Reversals: Changing Lanes

Letter reversals.

Letter Reversal is a controversial area, but has been related to higher orders of vision and visual processing. Reversal seems to be the most often feared problem by the parents. So many parents are convinced that this is a dyslexic problem, but in many cases its simply just vision and visual processing issues.

Let’s begin with the following: if a child read the sentence “I saw a Zebra,” it is a good bet that they won’t get the word saw backwards. They would certainly be confused if they read “I was a Zebra.” This problem occurs if you’re reading only one word at a time and if scanning RIGHT to LEFT. This in itself is a problem with the eye movements or ocular-motor skills.

Perhaps the child is a gambler. The odds are with her when guessing the letters since left sided letters (b) and numbers exceed right sided (d) and of course “e” is the most frequently used letter so a left to right guess is submitted. In other words, she has a better chance at guessing if she faces the letter to the right (b). This would be a problem of recognizing the letter in the “mind’s eye” or visualizing the individual letter.

Did you know that children that reverse words and letters tend to reverse the same letters and words consistently? The common letters are q,p,b,d,u and n. The common words are was, saw, no, on, pot, of and for and don’t forget stop and spot. The key to the word issue is that they are not randomly chosen, these words make sense when reversed. This not a neurological issue, it’s simply a problem with Spatial Discrimination.

Let’s look at some basic facts regarding reversal.

  1. It is normal to make reversals.
  2. Not recognizing Object Constancy is a reasonable cause.
  3. Inspecting of pattern from the right rather than the left is common for young children.
  4. Children don’t always grow out of their reversals.
  5. Frith, mentioned in 1971, ” that reversals have been found in some brain injury cases, especially those effecting the parietal and occipital regions.” This has certainly been the case with the large number of brain injury cases seen by this office.
  6. Finally, Moyer said, ” that reversals constitute about 45% of all errors of 4 year olds, 23% of 5 year olds, and drops to 7% of 7 year olds.”

It’s important to note that children 3 years to 8 will respond to the contour of a form before responding to the detail. Therefore, understanding of Visual Closure before Visual Discrimination seems to be the earliest concept. The orientation is not so important for the 3 to 5 year old’s. They don’t much care what side of the circle to put the stick on (l o l, b,d,q,p).

Reversals that are from writing or printing are considered to be kinetic or movement reversals. The other type of reversal is when confusion occurs from letter orientation or sequencing in a word as one reads. This would be called stationary reversal or static.

Stationary reversals tend to be associated with the problem of Visual Constancy. Here is an example, if you take a chair and turn it upside down, paint it black, and shrink it small, your result is what? A chair! A chair is a chair no matter what orientation, size, or color change is made. Now add in Spatial Awareness and you begin to see that moving from the 3 dimensional world to the 2 dimensional world becomes somewhat confusing. These children are not suffering from some deep neurological impairment but rather confusing a simple visual processing concept. Simner (1984) states “children must have an understanding of their own body imagery. If a child can’t differentiate between right and left, then he can’t be expected to differentiate b and d.”

As stated previously, Letter Reversal is a controversial area, but has been related to higher orders of vision and visual processing. The intent of this article was to help see the interplay of some of the visual and visual processing skills that are involved in the reversal of letters and words.

I would like to thank Ken Lane, OD, FCOVD author of Developing Ocular Motor and Visual Perceptual Skills for his terrific insight into Reversals.

ThinkVision

Dan

When a Vision Related Learning Problem is not Convergence Insufficiency

Reading trouble.

It seems that when Vision Therapy is mentioned then the following condition seems to be automatically mentioned and that is Convergence Insufficiency (CI).  CI  is that binocular condition in which the two eyes have difficulty maintaining near demanded tasks. This condition may result in double vision, asthenopia, and headaches.  No wonder it would cause reading issues as well as learning related problems. But, you don’t have to have this visual condition to have a visually related learning problem.

General visual skills dysfunction can be comprised of inadequate teaming skills, inadequate eye movement skills, focusing (Accommodative) problems or visual processing skills.

Teaming skills can be inadequate. This means that the skills may not provide the desired ranges necessary  for free and easy binocular movement of the eyes. The eyes seem to fatigue easily, asthenopia or discomfort sets in, headaches may or may not occur, or the individual just has no desire to read for any length of time.

Eye movement skills may be inadequate.  Simple observation may reveal inadequate fixation or scanning skills.  Evaluation may include but is not limited  to Fixation tests such as the modified King-Devic test.  A timed test of displayed single digit numbers in an array called out by the patient.

Focusing problems may be exhibited by what the optometrist refers to as Accommodative Infacility.  AI is an inability to change focus rapidly from near to far and then far to near.  Usually the child is slow at copying information from the board. This exhibits a delay in focus slowing down the child as he waits to receive the distance information and then responds with the near activity which is in most cases writing the information down.

Visual Processing skills can be measured in a variety of ways;

1) Visual Memory

2) Visual Motor Integration Skills-Speed and Accuracy

3)Visualization

4) Letter Reversals

Visual Memory can be tested in many ways but so much information is gathered when the memory test is presented as a set of symbols that must be memorized and reproduced on paper. Visual Motor Integration-SA is an evaluation that requires the gathering of information (eyes), the processing of the information (visual brain) and then the integration or the use of this processed information. Visualization is tested by manipulating shapes in the mind.  It is an important skill especially when incorporated with reading.  In order to retain the written word it must be visualized.  Letter Reversals is a controversial area, but has been related to higher orders of vision in respect to visual processing. Due to the complexity and controversy of the subject, Letter Reversals will be discussed in detail at a later date.

Teaming, focusing, and fixation skills along with visual processing skills may be at the core of most learning related problems.

Dr. Dan

ThinkVision

What is Vision Therapy?

What is Vision Therapy?

The definition is very complex and after reviewing the Wikipedia information that fictitious Brittany’s mother may have perused she must have become even more confused by vision therapy. A better definition comes from the organization that certifies both doctors and therapists in the art and science of developmental optometry. The College of Optometrists in Vision Development is the world leader in this area.

The definition offered by COVD.

“Optometric Vision Therapy is:

A progressive program of vision procedures

  • Performed under doctor supervision
  • Individualized to fit the visual needs of each patient
  • Generally conducted in-office, in once or twice weekly sessions of 30 minutes to an hour
  • Occasionally supplemented with procedures done at home between office visits

Depending on the case, the procedures are prescribed to:

  • Help patients develop or improve fundamental visual skills and abilities
  • Improve visual comfort, ease, and efficiency
  • Change how a patient processes or interprets visual information

Optometric Vision Therapy Is Not Just Eye Exercises

Unlike other forms of exercise, the goal of Optometric Vision Therapy is not to strengthen eye muscles. Your eye muscles are already incredibly strong. Optometric Vision Therapy should not be confused with any self-directed program of eye exercises which is or has been marketed to the public. Optometric vision therapy is supported by ongoing evidence-based scientific research. Here you can read the latest research published on optometric vision therapy.”

However, this definition just does not tell us what vision therapy encompasses.

The Optometrist Network offers an alternative definition.

The definition offered by Optometrist Network.

“Vision Therapy is an individualized, supervised, treatment program designed to correct visual-motor and/or perceptual-cognitive deficiencies. Vision Therapy sessions include procedures designed to enhance the brain’s ability to control:

  • eye alignment,
  • eye tracking and eye teaming,
  • eye focusing abilities,
  • eye movements, and/or visual processing.

Visual-motor skills and endurance are developed through the use of specialized computer and optical devices, including therapeutic lenses, prisms, and filters. During the final stages of therapy, the patient’s newly acquired visual skills are reinforced and made automatic through repetition and by integration with motor and cognitive skills.

Now that we have established a working definition for Vision Therapy its important to note who benefits from Vision Therapy.

Who Benefits from Vision Therapy?

Typically children and adults with visual challenges, such as:

Learning-related Vision Problems have benefited from these services.

  • Vision Therapy can help those individuals who lack the necessary visual skills for effective reading, writing, and learning (i.e., eye movement and focusing skills, convergence, eye-hand activity, visual memory skills, and other related visual processing issues.).

Poor Binocular (2-eyed) Coordination

  • Vision Therapy helps individuals develop normal coordination and teamwork of the two eyes (binocular vision). When the two eyes fail to work together as an effective team, performance in many areas can suffer (reading, sports, depth perception, eye contact, etc.).

Convergence Insufficiency (common near vision disorder)

  • Recent scientific research — funded by the National Eye Institute and conducted at Mayo Clinic — has proven that in-office Vision Therapy is the best treatment for Convergence Insufficiency.

Amblyopia (lazy eye), Diplopia (double vision), and Strabismus (cross-eyed, wandering eye, eye turns, etc.)

  • Vision Therapy programs offer much higher cure rates for turned eyes and/or lazy eye when compared to eye surgery, glasses, and/or patching, without therapy. The earlier the patient receives Vision Therapy the better, however, our office successfully treats patients well past 21 years of age.
  • Recent scientific research has disproven the long held belief that children with lazy eye, or amblyopia, can’t be helped after age 7.

Stress-related Visual Problems – Blurred Vision, Visual Stress from Reading and Computers, Eye Strain Headaches, and/or Vision-induced Stomachaches or Motion Sickness

  • 21st century life demands more from our vision than ever before. Many children and adults constantly use their near vision at school, work and home. Environmental stresses on the visual system (including excessive computer use or close work) can induce blurred vision, eyestrain, headaches, etc.

Visual Rehabilitation for Special Needs – Traumatic Brain Injury (TBI), Stroke, Birth Injury, Brain Damage, Head Injury, Whiplash, Cerebral Palsy, MS, etc.

  • Vision can be compromised as a result of neurological disorders or trauma to the nervous system. Vision Therapy can effectively treat the visual consequences of brain trauma (including double vision).

Sports Vision Improvement

  • Strong visual skills are critical to sports success. Not much happens in sports until your eyes instruct your hands and body as to what to do! We can measure and successfully improve eye-hand coordination, visual reaction time, peripheral vision, eye focusing, eye tracking and teaming, visualization skills, and more.”

To summarize, the definition for vision therapy is at best complex and complicated. Vision and Vision Processing is involved  from Amblyopia to Sports Vision and everything in between.

Dr. Dan
ThinkVision