Note: Effective visual processing interventions must be client-centered. There is not one solution, rather a trial and error and evaluation of the effectiveness of the intervention based on specific child's needs.
Occupational therapy intervention should consider the person, the environment and the occupation as identified in the CMOP-E model (Townsend & Polatajko, 2007). Below are examples of intervention strategies for each component.
PERSON
vision therapy
▪ Vision therapy has been shown to be effective to treat vision-based learning problems (The Children's Information Network, n.d.)
▪ The overall goal of vision therapy is to enhance the use of different brain processes to alleviate signs and symptoms of vision problems, and to maximize visual and overall performance (The Children's Information Network, n.d.)
▪ This is a remedial approach to intervention since it is targeting change within the child's visual system (Radomski & Trombly, 2008).
The Brock String
▪ To be used when the child has trouble with both eyes aiming and focusing on a particular point in space i.e. convergence insufficiency, eye tracking issues
▪ Usually one of the first techniques to be tried, and often assigned to home therapy programs for children (The Children's Information Network, n.d.)
How it Works:
▪ Obtain a Brock string and tie or hold one at eye level, and have the participant hold the other end to their nose.
▪ The beads should be placed such that the green bead is approximately 14 inches from the participants nose (This does not have to be exact, but should be placed at a comfortable distance which is one inch further than normal reading distance), the yellow bead is about 30 inches and the red bead is about 5 feet from the participant's nose.
Recommended frequency: once or twice daily for 5-6 weeks.(The Children's Information Network, n.d.)
See YouTube video below for a visual description.
▪ The overall goal of vision therapy is to enhance the use of different brain processes to alleviate signs and symptoms of vision problems, and to maximize visual and overall performance (The Children's Information Network, n.d.)
▪ This is a remedial approach to intervention since it is targeting change within the child's visual system (Radomski & Trombly, 2008).
The Brock String
▪ To be used when the child has trouble with both eyes aiming and focusing on a particular point in space i.e. convergence insufficiency, eye tracking issues
▪ Usually one of the first techniques to be tried, and often assigned to home therapy programs for children (The Children's Information Network, n.d.)
How it Works:
▪ Obtain a Brock string and tie or hold one at eye level, and have the participant hold the other end to their nose.
▪ The beads should be placed such that the green bead is approximately 14 inches from the participants nose (This does not have to be exact, but should be placed at a comfortable distance which is one inch further than normal reading distance), the yellow bead is about 30 inches and the red bead is about 5 feet from the participant's nose.
Recommended frequency: once or twice daily for 5-6 weeks.(The Children's Information Network, n.d.)
See YouTube video below for a visual description.
________________________________________________________ "the two strings will cross exactly where your eyes are pointing...the string provides feedback"
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Mental Minus ▪ A technique that is used to help the child to develop awareness of how to shift their eye's focus (Harmony Vision Care, 2014). ▪ Uses a minus-powered lens and performed for approximately 5-10 repetitions each eye (BGMD Eye Care, n.d.) See the YouTube video for a visual description. |
How It Works:
▪ Have the child sit or stand and look at printed material that is 0.5 to 2 cm away from them.
▪ The lens should be brought up to the child's eye and they are instructed to make the print behind the lens clear by shifting the focus of their eyes. When they explain that the print is clear, the lens is taken away and this process is repeated ( BMGD Eye Care, n.d.)
For a step-by-step review of the process, Click below.
▪ Have the child sit or stand and look at printed material that is 0.5 to 2 cm away from them.
▪ The lens should be brought up to the child's eye and they are instructed to make the print behind the lens clear by shifting the focus of their eyes. When they explain that the print is clear, the lens is taken away and this process is repeated ( BMGD Eye Care, n.d.)
For a step-by-step review of the process, Click below.
"Brain Gym": kinesthetic awareness:
▪ Many students fail to advance from writing techniques that are traditionally taught to automatic/kinesthetic motor competence of forming letters (Benbow, 1992).
▪ "Brain Gym" uses the principle of physical movement to help with sequential memory by using kinesthetic feedback (Benbow, 1992).
▪ Brain Gym® International is a non-profit organization founded in 1987 (Brain Gym International, 2011).
▪ Includes 26 activities that were developed by Paul E. Dennison and his wife and colleague, Gail E. Dennison, who say that "the interdependence of movement, cognition, and applied learning is the basis of their work".
▪The Brain Gym® 101 course is an introductory course that is offered to teach the 26 movements to anybody interested, and how to apply them using specific Brain Gym processes and techniques (Brain Gym International, 2011).
▪ "Brain gym activities can often significantly improve the way we receive and process visual information" (Brown, 2004).
▪ "Brain Gym" uses the principle of physical movement to help with sequential memory by using kinesthetic feedback (Benbow, 1992).
▪ Brain Gym® International is a non-profit organization founded in 1987 (Brain Gym International, 2011).
▪ Includes 26 activities that were developed by Paul E. Dennison and his wife and colleague, Gail E. Dennison, who say that "the interdependence of movement, cognition, and applied learning is the basis of their work".
▪The Brain Gym® 101 course is an introductory course that is offered to teach the 26 movements to anybody interested, and how to apply them using specific Brain Gym processes and techniques (Brain Gym International, 2011).
▪ "Brain gym activities can often significantly improve the way we receive and process visual information" (Brown, 2004).
Please click on the link below for Brain Gym ideas for teaching children letter formation.
remedial practice
▪ When practicing individual letters, it is beneficial to address one discrimination issue at a time. For example, if the child is having issues with reversing the letters "b" and "d", have the child practice these letters repeatedly before moving onto another letter that the child is having difficulty with (Kidsense, 2014).
▪ Use multi-sensory materials when teaching the letters and have the child say the letter name and sound aloud (Benbow, 1992).
▪ Use different writing surfaces and tools such as chalkboards, dry-erase writing, clay, playdough, paint, or worksheets taped to the wall (Benbow, 1992).
▪ Use multi-sensory materials when teaching the letters and have the child say the letter name and sound aloud (Benbow, 1992).
▪ Use different writing surfaces and tools such as chalkboards, dry-erase writing, clay, playdough, paint, or worksheets taped to the wall (Benbow, 1992).
ENVIRONMENT
classroom strategies
School health occupational therapists are able to focus intervention regarding children's academic performance, reading and writing difficulties in the classroom by liaising with teachers, support staff and parents to provide the best intervention based on specific children's needs (Feder et al, 2000).
Below are some strategies that can accommodate for various visual processing disorders with a focus on productivity in the school environment.
Slant Board
▪ Can be used to increase visual attention and promote good posture during writing or reading tasks (Stensaas, 2008).
Desk Positioning
▪ The orientation of the child's desk can have an influence on their visual processing.
▪ Desks should be facing forward, rather than facing each other as this will reduce directional and positional confusion (Benbow, 1992).
Lighting
▪ Use as much natural light as possible that is evenly distributed
▪ Florescent lights frequently produce the most problems (Stenaas, 2008).
Eliminate Visual Distractions:
▪ Remove visually stimulating and distracting classroom decorations, especially near the child's work space or the front of the room (Kidsense, 2014).
Below are some strategies that can accommodate for various visual processing disorders with a focus on productivity in the school environment.
Slant Board
▪ Can be used to increase visual attention and promote good posture during writing or reading tasks (Stensaas, 2008).
Desk Positioning
▪ The orientation of the child's desk can have an influence on their visual processing.
▪ Desks should be facing forward, rather than facing each other as this will reduce directional and positional confusion (Benbow, 1992).
Lighting
▪ Use as much natural light as possible that is evenly distributed
▪ Florescent lights frequently produce the most problems (Stenaas, 2008).
Eliminate Visual Distractions:
▪ Remove visually stimulating and distracting classroom decorations, especially near the child's work space or the front of the room (Kidsense, 2014).
OCCUPATION
use activities; make it fun!
Encourage activities that the child can practice with visual processing, while also providing enjoyment for the child.
Examples of games/activities include:
▪ Hidden Picture Games such as "Where's Waldo"/ "I Spy" books - figure ground
▪ "Simon Says" - visual-spatial
▪ Making letters out of pipe cleaner, popsicle sticks, play doh, etc.
▪ Provide the child with worksheets that require them to find appropriate letters or items▪ Include directional arrows in their agenda or homework to signal left to right orientation
▪ Highlight or colour-coded boundaries on paper to help with visual discrimination (Stensaas, 2008).
▪ Copying designs from a model (i.e. using lego, building blocks) - visual-spatial
▪ Dot to dot worksheets - visual-closure
▪ Puzzles - visual-motor, visual-spatial
▪ Outlining boundaries for drawing or cutting tasks
▪ Keep worksheets clear and simple
(Kidsense, 2014).
Examples of games/activities include:
▪ Hidden Picture Games such as "Where's Waldo"/ "I Spy" books - figure ground
▪ "Simon Says" - visual-spatial
▪ Making letters out of pipe cleaner, popsicle sticks, play doh, etc.
▪ Provide the child with worksheets that require them to find appropriate letters or items▪ Include directional arrows in their agenda or homework to signal left to right orientation
▪ Highlight or colour-coded boundaries on paper to help with visual discrimination (Stensaas, 2008).
▪ Copying designs from a model (i.e. using lego, building blocks) - visual-spatial
▪ Dot to dot worksheets - visual-closure
▪ Puzzles - visual-motor, visual-spatial
▪ Outlining boundaries for drawing or cutting tasks
▪ Keep worksheets clear and simple
(Kidsense, 2014).
time management strategies
▪ Observing how long the child can focus on a particular task, and breaking down activities into smaller parts
▪ Provide frequent, short physical breaks for the child's eyes to recover after concentration on a visual task
▪ Provide frequent, short physical breaks for the child's eyes to recover after concentration on a visual task
helpful resources/handouts
Below are some helpful books that are available for purchase for occupational therapists working with children with visual processing disorders.