Transcript Vision Therapy

Educational Vision
Therapy System
PUSD Special Education
Alternative Classroom Solution
For
Behavioral Based Vision Therapy
What is Vision Therapy?
• A method attempting to correct
or improve ocular, visual
processing and perceptual
disorders
• Also referred to as visual
training or vision training.
• Vision Therapy Consists of Two
Broad Categories:
1. Orthoptic
2. Behavioral
Orthoptic Vision Therapy
• Non surgical
techniques to correct
conditions which
might be responsible
for eye fatigue and
discomfort with close
work.
Orthoptic Vision Therapy
Used to correct:
•Convergence insufficiency ( the inability to have the eyes come
together toward a near target without undue effort)
•CI is one of the few ocular problems that can interfere with
the physical act of reading. It can cause blurring of vision
and the sensation that letters and words run together
especially during times of prolonged reading or near work.
•Most common treatment for CI is pencil push ups in which
the patient practices turning his/her eyes inward to
converge on a near target such as a pencil point.
Orthoptic Vision Therapy
Also used to correct:
•Accommodative insufficiency ( the inability of the eye to
focus properly on an object) After age 40 it is considered part of
the aging process. Usually seen in conjunction with convergence
insufficiency.
•Heterophorias ( misaligned eyes)
•Refractive errors ( need for glasses)
Note : Orthoptics can provide excellent results for patients who
have reading difficulty secondary to convergence and
accommodative problems.
However……… these ocular disorders are the less common
causes of true reading disabilities.
Behavioral Vision Therapy
• Eye movement and hand-eye
coordination training
techniques which attempt to
improve visual processing
skills, visual perception and
visual-motor integration.
•
May also include the use of
colored overlays or filters and
glasses for mild refractive
errors with or without prisms.
Behavioral Vision Therapy
Requires a number of office visits depending upon the
severity of the problem diagnosed by the vision therapy
provider.
Typical length of the program ranges from several weeks to
several months and may include activities to perform at
home.
Note : There is NO consistent scientific evidence that
supports the use of behavioral vision therapy as an
effective treatment for learning disabilities or for the
remediation of complex pediatric neurological
conditions such as autism spectrum disorders.
Two Schools of Thought
American Optometric
Association
VERSUS
American Academy of
Ophthalmology
American Academy of
Pediatrics
American Association for
Pediatric Ophthalmology
and Strabismus
Association for Science in
Autism Treatment
American Optometric Association Policy
Statement
•Optometric intervention for people with learning
related vision problems consists of lenses, prisms and
vision therapy.
•Vision therapy does not directly treat learning
disabilities or dyslexia.
• Vision therapy is a treatment to improve visual
efficiency and visual processing, thereby allowing the
person to be more responsive to educational instruction.
American Academy of Ophthalmology
American Academy of Pediatrics
American Association for Pediatric
Ophthalmology and Strabismus
•Do not recognize behavioral vision therapy as a treatment option for
reading disorders. Their criticism includes studies that are anecdotal in
origin, lack matched control groups and seem to be designed with the bias
that reading problems are caused by one factor.
•A further concern is for the patient’s time, financial resources and
expectations. The costs of vision therapy are often not covered by
insurance and can be substantial.
•These direct costs are in addition to the cost of lost wages, time and
productivity for working parents who may have to take time off to bring a
child in for repeated treatments. Finally, a program of vision therapy may
provide false hope and expectations.
Educational Perspective
• DIS services such as Vision Therapy
have been provided to students on IEPs
• The provision of such services is defined
and described in our Special Education
Code Article 4, 56363 (a)(b)(c).
Educational Perspective
• Designated Instructional Services (DIS)
or Related Services are services
designed to enable an individual with
exceptional needs to receive a free
appropriate public education as
described in the IEP
• DIS services may also be required to
assist an individual to benefit from
special education.
DIS Services
(including but not limited to)
• Language and Speech
• Audiological Services
• Orientation and Mobility
Services
• Instruction in
Home/Hospital
• APE
• PT and OT
• Vision Services
• Specialized Driver
Training
• Counseling and Guidance
• Psychological Services
• Parent Counseling and
Training
• Health and Nursing
• Social Worker Services
• Specially Designed
Vocational Ed. and
Career
• Recreation Services
• Specialized Services for
Low-Incidence
• Interpreting Services
Educational Perspective
• Later on in the Education code, each
DIS service is further defined in Article
5, 3051-3051.18
• Interestingly enough, 2 DIS services
appear in addition to those listed in
Article 4
• Services for Pupils with Chronic
Illnesses or Acute Health Problems AND
Vision Therapy
Vision Therapy in PUSD
• The District has been providing Vision
Therapy to students through their IEPs
for many years
• As time has progressed, many
difficulties have surfaced with
identification and delivery of Vision
Therapy services
Difficulties with Vision Therapy
in PUSD
• Poor communication between VT
providers and school staff
• Inability to connect service to an area of
need and specific goal on the IEP
• Students who are evaluated often never
attend sessions
• Lack of involvement in daily program by
VT providers
Difficulties with Vision Therapy
in PUSD
• Tracking of completed sessions and
reviewing progress in timely manner at
IEP meetings
• Cost
Cost to PUSD
• From 2005-2008, Vision Therapy cost
PUSD $237, 590.00
• We expect to have to spend another
$80,000 for the current school year!!!
Alternative Solution
• The Special Education office has been
working on an alternative solution to
Vision Therapy
• The alternative focuses on a classroom
program that can address educational
deficits a student could have that may
have previously resulted in a Vision
Therapy referral
Alternative Solution
• As with any IEP need, it’s important to
look to resources and programs that will
interfere the least with a student
accessing the General Education
curriculum and environment
• An alternative classroom based program
to Vision Therapy can reach more
students in a less restrictive way at less
expense to the district
Alternative Solution
• As a case manager or classroom teacher,
you will often be the first point of
contact for a parent who may have
concerns about Vision Therapy
• It will be important for you to have
updated and research based information
to support a classroom based program
versus a referral for a Vision Therapy
evaluation
Research: Reading and the
Eye
• Since we typically use our eyes to
read the printed word, it would,
at first glance, seem that
problems with reading equate to
eye problems. As a result, many
misconceptions regarding
reading have ensued.
• Although the eyes are obviously
necessary for vision, the brain
interprets visual symbols.
Therefore, correctly subtle visual
defects cannot alter the brain’s
processing of visual stimuli.
Dyslexia
Misconceptions
Reality
Research
Dyslexia : Misconception,
Reality and Research
• Misconception :
• Dyslexia was once thought
to be a visually based
learning problem causing
students confusion in the
way they see letters and
words.
Dyslexia : Misconception,
Reality and Research
• Reality :
• The standard definition of
dyslexia is “unexpected difficulty
in reading in children and
adults who otherwise possess the
intelligence, motivation and
schooling considered necessary
for accurate and fluent reading”.
• The definition does not include
reversing letter, mirror writing
or other commonly held
misbeliefs.
Dyslexia : Misconception,
Reality and Research
• Research :
• The vast majority of students
with severe reading difficulties
have substantial weakness in
auditory related skills such as
identifying sounds with words (
phonemic awareness) and
associating sounds with written
letters ( sound-symbol
relationship).
•
Fletcher and Lynon 1998; Shaywitz 1996 and
Torgeson, 1998
Dyslexia : Misconception,
Reality and Research
• Reality :
• Dyslexia is a language deficit and varies
from language to language.
• Interestingly, the phonemic complexity of
a language corresponds to the prevalence
of dyslexia, confirming the linguistic and
not ocular origin of the problem.
• Dyslexia in English-speaking countries is
twice as common as in Italy. Over 1000
different combinations of letters represent
the 40 sounds used to speak in English.
In contrast, Italian has only 25 sounds
represented by 33 combinations of letters.
Dyslexia : Misconception,
Reality and Research
• Research :
• Functional magnetic resonance
imaging (FMRI) has made it
possible for scientists to watch the
neural systems at work as readers
attempt to transcribe letters into
sounds.
• FMRI research has left no doubt
that the core problem in dyslexia is
phonologic : turning print into
sound.
•
(Shaywitz 2003)
Reading : A Complex Process
• Identification of individual words
– Decoding and accuracy
• Constructing Meaning
– Using global intelligence,
vocabulary, reasoning and
concept formation
Alternative Solution
• Given what we know about Vision
Therapy and reading research, what can
we do to address educational deficits our
students may have without using up
unnecessary resources from our District?
The Educational Vision
Therapy System
by Dr. John Hannaman
A Structured and Sequential System to
Develop :
• Directionality
• Tracking
• Letter Discrimination in Text
• Mid-Line Crossover Skills
Directionality and Letter/Word
Discrimination
– A learned and
trainable visual
perceptual skill.
– The ability to attach
meaning to objects
and concepts in the
physical world by
judging them to be
right- left or backfront relative to other
things.
Directionality and Object
Permanence
• Everyday objects do not change
their meaning based upon their
direction.
• A pencil is a pencil whether it is
held upside down or sideways.
• Letters are different………when
the letter d is turned upside down,
it becomes the letter p.
• This is a developmentally learned
task and not even the same in
every language.
Directionality and Word
Reading
• The words “was” and “saw” or
“bad” and “dad” may be interpreted
as the same or different depending
on which side of the word the eyes
are aimed at to begin decoding.
Visual Tracking and Saccades
• Reading is accomplished by
saccades ( fast eye
movements) from one word to
the next.
• Tracking lines of print is a
practiced task and becomes
self-correcting with enhanced
understanding of what is
read.
Skilled Readers and Saccades
• When reading English, people use predominantly rightward
saccades with intermittent fixations.
• About 20% of the saccades in normal reading are leftward
verification or regression saccades.
• Regression saccades are more prevalent with increasing difficulty
of the text and also in students beginning to read as well as
struggling readers.
• Although some have postulated that regression saccades are
responsible for poor reading; most experts consider them the
result-not the cause of difficulty reading text.
• No evidence suggests that saccade training results in better
reading………..but improved reading has been shown to change
saccades patterns.
The Educational Vision
Therapy System
• Designed for students who exhibit poor
eye coordination and/or sense of
directionality.
• Includes multi-sensory- kinesthetic,
auditory and visual exercises
• Starts with gross motor skills and moves
to fine motor skills.
The Educational Vision
Therapy System- 25 Exercises
• 1- Gross motor movement for right, left,
up and down
• 2- Right-Left dominance ( Ball Bounce)
• 3- Visual directionality with lines- first
step in transferring from a gross to a
fine skill
• 4- Reverse directionality
• 5- Body orientation and reversal
The Educational Vision
Therapy System
• 6- Directionality Reinforcement
• 7- Spatial Orientation of letters ( p,b,d,q)
• 8- Spatial Orientation of letters
(n,u,h,m)
• 9- Letter Identification for “b”
• 10-Letter Identification for “d”
• 11-Letter Identification for “p”
• 12-Letter Identification for “q”
The Educational Vision
Therapy System
• 13- Letter Identification for “n”
• 14- Letter Identification for “u”
• 15- Letter Identification for “h”
• 16- Letter Identification for “m”
• 17- Letter combinations “bd, db, pd”
• 18- Identification of letter patterns ( p,
q)
• 19-Identification of letter patterns
(n,u,h,m)
The Educational Vision
Therapy System
• 20-Letter Identification within text (“b”)
• 21-Letter Identification within text ( “d)
• 22-Letter Identification within text (“p”)
• 23-Letter Identification within text
(“b,d,p”)
• 24-Word Identification for commonly
reversed words ( bad, dad)
• 25-Word Identification within text
The Educational Vision
Therapy System
• Exercises must be done every day:
• Step 1- Set up a reward system with the student
for each successfully completed exercise. Record
the outcome of the days work on the daily log
• Step 2- Do not assume the student can perform a
task. Begin at the first exercise and test the
student. Students can progress quickly through
the exercises if they meet the success criteria
under practice duration and frequency.
The Educational Vision
Therapy System
• PRACTICE DURATION and FREQUENCY is dependent
upon each exercise, on average 3-5 days per exercise.
• For example:
• Exercise 1- to be practiced for 5 minutes twice a day until
student is correct 100% of the time.
• Exercise 10- to be completed once a day for a minimum of
3 days until the student can complete with 100% accuracy
within one minute.
Appropriate Candidates
Appropriate candidates for the
Educational Vision Therapy System are:
• Students who may have difficulties with
eye coordination, sense of directionality
and/or tracking
• Students whose parents or family
optometrist have inquired about Vision
Therapy
Appropriate Candidates
• You will know the students in your
Reading/English classes that have
difficulties with directionality and/or
tracking
• If you need more information, be sure to
check the Initial/Triennial testing for
results from the TVPS or other visual
discrimination tests
• Consult your School Psychologist
How to get started?
• When a teacher notices a specific deficit
or receives an informal parent request
for Vision Therapy, he/she can notify the
Special Education office of the need for
an Educational Vision Therapy System
workbook
• PUSD has a license to reproduce the
individual workbook for each child who
may need it
How to get started?
• This program is an independent work
program for students
• After some basic instruction on how to
complete exercises, each student should
be able to complete the daily exercises in
his/her workbook independently in the
classroom
How to get started?
• This program (like any instructional
material) will not be specifically listed in
the IEP nor will you document Vision
Therapy on the front page
• If you have noticed a specific deficit for a
student in directionality or tracking,
then an IEP goal can be written
Formal Requests for Vision
Therapy
• When a teacher receives a formal or written
request for a Vision Therapy evaluation, an
IEP team meeting should be convened
• The Program Specialist should be invited to
this IEP meeting
• Prior testing should be reviewed and a PUSD
evaluation should be conducted if necessary
(please see the VT procedures in the
handbook)
Formal Requests for Vision
Therapy
•
•
•
•
At the IEP, the teacher and Program Specialist will
discuss with the team:
Research about Vision Therapy (please see the article
entitled Learning Disabilities, Dyslexia, and Vision by
David Granet, M.D.)
The Educational Vision Therapy System we can
implement at school
How we will track the student’s progress in the
program and use data to make decisions
What the team can do if the program is not effective
and when to consider a referral to an
optometrist/ophthalmologist
Formal Requests for Vision
Therapy
• Should the parents continue to formally
request a Vision Therapy evaluation,
work with your Program Specialist to
identify the next steps and use your
Procedural Handbook as a reference for
necessary paperwork and procedures
Procedural Handbook
• 1 page handout describes the basic
information from this presentation.
This new information can be placed in
your handbook as a reference and will be
integrated into the Vision Therapy
section of the handbook for the following
school year
Final Thoughts
• If there is no scientific evidence to
support behavioral vision therapy, then
why would we spend our time on it?
• What else can we do to improve reading
if behavioral vision therapy will not
help?
Questions?
Educational Vision
Therapy System
PUSD Special Education
Alternative Classroom Solution
For
Behavioral Based Vision Therapy