Vision Therapy Changes in the Brain

            Everything that we learn changes our brains, but brain imaging is now able to show which areas of the brain change and how they change. The research described in the link below evaluated successful patients, pre- and post- vision therapy, matched with patients who did placebo therapy. The imaging (functional magnetic resonance imaging) confirmed which areas of the brain became more active and which areas became less active. These changes in brain efficiency enable improved ocular motor skills, improved attention, and reduced symptoms.

            Most visual problems which affect reading and learning are functional. The eyes and eye muscles are healthy, but they do not function efficiently. Focusing, tracking, and keeping two eyes precisely aligned are our fastest and most precise motor skills and are controlled by the brain. These ocular motor skills coordinate with cognitive processing. By enhancing brain efficiency, vision therapy develops more accurate and automatic vision. Vision therapy improves foundational visual skills and the processing of visual information.

            The visual condition used in this research was convergence insufficiency, the most common functional eye teaming problem. Convergence (aiming both eyes inward to have binocular vision at near) is not an isolated function. Most people with convergence insufficiency also have difficulty focusing and tracking. It is just one way in which the visual system does not develop adequately or becomes dysfunctional due to prolonged visual stress. Other functional visual conditions are treated similarly with comparable outcomes. Further research based on this study may reveal more about how vision and attention are linked in the brain and contribute to the continuing evolution of increasingly effective therapies.

            Vision therapy has been developing visual skills for many years; since 1941 in our office for example. Brain research and the associated technologies were primitive then by today’s standards. As vision therapy has evolved, it is a reminder that clinical observations and methodologies are typically in advance of research.

For More:


Visual Intelligence


Visual Factors in Reading


Children who reverse letters and numerals do not see them backwards. They have not developed the visual perceptual skills which are necessary to master orientation-specific symbols.

            Infant’s perception starts with recognizing faces and people. Early visual perception is global. Children’s ability to see detail and color gradually emerges over the first three to six months as the visual pathways develop. They quickly learn to recognize their mothers from the front and from the back. They can recognize them when they are seeing them right-side-up and when they see them upside-down, depending on how they are laying or being held. This impressive ability is known as object constancy. At an early stage, children also start to associate important people and objects with sounds (names).

            Young children learn to place objects and animals that have a wide range of appearances, but a distinguishing similarity, into categories, such as chairs and dogs. This is an amazing accomplishment. It is only when children start to encounter symbols that the rules change and even more sophisticated perceptual skills are required. Now instead of being able to look at 62 different breeds, sizes, ages, and colors of dogs in various positions and categorize them all as dogs, they have to learn what makes each of 62 stick shapes unique. The shapes all have names and orientation is now critical. Furthermore, some of the stick shapes are not only incorrect if they are not properly oriented, they actually turn into a different stick shape. How confusing is that?

            Mastering 62 symbols is dependent on many perceptual and developmental skills being ready at the same time; a time that is set by the curriculum and, therefore, cannot be right for all children. This mastery requires the ability to: discriminate detail; appreciate directionality; be able to visualize and store symbols; sustain attention; and match visual and auditory input. When these criteria are not met on time, learning the 62 symbols will take longer, require more rehearsal, and confusion is more likely (while the curriculum progresses to more complicated perceptual demands – strings of symbols in specific sequences). Under these conditions, persistent confusion may develop. Untangling confusion and relearning is much more difficult than initial learning and is further complicated by stress.

            Think of being introduced to two brothers on the same day who look very similar. Their names are Jacob and Jared. It is going to be difficult to keep them straight. It would have been much easier if you had met the second one after you already knew the first one. If you always see them together, the confusion tends to become embedded.

            Once you are confused, you may need to develop a trick, a mnemonic, to help you to remember who is who. This will be slow, but it will be dependable as long as it is your mnemonic. This will get faster over time and eventually will not be needed. The same is true for children with symbols if the incidence of reversals is not decreasing.  

            It is important to respect development and how we learn when children are working to make letters and numerals. Tension interferes with learning and with smooth movement. Early movements should be large and flowing, using large muscles and joints which are easier to control and provide more feedback. This also avoids the need for fingers to struggle to hold and control a thin, slippery pencil.

            Manuscript letters are complicated combinations of basic shapes which should be mastered first (the copy form shapes). Dr. Arnold Gesell started to research many areas of child development in the 1920s including when children master making the basic shapes. This research was repeated recently at the Gesell Institute and it was confirmed that children master the basic shapes at the same ages that they did 100 years ago. Children have not changed as much as have expectations. Development is uneven between individuals and within individuals. It can be stimulated and it can be retarded but it cannot be pushed, and it should not be ignored. It must also be remembered that development and intelligence are distinct traits. Expecting red marks on early writing to improve writing, when the child does not have the prerequisite skills, is like expecting a child to catch a ball better when you yell at them. It is more likely to create discouragement, failure, and learned helplessness than to suddenly stimulate confidence and success.

For those of you who would like additional information and resources on reversals, we recommend this blog by Dr. Leonard J. Press.

For More:

Visual Factors in Reading



Visual Word Form Area in Visual Cortex Remembers Words as Pictures

Stand Out of Our Light: Freedom and Resistance in the Attention Economy

James Williams

Distortion of the news, the power of advertising, and the control of minds are not new concerns. What is new is how: electronics has made these influences ubiquitous; the media are controlled by fewer and fewer people; and computing has refined how to get around “our better selves” and insidiously capture our attention. The news that is most effective to do this is emotional and appeals to our baser instincts. It stimulates polarization. It views issues as unresolvable extremes and makes us angry and adamant, or anxious and depressed, not hopeful and energized. It is good for the electronic media whose primary goal is to attract our attention and capture markets. It does not enrich our lives and make them more meaningful. It distracts us from acting on our values and even distracts us from thinking about what our values are. Time and attention are limited resources. Electronics have the ability to be an efficient resource for information, but they can also be used to direct our thoughts without being aware that we are being manipulated.

            James Williams has a background which is well-suited to this discussion. He worked for Google committed to their mission “to organize the world’s information and make it accessible and useful.” He left Google when he “came to understand that the cause in which I’d been conscripted wasn’t the organization of information at all, but of attention.” Realizing “that there’s a deep misalignment in the goals we have for ourselves and the goals our technologies have for us”, he left Google to attend Oxford University to study philosophy. The title of the book is from a story about a philosopher, Diogenes, who refused an offer by Alexander the Great to give to him anything that he wanted. His response was to “get out of my light” i.e., don’t distract my attention from what is important in life.

            As information has become abundant, the resource which has become scarce is attention. Our attention, like our memory, is an important part of who we are. It is being usurped. Technology and its messages shape our environment which shapes our thoughts and behavior. Persuasion has become industrialized with the assistance of digital technologies.

            In addition to heightening our awareness, James Williams outlines what may be done to address this problem. This goes beyond increasing our willpower. Research has made it clear that willpower, like attention, is a limited resource. If you have exhausted your willpower at work or dealing with your children, you are less likely to stick to your goals, especially when your willpower has to compete with an entire industry designed to capture our attention. We need time and quiet to think and to put things in perspective, not just react to the next piece of data. And to have perspective and to figure life out at any age, people need the freedom to be exposed to different ideas, other people, develop an appreciation of the value of the humanities, and to spend time in nature.

For More:

Not All Screen Time is Equal

Curiosity and a Core Curriculum

The Enchanted Hour

The Rights of the Reader

Curiosity and a Core Curriculum

            We have a brand-new grandson. When he is awake he is constantly exploring; looking and reaching. He does not need to be taught the important things that he needs to be learning at this stage of his life. He just needs love, health, and opportunity.

            As he grows, it is important that he keep that curiosity, not just for learning, but for joy and amazement. Young children are resilient. They do not quit. They keep trying as long as they are interested; as long as it is something that they want.

            We all agree that there are things that children should learn to prepare for life and life’s responsibilities. How can this innate curiosity be wedded to this process? If they are not interested in learning arithmetic or how to read, is that due to them or to us?

            Oliver Sacks was not an average person. His talents and accomplishments were many. He loved learning, libraries, and museums, but not school. His reading was deep and varied, but reading was not his primary method for learning. He experienced, he observed, he questioned, and he reflected. His is still just one experience from one person, but his words and thoughts are worth considering. The following are from Everything in its Place: First Loves and Last Tales which is a collection of his writings that were just published. They are on learning, on school, on the complexities of reading, and on the importance of nature – things for us to experience, question, and reflect on.

            On the whole, I disliked school, sitting in class, receiving instruction; information seemed to go in one ear and out the other. I could not be passive – I had to be active, learn for myself, learn what I wanted, and in the way that suited me best. I was not a good pupil, but I was a good learner, and in the Willesden Library – and all the libraries that came later – I roamed the shelves and stacks, had the freedom to select whatever I wanted, to follow paths that fascinated me, to become myself.

            Reading is a hugely complex task, one that calls upon many parts of the brain, but it is not a skill humans have acquired through evolution (unlike speech, which is largely hardwired). Reading is a relatively recent development, arising perhaps five thousand years ago, and it depends on a tiny area of the brain’s visual cortex. What we now call the visual word form area is part of the cortical region near the back of the left side of the brain that evolved to recognize basic shapes in nature but can be redeployed for the recognition of letters or words. This elementary shape or letter recognition is only the first step.

            From this visual word form area, two-way connections must be made to many other parts of the brain, including those responsible for grammar, memories, associations, and feelings, so that letters and words acquire their particular meanings for us. We each form unique neural pathways associated with reading, and we each bring to the act of reading a unique combination not only of memory and experience, but of sensory modalities, too. Some people may “hear” the sounds of words as they read (I do, but only if I am reading for pleasure, not when I am reading for information); others may visualize them, consciously or not. Some may be acutely aware of the acoustic rhythms or emphases of a sentence; others are more aware of its look or its shape.

            As a writer, I find gardens essential to the creative process; as a physician, I take my patients to gardens whenever possible. All of us have had the experience of wandering through a lush garden or a timeless desert, walking by a river or an ocean, or climbing a mountain and finding ourselves simultaneously calmed and reinvigorated, engaged in mind, refreshed in body and spirit. The importance of these physiological states on individual and community health is fundamental and wide-ranging. In forty years of medical practice, I have found only two types of non-pharmaceutical “therapy” to be vitally important for patients with chronic neurological diseases: music and gardens.

            I cannot say exactly how nature exerts its calming and organizing effects on our brains, but I have seen in my patients the restorative and healing powers of nature and gardens, even for those who are deeply disabled neurologically. In many cases, gardens and nature are more powerful than any medication.

For More:

The Enchanted Hour

The Rights of the Reader

How Children Succeed: Grit, Curiosity, and the Hidden Power of Character

More Posts including Oliver Sacks:

Reflections on Change

Mapping the Wilds of Mortality and Fatherhood

Narrative Medicine

Memory Book

The River of Consciousness

The Mind’s Eye: Oliver Sacks

The Rights of the Reader: Part 5

Daniel Pennac

…a continuation from The Rights of the Reader: Part 4 (See Part 1 Here).

The following is how Daniel Pennac expresses his concern for the over-scheduled lives of children. This was written in 1992. It hasn’t gotten better.

She won’t have a moment to herself.

No time to dream.

No chance of being bored.

But being bored is great.

A long stretch of boredom… and all kinds of creativity are possible.

He goes on to write:

Schools everywhere have always confined themselves to making students learn techniques and write essays, while proscribing reading for pleasure. It seems to be established in perpetuity, in every part of the world, that enjoyment has no part to play in the curriculum, and that knowledge can only be the fruit of suffering.

There’s a case to me made for this.

And no shortage of supporting arguments.

Schools can’t be about pleasure, with all the freedom that implies. They’re knowledge factories and require effort. The subjects taught are tools of consciousness, and it’s the teachers’ job to initiate their students in those subjects. You can’t expect them to promote education for education’s sake when every aspect of school life – timetables, marks, exams, ratings, courses, subject choices, departments – reinforces competitiveness and is dictated by the job market.

If a student occasionally comes across a teacher who’s genuinely enthusiastic about pure mathematics and teaches it like one of the fine arts, it’s down to luck, not the brilliance of the school. That teacher’s enthusiasm inspires a love of their subject and turns effort into pleasure.

Human beings will always have the capacity to inspire a love of life, even when life takes the form of quadratic equations, but enthusiasm has never been part of the curriculum.

It’s all about duty.

Life is elsewhere.

You learn to read at school.

But to love reading….

My personal experience is that there are more enthusiastic teachers here than David Pennac has found in France, despite the pressures on them. In the U. S., as in France, most of these decisions are made at the state or Federal level and imposed from above, where the children and students may become obscured by the political goals. In closing…

Curiosity is awakened, not forced.

For More:

The Enchanted Hour

How Children Succeed: Grit, Curiosity, and the Hidden Power of Character

How to Raise and Adult

Nurture Shock: New Thinking About Children

The Rights of the Reader: Part 4

Daniel Pennac

A continuation from The Rights of the Reader: Part 3

Reading is the scourge of childhood and almost the only occupation we know to prescribe…. A child is hardly interested in perfecting the instrument with which we torture him, but make that instrument serve his pleasures and he will soon apply himself, in spite of you…

A great to-do is made of finding the best methods for learning to read. We devise bureaux and cards, we turn the child’s bedroom into a printing press…. What a pity! A far surer method, and the one that always gets forgotten, is the desire to read. Give the child that desire, and leave your bureaux right there….any method will work from then on.

To capture his interest; that’s the great motive, and the only one that leads surely and far…

I will just add this word as an important maxim: which is that, ordinarily, we obtain most surely and quickly that which we’re in no hurry to obtain.

This is from Jeans-Jacques Rosseau. It reminds us that the adult obsession with “knowing how to read” is nothing new. Nor are foolish teaching methods that operate counter to the desire to learn. Our children will become good readers (we must recognize, despite the author’s  optimism, that there are exceptions) if the adults around them nourish their enthusiasm. If we stimulate their desire to learn before making them recite out loud; if we support them in their efforts instead of trying to catch them out; if we give up whole evenings instead of trying to save time; if we make the present come alive without threatening them with the future; if we refuse to make a pleasure into a chore but nurture it instead…. And their reading will get better and better the more they enjoy the experience.

For more:

The Enchanted Hour

How Children Succeed: Grit, Curiosity, and the Hidden Power of Character

How to Raise and Adult

17Nurture Shock: New Thinking About Children

Kitchen Table Wisdom: Stories that Heal.

Rachel Naomi Remen, M. D.

I have had this book on my desk for months, reading only a few pages at a time. The book is a collection of stories, each only a few pages long, about the author’s life and her experiences counselling patients with cancer. Rachel Remen started her career as a pediatrician. Realizing that more than medical care is necessary for people to heal, and frustrated by medicine’s goal of profession’s separation between patients and doctors, she changed her goal to filling this gap. A review cannot do this book justice. It must be experienced. Its power is in how you feel and think when you read it and how those thoughts stay with you. As a flimsy substitute, I offer the following, which risk sounding trite out of context.

The foreword to the book was written by Dr. Dean Ornish who borrows a quote from Dr. Denis Burkit: “Not everything that counts can be counted.” Medicine focuses on facts, but facts do not provide meaning. Stories provide value and meaning and show how we are similar and connected.

“Many of us do not know our own story. A story about who we are, not what we have done. All stories mix fact with meaning. Facts bring us knowledge, but stories lead to wisdom.”

“I am no longer inspired by expertise as I once was. Perhaps the worth of any lifetime is measured more in kindness than in competency.”

“A belief is more than just an idea. It seems to shift the way in which we actually experience ourselves and our lives. According to Talmudic teaching, ‘We do not see things as they are. We see them as we are.’”

“Objectivity is not whole. Life is the ultimate teacher, but its usually through experience and not scientific research that we discover its deepest lessons.”

“I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it is given from the heart. When people are talking, there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important then understanding it. Most of us don’t value ourselves or our love enough to know this. When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care.”

“The power of a personal sense of meaning to change the experience of work, of relationship, or even of life cannot be overstated.”

“Sometimes the messages we convey unawares may be even more coherent and relevant to the needs of others than the messages we consciously devise.”            

“Healing requires a certain willingness to hear and respond to life’s needs.”

For More:

The Rights of the Reader

The Enchanted Hour

Visual Perception and Who We Are

Stumbling on Happiness