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Slide 1
Integrating Sensory and Motor in Vision
Therapy through Reflex Foundations
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Slide 2
Patti Andrich, MA, OTR/L, COVT, INPP/L & Alex Andrich, OD, FCOVD
Integrating Sensory and Motor
in Vision Therapy
through Reflex Foundations
April 29, 2017
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Slide 3 Course Description
This 3 hour lecture/workshop focuses on the “how to” combine sensory and motor modalities in your VT practice to ultimately foster strong visual motor and visual perceptual functions.
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Slide 4 Disclaimer
I am not receiving any financial benefit for mentioning any program or products. I am not endorsing any one program over another. Furthermore, there are other notable programs not mentioned in this lecture that may be especially helpful to you.
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Slide 5 Copyright
The contents of this presentation are the property of Sensory Focus / The VISION Development Team and may not be reproduced or shared in any format without express written permission.
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Slide 6 About Us
Vision Therapy
Reflex Integration Therapy
Orthokeratology
Auditory Processing Therapy
Sports Vision
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Slide 7 We moved past 20/20 long ago
As of January 1, 2001 on the Gregorian calendar we entered into the
21 century which is also the first century of the 3rd millennium. The
twentieth century is now history, and so should the idea of “20/20 vision”.
We, behavioral optometrists and vision therapists, have moved past the
structures of the eye and are finding our successes when we look
deeper into the brain. For us, it’s all about the neural connections and
detailed brain maps that fire up inside our brains.
When we look into the eyes of our patients, we touch their souls.
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Slide 8 What Can We Find When We Go
Looking?
“Eyes don’t tell
brains what to see;
brains tell eyes what
to look for. ”
- Larry MacDonald
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Slide 9 Making Connections
Today we are going to learn more about Motor and Sensory so we can foster the neural connections that make detailed brain maps.
Better brain maps lead to successful lives
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Slide 10 What Are Brain Maps?
Different brain regions have specific functions.
Brain mapping uses neuroscience techniques to identify what different parts of the brain do.
Spatial representations of different brain regions are called brain maps.
As brains become neurologically more mature and
advanced, brain maps become more detailed.
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Slide 11 What Are Brain Maps?
As brains
become
neurologically
more mature and
advanced, brain
maps become
more detailed.
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Slide 12 What Are Brain Maps?
http://www.opencolleges.edu.au/informed/learning-strategies/
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Slide 13 Vision
“Vision is a dynamic interactive process of motor and sensory functions, mediated by the eyes for the purpose of simultaneous organization of posture, movement and spatial orientation, for manipulation of the environment and, to its highest degree, of perception and thought.”
- William V. Padula
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Slide 14
Why should we use Neuro-Motor Development
theories and principles to improve patient outcomes
in vision therapy?
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Slide 15
Because…
Vision guides motor
& motor is refined by optimized vision
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Slide 16 Primitive Reflex Integration and
Dr. Skeffington’s Model of Vision
Centering
Speech / AuditoryAnti-Gravity
(Vestibular)
Identification
Vision
Skeffington, 1964
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Slide 17 Neuro-Sensory Motor Maturity
The maturation of the
nervous system that occurs
when motor neurons link with
sensory neurons repetitively
to create detailed brain
maps that result in higher
levels of motor control and
greater understanding of our
world. - Andrich, P.
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Slide 18 Neuro-Sensory Motor Maturity
Begins with reflexive movement and leads to highly
refined, cortically controlled movement
It is simple to complex development
A transition from reactivity to connectivity and leads to
productivity
- Andrich, P.
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Slide 19 Model of Neuro-Sensory Motor Maturity
Re
fin
ed
Move
me
nt
Inte
gra
ted
Se
nse
s
Andrich, P. 2013
Reflexive Motor
Fine Motor
Gross Motor
Super
Fine
Motor
Tactile
Auditory
VestibularTaste
Smell
Vision
Proprioception
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Slide 20 The Sensory Motor Connection
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Slide 21
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Slide 22 Motor Seeds of Vision
Reflexive Motor
Primitive Reflexes
Our first movements
Primary motor patterns
Pathway to postural control
Psychological foundation to self regulation, self- esteem, confidence,
goal setting and visualization
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Slide 23 Motor Seeds of Vision
Gross Motor
Transition to cortically controlled movements
Large muscle movements
Led by vision
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Slide 24 Motor Seeds of Vision
Fine Motor/ Dexterity
Purposeful small muscle movements
Super Fine Motor
Seeing
Hearing
Speaking
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Slide 25 Vision’s Sensory System Partners
Auditory
Tactile
Olfactory
Taste
Proprioception
Sense of knowing- perceiving & intuition
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Slide 26 Making Sense of Sensations:
The Development of Perceptions
Sensations and perceptions are complimentary to one anotherTogether they help us interpret our world.
• Sensation: awareness of touch, taste, sight, sound, smell and movement
• Perception: a mental impression based on awareness, organization and interpretation of sensory information.
Perception is developed through experiencePerception does not always match reality
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Slide 27
The thalamus is located in the middle of the brain above the brain stem and below the cerebral cortex.
The thalamus relays motor and sensory signals to the cerebral cortex. It is also involved in consciousness, sleep, and sensory interpretation.
The Thalamus
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Slide 28 Sensory Pathways
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Slide 29 Making Neurological Connections
In vision therapy we use a wide array of whole brain techniques with vision paramount to nurture neurological
sensory-motor connections
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Slide 30 Making use of Hebb's Rule
“Cells that fire together, wire together” – Donald Hebb
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Slide 31 How to use Hebb's Rule in VT
The trick is to get supportive sensory systems firing at the same time as Visual Motor and Visual Perceptual pathways fire,
without overstimulating the patient!
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Slide 32 How to use Hebb's Rule in VT
Use tolerable amounts of sensory stimulation
Look for JND’s and symptoms of overstimulation
Be ready to load and unload activities
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Slide 33 Symptoms of too much too fast
Behavior: irritable, whinny,
meltdowns, angry outbursts
Difficulty maintaining posture
Adverse facial expressions
Skin changes (color-sweating)
Changes in breathing
Shuts down", or refuses to
participate in activities and/or
interact with others
Avoids touching or being
touched- moves away
Gets overexcited, laughs
excessively, silly
Covers eyes or ears with hands,
avoids eye contact
Increased difficulty with
attention
Fidgeting and restlessness
Difficulty sleeping
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Slide 34 Primitive Reflexes
Automatic, repetitive movement patterns
Initiated and controlled by the brainstem
Emerge in utero - integrated within 1st year of life
Important for survival and movement learning
Inhibited by higher brain areas and then integrated within the nervous system
Retained with atypical neurology, poorly developed motor systems
Reappear with trauma, dementia, or brain injury
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Slide 35 Postural Reflexes
Reflexes that help us to support our posture against gravity so that we can sit, stand, and move without falling over
Mediated by midbrain
Through childhood and into adulthood, we rely on these reflexes to maintain balance
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Slide 36 Functions of Reflexes
Survival- Automatic subconscious responses to changes or stimuli within or outside our bodies
Maintain homeostasis (heart rate, breathing rate, blood pressure, and digestion)
Automatic actions such as swallowing, sneezing, coughing, and vomiting
Serve as early motor experiences that are on course to become refined and complex
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Slide 37 Importance of Testing Reflexes
Patients who regress after completing vision therapy often
have significantly retained reflexes.
Parents report that it is common for their child to gain skills
and then later lose skills, in other areas of life. (school, sports,
etc)
We have found that children reach their vision therapy
goals faster when their reflexes are integrated.
Testing reflexes gives the optometrist a valuable road map
to sequencing therapy exercises.
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Slide 38
“My body decides for
me. My body always
makes the decision
before I can make
the decision.”- VT patient
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Slide 39 The Neurophysiological Basis for
Vision Development
The level of neuro-sensory motor maturity is directly correlated to the proper timing of the emergence, inhibition and integration of our motor reflexes
When reflexes emerge or integrate out of sequence, normal maturation of the nervous system is disturbed
The degree of abnormal reflex activity influences how well or how poorly nerve fibers are organized, thus affecting muscle tone, coordination, sensory perception, cognition, psychology and vision development
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Slide 40 The Neurophysiological Basis for
Vision Development
Our nervous system (Jenga tower) is only as strong as its support pieces
These pieces being specific reflex patterns emerging and being put in place at the proper time in development
High level motor and cognitive skills (top of Jenga tower) developed by a child later in life are reliant on earlier stages of development (the Jenga base)
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Slide 41 The Neurophysiological Basis for
Vision Development
Even though the child may have enough pieces in place for intellectual ability, the child may not reach their full potential due to missing foundation pieces
When the pieces are not put in place at the right time and sequence, development will occur at the expense of altered automaticity
Continuous, laborious and conscious effort will be needed to master even the simplest skills
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Slide 42 Stabilizing and Strengthening The Tower
Using specific reflex integration movements will help you to facilitate the myelination and proper functioning of the nerves, thereby improving brain circuitry
Supporting maturation of the nervous system facilitates communication between neural networks stimulating the development of vision skills as well as other sensory and motor functions
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Slide 43 From Head To Toe
“The subject matter of body bilaterality cannot be ignored inmost patients if efficient binocularity is going to beachieved. From a developmental standpoint, a child firstlearns to team the two halves of his body before he learnsto team his two eyes together…. The problem of strabismus isnot strictly an ocular or eye muscle problem. Most
strabismics are strabismics from head to toe”
- Donald Getz, OD, FAAO, FCOVD
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Slide 44 Identifying Neuro Sensory Motor
Immaturity
Developmental History Questionnaire
COVD Lifestyle Questionnaire
Retained Primitive Reflex Testing
Assessment of Gross and Fine Motor Skills
Assessment of Perceptual Skills
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Slide 45 Identifying Neuro Sensory Motor
ImmaturityVisual Perception Tests
Gardner Test of Visual-Perceptual Skills
Draw a Person
Gardner Reversal Frequency Test
Rapid Automatized Naming
Wold Sentence Copying Test
The Bender® Visual-Motor (Bender-Gestalt II) Test
Test of Auditory Perceptual Skills
Test Of Visual Perceptual Skills
Developmental Test Of Visual Perception
Wold Sentence Copy Test
Motor Speed and Precision
Screening of Residual Primitive Reflexes
Beery Test
Birch-Belmont Auditory/Visual Test
Spatial Localization
The Tansley Standard Visual Figures Test
Motor-free Visual Perception Test
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Slide 46 When using motor in VT…
Where do we start?
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Slide 47
Think about the what happened with the visual system at even the earliest stages of development.
If supportive stages of development are missing or weak, begin your therapy there.
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Slide 48 Integration of motor systems with sensory
systems
Set the stage for discovery
Provide opportunities for the sensory systems to interconnect
Refining growing perceptions
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Slide 49
Vestibular input
Tactile input
Reflexive movement patterns
Auditory- rhythms
In Utero
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Slide 50 Incorporating Vestibular Input in VT
Slow rotations
Standing rotations
BOSU® ball
Therapy ball
Vestibular swings
Zip lines
Airex balance pads
Virtual reality headsets
SVI balance module
Http://www.Svivision.Com/balance.Php
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Slide 51 Incorporating Tactile Input in VT
Deep Pressure
Face and Body Tapping
Hand and Foot massage
Relaxation Chair
Textures
Tactile tracing
Brushing
Alcohol swab dots
Weighted blankets
Tactile draw a person
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Slide 52 Incorporating Auditory/ Rhythm
Input in VT
Commonly Used Tests in VT
Test of Auditory Processing Skills:
Auditory Memory
Auditory Discrimination
Phonological Segmentation
Birch Belmont Auditory Visual Integration
Auditory Processing Questionnaire
Refer to Otolaryngologists for
Otolaryngological Exam Otoscopic exam & Tympanogram
Speech Audiometric Testing
UCL (Uncomfortable Loudness Level (dB-HL)
Ipsilateral Acoustic Reflexes (movement of bones in middle ear)
Contralateral Acoustic Reflex Auditory Processing Screening
Auditory Brainstem Response (ABR)
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Slide 53 Incorporating Auditory/ Rhythm
Input in VT
Metronome
Trampoline
Rhymes
Open air music
Classical
Children’s folk songs
Popular
Auditory processing programs
Dichotic word stimulation (left/right ears)
Auditory central peripheral processing/ figure ground
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Slide 54 Incorporating Reflex Movement
Patterns in VT
In order to incorporate a reflex pattern into VT you need to know the movement pattern and how it affects vision skills.
Once you know that you can create your own exercises and activities to help you achieve your vision goals.
There is no one “magic exercise” that works withall patients. You have to understand the “why” and “how” in order to choose the right reflex.
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Slide 55 Incorporating Reflex Movement Patterns in VT
Vision Skill
Deficit Area
Reflex Movement Patterns
to ConsiderAbbreviations
Accommodation STNR, TLR, Landau, FP& MR FP (Fear Paralysis)
MR (Moro Reflex)
ATNR (Asymmetric Tonic Neck
Reflex)
SG (Spinal Galant)
TLR (Tonic Labyrinthine
Reflex)
STNR (Symmetrical Tonic
Neck Reflex)
OHRR (Oculo Head Righting
Reactions)
LHRR (Labyrinthine Head
Righting Reactions)
SRR (Segmental Rolling
Reflex)
AR (Amphibian Reflex)
FTG (Foot Tendon Guard)
Central Peripheral
Processing
Moro Reflex, ATNR
Binocular Fusion ATNR, Landau, STNR
Eye Control ATNR, TLR
Vestibular FTG, Babinski, TLR, MR, ATNR,
STNR, Landau, HRR & SRR
Handwriting Palmar Grasp, ATNR, Babkin, STNR
Visual Perception ATNR, TLR,& AR
Visual Attention SG, ATNR, STNR, FTG SRR &
HRR
This chart is only
meant to get
you started
All reflexes
affect each
vision skill in
some way
In reality it is not
this clear cut
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Slide 56
Symmetrical Tonic Neck Reflex
(STNR) Segmental Rolling
Amphibian Reflex
Oculo-Head Righting Reflex
(OHRR) & Labyrinthine Head
Righting Reflex (LHRR)
Babinski Reflex
Spinal Galant
Asymmetrical Tonic Neck
Reflex (ATNR)
Tonic Labyrinthine Reflex (TLR)
Palmar Reflex
Moro Reflex
Incorporating Reflex Movement Patterns in VT
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Slide 57
Deep pressure
Breathing
Integration of primitive reflexes
Oculomotor development
Birth & Infancy
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Slide 58 Incorporating Breathing in VT
Breathing during traditional VT exercises and activities
Hum breathing
Hiss breathing
Superbrain Yoga®
Breathing with timers
Breathing & awareness of body
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Slide 59 Toddler Years
Postural control
Rapid development of language
Gross motor skills
Fine motor development
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Slide 60 Incorporating Postural Control in VT
Tilting seated games
Standing tilts
Using yoked prism
Virtual reality
Using therapeutic seat cushions
Using T stools
Using therapy balls
Using mirrors and sticks
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Slide 61 Incorporating Language in VT
Microphone
Karaoke
Projected videos with lyrics
Description games
Use of picture cards
Word repetition (iLs)
Rhymes and folk songs
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Slide 62 Incorporating Gross Motor in VT
Gross motor skills
Bilateral walking
Zoom ball
Army crawl
Creeping
Stair climbing
Infinity walk
Walking rail
Skipping
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Slide 63 Incorporating Fine Motor in VT
Finger isolation games
Lacing
Pin punching
Rice sorting
Micro-brock string
Bracelet making
Fidget toys
Lego building
Rubik's cubing
Musical instruments
Mirror box
VT Scrap book
Black light/ highlighter
Art
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Slide 64 Preschool Years
Refining Postural Control
Further development of Gross motor skills
Further development of Fine motor development
Further development of Perceptual skill
Imaginary Play
Social skills
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Slide 65 Incorporating Imaginary Play in VT
theme toys
shadow play
playdough face
video stories
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Slide 66 Incorporating Perceptual Skills in VT
Visualization
Rubik's Cube
Estimating distances
Estimating time
Rotating symbols
Chess
Khet
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Slide 67 Incorporating Social Skills in VT
How do you see it games
Congratulating others
Video analysis of social situations
Creating plays – role playing
Group summer camps
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Slide 68 School Years
Sport skills
Reading
Writing
Math
Science
Higher Level Perceptual Development
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Slide 69 Incorporating Sport Skills in VT
Using patient’s favorite sport equipment in VT
Strobes
Using strategy & official play diagrams and charts
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Slide 70 Incorporating Reading Skills in VT
Learn to read games
Read with style recordings
Microphone reading
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Slide 71 Incorporating Writing Skills in VT
Speed thoughts writing activity
Dry erase paper writing mat
Handwriting Without Tears® Wooden pieces
Writing camp
OEP writing activities
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Slide 72 Incorporating Math Skills in VT
Math saccade sticks
Math dots
Math stars
Cuisenaire rods
Math hart charts
Math machine labarge
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Slide 73 Incorporating Science in VT
Simple science experiments
Creating “My Discoveries” books
Science theme targets
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Slide 74
Through our vision
... we give vision
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Slide 75 Thank You
Patti Andrich, MA, OTR/L, COVT, INPP/L
Alex Andrich, OD, FCOVD
The VISION Development Team
10139 Royalton Rd., Suite D
North Royalton, Ohio 44133
440-230-0923
www.sensoryfocus.com
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Slide 76
Realize
Real eyes
Real Lives
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Slide 77 Resources & Acknowledgements
Barnes, M., Crutchfield, M., et al. (1990) Reflex and Vestibular Aspects of Motor Control, Motor
Development and Learning. Stokesville Publishing Co., Atlanta, GA.
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Carlson, B. M. (2014) Human Embryology and Developmental Biology 5th edition: Elsevier ISBN-
13 9781455727940
Gessell A., Ilg G.L., Bullis G.E. (1948) Vision: Its Development in Infant and Child. Harper & Row.
New York, NY.
Getz, D. Strabismus & Amblyopia: Body Bilaterality. OEP Continuing Education Courses Vol. 46
No.
Goddard Blythe, SA (2001) Reflexes, learning and behavior. Fern Ridge Press. Eugene. OR.
Goddard Blythe, SA (2012) INPP One Year Training Course in Neuro-Developmental Delay
Lecture Notes, Chester, UK.
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Slide 78 Resources & Acknowledgements
Goddard Blythe, SA (2009) Attention, Balance and Coordination: The ABC of Learning
Success. Wiley-Blackwell. Chichester, UK
Hebb, D.O. (1949). The Organization of Behavior. New York: Wiley & Sons.
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Vol. 57. No 4.
Margach. C. B, Functional (Intermodal) Training: An Analysis of Skeffington’s “Amodal
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Slide 79 Resources & Acknowledgements
Masgutova, S. (2012) Reflex Integration and Learning. Svetlana Masgutova Educational
Institute for Neuro-Sensory-Motor and Reflex Integration, LLC, USA.
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Neurosensormotor Reflex Integration. Svetlana Masgutova Educational Institute for Neuro-
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PANSKY, B. (1982) Review of MEDICAL EMBRYOLOGY, Embryome Sciences, Inc . Alameda,
CA.
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Slide 80 Resources & Acknowledgements
Raine, S., Meadows, L, Lynch-Ellerington, S. (2009) Bobath Concept: Theory and Clinical
Practice in Neurological Rehabilitation. Blackwell Publishing LTd. Oxford, UK.
Ratey, J., Hagerman, E. (2008) Spark: The Revolutionary science of Exercise and the Brain.
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Ratey, J. (2002) A User’s Guide to the Brain. Random House, Inc. New York, NY.
Schaffel, A. (1968) Vision Training: A new Developmental Concept in Child Vision. OEP,
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Shumway-Cook, A., Woollacott, M. (2012) Motor control: Translating Research into Clinical
Practice. Lippincott Williams & Wilkins, Baltimore, MD.
Sutton, A. (1984) Orientation in Visual Space: Building a Visual Space World. OEP Continuing
Curriculum II Vol. 47 No.3.
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Slide 81 Resources & Acknowledgements
https://visionhelp.wordpress.com/2011/05/22/sensorimotor-dynamics-and-two-visual-systems-
shades-of-skeffington-brock-part-1/ http://www.clipartpanda.com/clipart_images/stage-
curtain-page-clipart-59647833
http://classroomclipart.com/clipart-view/Animations/Sports/boy-with-exercise-ball-
animated_gif.htm
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Slide 82 Resources & Acknowledgements
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