Effectiveness of VT (I'm so excited!)

[NCW]

I have just finished the first of a two-day course taught by an OT and a DO together. Today was OT...

I look forward to sharing what I've learned with you, as VT is so often discussed here.

The vestibular and visual systems are intimately linked neurologically. Often poor vestibular development can lead to visual problems. The OT today said that typically, if VT has been unsuccessful (usually by not 'sticking'), it's because underlying vestibular problems have not been corrected.

So...ta dah! There's one of the reasons some of you have noticed that after OT tx there is an increase in the ability to process visual information. If the OT successfully treats vestibular processing deficits, it can bring the eyes along (they're connected by three powerful reflexes, as well as in other ways).

It's actually pretty complicated - for example, chronic ear infections can impact the development of the vestibular system. I'm really simplifying, but if the brain is only getting spotty, inconsistent input from a sensory organ, than it kind of shuts off paying attention to it, or switches back and forth selectively. This is how a child with chronic ear infections can have trouble eventually with phonemic awareness - they can't neurologically cut out the background ambience of low frequency tones and focus on the higher frequency tones of the human voice because their auditory processing never developed fully and efficiently.

Anatomically, sound waves hit the vestibular apparatus before they even get to the cochlea. If the brain has decided it can't trust input from that inner ear, then the processing of vestibular input will also be affected. People who have poor vestibular processing end up compensating with visual input...but because the visual system only works optimally in concert with the vestibular system, their visual system is also compromised. OK, so it is really complicated...but I'm loving having it all make sense finally.

Anyone who says we need more research is exactly right. However, we can't wait until it's done to help our kids. OTs are so into helping people that it's tough for them to do research...you always have to withhold assistance from a control group, and they can't stand doing that. Sigh. Several researchers and their work were mentioned today. If you need me to post that info, let me know.

If this is all jibberish to you, just ignore me. I've just had a really interesting day, and I'm looking forward to hearing the DO tomorrow.

NCW

[MicheleB]

Very interesting and helpful, NCW. Answered my other question I posted in my other thread. Helps make sense of some things. Thanks.

[godpoetry]

I am very interested in this. I have a son with nonverbal learning disorder seizures. He is struggling with vision problems right now. My oldest son has issues with dysgraphia, auditory processing, and some other problems that we are trying to solve. I would love to know more about what you learned from the seminars.

[Claire]

Wow! I agree with every single thing you posted! Sure hope you can keep us informed as you learn, as I'm sure there are many components to this. I don't know anyone else who has taken the type of course you are talking about. How did you find out about it?

[Rod Everson]

Hi,

Yes, very interesting. Post as much information as you've got the time for.

In my opinion, this is why so many different therapies seem to have an impact on reading. For instance, if you get a chance, ask the OT how Levinson's giving motion sickness medication to poor readers might have helped some of them. (certainly not all of them, but enough that some success stories were generated.)

It also, I think, explains why you'll see a lot of OT-type activity in a good vision therapy department. Let us know what your DO says about that in the presentation today. The developmental optometrists understand that vision skills are built on other more basic skills.

Also, if you get a chance, ask the OT how the cerebellum comes into play in all this, as that is where I think the common ground is going to be found across all therapies, including even those attempting to address the needs of autistic children.

Have a great day,

Rod Everson
OnTrack Reading (http://ontrackreading.com)

[NCW]

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[NCW]

Hi,
For instance, if you get a chance, ask the OT how Levinson's giving motion sickness medication to poor readers might have helped some of them. (certainly not all of them, but enough that some success stories were generated.)

Rod, unfortunately she headed directly for the airport Friday afternoon before I even placed my initial post. However, I read Levinson's work a couple of years ago. He has done us all a service by researching the link between the vestibular system and reading challenges. He wasn't mentioned this weekend. I have not found anyone else advocating the use of antihistamines/motion sickness medicine to treat vestibular issues. I'm assuming that they work for some for the reasons I mentioned in my first post - unclogging the inner ear can free up the vestibular apparatus to work correctly, allowing the eyes to click in and do their part. However, Dr. A did discuss motion sickness - it either is due to a physical problem in the middle ear (disease, etc.) or a visual processing problem. Most often, it's due to visual processing. His belief is that no one needs to suffer from motion sickness - it's entirely curable.

I personally found Levinson's elucidation of phobias related to inner ear dysfunction very helpful, and wish more researchers mentioned it. Because we now know that if you have a disordered vestibular system you definitely have disordered vision as well, it's no wonder these individuals have phobias! How can they know where they are in space? What's surprising is that even more aren't phobic.

Dr. A's opinion is that VT should be a last resort (after OT and other therapies have been tried), and that VT should always be in conjunction with OT. He also is of the opinion that a DO should be the one doing the VT, possibly with assistants, but the DO is directing, planning and overseeing therapy. He is also not in favor of computer programs for VT (can't be individualized, have no idea if they're really treating the problem, and computer use often exacerbates visual problems). In his opinion, VT should cost the same as OT or any other therapy, and most insurance covers it - HMOs are the least likely to, but otherwise it's generally covered.

I'll have to wait until this afternoon to write more...

[NCW]

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[Maria/ME]

Wow! Thanks so much for this information! I've found it very very helpful in sorting things out for our particular needs!

[NCW]

Sorry it's taken me so long to get back to this board. I actually don't make it over here very often, and usually in spurts.

Anyway, I wanted to thank you for allowing me to think out loud while I absorbed some of this information from my course. By that I mean discussing authors I've read and coming up with my own interpretations (because I see that's what I was doing). If it seemed that I disparaged any one of them, I didn't mean to - I've learned a lot from everyone I've read. As far as techniques I've personally used, Davis actually has been the most helpful. Two days later, I'm wondering if his "mind's eye" approach is a way of training the visual system, as opposed to a compensatory technique. I do know it helped dd's phobias (some). She got very frustrated with his clay work, though...but now I may have more ideas why. I have his book "Gift of Learning" also waiting to be read.

Back to the conference - I'll try to summarize as much as I can.

Skeffington brought VT to the US around 1928. His model of vision is still used:

(this part pasted from another website)
SKEFFINGTON'S FOUR CIRCLES








Dr. A.M. Skeffington utilized the schematic shown below to define vision and show how it emerges. The schematic shows that one must look at the whole body and not just the eye when defining vision.http://www.actg.org/images/icla.gif



I=IDENTIFICATION C=CENTERING L=LANGUAGE A=ANTI-GRAVITYV=VISION or EMERGENTIDENTIFICATION-What is it? Accurate sight, eye movements, accommodation (focusing), and visual analysis (form perception, visual-attention to detail, visual memory) skills are needed to be able to identify what an object is.

CENTERING-Where is it?
Normal eye teaming and literality/directionality are needed to perceive accurately where objects are.

LANGUAGE-What can I tell you about it?
Normal auditory visual integration and visual motor integration are needed to be able to communicate to others what one sees or has seen.

ANTIGRAVITY-Where am I?
Normal reflexes, balance/vestibular functioning, bilateral coordination, gross motor and fine motor skills are needed to be able to efficiently react and interact with our environment.
VISION = I+C+L+A
(end of pasted section)

From my course notes:
This model makes it appear that vestibular function is 1/4 of vision. However, vestibular reflexes underlie the other three areas as well - hence the huge impact of vestibular functioning on vision, and the reason why vision therapists are learning to use OT-looking treatment techniques.

The vestibular system provides:
a motor center - to move around three-dimensionally
an emotional center - for self-regulation
a perceptual center - so we're not lost in space, and can organize the world.
and a spatial-temporal center with which to relate to objects, people, and events in our world.

In essence, the vestibular system is the orienting system for the auditory and visual systems in time and space - it allows the use of eyes/ears for cognitive functioning.

An interesting point, though, is the finding that any child with attention or transition troubles has difficulty with ambient-focal flow (using peripheral and focal information and being able to switch easily between them). It also can result in social challenges, like not knowing how close to stand to someone. A lot of children with vision problems are diagnosed with ADD/ADHD.

The anatomy of the inner ear, tests for vestibular function, and specific treatment techniques were covered. The only part of that I'm going to put here is to answer Ron's question - The vestibular system is the only sensory system that feeds directly into the cerebellum, which has an area that is devoted to dealing with vestibular processing...this is how vestibular input is related to mental and physical agility. They have found that there is a large bundle of fibers between the pre-frontal cortex (cognition) and the cerebellum. OK, this would probably be a chapter in a neuroanatomy text!

Oh, and auditory programs like TLP among many others, can help improve vestibular function in some individuals.

I thought the following info was pertinent to frequent discussions here, so I pulled this paragraph from another site to add here (this study was quoted in our class, among many others, but her research is quite recent):

Margaret Livingstone, Department of Neurobiology, Harvard Medical School and the Dyslexia Research Laboratory, Beth Israel Hospital in Boston defined dyslexia as follows: "Developmental dyslexia is the selective impairment of reading skills despite normal intelligence, sensory acuity, and instruction. Several perceptual studies have suggested that dyslexic subjects process visual information more slowly than normal subjects. Visual abnormalities were reported to be found in more than 75% of the reading-disabled children tested." Therefore, it is important to rule out problems with sensory integration and/or sensory processing (including visual acuity and visual processing) before labelling an individual as truly dyslexic.

Dr. A indicated that studies have her 75% figure vary between 60-98%.

We also learned, among other things, the definitions of all the various optometry terms and how to screen for them to make an intelligent referral to a DO.

You have to understand that OTs don't get this kind of in-depth info in our degree programs - almost all practical knowledge of SI (and many other treatment techniques) is obtained in continuing ed courses like this. It's why they're required for us, and it makes sense this way, as it allows therapists to study what is most pertinent to the people they're working with.

OK, that's my understanding of this stuff today! Hope it helps someone.

[Rod Everson]

Thanks a lot for posting so much information from your conference! I've got a couple of observations below on points they made.


The only part of that I'm going to put here is to answer Rod's question - The vestibular system is the only sensory system that feeds directly into the cerebellum, which has an area that is devoted to dealing with vestibular processing...

Hi,

I think that they are finding now that a lot more processing goes through the cerebellum than previously thought, including a lot of visual processing. I don't pretend to know the details, but it is looking like the cerebellum is like the switchyard to the brain's sensory, motor and cognitive processing functions. This would explain why so many varying therapies seem to have an impact on reading ability, and also why so many therapies are sometimes necessary before everything falls into place. Basically, they all work on developing various aspects of an underdeveloped cerebellum. I'm speculating here, based on a lot of recent "clues" as to what is going on in various situations, for example, autism, where research is indicating an underdevelopment in areas of the cerebellum.


Margaret Livingstone, Department of Neurobiology, Harvard Medical School and the Dyslexia Research Laboratory, Beth Israel Hospital in Boston defined dyslexia as follows: "Developmental dyslexia is the selective impairment of reading skills despite normal intelligence, sensory acuity, and instruction. Several perceptual studies have suggested that dyslexic subjects process visual information more slowly than normal subjects. Visual abnormalities were reported to be found in more than 75% of the reading-disabled children tested." Therefore, it is important to rule out problems with sensory integration and/or sensory processing (including visual acuity and visual processing) before labeling an individual as truly dyslexic. [emphasis added]



I wonder if it wouldn't be more accurate to just think of all of this as dyslexia, rather than viewing dyslexia as that mysterious reading problem that remains after we've ruled out all other possible physical causes. For example, I tell parents that poor vision skills usually have a genetic cause and that, yes, their children are dyslexic in that their reading behavior is similar to other kids people consider dyslexic, but that fixing the vision problem and then making sure their children understand the system of phonics upon which English is built is sometimes enough to overcome the reading problem.

Are their children still dyslexic? Yes, because there's about a 50/50 chance that they will pass the problem on to their own children. Can it be fixed? I see it fixed all the time. But sometimes there are other developmental issues that still get in the way and these, too, need to be addressed with developmental therapies. At least, that's how I view the matter.

Summing up, here is approximately what I think we'll find (or are finding, actually.) Dyslexia is really a pattern of delayed development across several motor and sensory paths resulting in a child having, among other things, difficultly learning to read. The one consistent finding among all of the various conditions marked by delayed development is an underdeveloped cerebellum and any therapy that addresses an element of that underdeveloped cerebellum stands a chance of also improving reading ability. Address enough of those elements and a child will read, but he will still carry the gene that transmits the risk to his own children.

Therefore, parents need to be watchful, but can be hopeful that any emerging reading difficulties, i.e., the manifestation of dyslexia, can be overcome with proper treatments.

In addition, to the extent that we have more dyslexia now than previously (not yet proven, I feel), it's possible that basic changes in diet, exercise and even TV viewing habits might improve the odds of overcoming dyslexia, or put another way, such changes might enable the cerebellum to develop as efficiently as it once (might have) used to before we junked our diets, dumped our playground equipment, and began propping kids up in front of screens for hours on end each day.

By way of example concerning diet, I've linked to the page on my website where I discuss a fish oil experiment done in Great Britain that some of you might find interesting.

Rod Everson
OnTrack Reading-Fish Oil and Dyslexia (http://ontrackreading.com/the-diet-piece/fish-oil-and-dyslexia)