1. Acquired Brain Injury (Including TBI, CVA, and Vestibular Dysfunction)
- Oculomotor dysfunction
- Accommodative deficits
- Visual memory and visual attention deficits
- Visual motion sensitivity
- Visual information processing issues
- Visual-Vestibular interaction deficitis
- Spatial localization problems
- Visual field defects
- Tear Film Insufficiency
- Go Slow. If it takes 2-3 exams to gather all of the information you need to properly diagnose and understand all of the patient’s visual issues, that is okay.
- Be Patient. Vision therapy may take longer with a TBI patient versus a ‘non-TBI’ patient with similar diagnoses.
- Trial Therapy. I typically do a ‘trial’ of 12 sessions with my TBI patients to be able to gauge how the patient responds to therapy and track rate of progress. After those 12 sessions, I can have a better estimation for the patient/patient’s parents on how long the remediation process might take.
- Set Goals. What is important to the patient? If you get the patient’s findings to improve, but they still can’t function in everyday life, therapy was NOT a success.
- Integrate. The key to success with TBI patients is using the final stage of therapy to focus on integrating the visual, auditory, and vestibular systems. Challenge the patient to complete visual tasks with all of these systems working together.
Tip: Check distance fusional ranges in this population or use the new Bernell Tannen Flipper developed by Dr. Barry Tannen to assess distance fusional facility! Oftentimes, TBI patients show a deficit in distance fusion that translates into a sense of visual instability to the patient. Work on this with projected vectograms/RDS or prism flips (BI/BO) with a distance target encouraging fusion.
2. Autism Spectrum Disorder
- Be a team player. ASD is a pervasive disorder affecting every aspect of your patient’s life. This means you will be part of a large team of medical professionals helping your patient reach their highest level of functioning. Be open with your approach .
- Observe. If you take the time to really look at your patient and how they approach tasks visually, they will give you all of the answers you need to understand their visual system. Even when they are non-verbal.
- Think Outside the Box. There is no ‘cookbook’ approach to vision therapy here. Each patient will be different and your therapy must reflect that.
3. Learning Disabilities
- Non-specific reading disabilities
- Dyslexia (all types: dyseidesia, dysphonia and dysphoneidesia)
- Non-verbal learning disabilities such as poor motor coordination, poor organizational skills and social awkwardness
- Taking a Complete History. Have the patient fill out paperwork, asking specifically if there are any learning disabilities. If it is not filled out, you must follow-up by asking the patient/parent directly. Don't be shy, it is a very important piece of the puzzle. If necessary, a child can be taken into a separate room to 'play' if the parent feels more comfortable talking about the disabilities without the child being present.
- Perform Visual Information Processing (VIP) Testing. Almost all of my vision therapy work-ups include a full battery of VIP and visual perceptual testing skills. Adding in tests that screen for reading disabilities help me flag any potential patients that may have a learning disability versus a visual issue. If something is amiss, I will refer out for proper educational testing. Here are some of the tests included in my work-up:
- Development Eye Movement Test (DEM)/Visagraph
- Test of Visual Perceptual Skills (TVPS)
- A phonetic skills test: WIAT-II
- Test of Silent Word Reading Fluency (TOSWRF)
- If suspected, the Dyslexia Determination Test (DDT)
- Others: Tach/Span, Wold Sentence Copy
- Golden Rule. Vision therapy can help a patient with a learning disability! Don't automatically rule out a person with a learning disorder for vision therapy. Yes, they may have dyslexia, but their accommodative and convergence insufficiency isn't helping their cause. Set your goals accordingly for your patients!