NORA

Optometric Physicians and Nashville Vision Therapy just got back from the Neuro-Optometric Rehabilitation Association (NORA) conference in Memphis. We came away with a great understanding on how as committed individuals from various disciplines have to come and work together as a team. The rehabilitation for the neurologically-challenged patient needs a team of passionate individuals to build up their system. It was also refreshing the variety of the speakers - OD (Optometrist), OT (Occupational Therapist), PT (Physical Therapist), Chiropractor. It showed that we all can work together and we all need each other to support our patients. No one is better the rest, or more beneficial - we are a team. It was great to be reminded of that.

Stay tuned for more about the NORA conference.

Stroke Rehabilitation and Vision Therapy

Here at Nashville Vision Therapy, we treat many stroke survivors. Our hearts are passionate about helping our stroke survivors gain control and independence in everyday living situations. This subject is on our minds because next week our staff is traveling to Memphis for a conference with NORA.

What is NORA? It stands for Neuro-Optometric Rehabilitation Association. It is a group of committed individuals from various disciplines focus on advancing the art and science of rehabilitation for the neurologically challenged patient. We are excited to learn more about stroke rehabilitation.

After a stroke there can be fear, apprehension and uncertainty that stroke survivors and families face. Much rehabilitation come with the aftermath of a stroke. There are two main means rehabilitation that you may think of, Physical Therapy (PT) and Occupational Therapy (OT). But there is really is three primary means of rehabilitation, with Vision Therapy included.

National Stroke Association explains it best:
"Many stroke survivors have visual problems following their strokes. To be able to see well, the brain and the eyes have to work together. Because part of the brain is damaged in a stroke, vision problems can be partial or complete loss of sight. Stroke survivors may also experience blurred vision, confusion or difficulty in performing visual activities, and eye strain. For stroke survivors with vision problems, it's harder to go back to work or even perform simple household tasks. As soon as possible after a stroke, stroke survivors should have a complete eye exam to find out if their eyes are healthy. This exam will uncover any stroke-related vision problems. Opthalmologists or optometrists are important members of a stroke patient's rehabilitation team. They can diagnose specific problems and recommend a treatment plan. Different types of vision therapy are available to retrain, strengthen, or sharpen vision following stroke. The goal of the therapy is to train healthy parts of the brain to perform the work of the part of the brain damaged by stroke. According to research, neither the age of the patient nor when the stroke occurred makes a difference in the effectiveness of this type of therapy."

'My child gets vision screenings at school, isn't that good enough?'

Photo Compliments of Free Digital Photos



The title of this blog is a question we hear everyday in our office. To answer the question, “No, that isn't enough!” Children need a full comprehensive eye exam as early as six months. I have mentioned this in previous posts but I want to make sure we are on the same page. If you think about it, vision really is more than seeing 20/20. How are the eyes working together? How is your depth perception? How is your coordination? How is the alignment of the eyes? Finally, how are your visual perceptual skills? These are things we look for at Nashville Vision Therapy.

We are not all about a quick fix. We want to get to the root of every issue that we come across with each patient. You’d be amazed to learn what happens when the eyes don't move together - processing information is more difficult, coordination is lacking, hand writing is tiring, daily headaches, and more.

Many parents believe that school vision screenings are sufficient care for their children's eyes, but this is not true. My advice for every parent or guardian is schedule your child a comprehensive eye exam, be in touch with your child’s teachers, and find out where/if your child is struggling.

Let me leave you with this fact - 1 in 4 children have a vision problem that interferes with learning that a school screening does not detect. Let's work together and spread the word about how vision affects learning and have your child receive a comprehensive exam yearly.

Retained Reflexes related to Learning Difficulties



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Did you know that there are 70 known primary reflexes? Here at Optometric Physicians, Nashville Vision Therapy Center, we concentrate on the primary reflexes that are known to affect educational progress. From previous posts we have learned what primitive reflexes are, and how the reflexes become retained. Today we will explain briefly what these reflexes do and how they cause interference when they are retained.

 First up: Asymmetrical Tonic Neck Reflex (ATNR)

The ATNR reflex is noticed before 6 months of age when a baby turns its head to one side and the limbs on that side straighten then the limbs on the other side bend or flex. ATNR should be switched off at six months of age. The retention of this reflex causes the most interference with a child’s learning process. It is responsible for problems with:

• Handwriting - Problems with handwriting is the most obvious casualty of the retained ATNR. Each time a child turns his head to look at the page, his arm will want to extend and the fingers will want to open. Holding and working a pen or pencil for any length of time will require enormous effort. This leads to very heavy pencil grip and tension in the body. All the energy is now going into the writing and distracts attention from the writing content. Some children learn to compensate with an immature pencil grip. Writing may slope in different directions from one side of the page to the other so the child may rotate the page as much as 90 degrees when writing in an attempt to “accommodate” the effect of ATNR.
• Reading - This deals with eye tracking difficulties. When reading some things you might notice is the eyes do not move smoothly from one side of the page to the other, and they often jump. This results in loosing your place, loss of accuracy, which  then leads to poor comprehension.
• Mixed Laterality – Child may use left foot, right hand, left ear or child may use left and right hands interchangeably for the same task. The effect of mixed laterality can be failure to send information to the most efficient centre of the brain for that skill. Competition between 2 centres may occur, which is very like two people trying to drive the same car.

Symmetrical Tonic Neck Reflex (STNR)

This reflex allows the baby to straighten its arms and bend its legs when it looks up. The STNR reflex is present in normal development for a relatively short time span and is normally lost at 8 months after birth. If it is not lost, it can affect a child’s ability to crawl on hands and knees. Crawling is a major developmental milestone, as a baby crawls, as well as looking ahead, babies also learn hand-eye coordination from the movement of the hands.  Later on this ability will be essential for being able to read without losing the words at the middle of the line and to visually follow the moving hand when writing. The focusing distance and hand-eye coordination skills used in the act of crawling are at the same distance that the child will eventually use when reading and writing.

Other symptoms of retained STNR include:

• Poor posture
• Poor hand-eye coordination
• Clumsiness
• Slow at copying from board 

Moro Reflex:
The Moro Reflex should disappear at 2-4 months and should be replaced by the adult “Startle” reflex. The Moro reflex is a response to unexpected changes within the infant’s environment and acts as the infants’ “fight of flight” response. The prolonged retention of this reflex can be highly disruptive to a child’s development.


Symptoms of a retained Moro Reflex include:

• Poor coordination (particularly during ball games) – which leads to poor sequencing and memory skills
• Balance problems
• Motion sickness
• Sensitivity to bright lights
• Difficulty reading black print on white paper
• Tires easily under fluorescent lights
• Dislike of loud noises
• Easily distracted
• Allergies and lower immunity
• Dislike of change- child may be clingy or shy

Tonic Labyrinthine Reflex (TLR)
The TLR is the opposite of STNR; when a baby looks up TLR causes the baby to straighten it’s legs and arms, likewise when the head goes down the limbs fold in. This reflex should be fully present from the time of birth to 4 months old. It is active during the birthing process. It is linked to balance and muscle tone. If this reflex persists it will disrupt balance and gross motor skills. 
        Symptoms of this retained reflex can include:

• Poor posture
• Tendency to walk forward on toes
• Weak at ball skills
• Poor articulation

Spinal Galant Reflex:
This reflex is present at birth, and should disappear by the time the baby is 9 months old. The Spinal Galant Reflex provides the opportunity to experience a change from whole body movements to same side (homolateral) movements.  The Spinal Galant Reflex emerges at 20 weeks in utero, is actively present at birth, and should be integrated by the time the baby is 3 to 9 months of age. The Spinal Galant Reflex is present when a baby is placed in a prone position (on their stomach) and stimulation is placed to one side of the spine, the hip on the side of the stimulus will flex (curl toward that side).  This reflex helps the baby to work its way down the birth canal during the birthing process, and also allows the fetus to hear and feel the sound vibrations in the womb.The Spinal Galant Reflex is important in the development of hearing and auditory processing, as well as helping to achieve balance when the child is creeping and crawling.  If persists, the child experiences :

• Restlessness
• Fidgeting
• Inability to sit still
• Bedwetting
• A tendency to dislike tight clothing
• Poor concentration and short term memory

It is great to be educated on all these reflexes. The great news is we can do several different exercises to improve all the above areas. We now know that with retained reflexes it can hinder your child's educational progress. Let's work together, build up these reflexes and improve your child life!

What Causes Reflexes to Be Retained?

I have been doing a lot of research on Primitive Reflexes. I have so many great articles that have helped me understand each reflex and how to implement them into our office.  From Visual Dynamix inc. , I found this great article on what causes reflexes to be retained. Take a look!

What Causes Reflexes to Be Retained?

There are a number of different reasons why primitive reflexes fail to integrate.  One of the biggest factors that cause reflexes to be retained is a traumatic birthing process.  This includes prolonged or premature birth, breach position, births involving forceps or suction, and emergency Caesareans.  The general increase in Caesarean section births may also be a contributing factor to the increased incidence of retained primitive reflexes since some of the reflexes are stimulated by the process of passing through the birth canal during natural childbirth.  The reflexes involved in aiding the birthing process are more likely to still be ‘present’ at a later age with children that were born via Caesarian section. 

Societal factors can also come into play such as not allowing babies to spend enough time lying on their stomachs (tummy time) due to the fear of Sudden Infant Death Syndrome (SIDS).  *It is important to follow the advice of your pediatrician regarding SIDS. 

Another societal factor that can cause reflexes to be retained is the lack of exploration of the infant’s space and world during the creeping and crawling stage.  If an infant spends a great deal of time in a car seat, stroller, crib, or other confining environment it is more likely that the primitive reflexes will be retained past the typical timeline.

Doing “too much, too fast” can also be detrimental to the developmental process.  As a child develops they gain more and more control over their physical body. 

Children progress from lying on their back, to rolling over onto their stomach, to creeping, to crawling, and eventually to walking.  Some parents will comment, “My child was very fast to develop!  He was walking very early!”  Unfortunately, the child who spends little time crawling can miss out on some valuable developmental experiences for visual-spatial development. 

It is very important that we first gain mastery of our environment from the ground as this stage of development strengthens our muscular system and sets in place the building blocks for higher-level coordination and spatial awareness.  

What are Primative Reflexes?

When a child starts Vision Therapy we test their primitive reflexes and we integrate reflex exercises into our vision therapy plan. A lot of my parents ask questions like,  "What are primitive reflexes?",  and "How does this relate to the visual system?". For the next couple blogs we will go over all those questions.

First, primitive reflexes are the basic reflexes we are born with.

Take for example an infant child. When the child’s head is turned to one side, both his leg and arm automatically turn in the same direction. This is known as the Asymmetric Tonic Neck Reflex. As another example, when an infant is stroked on the lower back, his side muscles automatically contract performing what is known as the Spinal Galant Reflex. Lastly, when an infant is startled, he opens his eyes, throws his head back, and spreads his hands wide for what is called the Moro Reflex.  

Through these basic concepts physicians can determine the development of the infant based on the progression of their primitive reflexes.   

Ideally, the child’s primitive reflexes develop accordingly as he or she ages and advances in development. The body naturally integrates itself with the reflex or inhibits the reflex depending on the developmental stage. 

It is crucial that the body moves through these developmental stages and primitive reflexes according to nature’s plan. When the body fails to initiate, integrate, or inhibit these reflexes, the system automatically locks down in the developmental stage it is in. 

This “lock down” can restrain maturation of the body’s neural systems and possibly lead to learning disabilities that range from mild to severe.  

Next week we will talk about how retained reflexes have the potential to cultivate learning disabilities. Stay tuned!

Let Your Children Explore and Play!

Vision development in children is a very important part of child development which influences fine motor development, gross motor development, and visual perceptual development.  Good visual development in children is necessary for proper brain maturation, and, many cognitive stages of child development may be delayed and learning problems could arise if proper vision development has not occurred.

So what can parents to encourage good visual development in their preschoolers?

Proper play activities are the most important ways that parents can help encourage good visual development in children.  When a child plays, he or she is strengthening not only his muscles, but also strengthening their perceptions.  They are learning new skills and letting off excess energy.  They are also trying out different solutions to problems and learning how to interact with others.

Good visual play activities allow the child to explore and experience their world with vision driving the action.  This kind of play will build upon and enhance gross motor development, fine motor development, balance, eye movements, body awareness, spatial relationships, visualization skills, and much more.

We know that play affects visual development and visual development affects play.  Motor development and visual perceptual development are interdependent.  If a child experiences delays in motor development, visual perception can be skewed which reduces the child’s ability to explore and learn from the environment.

Remember, when there is a delay in one area of development such as motor development, there is often a delay in other areas as well.  School-aged children with functional visual disorders arising from poor vision development often face a lifetime of learning difficulties and frustration in the classroom and in everyday life. Let you children play and explore the world around them. Below is a great list of toys and games that can improve visual development:

Building toys – Develop eye-hand coordination and visualization/imagination.
1. Building Blocks
2. Legos/Duplos
3. Lincoln Logs
4. Tinker Toys
5. Erector Set

Fine motor skill toys – Develop fine motor skills including visual skills and manual eye-hand coordination.
6. Light Bright
7. Pegboard and Pegs
8. Coloring Books and Crayons
9. Dot-to-Dot Activity Books
10. Finger Paints
11. Playdough/Silly Putty/Modeling Clay
12. Chalkboard (24” x 36”)/Easel
13. Bead Stringing
14. Sewing Cards (craft)
15. Paint or Color By Numbers
16. Sand Art
17. Stencils
18. Bead Craft Kits
19. Models (car, airplane, ships, etc.)

Space perception toys – Develop depth perception and eye-hand coordination.
Within arm’s length:
20. Jumpin’ Monkeys
21. Fishin’ Around
22. Operation
23. Pick-up Sticks
24. KerPlunk
25. Jenga

Beyond arm’s length:
26. Oball (good for kids who aren’t very good at catching)
27. Ball (any kind!)
28. Pitchback
29. Toss Across (tic-tac-toe)
30. Ring Toss
31. Nerf Basketball
32. Dart Games (velcro)
33. Ping Pong

Visual thinking toys and games - Develop visual thinking including visualization, visual memory, form perception, pattern recognition, sequencing and eye tracking skills. These skills are important basics for academics including mathematics, reading and spelling.

34. Color Blocks and 1” Cubes
35. Parquetry Blocks
36. Attribute Blocks
37. Make N Break Game
38. Jigsaw Puzzles
39. Rory’s Story Cubes
40. Card Games (Old Maid, Go Fish, etc.)
41. Dominoes
42. Checkers
43. Chinese Checkers
44. Perplexus
45. Qwirkle
46. Battleship
47. Labyrinth
48. Blokus
49. Connect Four
50. Rush Hour/Rush Hour Jr.
51. Perfection
52. Tactilo
53. Bingo
54. Memory Games
55. Chicken Cha-Cha-Cha
56. Simon Flash
57. Bop It
58. Hyperdash

Balance and Coordination toys and games – Develop large motor skills.
59. Hoppity Hop
60. Jump Ropes
61. Sit and Spin
62. Slip ’n Slide
63. Trampoline
64. Stilts
65. Twister