Vision Therapy, round 2

[mommymonster]

DS10 is having increasing troubles with reading aloud and the more complicated math demands of fourth grade. I scheduled a regular eye exam today, and the optometrist mentioned that he thought that we needed to have a re-check with a COVD. As I was watching the optometrist check DS10's vision and doing a tracking check, I could see his eyes jumping... there was no smooth tracking again.

 

If you've done vision therapy multiple times, what were your experiences (for the subsequent rounds)? We had such a difficult go with our first round, I'm just filled with dread. We have a different provider, so that's something. Does it tend to take as long? Is there any new software or programs that have come along in the past two years I should look into? 

 

 

[Julie of KY]

How long did you do it the first time? The people I've talked to who talk about multiple rounds of vision therapy often have much shorter courses that we did to begin with. Our COVD doc recommends 30 weeks saying part of the time is learning the skills and the rest is making them become permanent so that you don't need more VT. I've been very happy with the long term results so far (over multiple years).

[mommymonster]

DS did over seven months of weekly appointments. We also did 3x daily homework, 7 days per week. It was not a quick process...

[PeterPan]

You need an OT eval first/instead.  That eyes jumping is a retained reflex.  There might be another explanation (midline issues in general, blah blah), but I'm saying it's one real solid explanation that would also fit why you had such a horrific time the first time through.  So get a good OT eval first from somebody who does RMT, etc.  Nuts, you can even look up the tests yourself and see.  You could have more OT issues going on, and there are sometimes PTs who are good at it.  But that's what you're looking for.  I'd get that fixed (if it's going on) before you go back for VT.

 

Some VT docs will check for OT issues because they have such a huge effect on vision and the effectiveness of the therapy.  I'm assuming yours didn't, which is why you might as well move on to an OT or someone who does.

Edited December 16, 2015 by OhElizabeth

[mommymonster]

Elizabeth, that's super interesting on retained reflexes. We've actually had two OT evals, but they weren't helpful. The first eval found DS below normal in writing skills. The second was a year later and he had the same time and raw scores, but lower percentiles (because a "normal" kid would have improved the times/raw scores). The OT suspected dysgraphia. DS was being tested through a neuropsych at the time, and he was diagnosed with a SLD in Written Expression. Perhaps it's time to get a third (private pay this time) eval. Goodness, I feel as though we've wasted a lot of time and effort...

[PeterPan]

OTs are a real crap shoot and totally vary.  That's why I said you need to find someone who does RMT.  It's a known, standard treatment for retained reflexes.  Look for someone dealing with a lot of autism, because that's where they're extremely common.  

 

My ds has seen 3 OTs this year, and they've been totally different.  It's sometimes a very hairbrained profession, more like car salesman than medical practitioners.  They get this nominal training really fast in grad school, and then come afterward with the workshops and CEUs.  So fine, CEUs are great, but then you realize your OT may or may not have even had training in the thing you might need?  Sometimes it seems more like they're purveyors of what they learned in those CEUs than anything.  (Oh, I took a course in this and they convinced me how great it is.  Let's try it.)  It's like SLPs.  They'll all treat you for apraxia, but 99% of them have not bothered to get the ONLY consistently effective treatment for it.  (Holding flashcards up is not effective for most people with praxis, hence the crap results and the community's willingness to diagnose apraxia down the road by the FAILURE of their therapies.)  

 

That's your cynical morning, mercy.  Google STNR and start there.  I think that might be the one that is most commonly associated with eyes jumping at the midline, but I don't remember.  There's a whole book (Stopping ADHD) just on that ONE reflex and the treating of it.  Yes, my ds has SLD writing, and his eyes were jumping at the midline with his first OT eval.  She specifically pointed it out.  These people are often very vague.  I swear their theory is "I'll do a bunch of stuff and eventually it will fix!"  Sigh.  So you could get someone who wasn't saying much who actually would have done the right things for it.  They all have their pet programs and ways they handle things.  Just makes it really hard as a consumer to get a direct answer like this is what the problem is and this is what we're going to do about it.

 

The other thing is that it reflects midline issues.  So you can do 8s, anything crossing midline, etc. etc. with him yourself.  You don't need an OT to tell you that and it's not rocket science.  Our OT has one of those figure 8 marble tracks, and that's really cool.  When we first started, she would have ds sit there and play with it for several minutes, just tracking the balls around and around, across the midline.  Balavisx is another thing where they're using their vision and tracking across the midline.  Even coloring or dot to dots, where the dc goes across the midline and you don't let him switch hands ;) can be good.  We've been doing some of the graph art books from I forget, TCR or EM.  Anyways, the graph art books have free samples for you to try.  They'll have small squares of coloring so you don't aggravate him, and the instructions are in lines so you can spread it across a week.

 

Did you actually follow up any of those OT evals with therapy?  Like I said, OT evals tend to be VERY vague.  Some aren't, but most are.  They're more like get you in the door appts.  

Edited December 16, 2015 by OhElizabeth

[ElizabethB]

My MIL does VT after a stroke at a place than mainly works with children, he is very good. He does quarterly checks on all his children, he said that if you catch their regression early it only takes a few weeks to fix, but if it goes longer it can take almost as long as the original time.

[Lecka]

My older son has dysgraphia and formerly had tracking issues.

 

But only a very specific type of tracking issue. His eyes "jumped at the midline." Other than that he tracked okay (from my understanding).

 

So, here is what we were told for that.

 

First, rule out convergence insufficiency.

 

We ruled out convergence insufficiency.

 

Then, in my town, it seems the OT and the vision therapist are both like "sometimes what we do helps, but other times, we refer kids to the other person, and they are helped by that person." Neither of them could say "oh, definitely OT" or "oh, definitely vision therapy." Neither of them could say that.

 

So, insurance paid for OT, etc. It seemed like it would be easier on my son, too. So, he did OT to improve "crossing the midline." It turned out, it did help his tracking.

 

Now he has OT again. His OT now thinks doing RMT exercises will help him, so he is doing them. She thinks that from things about him, it comes across like he would be helped. He has some sensory stuff, also.

 

But his tracking improved from the "crossing the midline" stuff. But now it seems like RMT is still recommended.

 

The exercises are simple, for him, he can do them on his own. It seems like it can't hurt. It is not the kind of thing where "we will see results on this timeframe." With the crossing the midline -- there was noticeable progress in 2 months. I remember, b/c after 6 weeks the OT said there was not noticeable progress and I might want to go ahead and call a vision therapist. I had heard about a more child-friendly practice and scheduled an appointment there. Before the appointment, he did show some signs of progress in OT (over the next two weeks) and I cancelled that appointment. Then he did make steady progress. His reading started improving. His coordination (that I had never even noticed as a problem) also improved. It was very nice.

 

But it is still, like, here we are, 3 years later, and he is doing some RMT exercises. I think it can just be that way sometimes. It is not so "okay, all done." Kids work on what they can work on, and then a little later, maybe there are more things to work on. It is still progress.

Edited December 16, 2015 by Lecka

[PeterPan]

RMT is for reflexes as a whole.  If you work on one specific thing, you'll sometimes get progress.  At that point it's a splinter skill, meaning you still have the overall problem (retained reflexes, whatever), but you've worked on this one tiny aspect of it.  

[mommymonster]

OTs are a real crap shoot and totally vary.  That's why I said you need to find someone who does RMT.  It's a known, standard treatment for retained reflexes.  Look for someone dealing with a lot of autism, because that's where they're extremely common.  

...

 

Did you actually follow up any of those OT evals with therapy?  Like I said, OT evals tend to be VERY vague.  Some aren't, but most are.  They're more like get you in the door appts.  

 

So we did the evals through our insurance, and they indicated the first time that DS needed to be two standard deviations below the norm, and he was 1 3/4 standard deviations below. To them, he wasn't "eligible" for covered OT. When we did the OT eval the second time, he was more than two standard deviations below the norm, but they said that nothing they offered would help. We were paying for VT out of pocket at the time, and just didn't have the money to pay for both. We were also doing the neuropsych eval and wanted to figure out what was coming out of that. After all the evals, we just didn't go back for another OT one. It's obvious something is amiss, and yet we don't seem to be finding the right person to help with the issues. STNR seems very, very likely, after looking through the list of symptoms.

 

I think we'll also look into yoga and Bal-a-vis-Ex. Both seem like something fun that can't hurt.

 

My MIL does VT after a stroke at a place than mainly works with children, he is very good. He does quarterly checks on all his children, he said that if you catch their regression early it only takes a few weeks to fix, but if it goes longer it can take almost as long as the original time.

 

Oh that's terrifying on the long timeframe to fix. I hope your MIL is doing well, though.

[ElizabethB]

Oh that's terrifying on the long timeframe to fix. I hope your MIL is doing well, though.

Well, hopefully it will be shorter!!

 

My MIL is doing much better, it has been a long 2 years, though. She has had OT and VT now and figured out how to manage her time, too much stimulation of certain types causes problems for her. She said that she should have followed her nagging Daughter in Law's advice to do VT a year earlier, it really helped her!

 

The exercises my MIL uses are similar in some ways and different in others, she also has computer homework that she still does. Her doctor said that as an adult you know how to do the stuff, you just have to jog your brain and eyes back into doing it and reconnecting pathways that already exist, but with children they are building up new processes. Also, she can give much better feedback than many of his patients, especially the really young ones.

 

Since your son is older, maybe it will be shorter since he should be old enough to give good feedback to make the process go faster, and hopefully he will be just reminding the brain and eyes what to do again like my MIL.

Edited December 17, 2015 by ElizabethB

[MerryAtHope]

Our VT insisted on working through retained reflexes first. In his experience, kids who don't work through them first tended to regress. This site has some of the exercises we did. My son spent about 13 months altogether in VT, but the vision exercises themselves were pretty light until he was through with the reflexes. Once he had worked through all of those, the actual remaining VT exercises went much quicker (about 9 months on reflexes--he had some that were really stubborn--and then 4 months on the remaining vision exercises, and then a couple of rechecks).

[kbutton]

We're on VT for child number two. He has a bunch of retained primitive reflexes, and even that is in the eye of the beholder--my son's Moro reflex appears to be okay with some tests, but the one the VT does shows big time Moro issues. Our VT uses a lot of OT stuff mixed in, and some insurances will actually cover part of the session as OT--I think it's about 1/3 OT. 

 

The VT says that Moro is the big one for vision issues, and then when they work on Moro, sometimes it integrates some of the others (sounds like maybe Moro is one that kind makes the others stay retained?). 

 

To test for Moro, have your child walk forward and then backward across the room with their toes pointed out like a V. Watch the hands. If the hands turn with the feet, Moro is there. The hands might not turn right away. It might take a bit of walking. Then try walking with toes in forward and backward. Watch the hands. If the hands turn in with the feet, Moro is there. Apparently Moro messes with midline stuff a lot.

 

THis particular child of mine has focusing issues and mild tracking issues. My other one had more straight covergence issues. I would strongly urge you to test and treat the retained reflexes. My older son was very mild on the symptoms, but the work in VT was dramatic. As dramatic as OT or more. I can't say enough good stuff about our VT's approach. I don't know that they are all created equal.

[geodob]

This 'jumping of the eyes', is actually termed as Nystagmus.

Though the 'way that they jump', is important?

Where they may jump: up and down, from side to side, or in a rotational movement?

 

But behind Nystagmus, is basically a difficulty with our 'vestibular balance system'.

Where our eyes need to know what position our head is in, to direct their movement.

The eyes check for 3 positions?

The first is its left to right position?

Is head faced directly in front, or pointed to left or right?

Secondly it checks whether it is leaning to the left or right, or straight up?

Thirdly, it checks its 'forward/ backward' position? Whether it is tilted up or down, and how much?

 

To appreciate this? Perhaps you could simply try reading, with your head tilted slightly to the left, and then to right?

Also with your head tilted slightly forward, and then back?

 

Where each of these positions, require a different use of the eye muscles. To suit the position of the head.

But then, you might consider the problem for the eyes?

If they aren't recieving accurate information, from any or all of these 3 positions?

Perhaps you can appreciate, how without this accurate information?

That the eyes would then have to 'jump around', to find where to look at next?

 

Though we aren't born with ability to locate our head?  Rather it involves a developmental process.

Which is what the STNR and ATNR are basically about.

STNR is the first process, with S for Symmetric.

This reflex is triggered as baby turns its head from left to right to left.

 

But it is important to understand how this position is detected?

Which basically uses 3 'semi-circular canals' in each ear.

That are partially filled with fluid.

Which work on the principle, that if you tilt a semi-circular canal from one side to the other?

Then the fluid will move to suit the new position.

In the same way, as when you tilt a glass to one side, the fluid will shift to that side and remain facing straight up.

 

Though the way that we develop the ability to sense these 3 positions?

Starts with being able to sense the position of the head, from left to right.  Lateral position.

Which takes advantage of a newborn, just laying on its back?

In this position, the only free movement that a baby can make with its head?

Is to turn it from left to right, and back?

But to help a baby to become of these different sides?

When it turns it head to left?

Its left arm will spring out as a reflex.

Then when it turns it head to right, its right arm springs out?

Though with this springing of the arms out to the left or right?

A baby becomes aware of a mid-point between them.

Where directly in front is.

Though a further advantage of 'laying on their back'?

Is that looking at the ceiling, their are no visual cues, to define left and right.

So that it has to develop the ability to sense the left to right position of their head?

 

Maybe you could close your eyes, and then turning your head from the left and right, back and forth a few times?

Keeping your eyes closed, try and position your head to be facing straight in front?

Which you might be able to do very precisely?

Where you developed this ability to do this, as a baby laying your back.

With the help of your SNTR.  

Symmetrical Tonic Neck Reflex

The Symmetrical, refers to the left/right balance.

 

The next stage in the developmental process, adds the elements of the head being 'tilted to front or back, or tilted to left or right side'.

Which uses the ATNR,  Asymmetrical Tonic Neck Reflex.

Assymetrical refers to the integration and coordination of these 3 different coordinate positions.

To develop this integration and sense these 3 different positions?

The main technique used for this?

Is 'Crawling'.

With crawling, the important thing, is that the 'head is tilted back'.

So that body and limbs are out sight.

As a baby crawls, moving one arm and leg after the other.

A baby becomes aware of the position of its head.  As its out of sight body, moves around under it.

As its head from side to side, and forward to back.

As it leans forward to extend an arm, and then pulls itself forward over the extended arm.

So that with the body out of sight?

It forces a baby to become aware of these 3 positions of its head.

 

Though coming back Nystagmus and 'jumping eyes?

Perhaps you can appreciate why the 'way that the eyes jump', is important?

For example, if the eyes 'jump up and down'?

Then this indicates that their is a difficulty with sensing how far the head is tilted forward or back?

So that as the eyes move from left to right, they will jump up and down.

 

Though for remediation of this?

Laying back with the eyes closed, and turning the head from left to right, back and forth can be used.

As well crawling, with the head tilted back.

[Lecka]

RMT is newer in my area. There is a level whatever person in a nearby city, now, and she came and gave a presentation at the autism workshop I went to this summer. (I went wrt my younger son, not my older son -- he does not have autism, to be clear.) But, I didn't go to her presentation, I signed up to go to a presentation by a speech therapist during that block of time.

 

Then, earlier this year, two OTs who work in our school district traveled to go to a training about RMT. One of these is working with my older son now.

 

I am hearing good stuff about it, but it is new in my area, too.

 

My son is able to do the RMT exercises, independently, right now, that he is doing. But the OT thinks it will help him to do them. It is not a "he can't do the exercises" situation.

 

I don't know.... I am taking someone else's word for it on this. I also think -- it is something that is not taking much time for my son, he does not mind it at all, and I think it is also a nice mini-exercise break for him and probably good for his sensory needs.

 

I do not really have a lot invested in it, though.

 

But I didn't have a lot invested in the "crossing the midline stuff," either, and then it turned out to be something I could see was really helpful for him.

[PeterPan]

It might be because he's older, but still I think that's missing the point of the slow, controlled *rhythm* to tell the dc to do them independently.  If you can have her demonstrate them to you, you can supervise to make sure he's doing them correctly.  Some are passive exercises someone else does to you.

[Lecka]

I have seen his target ones demonstrated, and he looks like he is doing them good to me.

 

One he does, the lowest level is a passive exercise (the one where the child lays on their back and you rock them back and forth).  I was told that if he does x, y (I think keeping his heels on the floor?????? and his shoulders on the floor???????) then he can do it independently, if he can't do it that way he needs to have someone with him. 

 

She thinks that one is good for him, and the other one she likes for him she calls "popcorn" and has him lay on his back, pull his body in, grasp his shins with opposite arms, and then "pop" like popcorn.  There is no way to help him unless he needs help to grasp his opposite shin -- but he can grasp his opposite shin now, without help to put his hand there.  It looks vaguely like he is doing some abdominal exercise.  For that I think I am supposed to watch that he holds his head up and that he is crossing his arms properly each time.

 

But it looks like he is doing it to me.

 

This is from school OT, so I have only talked to her about it once and had her demonstrate it to me once.  She told me she thought that after he learned them, he would be able to do them indepedently, though, with her watching him do it (probably once a week) to make sure he wasn't getting a bad habit. 

 

He is 10 and he does not have autism.  He has dysgraphia.  He has some sensory issues.  He has some executive function issues. 

 

She thinks it will help him, though.  She is aware of his history of having midline issues he worked on when he was younger (in OT).  She thinks it will help him with sitting in a chair!

 

 

[Lecka]

Oh, I just realized, maybe he is doing these exercises more as sensory "good things to do"?  It could be that.  I am not "on top of" OT stuff the way I am with some other areas. 

 

I was told at tme meeting, some behaviors where he is having trouble sitting, or else getting spacy, they (school psychologist, OT, resource teacher) think is definitely not caused by ADHD.  They think it is some combination of sensory issues and frustration with not having sufficient handwriting accommodations.  So, he is getting some sensory stuff and handwriting accommodations.

 

The thing is ---- he is a 5th grader in public school.  He is expected to be sitting and paying attention, or sitting and doing independent work, for long periods of time. 

 

So his "he doesn't sit and focus as well as he needs to" looks really, really, really different from my younger son who would not even sit down for circle time when he started pre-school. 

 

But RMT seems good, too.

 

But I have had it presented to me, sometimes, that RMT is the most basic one of a few programs, and then Brain Gym is a little more advanced, and Bal-a-vis-x, etc. 

 

For my older son, it is really not that he is doing RMT b/c he is not ready for Brain Gym.  (And there is another "name" program that is popular here, I can't remember right now.)  She just thinks this will be good for him.

 

When I went to the sensory workshop last year, it was presented a little bit like RMT was the most basic and Bal-a-vis-x was the most advanced, and Brain Gym was in the middle.

 

But, it is not like that for my older son.

 

She just thinks it will be helpful to him, that is really all I know.  And, he doesn't mind doing it.  He can do it at school in a small space without getting wound up, too.  That is pretty desirable. 

 

 

 

[kbutton]

The popcorn exercise is similar to an exercise a friend's daughter did for one of the retained reflexes (and it worked for her). So, Lecka, is part of the RMT to strengthen your son's core muscles? It sounds like it might be (sitting in a chair relies on core strength). Our VT is adding in stuff for my son's core along with the visual stuff and reflex stuff. It's strongly OT-based.

[Lecka]

Maybe it is! 

 

Back in 2nd-3rd grade the OT said he did not have core weakness. 

 

But he does have trouble sitting in a chair now.  But -- for 5th-grade expectations.

 

He could have been lower-average then and slipped behind. 

 

But honestly, I do not really know. 

 

Between my younger son and older son, there is a lot going on, and my older son's OT is something where I feel like "it seems good" and so I let it go at that. 

 

The meeting where this was discussed already ran over the alloted time and the OT stayed late to talk to me about it some more.  But I do not see her, she sees my son once a week, and she leaves a sensory card for him, that he can do independently and with minor supervision from the resource room teacher.... then she checks up on him once a week and does whatever she does with him once a week. 

 

But that would make sense!  It looks like it has the core strength angle, and definitely the "grasping opposite shins" which he is supposed to alternate which arm is on top of the other.  It is something where he needs to concentrate.  Then it is also like a "you are hugging yourself" thing which is probably good for the "proprioceptive sensory seeking" thing.

 

I think his chair issues are thought to have a component of "proprioceptive sensory seeking." 

 

But I am not really sure.

 

I think in this case, it is like "we will try a few things, if they work we will keep doing them."  But not necessarily a "we know exactly why we are doing each of these things."  I think she has a good idea, but I think it is also her sense of "I think this would be good."  And then if it didn't seem to be helping, I think she would switch to something else she would think would work. 

 

It is not quite the same as the "we have identified the exact problem, and the exact mechanism, and now we are doing this exact intervention."  But I think it is adequate and good when it works, and sometimes more honest when sometimes I think the exact mechanism may not be known exactly.  And, in some cases, I don't think it matters.  In other cases, I think it matters a lot. 

 

For this -- things have improved a ton since implementing the plans from this meeting.  Does anybody know exactly what percent is b/c of one thing, or the other, or the other?  No, I don't think so.  But taken together it is good! 

 

I think, too, for my son, he has a good relationship with this OT, and he likes the OT stuff.  So, I think there is the fuzzy area of "he is doing something for a bit of a break, and it is a bit special," that is over and beyond just "oh, he is doing this exercise."  Even if the exercise is a big part of it, too.

 

It is different than with my younger son, where sometimes he does not like OT, and then it is like ---- however helpful it might be, it is a problem if he hates it.  It is not worth doing it if he hates it consistently and nothing can be done to change that.  It becomes something that is bad to do at a certain point, even if it is helpful in its way. 

 

But my older son likes this stuff.  He has been frustrated with it in the past, but right now, my understanding is that he does think it helps him to have the little break to do the exercises. 

 

And then, if it is supposed to be a sensory break, on some level, it needs to be easy for him.  If it was hard ---- it would not be something you do for a break before going back to class. 

 

I think it is more of a break type of thing.  I think it will be something where he works on a new exercise with the OT, but is only having it on his card when he can do it easy/independent.

 

B/c for him a big part of the function is just "sitting and paying attention in class" and so it probably needs to be things that are simple/easy for him in this context, and for how long he is doing it.

 

It is not like for my younger son, when last year, if he needed to take a long sensory break, it was okay. 

 

That is not the expectation for my older son at all, b/c he does not need that. 

 

 

Edited December 18, 2015 by Lecka

[kbutton]

My younger son does some proprioceptive sensory seeking too. Very different from my ASD kiddo's sensory stuff. It seems to be related to not have that postural and core strength from what our OT told us. OTs are very big on multi-tasking assignments--each assignment is crafted to work on several issues at once. I have noticed with VT that the tend to choose one thing to do, but then add a distraction to it by upping the level of brain work or concentration required to complete the task once you're pretty good at it. I think there is value in both approaches. The OT approach builds muscle faster, I think. 

[kbutton]

I just read your edit to your post, and I think I like your OT. :-) She sounds a lot like or VT person. We liked our OT person too, but I feel like she had a lot of angles to come at this, and we had more need than we knew how to prioritize. With VT, it's more focused and things come up peripherally in a more organized fashion. But yes, they both wanted ot keep it simple and fun. My son loves to have the extra attention of the VT. It's special.

[PeterPan]

Lecka, your OT is probably blending things.  One of those exercises you described is RMT, the other is not, as far as I know.  Well I say that, and then is it on the Moro card or something?  There were a couple cards we didn't need, so I didn't really study those.  But I actually sat there with the RMT training cards for each reflex.  Anyways, no matter.  As long as she has her experience saying it works for what she's trying to do, it's fine.  Each reflex usually has about 5 activities they *could* be doing, and some overlap and are good for integrating other reflexes as well.  So it sounds like she's picking exercises he can most easily do correctly independently. 

 

That whole explanation on the spacing out seems odd to me, but whatever.  Of course our school bent over backward to deny ADHD as part of the mix when we have *2* private psychs diagnosing it.