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

Answering the ultimate question: What is Vision Therapy?

Working for a developmental optometrist it is inevitable that you will be asked the question,”what is vision therapy?” As an optometric technician it is our obligation to answer this daunting question. We all know the answer to the question, but for some reason there is a disconnect when explaining vision therapy to patients. Allow me to paint a familiar picture for you:

Our (fictitious) patient “Brittany” is referred by a local eye doctor. Brittany’s mother is so distraught she can’t keep it together in the office. She’s running a thousand errands that day, has three kids with her and now she’s been told her daughter is in need of vision therapy. Mom sends her three children to the play room and slides here iPhone out of her purse. She contemplates the term vision therapy but has no Idea what that means. She thinks to herself, “Google is my only friend.” Mom now studies what Google has told her, looks it over a few times to get a grasp of the concept and then peers over her phone to look at the optometric tech who is vigorously typing away at the computer.

“May I help you?” the tech asks sensing the question coming.

“Yes” the mother replies hesitantly. “The doctor told me Brittany needs some sort of therapy. What is that, is it like some sort of physical therapy?”

Their eyes meet and each seems just as puzzled as the other. The mother’s question is met with a low sigh as the optometric tech bites her lip while she conjures up the best response to the question. The tech musters up the courage to respond and replies with hesitation “yeah, it kind of is….but…there umm…there’s a lot of….well…no, not really”. After carefully rethinking her mumbled response the optometric tech comes back with a simple reply “it’s like exercising the eyes!”

Well, you can imagine what mom thought of that response. I have been in this situation before as an optometric technician, and believe me the problem has nothing to do with the competence of either party. Vision therapy is hugely complex and is not only difficult to comprehend but is equally daunting to explain. That is why I have asked Dr. Weinberg O.D. FCOVD to explain what vision therapy is for us. Keep a look out for Dr. Weinberg’s response in “what is vision part 2”.

-Zach

In the mean time here are some helpful links:

Advanced Vision of Louisville

COVD

Welcome to ThinkVision

Hello blogosphere, welcome to the official blog of Advanced Vision of Louisville! Through this blog we intend to share our appreciation for the art and science of visual rehabilitation and learning. The two are interwoven tighter than any known fabric and we would like to show you how. ThinkVision will feature interviews with developmental optometrist Dr. Daniel Weinberg O.D. FCOVD, insight from the vision therapists at Advanced Vision of Louisville, patient testimonials and much more! Future posts are already in the works so stay tuned.

-Zach

“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.”

-Dr. Seuss, I Can Read With My Eyes Shut.