Optometric Vision Therapy
Our body image is how we see ourselves. Our body schema is our subconscious sense of our body and how it relates to the space immediately around us. Movement is necessary to develop vision and body schema and to integrate them which enables us to move effectively. Our conscious brain has difficulty accepting that most of what we do is subconscious. Even when our movements are consciously ordered, not reflexive, the implementation is largely subconscious. Our conscious mind and focal vision are the strategists which make the overall plan while the subconscious mind, body, and ambient vision direct the tactics. It is now thought that learning does not take place solely in the brain but also in the body.
Focal vision is conscious: seeing objects, colors and symbols; recognizing what we see despite differences in size, distance, and position. Ambient vision is as complex as focal vision but is subconscious. It monitors where we are and where things are around us. It assists our balance. It directs eye movements to obtain information with phenomenal speed and precision. It helps us simultaneously process the movement of multiple objects around us. It enables us to navigate while our conscious mind is occupied. It stabilizes the images of what we are moving past so we perceive that it is our body that is moving and not our surroundings. Ambient vision is faster than focal vision and is able to multitask to accomplish all that it does. We are unaware of its existence until there is a problem.
Most of us develop adequate ambient visual skills and, if we don’t, we probably don’t realize it. We are who we are. We may become carsick easily, be clumsy, have difficulty tracking across a page to read, perceive movement that is not there, not coordinate our two eyes well, be uncomfortable in busy places, and be easily overstimulated compared with others, but we adapt and compensate. Unless the deficits are extreme, it also goes unnoticed by others. But these problems are obvious when they develop suddenly such as after a head injury and may be extreme.
It is intriguing to watch vision and body schema develop in infants. We have an infant grandson who just started sitting in a highchair. Being able to sit expands what he can do with his hands and vision. He can pick up food and start to get it into his mouth. Sometimes he can control letting go of things to accomplish the all-important milestone of dropping objects and watching them fall to the floor. This is the beginning of thousands of experiences of trying and developing.
If vision and body schema have not developed adequately, they have the potential to be improved through therapy. A surprising degree of plasticity remains even into old age. Just trying harder tends to reinforce inefficient behaviors, not foster change. The visual system can be incrementally modified through optometric vision therapy; an individualized sequence of activities. The new or modified skill must then be practiced with attentive repetition to become automatic. Effective attention is subconscious as is effective vision. Forced attention (concentration) is much less effective.
Attentive repetition is difficult to achieve in the infant and young child. When possible, carefully chosen games which rely on the developing visual skill are employed which stimulate engagement. Success in the game is dependent on improving the deficient visual skills. Games may also reduce the rehearsal required to become automatic because the skill is developing implicitly. The roles of the therapist and doctor are critical. They plan and modify the sequence of activities for each patient based on the diagnosis and progress. Knowledge and experience are critical, but the success of care is equally dependent on empathy and support as in all of the healing arts. Being scientific and evidence-based does not reduce the importance of the personal connections.
Most change has to be done consciously at first and then practiced until it becomes automatic. The actions are consciously directed, but all action is too intricate to be consciously controlled. The conditions need to be arranged to facilitate the subconscious creation of new patterns. Trying to guide a ball instead of looking at a target and throwing it naturally is a good example.
The role of personality in development and in therapy cannot be ignored. Some children are more adventurous. Some are less flexible and less resilient. Mindsets can change dramatically as a child becomes empowered through growth, but some are still resistant to change. This is influenced by a history of failures, but it can also be their inherent temperament.
Some of the brightest and most determined patients can be the most challenging. Their intelligence and determination have enabled them to find ways to compensate. It can be difficult to get them to stop overthinking to enable their subconscious to guide the development of automaticity. A dog which loses a leg can soon learn to run effectively on three legs. Having minimal consciousness may be an asset in this circumstance.
The success of vision therapy is dependent on a team effort and dedication. Appointments need to be kept and reinforcement activities need to be practiced at home to foster automaticity. Temporary accommodations may be necessary in school to relieve the visual load.
Helping develop vision is natural. Our species would not survive without it and it does not usually require professional guidance. It is a primary reason for the importance of play. Further development of visual skills is critical for athletes, dancers, artists, TSA workers, those in law enforcement, and all children who are learning to read. However, this is not the same as rehabilitating visual dysfunctions. Doctors and therapists who have been certified by the College of Optometrists in Vision Development have demonstrated their knowledge and clinical skills in vision development and vision therapy.