no formal certification.

 

But then I wondered if maybe it is not as "required" as I would assume and wondered what other people have noticed where they do VT?  And I agree personality and trust sometimes outweigh certification.

[PeterPan]

So this place does OT as well?  That's cool!  Sounds like it will be a good experience.  And yes, I would not be bashful about getting the most experienced person and the person most likely to mesh with your dc.  But therapists already know that.  They value their reputation and want you to have a good experience too.  :)

[mom22kids]

What was the doctor's plan for treating the retained reflexes?  No, you should not do VT until you have worked on the reflexes or else made a plan that coordinates working on them with the VT.  Some eye docs will do it themselves and some will send out to an OT.  Those MUST be worked on to make progress.

 

It's not a problem that only one therapist is certified.  It's very involved and expensive.  Odds are they get their lead person certified and that person supervises everyone else.  That's fine.

 

That's great that you got a thorough eval and are getting some answers!

 

Well I won't meet with the Dr and get the formal report/plan of action until Aug.  But I asked loads of questions and it was evident that they will first work on the primitive reflexes (in house - the girl we worked with is able to do it if we opt for her) and get them integrated first and then move on to the other treatments.  It is a 50 min weekly appointment and 15-20 mins of exercises daily at home.  She guessed we would be a 38 week program.

[mom22kids]

So this place does OT as well?  That's cool!  Sounds like it will be a good experience.  And yes, I would not be bashful about getting the most experienced person and the person most likely to mesh with your dc.  But therapists already know that.  They value their reputation and want you to have a good experience too.   :)

 

Well that's the thing I am struggling with/wondering about...they do integrate the reflexes in house...but...there is no OT on staff??  They all have a variety of experiences and ONE is VT certified.  Do you need to be an OT to integrate reflexes effectively?  I just have no idea so I am concerned-ish. lol!

 

[PeterPan]

It sounds like it could work.  Is that 38 weeks including the VT?  Main thing is track record, reputation.  Does what they're doing WORK?  Have you talked with people who were satisified?  Are they organized and giving good homework?  Do they meet with the doc every month or so to assess progress?  Benchmarks?  As long as you're hearing this kind of stuff, it sounds really good.  It sounds like they're invested and doing it a lot, so they probably have a combination they've found works.

[mom22kids]

It sounds like it could work.  Is that 38 weeks including the VT?  Main thing is track record, reputation.  Does what they're doing WORK?  Have you talked with people who were satisified?  Are they organized and giving good homework?  Do they meet with the doc every month or so to assess progress?  Benchmarks?  As long as you're hearing this kind of stuff, it sounds really good.  It sounds like they're invested and doing it a lot, so they probably have a combination they've found works.

 

The 38 weeks does involve the VT and they acknowledge that unforeseen circumstances could add a few weeks to that.  I plan on asking for references when I get the formal assessment.  But I am always wary of those..no one gives out references to unhappy clients.  So I am sure they will check out kwim?

 

They are SUPER organized I could see that in my visit.  And for sure she will be given homework.  I loved how professional and friendly it was,  Very warm and welcoming.  Very high tech and yet comfortable.  I was just wary about the lack of certification from the staff.

 

I will know more at the formal results meeting I guess.  These are all great questions for me to ask.   Thanks!

[Lecka]

For some things with reflexes, you can go to trainings without having gone to college for OT.

 

So you can ask what their training/experience is.

 

I also think in my area that the reflexes are newer and I wouldn't count on a certified OT to automatically know about it if maybe they don't work in this area.

 

So I would ask.

 

I could have gone to the lowest level of Rhythmic Movement Training last year as a parent.

 

But someone who works with autism but went to school for something else could go through more levels. I don't know all the details.

 

And it is not like all of a sudden you are an OT.

 

But it could be like you have got experience with retained primitive reflexes.

 

At a certain point you may want an OT.

 

At a certain point you may be satisfied your needs are met without one.

 

I think it is worth asking. You can see what you think about how thorough their training is and what you think about it.

[mom22kids]

For some things with reflexes, you can go to trainings without having gone to college for OT.

 

So you can ask what their training/experience is.

 

I also think in my area that the reflexes are newer and I wouldn't count on a certified OT to automatically know about it if maybe they don't work in this area.

 

So I would ask.

 

I could have gone to the lowest level of Rhythmic Movement Training last year as a parent.

 

But someone who works with autism but went to school for something else could go through more levels. I don't know all the details.

 

And it is not like all of a sudden you are an OT.

 

But it could be like you have got experience with retained primitive reflexes.

 

At a certain point you may want an OT.

 

At a certain point you may be satisfied your needs are met without one.

 

I think it is worth asking. You can see what you think about how thorough their training is and what you think about it.

 

A lot of what you are saying makes sense and makes me more comfortable with the thought of having someone who is NOT an OT work on the reflexes.  Thanks!

 

[PeterPan]

Even just google search, see what their online reputation is, ask around...

[Lecka]

This is not just primitive reflexes, but for the movement ones, in my area there are 4 that are popular. People have gone to trainings for various ones and have different kinds of clients they work with (basically autism, ADHD, or trouble learning to read).

 

Then out of these the easiest is (very generally) Rhythmic Movement Training. Then Brain Gym. Then Bal-a-vis-x.

 

Then one I am forgetting. I think there is one more that is popular here.

 

We live near the place Bal-a-vis-x is from, and it is very popular and it is very easy for people to attend trainings. Where -- for some, to attend a higher training maybe people have to pay to fly to California and stay in a hotel.

 

There are people locally who have not been to actual trainings, but have carried out plans and been informally trained by someone to help certain kids (bc they are working with those kids anyway and it needs to be done several times a week, so this is how it works out). So they can get to have a lot of experience. But it is not really like they would design a program.

 

But you could have a lot of experience and some training, and not be an OT.

 

This can happen with people who work with kids who have autism, ADHD, or trouble learning to read, that they end up incorporating things.

 

But probably where you are going they have been to actual trainings and everything!

 

But it is not like it is so hard that it is really hard to pick up how to do it, I think. Especially if you see it is working out.

 

Like -- for Bal-a-vis-x, classroom teachers can go to a training and then incorporate things as they choose. And it is good! But it is not like what you might need if either it wasn't going well, or it was promising and you wanted to do more of it.

 

I think when kids can't do the movements correctly (even with the help of the person, or past where they seem they should do it more independently) then that is when a higher level is called for. Also if there is a question about what specific exercises to do, maybe it is needed. But if you are satisfied, then I think it is good.

 

Edit: I went to a workshop on sensory needs a few years ago that had a session about this, so this is mostly what I heard at this session, and then some stuff from my kids.

 

At the sensory workshop we were practicing things on our kids and getting demonstrated on by the leaders, and then some people could get some advice about certain exercises for their kids. For my son at the time they were like "probably he should go through RMT with a specialist." But there were people with older kids who were getting more advice of being able to buy a workbook and go through it. So I think it can just depend. Plus that was about sensory needs anyway (not vision or just integrating primitively reflexes), but that is how the session was, and I thought it was good. It was run by OTs, but they have worked with a lot of people around town bc they usually need other people to do some bc they are not seeing kids every day, and they want other people to incorporate it.

Edited July 13, 2016 by Lecka

[kbutton]

Our COVD doctor personally trained the therapists that worked with my kids. I think one had more formal certifications (or was working toward them), but they both worked 1:1 with my kids to see readily what worked, what didn't, what they liked personally to optimize the experience. I think the biggest thing is that they can work with the doctor to design a customized program and respond to the individual needs of the child. Sometimes the doc would have specific therapists work with specific kids based on their issues or their personalities. 

 

If it's a more regimented program (everyone does all the same exercises for mostly the same number of sessions, etc.), I would have no idea how to evaluate that except to find people who've done therapy there and ask.

[Guest2]

It may work, but I think it won't work as well as seeing the COVD. I refused to see my COVD's " assistant" and made it clear. The office made it seem like they were interchangeable. The cost was the same, ect. it is a money maker for the office! The assistant in my case was a high school graduate and was attending cc for nursing pre-requisites ( history and comp classes). Yikes. That may not be the case for you.

 

Ask questions, find out how how the non COVD personnel are trained. Weekend courses? On the job training? I didn't have confidence that the office trained personnel could change course of treatment based on how my kids were performing during session. It is like paying for the expertise of an O.T. and getting an O.T aide and still paying through the nose. The OT aide has been trained a little and observed O.T., but she won't be able to adjust treatment to accomodate progress, regression, fatigue , increase in skill, enurdance ,ect... I am not saying it won't work a little, but I personally would keep looking.

 

On a financial note, i think it is insane to pay much for that. It was $140 a session for my family to see a COVD, and the same $ to see a kid a few years older than one of my kids being treated with the same education. No thanks. But i respect you may not feel the same way. Get a price adjustment based on who you see?

Edited July 22, 2016 by Silver Brook

[kbutton]

Our COVD's therapists did change midstream if needed, and the COVD did periodic checkups throughout VT--it was built into the fee, which was charged for six or eight weeks of therapy at a time. I suspect the COVD also reviewed charts between her checkups--everyone kept detailed notes of progress, therapies tried, homework, homework compliance, etc. It was as top-notch as anything we'd ever done, including OT at a clinic that is a regional landmark that puts on continuing education and things like that for other OTs.

 

It was not a big VT clinic, and i wonder if that makes a difference. It wasn't a "money-maker" in the way that some clinics are. The VT side of things was one very small part of the whole office--most of the optometrists were not COVD's and didn't do therapy, etc.