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

iPhones, iPads, Nintendo DS...OH MY!

If you are sitting in a waiting room or out shopping, you probably see a lot of children on electronics like an iPhone/iPad or a Nintendo DS to keep them busy. Unfortunately, some of these children may be in danger of future vision problems if these devices are used as a crutch to entertain a child. Now I am not saying children shouldn’t have electronics – as an educational tool, they can do wonders – but what if we could minimized the amount of time they use the device.

When children are very young, their visual systems are still developing. Developing children need to interact with objects in real space. It’s how they develop depth perception, eye teaming, tracking and other visual skills.

Here are a couple tips to avoid vision problems:

• Preschoolers should not play on an iPhone or small screen video game for longer than 15 minutes per day.
• Older children should be limited to 30-60 minutes per day and take breaks every 15 minutes.Both children and adults should try and balance their gaming and computer usage with outdoor activities or sports that include a ball.
• A child should not hold the screen too close to their eyes. Use the Harmon distance, which is the distance from the elbow to the middle knuckle.

Now we are not saying every child will develop vision problems or computer eye strain if they use a small screen video device.  What we are saying is we need to practice good viewing habits, your child could experience issues such as headaches, eye strain, or possibly develop nearsightedness.

If your child is currently in Vision Therapy and they abuse their time with video games or small electronics, by using these devices too much they could worsen the condition. Your children can still have fun with video games and games on the iPhone or iPad, just be smart and limit their time!

Why are eye exams so important?

Have any of you watched The Doctors show? Check out this video: http://www.thedoctorstv.com/main/home_page?init_type=Feature&init_id=4988

We can learn a lot from this video. This video states how important a comprehesive approach to testing for eye issues. When going to your local eye doctors make sure they are testing more than your child's visual acuity. When we do our comprehensive exams we test for: Alignment of the eyes, binocular depth perception, eye movements necessary for reading (‘tracking’), magnitude and flexibility of accommodation (‘focusing’), visual motor integration and visual perceptual abilities. We stress that vision is more than seeing 20/20.

What I also love about this video is how they state that your child should have an eye exam starting at 6 months! So, make sure your child receives an eye exam before age 1, at 3 years old, and before they enter kindergarten.  After that, if vision is developing on schedule, children should be seen every one to two years as directed by their eye doctor.

Lastly, like this child's teacher noticing her student was looking very closely to her page, look to see if your a child rubbing his or her eyes, avoiding reading, complaining of headaches or eyestrain, it should be a warning sign that more testing is needed.

It’s Not About the Patch

A great article about Amblyopia from the COVD Blog:

Amblyopia, also referred to by the public as “lazy eye”, is a unilateral or less commonly bilateral condition in which the best corrected visual acuity is poorer than 20/20 in the absence of any obvious structural anomalies or ocular disease. Amblyopia is associated with strabismus (an eye turn) and/or anisometropia (difference in refractive status between the eyes).  Amblyopia is the BRAIN’S response to the imperfect and unequal visual input received from the eyes.

Treatment of amblyopia is based on eliminating its most obvious symptom: the reduction in visual acuity.  An amblyopic child cannot read the 20/20 line with the amblyopic eye and this becomes the primary focus of most interventions.  First, children are provided with glasses to neutralize any differences in refractive status between the eyes, then the patching begins.  Patching is a form of penalization.  By penalizing the better seeing eye, the child is forced to use the amblyopic eye, and improvements in visual acuity are measured.   The scientific evidence of the benefits of patching in the treatment of amblyopia is extensive and well-founded.  When evaluating the effectiveness of patching in populations of amblyopic children, most of them show statistically significant improvements in visual acuity….. but not all patients.

At COVD’s annual meeting, Drs. Janna Iyer and Genia Beasley presented a case of a 10 year old girl with amblyopia.  She had been treated with patching and atropine (a pharmacological form of penalization) for YEARS.  She hated the patch and the blur-inducing eye drops and found many ways to “beat the system” and use her better seeing eye.  The visual acuity in the amblyopic eye remained 20/100.  Drs. Iyer and Beasley recommended a paradigm shift.  Instead of focusing on amblyopia as a monocular problem, they began to treat the binocular problem and shifted emphasis to the integration of the visual inputs in the BRAIN from a 3-dimensional world.  Activities designed to use the eyes together in order to make judgements about where things are in space were emphasized.  Activities involving patching and identifying what things are  were significantly reduced.   Her visual acuity improved within weeks of initiating this therapy program.  More important, her academic performance skyrocketed.

Amblyopia is much more than a reduction in visual acuity.  Amblyopic eyes have poor eye movement and focusing skills; the amblyopia causes distortions and difficulty processing spaces between objects.  On any visual task you design, amblyopic eyes will perform slower and with less accuracy.  Even when using both eyes, amblyopic children often do not perform as well as “normal” children.  The consequences of amblyopia are far greater than reduced visual acuity.  Clearly treatment must move beyond the patch to the brain.  Only then will these children begin to demonstrate improvements in their living and learning skills and not just their ability to read the little letters on the doctor’s chart at the end of the examination room.

-Dr. Rochelle Mozlin

Here at Optometric Physicians we have many amblyopic children. Where patching does improve the visual acuity of the amblyopic eye, it shouldn't stop there. That eye still has poor eye tracking and focus abilities, and that is where vision therapy comes in. A combination of patching and vision therapy will improve your child's overall living and learning skills.

How are Vision and Learning linked?

Did you know that much of what you learn comes through your visual system? If a child is struggling with school and says things like, "I am not smart," "I can't," and "it's too hard," you begin to do everything you can to help your child to succeed. You get them a tutor, you have them stay after school to get help, you spend countless hours helping them with homework and at the end of the day your child is frustrated, unmotivated and overly tired. This sounds all too familar, right?

Studies show that children who have problems with reading, spelling, writing, math, and/or many social skills are often deficient in the execution of many types of eye movements.

• They do not work both eyes well together as a team (binocularity)
• They move their eyes asymmetrically when trying to converge (point the eyes closer)
• They diverge (point the eyes further away) their eyes
• They have difficulty keeping a target clear where they are looking (focusing and accommodation)
• They make errors when trying to fixate or track a moving object (saccades and pursuits)

These poor eye movement skills play a large role in understanding the problems that children encounter when attempting to perform school work and other visual tasks. They have caused their vision to perform inaccurately, to be much less useful for them than for other individuals, and to cause a variety of visual perceptual problems.

Here are ten examples of how vision impacts your child in school:

1. When children are first learning to read, vision problems can impede the development of basic reading skills. 
2. When children are reading to learn, as is the case with older readers, blurry or double vision can impact their ability to read for long periods of time.  Reading comprehension can be severely reduced.
3. When children have trouble seeing things as clear and single (instead of two images, as is the case with double vision), they may have trouble identifying decimals and/or signs in math.
4. When children have poor visual skills, it impacts their ability to organize their writing, and may impair their ability to line up numbers in math.
5. In math, not seeing the numbers correctly can lead to miscalculations. When children lack visualization skills, they may have to count on their fingers or verbalize number sequences, which can affect their performance on timed tests.
6. When children are adept at math, they may still do poorly because their vision problems affect their ability to read story problems correctly and efficiently.
7. When children have problems with visual recall, which is the ability to create a visual image based on past visual experience, they may have difficulty with spelling.
8. When children have vision problems, their handwriting may suffer. Vision leads the hand when writing, and a poorly functioning visual system can lead to difficulty with neatness and organization of handwriting.
9. When children have laterality and directionality problems, they will have problems differentiating similarly-shaped letters in different orientations (b, d, p, q) and may read or write them backwards.
10. When children have poor visualization skills, they may not be able to organize and reorganize a composition in their head, which can affect their writing.

As you can imagine, these are just a few of the many examples of how vision and learning are intricately intertwined. The relationship exists on many levels and affects virtually every subject, which is why a vision problem can be so debilitating to a young learner.

Our goal at Optometric Physicians is to effectively get your child's eyes working together as a team. This blog is a great tool on understanding how your child's vision is affecting them to learn and process information. Please call our office if you have any further question at 615-386-3036.

Does Your Child Have Bad Handwriting?

Parents and educators tend to be the first people who will determine if there is a need for vision therapy for children. Once they understand the telltale symptoms, such as handwriting issues, they can spot children who may have a vision problem.

One area in which vision problems manifest is in a child’s handwriting. Take a look at some handwriting issues experienced by students with vision problems:


These are some examples of how handwriting can be affected by a vision problem. However, another common symptom is that a child has very neat handwriting, but they’re very slow when it comes to actually writing.

As you examine your child’s handwriting, look for the other symptoms typical of vision problems. Some typical symptoms include rubbing eyes, having watery eyes or avoiding writing. Children may also suffer from headaches or have a short attention span while writing. Check out our first blog for the long list of symptoms of vision problems.