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Vision Therapy Can Help Spectrum Children With Visual Dysfunctions by Jeffrey Becker, OD
Vision Therapy Can Help Spectrum Children With Visual Dysfunctions by Jeffrey Becker, OD
Vision Therapy Can Help Spectrum Children With Visual Dysfunctions by Jeffrey Becker, OD
ISSUE 33 2009 REPRINTED WITH PERMISSION © THE AUTISM FILE www.autismfile.com | THE AUTISM FILE 77
EDUCATION & THERAPIES
using the flipper and wanted to hold it maintain a vertical position. To get a smooth and coordinated. It can take up to
himself at times. He progressed with the sense of this problem, recall the sensation another eight to 12 weeks for this phase
flippers and eye movement therapy at a of having ridden a merry-go-round at of the therapy. Many children report it to
steady pace over a two-month period, the playground. When it stopped, you be the most enjoyable part of the program
meeting all the goals set for him. likely felt unbalanced, moving in an because it involves movement. With DG, it
The biggest stumbling block to therapy uncontrolled manner and in various took five weeks and he was able to reach
(and this happened to DG) occurs when directions. Children with ASD may move all of his goals while engaging in gross
a child falls ill with a cold or flu. This is in such ways on a regular basis. Many motor and cognitive skills.
not an unusual circumstance and can of them have small, inaccurate eye
result in a setback in the therapy program movements called nystagmus. If so, they FINAL OUTCOME:
that lasts for several weeks until we can may feel as though the room is moving DG’s mother was completely amazed
get the child back into the program on a around them, making the afferent by her son’s progress. His eye contact
regular basis. An important factor in all sensory information contradictory and improved, his visual stimming significantly
therapies is consistency, including with confusing. The result may be a child who decreased, and his school performance
respect to therapy day, appointment engages in seemingly senseless whole- accelerated. His teachers wanted to
time, and therapist. Children with ASD, in body movements or even drops to the know what his mother had done to get
general, need consistency for any type of floor (Allison, et al., 2007; Trachtman, him this far. He was a more pleasant
activity to be willing to participate. Also, 2008). child according to what others told DG’s
having the same therapist, a quiet room, The integration phase of therapy mother. Most importantly, DG now knows
and engagement in therapy on a one-on- teaches the body and brain to work he can do these tasks and has improved
one basis is a must for children with ASD. together, overcoming inappropriate self-esteem.
The third phase of DG’s therapy was vestibular influences and enabling these Once the in-office rehabilitation
to address his convergence and depth new skills to become natural. These program is completed, a reduction in
perception problems. Although they are learned activities and need to be rehabilitation time is given to the child
are two separate processes, they can be incorporated into the child’s daily routine and a phase-out program is begun for
addressed together. The computer-based to embed them so the child can use them several months. This is done to monitor
therapy required DG to wear a special with every waking moment. Integration and maintain all visual skills that are
pair of glasses that created a 3-D image. therapy is accomplished with balance learned and to make sure the child has
Reluctant to wear them at first, our boards, trampolines, balance beams, ball adapted adequately to the new visual-
therapist also donned a pair to persuade catching and rolling, and cognitive skills functioning environment.
DG to use them. DG wanted to imitate training. In DG’s case, one of the tasks As a final step, DG was given a
the therapist so he then put on his pair of that we had him perform was to count to maintenance vision therapy program of
special glasses and together they worked 10 backwards, then call out the alphabet home exercises to follow and is checked
on his convergence and depth perception at the same time as he engaged in balance every three months in the office to
problems. At a rate of two sessions per exercises and eye therapy programs. confirm that he has not regressed. The
week, DG reached his goals in seven We repeated all the therapies that home maintenance program can be a
weeks for both convergence and depth have been described while DG was doing computer-based program (HTS) or the
perception. gross motor activities. By doing this, his procedures that are outlined in the next
brain had to incorporate all the new skills section. It is very important to do this
NEXT STEPS: developed so that functioning could be program with the understanding that
Once DG’s visual skills progressed to these visual skills have been learned and
the point where he could perform fine DG’s mother was completely can easily be unlearned if they are not
and gross motor tasks, one more focus reinforced on a routine basis at home.
of therapy remained. This is called an
amazed by her son’s progress. VISION REHABILITATION IS NOT
“integration phase” and helps with any His eye contact improved, his SOMETHING THAT IS DONE TO A
vestibular deficits the child with ASD visual stimming significantly PATIENT OR TO A PATIENT’S EYES. IT IS
may have. Many children with ASD have decreased, and his school RE-EDUCATION AND RELEARNING OF
vestibular deficits, making it difficult performance accelerated. VISUAL SKILLS THAT A PATIENT HAS
for the child to remain stationary or NEVER GAINED NOR LOST.
78 THE AUTISM FILE | www.autismfile.com REPRINTED WITH PERMISSION © THE AUTISM FILE ISSUE 33 2009
OCULOMOTOR, EYE FOCUSING, AND CONVERGENCE
PROCEDURES THAT CAN BE DONE AT HOME
3. Observe your child’s ocular movements CONVERGENCE TRAINING:
as the ball swings in and out from his or Below you will find a useful procedure in
her face. This should last for one minute. the treatment of many vision problems,
If your child wants to turn his or her head, especially convergence insufficiency and
try to hold his or her head in place while depth perception.
your child is moving his or her eyes. Obtain a piece of white string 10 feet
long, with three movable color beads
4. After the ball is at rest, pull the ball to placed on it. (This is easily purchased at
the side of your child and let go so the any hobby or craft store.)
ball swings left to right and right to left Normally, one end of the string is
for one minute. Observe your child’s eye placed on a distant object such as a
movements laterally. doorknob. Place one index finger over
the other end and hold it to the tip of
5. When the ball is at rest, begin by the nose. The first bead is placed at a
throwing the ball in a circular motion distance of 16 inches from the nose, the
clockwise. Instruct your child to follow second bead at 5 feet, and the last one at
the ball with his or her eyes for one about 9 feet.
minute. When the child looks at the first bead,
he or she should see one bead with two
Proper setup for tracking exercise 6. When the ball is at rest, begin short strings leading toward it and two
by throwing it in a circular motion longer strings leaving it. On the two
OCULOMOTOR EYE MOVEMENTS: counterclockwise. Tell your child to follow strings which leave the bead there will be
Visual Tracking the ball with his or her eyes for one – to the child’s perception – two beads at
Visual skills emphasized are pursuit eye minute. the 5-foot distance and two more beads
movements, tracking skills, and eye-hand at the 9-foot distance. Next, have him or
coordination skills. Pursuit eye movement 7. Continue this daily for three minutes her look at the second bead and again the
and tracking skills are important for several times per day. As you do this your subject should see two strings entering
effective near point tasks, eye contact, child will begin to improve his or her eye the bead and two strings leaving it,
and the development of good reading movements. making a large “X.” At this position there
skills. Eye-hand skills are important for will now be two beads – to the child’s
writing, eating, and the knowledge of EYE FOCUSING SKILLS:
directionality and laterality. The near/far chart is used for eye
Ball Rotations Procedure is a simple focusing. Cut out pictures that your child
but useful task used in the treatment of likes and put them on cardboard and
oculomotor deficits. place them 6 to 10 feet away at standing
The equipment needed is a ball with height. Make copies of these and shrink
letters written around the center of the them and place them on cardboard to be
ball or a picture that your child may like, held in front of the child about 12 inches
a string, and a hook. Hang the ball (or away.
picture) from the ceiling and adjust the Have your child look at the first picture
height to his or her nose level. on the distance chart, and then have
Follow these procedures: him or her find the same picture on the
close chart. Continue repeating this and
1. Place your child a comfortable distance increase the speed. This will allow his or
(approximately 3 to 4 feet) from the her eyes to quickly focus at distance and
hanging ball. This can be done lying down near. Make a game of it and make sure
or sitting up. that the pictures are of interest to him
or her. Always change the pictures and
2. Bring the ball within one inch from at times hold the close chart at different
the child’s nose, and instruct the child to rotations so that he or she still has to
follow the ball with just his or her eyes. recognize the picture even though it may A patient displaying proper setup for
Let go of the ball. be oriented in a different position. convergence training
ISSUE 33 2009 REPRINTED WITH PERMISSION © THE AUTISM FILE www.autismfile.com | THE AUTISM FILE 79
EDUCATION & THERAPIES
80 THE AUTISM FILE | www.autismfile.com REPRINTED WITH PERMISSION © THE AUTISM FILE ISSUE 33 2009
accomplished, the next goal is to be able Finally, this training technique can
to look away from the beads at a distant be used while the child is on a balance References
object and then look back at them and board, balance beam, or trampoline, Allison, C.L., Gabriel, H., Schlange, D., &
regain fusion. Alternate beads after each incorporating all sensory systems Frederickson, S. (2007). An optometric approach
to patients with sensory integration dysfunction.
distance glance. at once. Optometry 78(12), 644-651.
Cohen, A. H., Lowe, S.E., Steele, G.T., Suchoff,
HOW TO FIND A QUALIFIED EYE CARE SPECIALIST I.B., Gottlieb, D.D., & Trevorrow, T.L. (1988). The
efficacy of optometric vision therapy, Journal
of the American Optometric Association, 59(2),
To locate a neuro-developmental optometrist in your area, log onto 95-105.
www.nora.cc (Neuro-Optometric Rehabilitation Association). Holmes, J., Rice, M., Karlsson, V., Nielsen, B.,
When making an appointment, ask the following questions: Sease, J., & Shevlin, T. (2008). The best treatment
determined for childhood eye problem. Archives
1. H ow frequently does the doctor examine children with autism spectrum of Ophthalmology, 126(10) 1336-1349.
disorders? HTS Inc. (2009). 6788 S. Kings Ranch Rd., Gold
Canyon, AZ 85118.
2. Does the doctor do functional vision testing, not just acuity testing? NeuroSensory Centers of America. (2009). 300
3. Does the doctor prescribe vision therapy, and who carries out the therapy? Beardsley Road, Austin, TX 78746
Taub, M.B., & Russell, R. (2007). Autism spectrum
4. How long is the examination process with the doctor? (It should last at least disorders: A primer for the optometrist. Review of
90 minutes to get a good understanding of the child’s deficits.) Optometry. 144(5). 82-91
5. Will the doctor write and correspond with the school and/or other Trachtman, J.N. (2008). Background and history
of autism in relation to vision care, Optometry,
professionals? 79(7), 391-396.
ERRATA
Going back and forth in the editorial process, words get switched around, sentences get changed
and, occasionally, an error results. This was the case with the article from Dr. Nancy Mullan,
which was printed in the July edition (issue #32). We are reprinting the paragraphs below, which
emphasize the need to be cautious about high glycemic index foods.
Diet is foundational. A symptom which Thyroid and adrenal functions sugar levels rapidly and then let
is being caused by a food or a substance potentiate each other. If adrenal them drop, are a stressor to the
the patient is ingesting will not resolve gland function is low, there is strain adrenal glands. Cortisol is the
until that substance is removed. The on the thyroid. If appropriate thyroid hormone which must be secreted
foods chosen should have nutritional support gives the patient symptoms, to prevent that blood sugar drop.
value, be organic, be free of chemicals, the adrenal gland must be treated Patients with hypoglycemia are not
additives, preservatives, and other first, and the thyroid addressed able to produce enough cortisol
pollutants, and be eaten in the least again later. The adrenal glands are quickly enough to keep their blood
processed form possible. Double the body’s first line of defense sugar levels steady. Patients with
handfuls of nutritional supplements against stress. They produce cortisol, postural hypotension, dizziness
can be negated by poor food choice or a stress hormone with important upon coming to an upright position
quality. High glycemic index foods should functions. Adrenal stressors include quickly, are experiencing a blood
be avoided as blood sugar fluctuations chemical toxins, allergies, infections pressure drop that indicates that
are a common cause of psychiatric and psychological stress, among their adrenal function is impaired.
symptoms of all varieties, especially in other things. High glycemic index Adrenal hormones regulate blood
the bipolar individual. foods, foods that increase blood pressure also.
We apologize for any confusion this may have caused. If you would like a corrected .pdf file of this article e-mailed to you, please e-mail
Teri at teri@autismfile.com.
Also in the July 2009 edition, concerning the article titled “Are Federal Research Dollars Being Spent Wisely?” the lead author should
have been listed as Theresa Wrangham, with Vicky Debold, PhD, RN, as contributing author.
ISSUE 33 2009 REPRINTED WITH PERMISSION © THE AUTISM FILE www.autismfile.com | THE AUTISM FILE 81