Early

Sarah DiGregorio

I found this book to be all that the book jacket promises. Since I cannot improve on that description, the following is directly from the cover of this book.

“The Neonatal Intensive Care Unit (NICU) is a place where humanity, ethics, and science collide in dramatic and deeply personal ways, as parents, physicians, and nurses grapple with sometimes unanswerable questions. When does life begin? When and how should life end? And what does it mean to be human?

The NICU is a place made of stories – the stories of parents and babies who spend days, weeks, and even months waiting to go home, and of the dedicated clinicians who care for these tiny, developing humans. Early explores the fascinating evolution of neonatology and its significant breakthroughs – modern medicine can now save infants at five and a half months gestation who weigh less than a pound, when only fifty years ago there were a few effective treatments for premature babies. Each year, nearly four hundred thousand babies are born prematurely in the United States. When the scope is widened to include the entire world, that number climbs to fifteen million.

For the first time, journalist Sarah DiGregorio tells the rich and complex story of one of the most boundary-pushing medical disciplines – and the many people it has touched. Weaving her own story and those of other parents and NICU clinicians with in-depth reporting, DiGregorio examines the history and future of neonatology: how the first American NICU was set up as a sideshow on the Coney Island boardwalk; how modern advancements have allowed viability to be pushed to a mere twenty-two weeks; the political, cultural, and ethical issues that continue to arise in the face of dramatic scientific developments; and the clinicians at the front lines who are moving to new frontiers. Eye-opening and vital, Early uses premature birth as a window into our own humanity.”

For More:

Developmental Variation and Learning Disorders

Vision: It’s Development in Infant and Child

The Role of Accommodations in the Management of Visual Problems

Accommodations are modifications in the visual demands of a task with the intent of making the task easier. When visual problems are more severe, accommodations will be less effective or totally ineffective. The accommodations that I am going to address here are those that relate to the difficulties that students with healthy eyes have learning and while taking examinations.

The children who would receive that most benefit from accommodations are many children who have undiagnosed visual problems. These children have been able to cope with tracking, crowding, eye-hand coordination, focusing, and eye teaming problems, but school work could be easier for them and they could perform better if the print was bigger, the pages less crowded, they had frequent breaks, and they had more time to complete their work.

Children with diagnosed visual problems typically have more severe visual difficulties. While the above accommodations may still be appropriate, their effects will be limited.

This became personal for me lately due to the need for hip replacement surgery. Prior to the surgery and during the recovery, there were things that I just could not do regardless of accommodations. When I was able to “walk” with a walker and then for short distances with a walking stick, this was still far from walking automatically. I had to attend to walking. I was slow. There was little that I could think of other than walking due to the attention required and the associated discomfort. I fatigued quickly. Other parts of my body hurt from compensating. Student’s visual problems are no less incapacitating. I can look forward to putting this in my past. Without effective treatment, this will not happen for the children with significant visual problems.

A common example is a child who can keep their place much better when they point to each word with their finger. They cannot read without the finger and this can seem like a miracle, but it should not be equated with normal reading. It is similar to walking with a walker. It cannot be smooth. It takes longer. It is more tiresome. Attention is distracted from the reading material (comprehension) to the mechanics of reading. It is clumsy.

We will continue to recommend accommodations as appropriate. We don’t take crutches away from people who need them, but everyone who works with these children cannot forget that the effects of their problems have not been eliminated, even in the short-term.

Ironically, visual problems are less visible than many other problems. When I am walking with my walking stick, everyone knows that I have a problem and they do not expect me to function as if I did not have the problem. That can only happen when my problem is resolved. The same is also true for visual problems.

For More:

Crowding

Tracking

Eye-Hand Coordination

Visual Factors in Reading

Vision Therapy is Messy

In his book Messy: How to be Creative and Resilient in a Tidy-Minded World, Tim Harford provides examples of how extreme organization and structure, reduced diversity, and oversimplification makes things easier but constrain and compromise outcomes.

Vision is complex and each person’s combinations of problems and circumstances is unique. Vision doesn’t function in isolation. It is represented in more areas of the brain than any other sense. It is involved in almost everything we do. How we see the world is an integral part of who we are. It follows that enhancing essential visual functions;

-eye alignment and movement,

-focusing,

-object perception, spatial perception, and guidance of movement

is messy and complex and that it is naïve to think that therapy is not influenced by the patient’s mindset, age, conflicts, and prior experiences.

All of this must be taken into consideration to treat patients. Computerized programs cannot do this but they can be useful to stimulate attention and motivation. It also requires more than a list of techniques. Doctors and therapists need to be ready and able to modify plans to match the patient’s current visual abilities. Optometric vision therapy is provided by doctors and therapists with specialty qualifications. Certified doctors are Fellows in the College of Optometrists in Vision Development (FCOVD). Certified therapists earn the title, Certified Optometric Vision Therapists (COVT). The College of Optometrists in Vision Development is the certifying body for this specialty.

Relationships between providers, patients, and their families are integral to the success of all healthcare, especially incremental care. Atul Gawande wrote about one of thirteen centers for treating patients with cystic fibrosis in the US in his book Better. One center had much better outcomes than all of the others even though the centers all followed the same protocol. The difference was that the director in one center got to know his patients personally. The better understanding and communication that resulted from these personal relationships fostered improved compliance. Atul Gawande also addresses this in his article on The Heroism of Incremental Care.

Therapy is an interplay between treatment and assessment as the patient progresses. The doctor and therapist continue to learn about patients from the way each patient responds. Dwight D. Eisenhower stated in reference to war that “Plans are useless, but planning is indispensable.” This also applies to other complex, messy situations.

Vision therapy is not easy and can be frustrating. Plasticity in Sensory Systems makes therapy possible. While neuroplasticity declines with age, it continues throughout life. Motivation can recruit surprising amounts of plasticity.  The Power of Habit balances our ability to change. Habit enables us to function without consciously thinking through everything we do, which is not possible, but it can also cause us to err when conditions change. Therapy develops new visual habits.  Focused rehearsal under a variety of circumstances facilitates supplanting existing habits with new skills and makes them more automatic than the dysfunctional patterns that they are replacing.

Optometric vision therapy takes advantage of neuroplasticity and the messiness in our visual system to make change possible. Therapy creates new visual patterns to be more efficient, more comfortable, and less taxing. Patients must achieve this for themselves, but appropriate feedback at the right time can be powerful, which is why doctors and therapists are indispensable in this process. Daniel Coyne provides example which demonstrate this in The Talent Code as does Norman Doidge in The Brain that Changes Itself. Humans are endowed with amazing abilities to learn and to adapt.

The Body: A Guide for Occupants

Bill Bryson

Bill Bryson is a talented communicator who has written about travel, language and science and manages to insinuate humor to increase the reader’s pleasure and to inject emphasis which makes facts more meaningful and memorable. The Body is his latest book which would make a wonderful Christmas gift for any curious readers on your list. Instead of attempting a review, I will include two excerpts as examples.

“The great paradox of the brain is that everything you know about the world is provided to you by an organ that has itself never seen that world. The brain exists in silence and darkness, like a dungeoned prisoner. It has no pain receptors, literally no feelings. It has never felt warm sunshine or a soft breeze. To your brain, the world is just a stream of electrical pulses, like taps of Morse code. And out of this bare and neutral information it creates for you – quite literally creates – a vibrant, three-dimensional, sensually engaging universe. Your brain is you. Everything else is just plumbing and scaffolding.”

“Just sitting quietly, doing nothing at all, your brain churns through more information in thirty seconds than the Hubble Space Telescope has processed in thirty years. A morsel of cortex one cubic millimeter in size – about the size of a grain of sand – could hold two thousand terabytes of information, enough to store all the movies ever made, trailers included, or about 1.2 billion copies of this book. Altogether, the human brain is estimated to hold something on the order of two hundred exabytes of information, roughly equal to “the entire digital content of today’s world,” according to Nature Neuroscience. If that is not the most extraordinary think in the universe, then we certainly have some wonders to find yet….”

“There is a huge amount we have left to learn and many things we may never learn. But equally some of the things we do know are at least as amazing as the things we don’t. Consider how we see – or, to put it slightly more accurately, how the brain tells us what we see.”

“Just look around you now. The eyes send a hundred billion signals to the brain every second. But that’s only part of the story. When you “see” something, only about 10 percent of the information comes from the optic nerve. Other parts of the brain have to deconstruct the signals – recognize faces, interpret movement, identify danger. In other words, the biggest part of seeing isn’t receiving images; it’s making sense of them.”

“For each visual input, it takes a tiny but perceptible amount of time – about two hundred milliseconds, one-fifth of a second – for the information to be processed and interpreted. One-fifth of a second is not a trivial span of time when a rapid response is required – to step back from an oncoming car, say, or to avoid a blow to the head. To help us deal better with this fractional lag, the brain does a truly extraordinary thing: it continuously forecasts what the world will be like a fifth of a second from now, and that is what it gives us as the present. That means that we never see the world as it is at this very instant, but rather as it will be a fraction of a moment in the future. We spend our whole lives, in other words, living in a world that doesn’t quite exist yet….”

All the richness of life is created inside your head. What you see is not what it is but what your brain tells you it is, and that’s not the same thing at all.What Bill Bryson does not say is that much of this function is learned though experimentation and experience disguised as play and we all learn a little differently.

For More:

Action in Perception

The River of Consciousness

Why effective Amblyopia treatment requires binocular vision rehabilitation

Great post!

The VisionHelp Blog

Recognized as a significant vision problem that affects millions of people worldwide, one of the “hot topics” of  advocacy at the recent 2019 VisionHelp Annual Meeting  was Amblyopia. 

Amblyopia/Lazy eye is a serious neurodevelopmental vision problem that causes vision loss in approximately 2-4% of the population or 1 in 30 people. Neuroscience has shown that Amblyopia occurs when there is a unilateral failure in binocular vision, occurring early in life typically infancy or toddlerhood.

When the binocular system is broken at a young age, a neuroadaptation occurs, known as suppression where the signal from one eye is “shut down” by the brain to counteract the confusion created by the broken binocular system. As a result of this unilateral failure of binocular function a cascade of delayed visual function occurs leading to the following:

  1. Reduced visual acuity (eye sight) in one eye
  2. Reduced, or no stereo acuity (depth perception)
  3. Poor…

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Curiosity

In her book, The Hungry Mind, Susan Engel shares that we know more about curiosity in childhood than is generally recognized due to research done in the last two decades. Everyone agrees that all children are born curious, that they become less curious, that curiosity is critical for learning, and that curiosity is more often discouraged than encouraged, especially in classrooms with strict agendas and no time to explore.

It is natural for some curiosity to decline as children understand more. Curiosity is both intellectual and emotional. It is tempered by a child’s tolerance for danger and uncertainty. The more secure a toddler feels, the more that they will explore. Their security usually comes from their relationship with their mother. When this relationship is strong, the child will venture out to explore, come back for reassurance, and then feel comfortable venturing out again.

The parents’ invitation or prohibition to explore is more important for most children than the inherent risk. Anxiety interferes with exploration and curiosity. The parents’ modeling of curiosity is a significant factor as is the classroom environment. Teachers with timelines and specific goals will see curiosity as an interruption and an interference with learning (explicit instruction).

Before children go to school, most learning is informal. It is embedded in what is being done. It has relevance and immediate application. The way that reading and math are typically taught has neither. The initial steps, learning letter names and sounds, memorizing math facts, do not have immediate value. Math facts are not useful unless you know how to apply them. Letter names and sounds are a long way from reading.

Mastery rather than enquiry, is the primary goal in most classrooms. Learning to question is not a core goal. Questions can get in the way, but curiosity and questions are at the root of real learning. This is known as the “double-edged sword of pedagogy”. Instruction can limit exploration.

Asking counterfactual questions does not come naturally. It is not taught and the best way for it to develop is through play. If we can’t imagine being wrong, it is easy to delude ourselves into making poor decisions.

Stories are an almost infallible way to create curiosity and have been used as a teaching tool for thousands of years. Children almost always pay attention when the teacher is reading. The other thing in classrooms that almost invariably catch attention is aquariums and terrariums. Is it because they show nature or is it because what happens is unpredictable which creates curiosity?

Information about others is also almost fail-safe. This has evolved as it is essential to know about others to have successful communal living. Almost no one can resist gossip. Peer influence can stimulate curiosity and also cause children to be more daring, like going down the slide in the playground.

Japanese teachers develop lesson plans together and work mystery and uncertainty into lessons so the students naturally form questions to be answered. They then meet to assess how the plan went and modify it to try to improve it. Ironically, oversimplification to make things easier to understand, can backfire. If it is too simple, children become less curious.

Research correlates reading literature with empathy. Children who read novels are demonstrating that they are interested in the thoughts and feelings of others. Perhaps curiosity is an antecedent to empathy.

Loneliness can a problem, but the need for solitude to pursue questions and interests is under recognized. Loneliness and solitude are not synonymous. Free play and solitude contribute to intellectual development.   

As important as curiosity is, it is surprising that we have not been more curious about it. In the past it was assumed that emotions and characteristics like curiosity could not be studied. Studying curiosity is difficult, but it is possible. While it is easier to discourage curiosity than generate it, stimulating curiosity is possible. Unfortunately, the current demands of what is to be taught and when, can miss that bigger picture and goals. Little time is left for exploration and curiosity, even in many preschool classrooms.

For More:

Curiosity and a Core Curriculum

Let the Children Play

Let them Eat Dirt

Sleights of Mind

 

By Stephen L. Machnik and Susana Martinez-Conde

With Sandra Blakeslee

This book, written by two specialists in visual neuroscience with the help of a science writer, uses magic and visual illusions to explain perception. The use of magic makes the book fun to read and it is fascinating to realize that magicians have had an empirical understanding of visual attention, perception and distraction for centuries. The following excerpts address some of the illusions that we have about how we function. Continue reading