Message from Misti
When a child is struggling with visual skills, my go to reflex to check is Symmetric Tonic Neck Reflex (STNR). When the head can’t stabilize against gravity, the eyes are not free to move with control. The Vestibular Ocular Reflex (VOR) is necessary for us to stabilize our eyes even as we move in our chair or through a room. Both these reflexes allow for control. Visual perception and visual motor control have so many different components, this month we will look at visual modulation. Visual modulation plays a large role in how we interact with the world around us; when the brain is over or under sensitive to visual information, our behavior and learning are impacted. Our academic classrooms are set up for visual learning, which makes problems with visual modulation even more difficult. This month I share many accommodations to the environment which help children who struggle with modulating visual input. Even when our head and eyes can stabilize and our perception is working properly, our eyes need to move smoothly across a sheet of paper or within the environment. Visual Motor skills such as tracking, saccades, gaze stabilization and convergence/divergence can be practiced to improve social participation and reading, so there are several activities I use that help develop these important skill.
I hope you find this information helpful in understanding the relationships between these three topics. As always, please share this blog with someone who may have concerns in this area.
Reflex Highlight: Symmetric Tonic Neck Reflex (STNR)
Protective Purpose: This reflex works alongside the Tonic Labyrinthine Reflex to control the head against gravity and prepare the infant for crawling. Body responds within three distinct positions: lying on belly prone, sitting, and later resting on all fours. Moving through all 3 positions shifts the infants gravity center for later controlled movement such as crawling.
Sensory Stimulus: Visual or auditory information causes movement of the head up or down
Motor response:
Position 1 – On belly/arms with rear end in the air: downward movement of the head causes flexion of the elbows and extension of the lower limbs. Upward movement causes arms to straighten, legs to flex.
Position 2 – Sphinx position, sitting on heals with hands resting on floor in front of knees: upward head movement causes extension of the arms and flexion of the lower limbs. Downward movement of head causes arms to flex, legs to straighten.
Position 3 – On hands and knees: upward movement of the head causes extension of the arms; lower limbs bend to keep the body in position. Downward movement of head causes arching of spine, flexion of arms and extension of legs.
Effects of Proper Integration
· Helps to integrate the TLR
· Coordination of the head with hand/arm and core trunk muscles
· Helps develop postural control necessary for later fine motor development
· Helps develop binocular vision and visual field stability
· Assists in developing easy focus and memory
· Allows for curiosity, moving to learn and explore
Effects of Non-Integration
· Poor differentiation of head from arm and leg movements
· Immature TLR and ATNR patterns
· Often uses “w” sitting pattern
· Fatigue when sitting, prefers to stand or will lock legs around chair legs
· Extreme difficulty maintaining a hands and knees position, arms collapse down, or legs move back to a push up position.
· Hypo/hypertonic neck muscles leading to decreased head control
· Impulsivity, hyperactivity, symptoms of ADD/ADHD
· Poor balance and equilibrium
· Poor binocular vision and decreased depth perception
· Poor spatial and temporal awareness
· Academic challenges with reading, writing, art, music, copying from a board
Vestibular Ocular Reflex (VOR)
Purpose: maintaining a stable visual field during head movements. It works by producing eye movements in the opposite direction of head movement, keeping the visual image fixed on the retina and allowing for clear vision even when the body is in motion. Without VOR, even slight head movements could cause blurry or shifting vision, making it difficult to focus on objects and navigate the environment. This is actually a reflex of the vestibular system; however we discuss it here this month as it contributes a large role in gaze stabilization.
Sensory stimulus: Head movement in any direction.
Effects of a functioning VOR:
· Maintains focus
· Keeps visual image clear
· Essential for balance
Effects of malfunctioning VOR:
· Oscillopsia, blurry images when moving
· Abnormal nystagmus
· Motion sickness
· Clumsy
· Difficult maintaining balance
Sensory Connection:
Visual Regulation Difficulties and Adaptations
When a child’s head can’t stabilize, their eyes are often not in optimal position to develop necessary visual skills for receiving important information from the environment. Our eyes play such an important role in determining what we pay attention to and how we move through our world.
Children who are under-responsive or hyposensitive strive to see the differences in visual information; in turn they may seek extra or additional information to help them make sense of what they are seeing. These children might
· enjoy bright, reflective, spinning objects or light patterns
· they might not see objects within challenging backgrounds
· have a hard time understanding the differences in colors, shapes, and sizes.
For these children, we want to reduce visual clutter both in the environment and on worksheets. This can be done in a room by
· covering open shelving with a curtain
· covering bulletin boards or anchor charts with plain paper when that subject is not being taught
· covering half of a worksheet to reveal a smaller amount of work.
Hyposensitive children also struggle with processing the information in front of them, so it helps to create a visual structure such as creating a highlighted box around important information or creating a border around different pieces of information on a whiteboard. It also helps to keep important object or information in the same place, so it is easily located when needed ie: having a specific place to keep shoes and backpack by the door or writing homework assignments in the same place on the whiteboard. Color coding information or materials is another strategy to help these children organize information and objects.
A classroom which has too much visual information, making it difficult to focus on important information.
Even though this bedroom is very organized, it has too many different patterns and extraneous objects on the shelves making it difficult to find and focus on any specific object.
Children who are over-responsive or hypersensitive are most commonly overly sensitive to light, however they can also be sensitive to motion, patterns, shadows, or colors. This intense hypersensitivity can lead to headaches and nausea. It is also very hard for these children to screen out unimportant information – they are noticing everything in the room all the time. From the small string on the floor to the paper waving next to the window they are noting it. This makes it difficult for them to focus on the important information at hand. These student need:
· reduced visual clutter
· Keeping toys and items organized on shelves,
· providing covers for shelves when items are not in use
· keeping knickknacks or artwork to a minimum.
Children who are sensitive to light may need sunglasses when they are outside or even inside if their desk or chair or in a sunny spot. Sometimes, they benefit from wearing a hat with a brim to block out visual information and light from above. Try to provide soft, natural light or a floor lamp for their play and workspaces, with the ability to dim the light.
After intense periods of processing visual information, these children may need a break and seek out a very dark corner or sit with eyes closed to help them regulate and be ready for more interaction and learning.
An example of using borders and color coding to direct attention to important information
A classroom with items organized by size and color with open space on walls and bulletin boards making it easier to find important information.
Although avoiding eye contact is associated with being on the Autism Spectrum, there are other reasons why individuals may not meet eye contact from others. While those on the spectrum may find it difficult to take in the social, behavioral, or emotional responses they are seeing, those who are visually hypersensitive may be distracted by specific features or movements of another face. Additionally, someone is who is hypersensitive to visual information may find it very difficult to engage both the auditory channels and visual channels at the same time. During conversation they might look away to better understand what they hear. When a child is avoiding eye contact it does not necessarily mean they are not paying attention, and demanding eye contact may lead to sensory overload where they actually can’t attend to take in information.
One note about vision and safety: when we are not attending to the important information in the room either because we don’t notice it or we are too busy noticing everything else, moving through the space and between objects can be challenging. Remember, busy patterns on walls, furniture or rugs can make it difficult for individuals to know where objects begin and end. Using simple, contrasting colors to decorate walls and furniture helps children better organize information about where items in the environment exist. You can use colored tape to highlight around door frames or potential trouble spots to increase safety awareness for those who have trouble distinguishing spatial relationships between objects or themselves.
Skill Development: Visual Motor Skills
The ability to control our eye movements is important for body awareness, postural control, coordination, and reading. To interact within our environment, we need to be able to follow people and objects moving through space or stabilize our eyes as we move through space. Although a child may have 20/20 vision, they may still have significant difficulty “seeing” letters and words on a page because controlling the movement of their eyes is impaired.
· Visual tracking is an important visual skill necessary for reading. Visual tracking is the ability to focus one's eyes and follow a moving object without moving the entire head.
· Gaze Stability - the ability to keep your eyes focused on a stationary point while your head is moving, which relies on the Vestibular Ocular Reflex.
· Visual convergence is the coordinated movement of both eyes inward when focusing on nearby objects. It's a vital visual skill that allows us to see single, clear images at near distances, essential for tasks like reading, writing, and using devices. When the eyes fail to converge properly, it can lead to double vision or other visual problems.
· Visual divergence refers to the ability of the eyes to move outward, away from each other, when focusing on a distant object. Proper divergence is essential for tasks like reading distant signs, watching movies, or focusing on objects far away.
· Visual saccades, also known as saccadic eye movements, are rapid, jerky eye movements that shift the focus of vision from one point to another. They are essential for tasks involving visual attention, such as reading, driving, or scanning a scene. Saccades are not smooth, but rather involve quick jumps in gaze, allowing us to quickly shift our focus to different points of interest.
Difficulties with visual motor skills in the environment leads to poor ability to catch a ball or bumping into people and objects when moving through a room. When children have difficulty with visual motor skills, reading difficulties could look like losing their place easily, skipping words or lines, or confusing one word with another. This leads to poor reading comprehension. Short periods of reading can cause fatigue or headaches. Fortunately, there are fun games and activities you can play to improve visual motor abilities.
In three-dimensional space:
· Games with balls – use large, lightweight balls like beach balls or balloons that move slower through the air. This allows more time for a child’s eyes to fixate on the object and follow it. Use brightly colored balls to help distinguish it as it moves. Use a badminton racket or pool noodle to keep it up in the air.
· Practice throwing a ball at a target, emphasize using the eyes to look at the spot they are throwing to.
· Flashlight games – in a darkened room with two flashlights, play flashlight tag having the child follow your light trying to catch you. Start with slow movement across the walls and ceiling and increase the speed as the child is better able to follow and catch your light.
· Playing tag- the child needs to visually track people around them while moving.
· While walking or riding in a car, point out objects that they can then describe or tell you one or two characteristics- they will need to stabilize their gaze on the object while moving to take in the details.
· Marble runs are great for tracking moving objects because the marble will move in a predictable path.
· Wind-up cars, slot cars or remote-control cars – following the car builds visual attention while working on eye tracking.
· Play with bubbles, blow a few bubbles, and have the child track the bubbles to pinch/pop them.
· Mazes! With and without a pencil. I often have children use their finger first so they can visually plan when they are using the pencil. There are also many kinds of books that are made for using your finger so you can do them over and over
· Dot to dot drawings require the eyes to locate (fixate) on a target then stabilize on the target while drawing with the pencil.
· Scanning for letters in a paragraph: have the child circle all of a certain letter in a paragraph. There are also many free resources out there to print out your own worksheets. I love this resource at senteacher.org where you can change the letter, color, typeface, control size and spacing between lines, use all upper case or all lower cased, or mix it up and use both. As a bonus, you can set the target to be a grouping of letters like ing, st, or th.
· Another fun way to work on tracking on paper is to have the child track through lines of print and first mark the a, then the next b that comes along, then the next c, and so on. This incorporates more cognitive thinking while visually scanning.
· There are a few fantastic apps for the iPad or tablet that work specifically on visual tracking. For younger kids that don’t have letter recognition skills yet, there is Bugs and Buttons,. For older students that have letter recognition down there is Visual Attention which assists the player in starting on the left side each time and has an option to not let the player skip letters.
· Matrix Games 3 is an app for school age kids and older that has the eyes tracking up/down while also tracking left/right on a grid to match the correct shapes.
While all these activities help build better visual motor skills, if you notice a child is struggling with any of these games, it’s time to get an occupational therapy evaluation. For the eyes to work together and track objects the head needs to be stable, hence making sure the STNR and ATNR reflexes are fully integrated is a first step. Then assessing the individual visual motor skills and perceptual abilities would be next.
If you know a child who seems clumsy, is struggling to learn or is easily overwhelmed,
contact Misti to set up an evaluation.