Vision therapy and what types of exercises to expect?

Cost is, of course, an issue, but first I would determine the type of therapy each offers. If the therapy is ineffective or limited in it’s effectiveness, it doesn’t matter how little it costs.

My son is 9 also. He’s been to 2 different developmental optometrists and they have 2 completely different therapy programs. He went to the first guy for an entire year. His diagnosis was “visually inefficient”. I think that means that he had general weaknesses in many areas. The therapy he received with the first dr. was primarily on a computer (I think the name of the program is HTS). they did do some other exercises, like walking on a balance beam, but it was primarily computer work. The optometrist re-tested him a couple of times and he showed some improvement each time (although I was never given the #’s.) I was initially told therapy typically lasts 6 months. In all fairness, my son rarely did the vision exercise he was supposed to do each night (he hated it so much it was like a war zone around our house - I eventually gave up). He was receiving OT twice a week during this time also.

It’s very hard to say whether this first type of VT helped him or not. He was receiving OT also, so that confused things. I think there was slight improvements, but nothing huge. My son is an odd one…with all his motor problems (visual motor, motor planning, etc.) and mild sensory stuff - he was way ahead in reading. He did skip words and paraphrase a bit as he went along, but he would almost always comprehend the meaning of what he read. I think he ad a natural ability in many areas of reading, but the motor deficits did hurt him. At the time, his teacher thought he was a speedreader. It eventually became clear that the real cause of the word skipping and paraphrasing was his visual weaknesses. His main schoolwork problems were with written work, following directions, organizing himself and his math facts.

I thought I’d send what I had written so far because I had problems earlier.

I’m sorry to be so long winded, but maybe some of what I’ve experienced will help you with your decision.

We stopped VT with this guy after a year and started neuronet therapy. I have to say that this therapy helped my son without a question. It was noticeable in about 3 weeks. His OT was so impressed that she went to a nnet seminar to become certified and blend the exercises into her therapy. As you may know, nnet works on the vestibular system. My son could catch a ball much better after 3 weeks of nnet therapy than he did the whole year before with OT and VT.

Eventually our nnet therapist referred us back to VT to a different Dr. Although my son flew through all the nnet exercises, he got very frustrated with the exercises which required alot from the visual system. As a mentioned, he struggled with remembering his basic math facts…he used his fingers often. It was so frustrating because he was a kid who grasped pretty advanced math concepts easily, but ask him what 5 + 2 is and you could get the wrong answer from him!

The second Dr. worked totally differently from the first. He used a whole body/vestibular approach. We saw some improvements in his writing and ability to use his written space better. He also started skipping words less.

We stopped VT temporarily to do IM last December. Then IM was put on hold (long story). We haven’t been doing any formal therapy since. I’ve been doing audiblox with my son, albeit not near as often as they recommend or I would like to do. This program helps with visual skills. I did addition and subtraction flash cards with him for the first time the last 3 nights and I see a huge improvement….NO FINGERS.

IMHO, I would recommend you go to someone who uses a whole body approach vs. the computer. If neither do, and you can, I would do audiblox with him.

Lori

I think Lori is right. Go with a therapist that takes a full body approach.
You really should know going in that it is a lot of work. The more work you do the better and faster the results. I wouldn’t even bother if it was just once or twice a week in the office with no homework. We do it everyday.
We do things like following a pencil with his eyes with and without a patch, praciticing balance, reading charts near and then far. There are too many exercises to go into all of them.

We just had a progress eval done we are in our 6th month. My son is doing great. Most of his skills are normal some even above average.He still has a few to work on. His visual perception 100 times better. It was terrible to begin with.

The doctor has been amazed at his progress.

I mentioned that he has backtracked in his desire to read. After the initial 12 weeks he was a reading machine. He said that it is normal to have periods where things get worse before they get better. I have noticed big improvements in sports and some writing improvement recently. His reading speed is above average for his age 145 wpm. He said he will like reading again, just to give it time.

Relatively few vision therapists incorporate whole bodywork into their programs. It’s great if you can find one who does. However, the reality is that not all children with vision problems need bodywork. Some do, but many do not.

An occupational therapy evaluation (usually covered by medical insurance) is a good indicator of whether bodywork is needed. If it is, and your optometrist doesn’t do it, the next best thing is to do both vision therapy and occupational therapy.

Maja, it sounds as if your second choice of optometrist uses HTS. The website for this program is http://www.homevisiontherapy.com . This is a sort of standardized means of delivering vision therapy for commonly diagnosed problems. However, not all vision problems can be treated with this program. Whether or not this would be a good choice for you probably depends on the exact combination of problems your child has, and possibly on severity also.

Totally in-office therapy is the most expensive form of vision therapy. Many optometrists will supervise primarily home-based vision therapy — where they teach you how to do the exercises at home daily, and then you come in periodically (usually once a month) for re-checks and new exercises. You could ask the first optometrist if she would be willing to do this but, if she hasn’t already offered, she may be one of those who doesn’t.

“Eyes on Track” is supposed to be a pretty good book. I haven’t seen it myself, but have seen it recommended by a number of people. Website for it is http://www.eyesontrack.com but you may be able to purchase it for less elsewhere (Amazon, etc.).

Visual efficiency skills refer to things such as focusing, accommodation, convergence, etc. — basic sensory-motor vision skills. It looks as if your son has problems in all three areas. These all tend to respond well to vision therapy and, because they are all pretty basic problems, probably would respond to HTS.

I don’t know much of anything about visual figure-ground. Visual-spatial skills can usually be developed with Critical Thinking books (assuming visual efficiency skills are reasonable). Visual sequential memory is usually very responsive to cognitive training programs such as Audiblox or PACE — but again, these are useful only if major visual efficiency skills are in place.

One thing you should probably do is take a look at overall finances and decide on how much you can spend in the coming year. Most children need more than one therapy in order to achieve optimal remediation, so you need to budget your money and energy. In your son’s case, I would say it’s highly likely he will need a cognitive training program as a follow-up to vision therapy in order to fully develop visual processing skills (visual sequencing, visual short-term memory, pattern recognition, etc.), which build on visual efficiency skills (focusing, accommodation, etc.). You do not want to spend all of your money and all of your time and energy just on vision therapy.

If you are really tight on cash and time (but have some energy to supervise work at hom), then HTS followed by Audiblox might be a good choice. If your son needs bodywork also, though, you will have to incorporate the occupational therapy piece also.

Nancy

Also, Maja, in case you haven’t noticed, the thread right below this one on the board has posts about computerized home vision therapy. If your second optometrist is listed on the http://www.homevisiontherapy.com website, then HTS is probably the computerized home vision therapy program he uses.

Nancy

We do aspects of audiblox, OT and other visual processing work through vision therapy.

It is nice to have the program tailored to my son’s specific deficits based on ongoing evaluations.

If you can find an optometrist who truely knows what he is doing it really can relieve a parents burden.

I have a preference for optometrists who have been doing this for a long time. There is a tremendous amount of skill and knowledge needed to address specific deficits.

Just want to tell everyone thanks for your help so far. I had what I felt was a really well written reply and some questions ready to post and something happened (I used to tell the people I worked with at IBM that their computer had a headache!!!) and I lost my post. Anyway, I’ll try again later. Its late here and we have our 2nd day of school later. Gee, today was really stressful for my son. He got glasses over the summer and hasn’t slept for several days because he was worried about what everyone would think. But we made it through and he feels ok about glasses.

Thanks again.

Thanks for all your input regarding vision therapy. It helped tremendously when I talked to the vision therapist today.

It turns out her training covers the whole body and includes some cognitive training. She doesn’t do formal OT or cognitive training but includes it in her vision training. I was also very frank with her about the money situation and she is willing to work with us. Yeah! Her preference is an office visit weekly with evaluations at the end of each eight week unit. I’m thinking that we could go every other week.

During our conversation she said she isn’t aware of anyone who does cognitive training (apparently she’s looked into a lot of the “tutoring” here and found that most of them are exactly that.) So my next question is does anyone know how to go about finding a cognitive therapist in a given area? Given that we have a large children’s hospital that treats children from several states I’m guessing there are cognitive therapists here. I just need to figure out how to find therm. Are there web sites or a professional organizations that can help me?

I guess my next question is do should I persue occupational therapy at the same time I persue vision therapy and then later persue cognitive training or do I persue them squentially. I got the impression from talking to the vision therapist that until more of the basic vision skills are in place I should wait to persue cognitive training. Any ideas?

I looked at the HTS web site and you are right, the second VT is listed there. From what he told me he requires his patients to purchase it and use it at home. Given his lack of experience I decided to go with the VT with 20 years experience even though he is 5 minutes from our house and she is 45 minutes away.

I’m getting anxious to get on with this. Up until this year my son has been in relatively small classes but this year instead of having 2 regular classes and a split grade class they only have 2 regular classes. There will be over 30 students in his class and the teacher doesn’t know how to handle it. I had a short conversation with her today. They’ve always had three teachers and been able to divide the grade into 3 groups. This is not a possibility this year. I’m afraid my son is going to get lost and fall farther and farther behind. Any tips for helping him keep pace? He’s in fourth grade.

Thanks for your input. Thanks doesn’t seem adequate but I appreciate the replies I’ve gotten.

If the OD incorporates enough body work, OT separately may not be necessary. If she does some but you think your child needs more, I would do them at the same time.

I would do cognitive afterwards. Audioblox is good for kids with vision based problems and you can do it yourself rather inexpensively. PACE is the other well known cognitive program and it is much more expensive because it requires a provider, although Brainskills (the home based program) is far less expensive. PACE has more auditory work than Audioblox but if your son’s problems are vision based that may not be necessary.

Beth

I would look into PACE or audiblox after vision therapy. This is my plan if vision therapy does not get us as far as I would like. We do some aspects of PACE and audiblox in vision therapy but it is too soon to tell if it is enough. I tired doing audiblox with vision therapy but it was just too much.

Audiblox is done at home and is cheap and PACE is done in an office but is more expensive. PACE does have a home version but it still is pretty expensive. Both programs address a variety of cognitive issues.

You may want to consider something like interactive metronome as well if you child has attentional, sequencing or motor issues. I used this in place of OT although he did get some OT in school. I had an evaluation done by a sensory integration OT and she said that IM was just the thing for my son’s specific issues and she was right.

www.interactivemetronome.com

Also, is there anyway to get OT at school. Sometimes a letter from you doctor will get services at school.

The Audiblox website is http://www.audiblox2000.com . A home kit costs about $150.

PACE website is http://www.processingskills.com . You can email them for referral to PACE providers in your area. PACE requires 36 hours of one-on-one tutoring with a trainer, which is why it is so expensive. At $50 per hour that adds up to $1,800. In many locations the hourly tutoring price is considerably higher than $50, so PACE can cost even more.

Your optometrist might be interested in becoming a PACE provider. They are often the most successful providers because they already have an office setup and a stream of potential clients.

Nancy

My son, whose issues always seem to come back to some mild motor planning issues at the root, did 18 sessions of VT for focusing,accomodation and memory. He went once a week, and we were pretty good with the home stuff. I just had him reevaluated because we are changing doctors and although he found some improvements in those areas, it wasn’t significant. Which is deeply disappointing given the expense and money. However, I am excited by the new doctor. He will see DS twice a week (I always think intensive is better) and is going to incorporate body work. He correctly pegged my kid right away as a child that works accurately, but slowly , because his responses are n’t automatic enough. I have high hopes for this new course of VT.

I will say that although we haven’t seen much improvement in reading, we have seen a big improvement in eye contact, and hey, that’s pretty important in the real world.