Category Archives: Visual

Challenges of Low Vision in Children

Definition and Impact:

Vision is the interpretation of what an individual sees. The visual system includes the following components: acuity, binocularity, fixation, and visual tracking. Low vision is a condition characterized by reduced vision that cannot be fully corrected with glasses, contact lenses, or surgery. “Challenged vision” seems to be a more descriptive term for this multi-faceted diagnosis because low vision seems to imply decreased visual acuity whereas challenged vision is a broader term and implies how vision problems affect visual perception. However, for this article, the term “low vision” will continue to be used to be inclusive of the many difficulties that are more inclusive than only visual acuity. Low vision may manifest with a number of problems including blurry vision, decreased depth perception, poor reading skills, discomfort sustaining visual attention, headaches, and more. Low vision can severely affect children’s ability to learn, develop social skills, and participate in daily activities.

The Vision Council is an organization that aspires to be a vision care leader in “enabling better vision for better lives.” Its mission includes promoting growth in vision care through advocacy, education, research, and consumer outreach. In June 2024, The Vision Council published a report: Focused inSights: Patients with Low Vision. Results were based on two Focus Groups representing participants with low vision (adults) and primary caregivers of children with low vision. Children were diagnosed, primarily by optometrists (41%), typically when a child began school. Symptoms included: blurry vision, light sensitivity, inability to see in low light, and struggles with reading. From there they were referred to other providers including low vision specialists, occupational therapists, and assistive technology specialists.

Developmental Challenges for Children with Low Vison:

Children with low vision often face developmental delays, particularly in motor skills, visual-spatial tasks, and academic skills including reading and writing. These challenges can lead to difficulties in reading, writing, and navigating the environment. The lack of visual cues can also hinder their social interactions and ability to learn from their surroundings. Low vision can lead to emotional and psychological challenges, such as frustration, anxiety, or social withdrawal, which are common in children dealing with impaired visual functioning.

Educational Needs for Children with Low Vision:

Education for children with low vision must be tailored to their specific needs. This often includes the use of assistive technologies, such as magnifiers and screen readers to support their learning. Schools provide individualized education plans (IEPs) to accommodate these children effectively. Additionally, teachers can arrange their classrooms to avoid visual overstimulation for all students. Incorporating movement into a teaching activity, like pairing up with a classmate to throw and catch letter beanbags to learn letters works on learning letters while using bilateral skills and spatial skills.

Therapeutic Interventions for Children with Low Vision:

Vision is considered more than optical clarity or muscle and nerve functioning; it examines vision development and is influenced by what the child sees along with their physical actions. Occupational therapy, vision therapy with a behavioral/developmental optometrist, and a vision professional with specialized training can help children with low vision
develop compensatory skills. These therapies focus on improving the child’s ability to perform daily activities, enhancing their remaining vision, and promoting independence.

The June 4, 2024 Therapro webinar recording: Getting and Keeping Your Child’s Vision in Sync and the September 10, 2024 webinar, In-Sync Child Activities to Help Kids Develop and Enhance Visual Processing Skills by Joye Newman, are available to watch on demand. Joyce Newman provides a wonderful overview of how vision develops, components of the visual system, symptoms of dysfunction, and suggestions for treating them. Therapro has materials Joye recommended to address vision issues.

Parental and Caregiver Support:

Parents and caregivers play a vital role in supporting children with low vision. This support includes advocating for appropriate services, creating an accessible home environment, and helping children develop self-care and independence skills. Family involvement is crucial in helping children adapt to their visual challenges. Family is a crucial component of the
child’s team. Consistent carryover of teachers’ , therapists’, and vision specialists’ recommendations optimizes a child’s visual skills and visual development at home, school, and in the community.

Summary:

Early detection, intervention, and support are crucial to managing the impact of low vision on a child’s development. The quality of vision affects a child’s intellectual, emotional, behavioral, and social growth and development. Working as a team with teachers, therapists, and vision
specialists will empower parents and caregivers to support their child with low vision effectively.

Guest Author: Filomena Connor, MSOT-Retired

Saturday Seminar: Brains Rule – Perceptual Learning to See Better, Learn Faster, and Work Smarter

Cathy_SternOn February 13th Dr. Cathy Stern, OD, FCOVD, FCSO, FNORA, a developmental and behavioral optometrist, shared her knowledge and passion in a Saturday seminar entitled: Brains Rule – Perceptual Learning to See Better, Learn Faster, and Work Smarter. In her private practice in Canton, MA, she has extensive experience in the diagnosis of developmental and behavioral vision problems and treatment of children and adults with vision therapy and vision rehabilitation.  The Massachusetts Society of Optometrists recently recognized her as a leader in vision therapy.

The majority of the audience was made up of occupational therapists, who absorbed the information Dr. Stern imparted with rapt attention.  Dr. Stern put a new spin on information already familiar to OTs by explaining how perceptual learning occurs and how it helps a student respond to the world around him/her more efficiently. She stated, “Perceptual learning occurs when practice-induced changes enhance the brain’s visual processing speed and accuracy.”  She suggested that if we get referrals for students with decreased attention and behavioral problems, we should take a closer look at the student’s visual processing ability. Dr. Stern noted the staggering statistic that 70-90% of special education students have vision issues, that may or may not be diagnosed.

The principles of perceptual learning dictate that a student learns to recognize features that are relevant and then apply them to new problems.  The student attends to what he/she has learned in the past, which guides him/her when tackling new problems more quickly and more accurately.  Dr. Stern gave examples of professions that require perceptual learning to be successful, i.e. a baseball batter who needs to recognize the type of pitch he’s receiving so he can adapt and swing accurately. A familiar example of perceptual learning is seen in the “Where’s Waldo?” searches.  We know we need to search for red and white stripes, stocking hat, etc. to locate Waldo. Dr. Stern explained that based on our past experience with this game, we know the salient features that make Waldo stand out.  We can decide very quickly what’s important and what is not in the scenes.  So too for a student who needs to zero in on information and not get sidetracked completely by the background (peripheral) information.  We must remember that background information is important to register, such as peripheral vision, which is essential as a “motion detector.”  If we see a student who is having difficulty navigating space, we should consider that he/she is not able to process vision accurately or quickly enough.

Perceptual learning, like motor planning, involves time and space.  With training the brain to improve processing, changes can occur in improved attention, concentration, time planning, and spatial planning.  One tool in Dr. Stern’s toolbox for addressing these issues is a metronome, but there are many tools that can be individualized to a particular student’s needs.

Collaboration between occupational therapists and behavioral/developmental optometrists appears to have great potential in optimizing a student’s classroom success.

Here is a sampling of attendees’ responses to Dr. Stern’s seminar:

“Interesting and exciting!  Good information and clearly the speaker had tremendous knowledge!!”  Anita A., Occupational Therapist

 “This was a whole new way of framing learning issues – combining vision with audition, and timing.  I never thought of learning this way!”   Robin L., Occupational Therapist

 “Excellent information.  Easy to understand.  Very useful seminar.”  Kimberley H., Occupational Therapist

 “This was wonderful information about learning from a different viewpoint.  Dr. Stern was able to integrate knowledge from many disciplines to help us understand vision.”  Michelle B., Occupational Therapist

 “So knowledgeable!  A pleasure to listen to her info, explained in easy to understand terms.  Excellent!”  Anonymous, Occupational Therapist

Thank you, Cathy!

Filomena Connor, MS, OTR/L

Saturday Seminar: OT Rubrics for Fine Motor, Visual Motor and Handwriting Skills

Valorie_ToddWhen a group of OTs get together to brainstorm, there’s bound to be some exciting “stuff” that is the outcome. Valorie Todd, MA, OTR/L and her school-based practice colleagues in the New York and New Jersey vicinity had a goal in mind. They wanted to devise a way to monitor quarterly progress in performance skills they identified as “OT goals” or “Areas of Need” on the IEP that was based on normative data. Valorie discussed the rubrics her group developed during her Therapro Saturday Seminar Series workshop on August 22, 2015 entitled:  OT Rubrics for Fine Motor, Visual Motor and Handwriting Skills.

This seminar was the kick-off for the Fall Saturday Seminar Series and attracted about 60 attendees who listened closely, commented freely, and shared thoughts. Valorie and her colleagues were determined to conceive a way to assess a student’s performance against predetermined criteria, in which a student is measured against his own performance.

Valorie’s group identified 7 areas for assessment including:

  • Postural Control
  • Sensory Modulation
  • Ocular Motor Skills
  • Object Manipulation: Fine Motor/Hand Skills
  • Controlled Tool Use: Color, Trace, Cut
  • Design Copy: Graphics/Objects, and
  • Handwriting.

In her seminar, Valorie discussed Object Manipulation, Controlled Tool Use, Design Copy, and Handwriting. Rubrics for Kindergarten and Grade 1 were identified.

Valorie offered a thoroughly researched plan on how to assess function and address the skill through worksheets that acknowledged how a student was expected to progress sequentially in each area.  She made clear distinctions in skills expected of a kindergartner versus a first grader.  For example, when assessing “Tracing,” specifically Pencil Control:

kindergartner would receive a score of 4 if he:

  • “Controls lines with min. errors 90-100%”
  • “Stops/turns at corners (angles/arcs)”

A first grader would receive a score of 4 if he

  • “Has good control within/on lines in all directions (90-100%)”
  • “Starts/stops on dots with 1-2 errors”

Valorie’s rubrics were well-defined and can be easily replicated. She was very enthused about sharing her work, including worksheets, and encouraged therapists to use her rubrics and provide her with feedback so that the rubrics can further be developed with input and use over time. As a result, a meaningful assessment of quarterly progress can be obtained and insufficient areas can be addressed systematically and meaningfully before the student is due for the next standardized evaluation.

Attendees comments were very positive and encouraging:

“It was excellent! So much info, well related to school based OTs. This will be helpful in writing goals, tracking progress, presenting at meetings, and for my Teachpoint eval.”  Amanda B., Occupational Therapist

“It helps so much to have these rubrics to support our clinical observations when IEPs are moving toward data driven/measurable goals and objectives. It will help with tracking and also guide thinking when working on skills.”  Anonymous, Occupational Therapist

“Love the practicality of the Rubrics.  Anything we can take away & use is terrific!”  Amanda H., Occupational Therapist

“Looks at detail of task performance and observation of foundational skills which students have or need to build on.”  Anonymous,  Occupational Therapist

“I would recommend this seminar to a colleague because it was well researched and the information was very comprehensive.  The material is very current and I can readily apply this information.”  Anonymous, Occupational Therapist

Thank you, Val!

Filomena Connor, MS, OTR/L