A Vision and Eye-Care Professional Primer for Occupational Therapists

A Vision and Eye-Care Professional Primer for Occupational Therapists

by Katherine J. Collmer, M.Ed., OTR/L

 

Vision Facts to Guide Assessment and Treatment:

childs eyes - aroni- by Bessi pixabay

The visual sense is the primary way in which we understand what we see.  It is “our most far-reaching sense” and the one through which we obtain 75-85 percent of what we learn about ourselves and the world around us.  (1, p. 3)   Vision as a term is most often confused with that of eyesight.  However, the terms are not interchangeable.

 

Eyesight consists of our level of visual acuity and our ability to recognize contrasts.  It is a measure of our distance vision and does not effectively determine the efficiency of our near vision skills.  It is also an indicator of eye health.

 

Vision is comprised of 17 skills, one of which is eyesight.  (2)  The measure of 20/20 eyesight and a healthy medical condition of the eyes does not entail the complexity of the visual system.  “In addition to clear vision, an individual must have the ability to use his or her eyes for extended periods of time without discomfort, be able to analyze and interpret the incoming information, and be able to respond to what is being seen.”   (1, p. 6)

 

Visual Brain Journey thru the cortex
The Visual Brain

Vision does not occur in the eyes but in the brain.  The eyes are actually a part of the brain and act as the sensory receptors that collect light and transmit it to the visual brain (3) to “form a model of our world, to identify objects and events, to attach meaning and significance to them, and to establish their causal relations” for the ultimate production of adaptive behavior.   The visual brain is influenced by the brain’s visual pathways and includes the vision that is used for action and that which is utilized for perception. (4)  Neurons devoted to visual processing in the brain account for about 30 percent of the cortex with millions of optic nerve fibers carrying information from the retina to these areas.  In contrast, touch and hearing are represented by 8 and 3 percent of the brain’s cortex, respectively, with each auditory nerve carrying 30,000 signals.  (5)

 

Models of vision have been developed that emphasize vision as a learned process and one that organizes and manipulates space.   It is the sensory system through which we understand the information collected through our other senses.  It a movement pattern and is developed through the use of our motor skills, much like walking and talking.   Vision provides the brain with accurate translation of the information collected through our eyesight.  (1, p. 6)   Therefore, vision plays a key role in learning and can influence the quality of learning through visual efficiency and visual information processing.  Visual efficiency comprises the process of visual acuity and refractive error, accommodation, vergence, and ocular motility.  Visual information Processing involves the higher level brain functions that include the non-motor aspects of visual perception and cognition, and their integration with motor, auditory, language, and attention systems. Deficits in either of these aspects of vision can result in some form of learning problem.  Proper diagnosis of learning related vision problems therefore requires comprehensive evaluation of visual efficiency and visual information processing skills.  (6)

 

vision assessment schedule by hooptometristUndetected vision problems can affect a child’s ability to learn in school by interfering with his ability to see clearly, interpret what he sees, and use his eyes to guide movement.   Although vision screenings are performed by pediatricians and school nurses, their tests are designed to assess for visual acuity and do not reflect how well the eyes focus up close, track, or work together.  Occupational therapists are in a key position to detect the common signs and symptoms that indicate a potential vision problem in these areas and that may be the cause of a reading, learning, or motor performance need.  An efficient OT evaluation will include a vision screening that checks visual acuity, eye teaming, eye movement control, and visual motor integration.  Therefore, it is important to understand and recognize the five most common symptoms that can identify a person is in need of a vision assessment by a developmental optometrist.

 

  • Frequent loss of place when reading
  • Slopping handwriting
  • Eye fatigue or headaches after reading
  • Avoidance of close work
  • Attention problems (7)

 

In addition, it is important for occupational therapists to inform parents and teachers about the importance of early detection of vision-related problems by sharing visual behavior checklists (8) and resources about vision assessments (9) and vision therapy (2).   Equally as important as recognizing early symptoms and sharing information about visual problems, occupational therapists should have a solid understanding about the areas of expertise for those professionals who specialize in eye care.

 

Eye-Care Professionals Guide

Maintaining eye and vision health relies upon regularly scheduled assessments that can alert us and our doctors to the presence of eye diseases and vision disorders.  The early detection of these conditions depends upon the selection of the appropriate eye-care professional to address these specialized areas.  There are four areas of expertise and levels of training that define the providers that address eye and vision health.  (The following was adapted from References 10, 11, and 12.)

 

  • Ophthalmologists (MD) are medical or osteopathic doctors who have completed college and at least eight years of additional medical training. They are licensed to practice medicine and surgery and specialize in the diagnosis and treatment of eye disease.  Ophthalmologists diagnose and treat all eye diseases, perform eye surgery, and prescribe and fit eyeglasses and contact lenses to correct vision problems.  In general, they use medical and surgical methods to treat eyes diseases and vision disorders.
  • Optometrists (OD) are Doctors of Optometry and the primary health care professionals for the eye. Optometrists complete a pre-professional undergraduate education at a college or university followed by four years of professional education at a college of optometry.  Following graduation, optometrists have the option to complete a one-year residency for additional training in a specific area of practice.  They are licensed to examine, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures.  They are trained to perform eye exams, prescribe and dispense corrective lenses, detect certain eye abnormalities, and prescribe mediation for certain eye diseases.
  • Developmental Optometrists (FCOVD) provide vision care based on the principle that vision can be developed and changed. They are health care professionals who obtain board certification from the College of Optometrists in Vision Development (COVD) to provide specialized services in behavioral and developmental vision care, vision therapy, and vision rehabilitations.  Developmental Optometrists specialize in the treatment of functional vision problems, including difficulties with binocular vision, eye movements, and depth perception, as well as visual deficits following brain injuries and are skilled in the use of lenses, prisms, and optometric vision therapy.   They perform functional vision tests to determine underlying vision deficits.
  • Opticians are technicians trained to design, verify, and fit eyeglass lenses and frames, contact lenses, and other eyesight correction devices. They provide services through prescriptions supplied by ophthalmologists or optometrists.

 

A downloadable version of this resource is available at the Handwriting is Fun! Resource Page.

 

 

Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of handwriting skills and understands the link between handwriting skills and writing.  In her current book, Handwriting Development Assessment and Remediation:  A Practice Model for Occupational Therapists,  she shares a comprehensive guide and consistent tool for addressing handwriting development needs.  She can be contacted via her website, Handwriting With Katherine

 

 

 

 

 Disclaimer: The information shared on the Handwriting With Katherine website, blog, Facebook page, Twitter page, Pinterest page; in the Universal Publishing Handwriting Teachers’ Guides; on any guest blog posts or any other social media is for general informational purposes only and should not be relied upon as a substitute for sound professional medical advice or evaluation and care from your physician/medical team or any other qualified health care providers. Therefore, the author of these links/posts take no responsibility for any liability, loss, or risk taken by individuals as a result of applying the ideas or resources.
Photos are the property of the photographers at Pixabay or authors on specific online sites.  Their use should include the link provided with the pictures.
References:
  1. Scheiman, Mitchell. Understanding and Managing Vision Deficits a Guide for Occupational Therapists. 3rd ed. Thorofare, NJ: Slack, 2011. Print.
  2. “Vital Visual Skills -.” COVD.org. College of Optometrists in Vision Development (COVD), n.d. Web. 26 Oct. 2015. <http://www.covd.org/?page=Visual_Skills>.
  3. Hubel, David H. “Eye, Brain, and Vision.” Eye, Brain, and Vision. David Hubel, n.d. Web. 24 June 2015. <http://hubel.med.harvard.edu/book/b8.htm>. Text Publication: Henry Holt and Company, May 15, 1995
  4. Milner, A.. David, and Melvyn A. Goodall. “The Visual Brain in Action.” Assc.org. The Association for the Scientific Study of Consciousness, n.d. Web. 26 Oct. 2015. <http://www.theassc.org/files/assc/2367.pdf>.
  5. Grady, Denise. “The Vision Thing: Mainly in the Brain.” Discover Magazine. Discover Magazine, 01 June 1993. Web. 26 Oct. 2015. <http://discovermagazine.com/1993/jun/thevisionthingma227>.
  6. Garcia, Ralph P., O.D., Steven B. Nicholson, O.D., Leonard J. Press, O.D., Mitchell M. Scheiman, O.D., and Harold A. Solan, O.D. “Optometric Management of Learning-Related Vision Problems, 2nd Edition.” Clin Exp Optometry Clinical and Experimental Optometry 89.6 (2006): 403-04. Aha.org. American Optometric Association, 2008. Web. 26 Oct. 2015. <http://www.aoa.org/documents/optometrists/CPG-20.pdf>.
  7. Hong, Carole L., OD, FCOVD. “Vision Screenings & When to Refer for a Developmental Vision Evaluation: What Every OTR Should Know.” PediaStaff. PediaStaff, Inc., 26 May 2011. Web. 26 Oct. 2015. <http://www.pediastaff.com/blog/qa-ask-the-expert-vision-screenings-when-to-refer-for-a-developmental-vision-evaluation-what-every-otr-should-know-3592>.
  8. Collmer, Katherine J., M. Ed., OTR/L. “Resources for Handwriting/Writing Development.” Handwriting With Katherine. Katherine J. Collmer, M.Ed., OTR/L, n.d. Web. 26 Oct. 2015. <http://www.handwritingwithkatherine.com/resources.html>.
  9. “InfantSEE: A Public Health Program for Infants | Helping Infants to Establish a Lifetime of Healthy Vision.” InfantSEE. Optometry Cares – The American Optometric Association, n.d. Web. 26 Oct. 2015. <http://www.infantsee.org/>. InfantSEE®, a public health program, managed by Optometry Cares® – the AOA Foundation, is designed to ensure that eye and vision care becomes an essential part of infant wellness care to improve a child’s quality of life.
  10. Mischio, Greg. “What’s the Difference between Optometrist vs. Ophthalmologist?” Vision Therapy Center. Vision Therapy Center, 14 Nov. 2011. Web. 26 Oct. 2015. <http://www.thevisiontherapycenter.com/discovering-vision-therapy/bid/75509/What-s-the-difference-between-optometrist-vs-ophthalmologist>.
  11. “Difference between an Ophthalmologist, Optometrist and Optician.” Difference between an Ophthalmologist, Optometrist and Optician — AAPOS. American Association for Pediatric Ophthalmology and Strabismus, n.d. Web. 26 Oct. 2015. <http://www.aapos.org/terms/conditions/132>.
  12. “About COVD.” COVD. College of Optometrists in Vision Development (COVD), n.d. Web. 26 Oct. 2015. <http://www.covd.org/?page=About_Us>.

 

 

 

 

Growth Mindsets: Their Implications in Pediatric Occupational Therapy

mind john hain pixabay

Growth Mindsets:  Their Implications in Pediatric Occupational Therapy

by Katherine J. Collmer, M.Ed., OTR/L

What is the element in therapy that transforms a goal from one focused upon performance to that which targets learning?  What facet of our service approach drives motivation and addresses or prevents the client’s sense of “learned helplessness?”  At what point do we, as therapists, influence the mindset of our clients and facilitate their growth in rehabilitation?

These questions lie at the foundation of our own growth as a profession as the health care reform initiatives align with our long-held principles of client-centered treatment.  But, just as we are beginning to understand that the medical community is catching up to our perspective, we are equally becoming aware that a client-centered practice framework can produce outcomes that reflect the “shift toward value-based-reimbursement” and “challenge(s) occupational practitioners to demonstrate their unique contributions” (1) to healthcare.  In turn, the quality of a framework that stresses the importance of individuality, holism, and a sense of self and one that values the development of both the individual and a client-therapist relationship is contingent in part on the (client’s) experience of care and his perspective of his involvement in the process.  Toward that end, research and discussions have been directed toward the development of a “working alliance” and a stable relationship that foster a positive rapport with our clients and serves as a means for active participation in their service plans. (2)

possible-geralt pixabay

Active participation implies motivation.  And motivation suggests a belief that one can succeed in his attempts to learn and grow and to achieve his personal potential.  Our ability to motivate our clients demands a certain awareness of the ways in which people are motivated and how their responses to failures can provoke either a helpless response or the determination to master new things and conquer challenges.  Carol Dweck, author of Mindset:  The New Psychology of Success, conducted research to uncover the factors that motivate and direct a learner’s pattern of success or failure.  She concluded that children who were guided toward persisting in the face of challenges and encouraged to believe that failures were due to their lack of trying versus a lack of ability developed “mastery-oriented patterns.”  (3)  Their “attributions” toward success and failure reflected their judgments about the causes of events and behavior, as well as the recognition of the consequences of those attributions, and drove them to strive for learning versus performance.  There is an important difference between performance-oriented and learning-focused goals.  Dweck noted that performance goals focus upon demonstrating the ability to do something while learning-focused goals encourages the increase of ability.  The difference lies in one being static and fixed and the other dynamic and malleable.  The success of client-centered therapy relies upon the participant believing that he has the ability to increase his ability.  It is based upon a growth mindset.

Fostering a Growth Mindset in a Therapeutic Environment

Mindset is defined as “a fixed mental attitude or disposition that predetermines a person’s responses to and interpretations of situations.”  It is a frame-of-mind, a perspective, and a set of behaviorisms that become an inclination or a habit.  According to the prominent dictionaries, a habit is a recurrent and often unconscious behavior that is acquired through frequent repetition and becomes an established disposition of the mind or character.  Therefore, habits can be developed as well as broken.  Fostering a growth mindset in our pediatric therapy sessions is a viable and applicable target in a client-centered service delivery model.  The same assumptions about success relative to a child’s level of academic achievement can be applied to a pediatric client’s success toward therapy goals.  A research team reviewed the literature that studied the “noncognitive factors” involved in student learning.   These included both their Academic Behaviors, such as going to class, completing homework, active classroom engagement, and studying, and their levels of Academic Perseverance, labeled as tenacity or stick-to-it-ness.  They both were determined to be indicators of how likely a child was to continue to pursue academic goals despite challenges.  (4) The results of the review suggested that “one of the best levers for increasing students’ perseverance and improving their academic behaviors (was) by supporting the development of Academic Mindsets.”

key GLady PixabayThe key mindsets that the research team defined as those associated with increased perseverance, better academic behaviors, and higher grades can be applied to our therapy services.

  • Belonging to a learning community.  Our therapy sessions revolve around learning (or unlearning) habits and behaviors that will enhance a child’s opportunity for success.  Our willingness to build a rapport that fosters trust and develops into a working alliance that encourages communication, and in the end becomes a stable relationship that incorporates the child’s opinions and ideas into the rehabilitation process, encourages a sense of belonging in the therapy environment.  (2)
  • Belief in the likelihood of success.  Studies have shown that self-efficacy was a strong determinant of success among similar-ability students.  A child’s sense of his ability to succeed is “malleable” and can be influenced by feedback on performance and ability, as well as the provision of training and assistance with setting goals. (4)  The core components of client-centered care (respect, collaboration, communication, support, and inclusion) and the part that hope and self-perception play in an occupational practice (1) foster the building of self-efficacy.  It is our role as occupational therapists to help our clients to “celebrate” their willingness to take risks, to allow themselves to fail, and to learn from those failures. (5)
  • Belief that abilities and intelligence can grow with effort.  Carol Dweck considers students with a growth mindset to believe that “the brain is like a muscle” that gets stronger with use.  (6, qtd in 4) They are motivated by mastery and enjoy challenging themselves with new ideas and learning opportunities.  (4)  It is our role as therapy practitioners to provide the “just-right challenges” that will build brain muscle and encourage our clients to believe that they can learn and grow despite their personal challenges.
  • Belief in a sense of meaning and value surrounding the work.  As we continue to interpret and make meaning of our experiences, our brains are looking for connections in order to process new information and ideas.  (4)  Tasks and information that do not represent meaning nor constitute any value to our clients will fall short of the mark and limit their potential for success.   Purposeful activities are planned and directed tasks that are key to planning an occupational therapy program, while meaningful activities are those that achieve the program goals through an intrinsic motivation for the patient.  (7)  It is our role as therapists to offer our clients activities that are both purposeful and meaningful and that will bring them back to therapy to build the sense of belonging and self-efficacy that results from a mastery mindset.

Fostering a learning mindset in therapy begins with the principles laid out in the client-centered approach to our occupational practice that build rapport, a working alliance, and a stable relationship, no matter the age of client.

Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine

atherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of handwriting skills. In her current book, Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists, she shares a comprehensive guide and consistent tool for addressing handwriting development needs. She can be contacted via her website, Handwriting With Katherine.

Collmer Handwriting Development Assessment and Remediation

Photos are the property of photographers on Pixabay and their use should include the link attached to their photographs. 
 
 Disclaimer: The information shared on the Handwriting With Katherine website, blog, Facebook page, Twitter page, Pinterest page; in the Universal Publishing Handwriting Teachers’ Guides; on any guest blog posts or any other social media is for general informational purposes only and should not be relied upon as a substitute for sound professional medical advice or evaluation and care from your physician/medical team or any other qualified health care providers. Therefore, the author of these links/posts take no responsibility for any liability, loss, or risk taken by individuals as a result of applying the ideas or resources.
 
 
  1. Mroz, Tracy M., Jennifer S. Pitonyak, Donald Fogelberg, and Natalie E. Leland. “Client Centeredness and Health Reform: Key Issues for Occupational Therapy.” Am J Occup Ther American Journal of Occupational Therapy 69.5 (2015): 1-8. Web. 3 Oct. 2015.
  2. Collmer, Katherine J., M.Ed., OTR/L. “Client-centered Practice in Pediatrics.” Handwriting Is Fun! Blog. Handwriting With Katherine, 29 Sept. 2015. Web. 3 Oct. 2015. <http://blog.handwritingwithkatherine.com/client-centered-practice-in-pediatrics/>.
  3. Krakovsky, Marina. “The Effort Effect.” Stanford Magazine. Stanford University, Mar.-Apr. 2007. Web. 03 Oct. 2015. <http://alumni.stanford.edu/get/page/magazine/article/?article_id=32124>.
  4. Farrington, Camille A. “Academic Mindsets as a Critical Component of Deeper Learning.” Hewlett Foundation News. William and Flora Hewlett Foundation, n.d. Web. 03 Oct. 2015. <http://www.hewlett.org/library/grantee-publication/academic-mindsets-critical-component-deeper-learning>.
  5. Schwartz, Katrina. “What’s Your Learning Disposition? How to Foster Students’ Mindsets.” MindShift. KQED News, 25 Mar. 2014. Web. 03 Oct. 2015. <http://ww2.kqed.org/mindshift/2014/03/25/whats-your-learning-disposition-how-to-foster-students-mindsets/>.
  6. Dweck, Carol S. Mindset: The New Psychology of Success. S.l.: Random House, 2008. Print.
  7. Senior, Rob. “Better, Faster, Stronger.” Better, Faster, Stronger. Advance Healthcare Network, 28 Sept. 2010. Web. 03 Oct. 2015. <http://occupational-therapy.advanceweb.com/Archives/Article-Archives/Better-Faster-Stronger.aspx>.

A Handwriting with Katherine Thank You Note

A Handwriting with Katherine Thank You Note

from Katherine J. Collmer, M.Ed., OTR/L

 

 

thank you artsy bee pixabayThis summer, I was honored and humbled by the thoughtfulness of eight inspiring and knowledgeable Occupational Therapists who so lovingly shared their time and expertise with my readers on the Handwriting is Fun! Blog. Their willingness to jump in and give me a hand when I needed it most won’t ever be forgotten, for sure.

Most importantly, however, their words of wisdom in the 10 blogs they shared will help so many readers for years to come.

 

In that light, I wanted to take a moment to thank them personally and to share their work with you once again.  And, as always, thank you to my readers.  You are the foundation upon which the success of the Handwriting is Fun! Blog is built.

 

Thank you so much

Spaghetti and Meatball Spacing by Miss Jaime OT
Spaghetti and Meatball Spacing by Jaime Spencer, MA, OTR/L, Miss Jaime OT

 

Jaime Spencer from Miss Jaime OT,

 

 

 

 

 

 

Tips for Getting Away From Table-Top Activities by Rebecca Klockars, OT Mommy
Tips for Getting Away From Table-Top Activities by Rebecca Klockars, OT, OT Mommy

 

 

 

 

 

 

 

Rebecca Klockars from OT Mommy,

Low Tech Assistive Technology: MacGyver Inspired by Rebecca Klockars, OT, OT Mommy
Low Tech Assistive Technology: MacGyver Inspired by Rebecca Klockars, OT, OT Mommy

 

 

 

 

 

 

 

 

Is Summer Handwriting Fun? by Stacy Turke, OTR/L
Is Summer Handwriting Fun? by Stacy Turke, OTR/L, On the Road with @stacyturke OTR

 

Stacy Turke from On The Road with @stacyturke OTR,

 

 

 

 

 

 

The Challenge of Moving Toward Self-Sufficiency with or without Assistive Technology by Eleanor Cawley, MS, OTR/L
The Challenge of Moving Toward Self-Sufficiency with or without Assistive Technology by Eleanor Cawley, MS, OTR/L, EleanorOT

 

 

 

 

 

 

 

 

 

Eleanor Cawley from EleanorOT,

Learning and Retaining through Technology, by Eleanor Cawley, M.S., OTR/L
Learning and Retaining through Technology, by Eleanor Cawley, M.S., OTR/L, EleanorOT

 

 

 

 

 

 

 

 

Help With Handwriting: A Screening Activity by Lyn Armstrong, OTR
Help With Handwriting: A Screening Activity by Lyn Armstrong, OTR, LynOT

 

Lyn Armstrong from LynOT,

 

 

 

 

 

 

An OT Advocate for Change - Handwriting gets the help it deserves, by Marie Toole, OTR/L
An OT Advocate for Change – Handwriting gets the help it deserves, by Marie Toole, OTR/L, School Tools

 

Marie Toole from School Tools, and

 

 

 

 

 

 

No child wants to fail!
Behavior and Transitions in School Settings by Cara Koscinski, MOT, OTR/L, The Pocket OT

 

Cara Koscinski from The Pocket OT.

 

 

 

 

 

 

 

Thank you!
 Thank you! I couldn’t have done it without you!

 

 

 

Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of handwriting skills and understands the link between handwriting skills and writing.  She can be contacted via her website, Handwriting With Katherine.
 
 
 
 
 
  
Disclaimer: The information shared on the Handwriting With Katherine website, blog, Facebook page, Twitter page, Pinterest page; in the Universal Publishing Handwriting Teachers’ Guides; on any guest blog posts or any other social media is for general informational purposes only and should not be relied upon as a substitute for sound professional medical advice or evaluation and care from your physician/medical team or any other qualified health care providers. Therefore, the author of these links/posts take no responsibility for any liability, loss, or risk taken by individuals as a result of applying the ideas or resources.
 
Photos are the property of Handwriting With Katherine, the authors, or the photographers on Pixabay and are not to be used in any fashion except as links to the appropriate blog or the Handwriting With Katherine website without the expressed, written permission of Katherine Collmer or the authors.  Use of the photographer’s work should include the link attached to their photographs.

 

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