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大宅

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21#
發表於 06-1-4 18:48 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

[size=large]遠視 (三)

平行於視軸的光線,進入眼睛經過折射後成像於網膜後方的情況，則稱為(遠視)，因此(遠視)看遠也是不清楚，如同拍照片時，照相機的鏡頭焦距調整過度或不足，照片都會不清晰一樣。

常常有人將視力1.5以上稱為(遠視)，是個嚴重錯誤的觀念。小孩眼睛的前後徑較短，影像易成像於網膜後方，因此四五歲以下的小孩，百分之七十有某種程度的遠視存在。

通常遠視在二∼三屈光度（即俗稱之二∼三百度）以內，小孩可利用其調節力將原先在網膜後方的影像調整到網膜上，因此遠處亦可看得清楚，只是因須靠調整眼睛，較易疲勞。隨著年齡成長，眼軸亦會漸漸增長，意即遠視就會漸漸減輕，甚至達到正常。

所以二百度以內的遠視，通常並不一定要配戴眼鏡。但若超過四五百，小孩就無法自行調整到清晰的程度，以致遠近都看不清楚，而有形成「弱視」的可能性，應儘早請專業驗光師檢查配戴眼鏡矯正。
誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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22#
發表於 06-1-4 19:27 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

[size=large]遠視與智力測驗之關係

遠視(遠視眼)

當眼睛屈光能力太低而無法在其眼軸的長度內達到聚焦目的時，就會造成遠視的情況。此種屈光不正的現像可能起因於眼軸的長度過短或單一個屈光元件或是多個屈光元件的屈折能力太低。所以當平行光進入眼中時，會在通過網膜後面才聚焦，所以產生不清楚的現像。

遠視者一般通常的徵候為，固視近距離的目標時很難維持一定的注意與清楚的狀態，在一段時間的近點工作之後，眼睛處於一種緊張的狀態，感覺疲乏及頭痛，眼睛感覺隱隱作痛或灼熱感，在一段時間的集中精神於近點工作後會變得焦躁不安或暴躁。

通常在學校所作的的視覺篩檢，是無法發覺出學童遠視的問題，因學校的篩檢一般偏重於針對遠方的視力問題。廣泛的驗光檢查，通常會包含遠視的檢查，在一般不嚴重 的遠視例子中，可能會因自己本身調節能力的補償作用而 未作遠視的矯正。

但在其他的情況下，你的眼科醫師或驗光師能夠以戴用眼 鏡或隱形眼鏡的方式，協助您矯正光進入您眼中的情況，來消減掉因遠視所造成的困擾。

說明：
早年的文獻一直都無法給予遠視與老花眼一個明確的定義。直到Donders在1864年區別出此兩種屈光不正之間的不同。除此之外，在早年尚有學者誤以為老花眼會出現於年輕人的身上，甚至會有先天性的老花眼的現象產生，以現今的學說來解釋，這種說法很可能就是誤將遠視當作老花眼。不過在數百年前，這種說法也曾被流傳過，一切因由可能根基於老花眼與遠視的矯正皆是使用正的球面鏡片所造成的誤解。

一般來說：遠視眼不像近視眼般的引人注意，可能的原因通 常它是因遺傳因素所造成，而這其中幾無環境因素的影響存在。它可能造成遠方與近方的視力都產生不良的狀態，取決於遠視者本身調節能力的強或弱。

然而遠視者通常的徵狀都發生於看近時，造成孩童的遠視伴隨著較差的閱讀能力，可能影響智力的發展，學習困難，和與視覺發展能力遲滯。但是，此種說法卻可能不盡真實。

(一)Hirsch氏於1959年提出下列四個假設的來說明
，雖非完整但在統計上似乎代表著屈光不正與智力測驗的成績之間有著某些關聯，因近視的人表現遠遠的超越了遠視的人:
1.遠視和近視可能代表著眼睛的發育不全或眼睛的過份發展，各自代表著與眼睛與腦部的發展有關。

2.智力測驗的分數可能與閱讀的速度有關，近視的人閱讀的量會比遠視的人來的多。

3.聰明的孩子可能讀的更多，也可能是他(她)變成近視的原因。相反地，比較不聰明的孩子可能讀的較少，因而較不容易變成近視；那也可能造成他(她)保持遠視的狀態。

4. 許多的智力測試中需要孩童在較長的時間內，感知近處精微的細節。此一情況讓近視的孩童處於較為優勢的地位，因為他所需要用到的調節力量小於遠視的孩童，特別是處於屈光未矯正的情況下時。

( 二 )Grosvenor氏在1970年的一項研究

藉著使用一個不需任何閱讀能力的智力測驗，藉以達到使遠視與近視幾近無區別的狀態。證明在閱讀能力與屈光不正之間的關係。大於智力和屈光不正之間的關係。
誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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23#
發表於 06-1-4 19:31 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

[size=large]遠視對學習的影響..(一)

Hyperopia
The Effect on Visual Perceptual Skills and Classroom Achievement
Kyle L. Florio, M.S.
Grand Rounds and New Developments
July 18, 2003


Abstract: There is evidence linking uncorrected hyperopia in children with academic learning problems, even when the refractive error is moderate.

A study involving 710 subjects showed that seventy-eight percent (78%) of the 6-12 year old hyperopic children with learning disabilities (all were eye clinic patients) displayed visual perceptual skills dysfunction in contrast to twenty-five percent (25%) of the children who had been shown as not having a learning disability.1

This is relevant because hyperopia, in addition to being related to school achievement, has been shown to be a significant factor in the rate at which children develop visual perceptual skills.

The term visual perceptual skills in this paper refers to the ability to identify such salient concrete features of absolute and relative quantity, magnitude, and relationships in spatial-temporal presentations.

Visual perceptual skills are developed naturally, normally emerging on a predictable schedule from birth to about age 10-12. Visual perceptual skills are often tested using geometric design copying tests (such as the Spatial Awareness Skills Program [SASP] test and the Rutgers Drawing Test [RDT]).

Although these tests may be considered to assess the same skill, they differ in that the RDT is a screening test while the SASP test provides treatment information. Treatment options usually include referral, delayed entry into a learning environment that assumes competent visual perceptual skills, a training program to improve the child’s perceptual skills, and/or modification of child’s instruction in a way that takes his developmental deficits into account.

Key Words: Hyperopia, visual perceptual skills, Spatial Awareness Skills Program (SASP), Rutgers Drawing Test (RDT)

Case Report: A five year old male reported to the Development Center, University Eye Institute, Houston, Texas on referral from the child’s school nurse. The child had passed vision screening tests since he was two, but he failed his screening in kindergarten. Past ocular history was negative for injuries, infections, surgeries, or other pertinent ocular information. The child was born full term by Caesarian delivery with a birth weight of 9lbs, 11oz.

His physical status at birth was good, and he thrived during infancy and early childhood. Motor development was on course: he sat up, stood and walked at the expected ages. His speech/language development was somewhat precocious: first words at 7 months, and three words together slightly later than 12 months.

Past medical history revealed good general health, normal hearing, no ear infections, but one febrile seizure of unknown etiology, at age two.

On November 26, 2002 the patient’s visual acuities without correction were 20/50+1 OD and 20/60+2 OS. A manifest refraction revealed moderate/severe hyperopia, +5.25 –0.50 X180 OD and +5.00 DS OS.
Cycloplegic refraction yielded much the same prescription: +5.25 DS OD and +5.75 DS OS. The child’s best corrected visual acuity was 20/25-2 OD & OS. Cover test, without correction, measured orthophoric at near and four prism diopters exophoric at distance.

Stereo acuity was measured with the Lang stereo test and revealed 200” (moon). It should be noted that on two separate occasions the patient would not fixate for any extended period of time during the cover test or stereo acuity assessment. Because of poor fixation it is possible that the quantitative values placed on these measurements are not exact.

The pupils were equal and round with a brisk reaction to direct and consensual light, and no afferent pupillary defect was detected. Color vision testing was unreliable. Biomicroscopy revealed trace flaking OU and no other remarkable findings. Intraocular pressures were equal and soft to palpitation, and a dilated fundus exam revealed C/D ratios of .2/.2 and .15/.15 respectively.

The macula appeared flat and evenly pigmented, and the vessels had an A/V ratio of 2/3. The peripheral fundus was unremarkable for pathology or abnormalities OU.
The patient also was given tests assessing visual and auditory perceptual skills, his current academic status, and verbal and non-verbal IQ.

Only the visual perceptual skills tests will be discussed in detail in this paper. It is sufficient to note that, in regard to the other tests cited above, the patient performed and/or was at his expected age level. The patient’s visual perceptual skills test scores were; RDT-A =4, estimated drawing age (EDA) = 4.3; SASP=0, age equivalent (AE) = <4.0;

Visual perceptual skills training and adaptive instruction were recommended in addition to glasses (+4.75 DS OD, +5.25 DS OS, equal base curve and center thickness). During a post exam conference the patient’s parents were educated in how to administer the recommended home-based skills training program.

This included the use of certain manipulatives, workbooks, and computer programs. The patient was asked to return for a follow-up visit in six months.
The patient returned June 10, 2003. Aided visual acuities were 20/25 –3 OD & OS. Pupils, binocular alignment, and refractive state were unchanged.
Perceptual skills tests were also administered. Qualitative and quantitative gains were apparent. His scores were: RDT-A =8, EDA= 4.8, SASP= 2, AE=4.6 to 4.11. The parents were advised to continue the home-training program over the summer and to return to clinic in three months for a full eye exam and a follow-up developmental assessment.

Discussion: There is a high prevalence of hyperopia in young children. Hyperopia, unlike myopia, is not acquired, nor does it worsen significantly over time in the normal eye. On the contrary, it often reduces as the child grows into pre-adolescence. Most neonates are 1.00 D or more hyperopic, with the mean refractive error being about +2.00 D2,3,4 (spherical equivalent +1.4 D).5 There is no significant difference in the average refractive error between girls and boys.6

The process of emmetropization during school age years, somewhat reduces the prevalence of hyperopia, with the resultant being 26% of the adolescent population is hyperopic.4
Although it is uncommon for a refractive state to affect a child’s interest in word games and other activities which heighten awareness of the phonemic attributes of spoken words, it is very likely to affect a child’s interest in near-point visual activities (e.g., puzzles, cutting out and coloring patterns, and block play).7

Such activities require sustained near-point fixation and result in extra burden placed on the accommodation system. These near-point activities are believed essential in a child’s intellectual and academic development. Perceptual development provides the tools and the processes essential to the utilization of one’s intellect.8

An example is provided in a study by Rosner and Rosner, comparing the visual characteristics of children who were not making satisfactory progress in school. Nineteen percent (19%) of the group who had school learning difficulties were myopic (> -0.25), and fifty-four percent (54%) were hyperopic (> +0.75). The opposite (and remarkably symmetrical) trend was displayed by the group of children who did not have school learning difficulties.

Fifty-four percent (54%) of that group were myopic, and only sixteen percent (16%) were hyperopic.9
Of particular interest is a subset of studies by Hirsch which examined the relationship among classroom achievement, IQ score, and the refractive status of school aged children.

The general conclusion of these studies was that myopes out-perform hyperopes on IQ tests which require reasonably competent reading ability, but the results were not the same on tests that depend instead on rapid visual perception.5,10 Grosvenor’s further testing indicated that myopes do, infact, out-perform hyperopes (but not emmetropes) on IQ tests which require sustained reading ability.1,7,10

Further study has been done to address a second topic: the minimal amount of uncorrected hyperopia that appears to impede elementary school performance. The results suggest that practitioners should consider the potential benefit to be derived from compensatory lenses for children who exhibit 1.25 D or more of hyperopia; even if they are asymptomatic and capable of excellent unaided visual acuity at near and distance.

The benefits of spectacle correction for infants with hyperopia can be achieved without impairing the normal developmental regulation of refraction.11 Statistical analysis indicated significantly lower achievement test scores among hyperopic children (first through fifth grade) whose refractive errors exceeded 1.25 D.12 Additional basis for the belief that uncorrected hyperopia may impede a child’s success in elementary school performance lies in a study involving 710 elementary school-aged children (6-12 years old).

The study reported that substandard visual analysis skills were observed in eighty-two percent (82%) of the hyperopes (> +0.75 D), thirty-eight percent (38%) of the emmetropes, and only fourteen (14%) of the myopes (> -0.25 D).1 Most myopes manifest their refractive ametropia well past the age of 6 or 7 years. It is, therefore, difficult to propose that myopia is the generator of skills that are typically well developed by that age.7

In addition, Grosvenor concluded that if left untreated, even a moderate degree of hyperopia may have a significant and detrimental influence on how readily a child develops the capacity to view spatially organized information in an analytical manner and how well/easily a child gets started in school.1

Rosner and Rosner identified the age of four as the threshold age at which hyperopic children should receive correction. The study compared visual perceptual skills among young +2.25 D hyperopes as they related to the age when compensatory lenses were first obtained.

The data suggested that early application of compensatory lenses had beneficial subsequent effects; hyperopic children who start to wear glasses early in life seem more likely to develop appropriate visual perceptual skills than are hyperopic children who obtain their first glasses closer to the time of entering first grade.13,14

When children have delayed visual perceptual skills, treatment/training has been shown to be effective. The data collected from a visual perceptual skills training study involving inner-city preschool children, are testament to the efficacy of a perceptual skills treatment/training program.

The data showed that inner-city kindergarten children were able to show age norm15 visual-motor skills after participating in a visual perceptual skills training program during their year in a pre-school class. In contrast, those children who had not received pre-school training demonstrated significantly poorer visual-motor skills.16

Conclusion: A clear relationship has been documented between hyperopia and school learning difficulties, at least in part because hyperopia tends to have a negative effect on the development of visual perceptual skills and visual perceptual skills. These, in turn, have a strong influence on how well a child learns the basic skills taught in a standard mainstream primary grade classroom.

誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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大宅

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24#
發表於 06-1-4 19:35 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

[size=large]Noting that decreased binocular vision and depth perception can lead to problems in gross motor and fine motor development, and that uncorrected hyperopia is associated with deficits in visual perceptual skills, reading readiness, intelligence quotient, and reading achievement,11-19 and correction of hyperopia by age 4 improves the expected reading achievement later in school20

誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
私人傳訊

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大宅

積分: 3761


25#
發表於 06-1-4 21:21 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

[size=large]視力和學習問題

LEARNING PROBLEMS
Often overlooked or frequently ignored, vision is a most important aspect in learning. Several months ago, Dr. Joseph N. Trachtman, the inventor of the Accommotrac &reg; Vision Trainer, was interviewed on the radio regarding the importance of vision in learning by stating that it was his experience that approximately 85% of children diagnosed A.D.D./A.D.H.D. have a vision problem.

After the program, Dr. Trachtman received many calls from parents concerned about their children's learning.

The first appointment scheduled from these inquires was for a six-year-old boy, whose mother was frantic because he was not reading at the proper "level" and this would negate his ever applying to an Ivy League College. Apparently both the teacher and the school psychologist were putting pressure on the parents to medicate the child.

Upon a thorough eye health examination and vision function evaluation, the boy was noted to be quite farsighted.

This finding readily explained why the child does not make much eye contact, apparently staring off into space, while retaining information presented auditorily.

Dr. Trachtman placed some lenses in a frame to stimulate the farsightedness for the parents. Neither could sustain looking at an eye chart for more than a few minutes due to the tremendous eye strain. At that point it became obvious why their son behaved as he did. In fact, that he could read at all only indicated his overall intelligence and will to learn.

A recent letter from the mother of a boy who could not read for more than 20 minutes:
Regarding the visual training program of Dr. Trachtman, I attribute his training as a significant contributor toward the success on my son, John's, academic performance. John graduated from Lebanon Valley College with a dual major of Bio-Chemistry.

Following the results of this Biology GRE examination, he was accepted at the universities of Cornell, Penn, Johns Hopkins and Georgetown in Bio-Medical research. In addition, all of these institutions offered John full free tuition as well as $15,500 a year. John chose the University of Pennsylvania and is doing quite well.

As a Community Psychologist, working in a variety of settings and with diverse populations, I recognize a plethora of benefits that could be realized through the visual training program offered by Dr. Trachtman.

What makes this story even more compelling is the fact that during John's training his older brother was in jail for substance abuse. The reason John was brought for training was that he was beginning to follow in the footsteps of his older brother. After getting out of jail, the older brother came in for training, and has not been in jail since.
誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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26#
發表於 06-1-4 21:45 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

有關早期視力影響小朋友各項發展的資料 (例如誤認嬰兒時期沒有眼神接觸為自閉傾向等等...)

[size=large]Vision in Early Development
Lea Hyv&auml;rinen, MD

Assessment of vision occurs several times during childhood, if the infant or child does not seem to use vision in an age appropriate way. Since there are so many different types of visual impairment this short text covers only some important features of assessment of the different groups of infants and children with low vision. I would like to stress three features in the assessment:

1.it covers all visual functions, form perception, colour perception and motion perception; not only visual acuity and the size of visual field.

2.its goal is a thorough evaluation of strengths and weaknesses in all functional areas so that special education and early intervention can be tailored to meet the needs of each child.

3.it is performed as a transdisciplinary activity.
In the assessment of adult persons and school children we can define four main functional areas where vision usually plays an important role (Hyv&auml;rinen 1985):

1.communication, both person-to-person, group communication and distance communication
2.orientation and mobility
3.activities and tasks of every day life (ADL)
4.sustained near vision tasks, like reading and writing.

In the assessment of infants each of these functional areas gets an additional feature: the role of vision in the development of each function, both at present and in learning the next level of functioning. The most important areas of development during the first year are:
· communication and interaction
· motor functions
· development of spatial concepts and orientation in space
· object permanence
· language development.

During the assessment we remember to ask ourselves:
1.What is the quality of the image that the infant/child uses?
2.How does the infant/child use visual information in the higher visual functions?
3.How do the impaired functions affect the development of the child?

Image quality
In the clinical assessment of impaired vision we usually measure grating or optotype acuity and visual field. Images have also other important qualities. We perceive:
· forms
· colours
· motion
Of these basic components of images colour perception and motion perception are functionally often more important than form perception, yet they are rarely measured as a part of functional assessment of low vision. Of form perception, usually only form vision at high contrast levels is measured with visual acuity tests. No wonder that the quality of image seen by a child or adult person with visual impairment so often is misunderstood.

Visual field needs to be measured, both its extent and, when the child is old enough, the structure of the visual field in detail.

Visual adaptation is measured early in cases of retinal degenerations and oculomotor functions and eye-hand coordination assessed carefully. When a child has other impairments, their influence on use of vision and, vice versa, the effect of impaired vision on the other impairments, needs to be evaluated.
Assessment of young infants

In early interaction, bodily contact is central during the earliest weeks but then vision is the most important avenue in communication. A normally sighted infant expresses the joy she or he feels in communication; we understand the infant without any explanations (Figure 1.A).

A visually impaired infant may not see enough to copy the smiles of the adult persons and therefore needs enforcement through tactile and auditory information (Figure 1.B).

Since the visually impaired infant often has to concentrate on listening and does not have the usual eye contact, the infant is in danger of being thought to be uninterested in interaction.

The most important task in the assessment of infants is to find out how much vision there is for visual communication, whether
1.the infant uses central vision and thus has a possibility to have normal eye-contact or
2.uses an extrafoveal area of the retina to look straight ahead and seems to look past when looking at a persons face and
3.how close an adult needs to be to be seen by the infant.

Our expectations of the infant's responses are based on interaction with normally sighted infants and therefore it is difficult to accept and understand another type of response as a normal response in the case of visual impairment.

The communication situation needs to be explained to the adult persons several times. Video recordings of early interaction are effective in demonstrating to the adult persons that the infant wants to communicate and enjoys interaction (Figure 1.).

Figure 1. Early interaction of a normally sighted infant and an infant with dual sensory impairment (visual and hearing impairment).

A. At the age of three months, visual communication of a normally sighted infant is an effective bonding function; the infant and the adult person understand each other right from the start.

B. A visually impaired infant may not have normal eye contact and may seem to look at the hair of the adult because of eccentric fixation. The infant uses tactile confirmation of auditory communication when lip movements cannot be seen. In such a situation the parents and caretakers need support and training in early interaction. (Pictures are from video recordings in the CD "LH-Materials for Teaching".)

If an infant has hypotonic accommodation (children with general hypotonia and some infants with Down Syndrome) or hyperopia, long-sightedness, the blurred image disturbs communication and therefore proper near correction lenses must be prescribed as soon as the difficulty in interaction becomes diagnosed, usually at the age of 3-4 months.

If hyperopia is high, 6 dioptres or more, glasses are prescribed even earlier. A practical difficulty at that age is to find good spectacle frames that fit the small face.

Vision for motor development is the second most important aspect of the assessment. Reaching for objects and grasping, crawling toward an interesting toy and pulling oneself up to stand are all closely related to the development of spatial concepts of one's own body and of the surrounding environment. Therefore vision for development of spatial concepts needs to be assessed.

Lack of detailed information on near space needs to be compensated by using playthings that give visual, tactile and auditory information (Hyv&auml;rinen 1998).

Visually impaired infants often have motor impairments and thus get early motor training. Even infants without primary motor problems need guidance by an experienced therapist to avoid delays in their motor development. If the therapist has not previously taken care of visually impaired infants (s)he should get information and support from the early intervention team.

The therapist is usually the person who works most closely with an infant and the family and learns to make important observations on the child's use of vision and changes in it.

During the first year, the number of tests is limited. At the beginning of an assessment we usually first observe how the infant looks around and whether (s)he has visual communication with the parents; then evaluate motor functions, fixation, tracking movements, convergence and saccades; binocularity by observing whether the eyes are looking at the same point in space (Hirshberg's test, cover test and Lang stereo test), visual field with confrontation tests and using ball games, visual acuity as grating acuity and contrast sensitivity with Hiding Heidi test.

Visual anticipation and the infant's ability to evaluate velocity can be assessed with the simple "castle" game where an interesting object moving at a certain speed is first shown to the infant, then it moves with the same speed behind a 10 cm "tower", becomes visible between the first and the second tower, disappears again and reappears between the second and the third tower.

If the infant can correctly analyse the speed of the object and its direction of movement, the eyes move with correct speed to look at the object when it reappears (Figure 2.).

Figure 2. Infant's ability to anticipate the position of a moving object can be observed in this test situation where the object is shown and hidden in turn when moving behind the 'towers' of the 'castle'.

The target has been moved behind the 'tower' and is just to appear. The infant has moved his eyes with the same speed that the target had when it was visible and thus his gaze is at the edge of castle simultaneously with the target (with permission from Prof. Francois Vital-Durand).

Infants usually copy facial expressions quite early and respond in a meaningful way to many expressions. If these responses are not present, either the infant does not see the expressions clearly enough (anterior visual impairment) or the cortical analytic functions or connections to memory have not developed.

Toward the end of the first year it is possible to observe whether an infant recognises family members and responds to them differently from other persons. If an infant seems to have problems in recognition of facial features and/or expressions, specific communicative therapy is necessary to help the infant develop participation in social interactions.

Figure 3.This 4 month old infant was diagnosed as having infantile autism because she did not have normal eye contact with adult persons but seemed to 'avoid eye-contact'. The infant did not accommodate to usual fixation targets. Therefore we tried 'reading lenses', near correction, that gave her clear image on the retina from objects at near.

The infant immediately looked surprised and after a few seconds developed a normal social smile and good eye-contact with her mother. Like many other infants who have difficulties in developing smooth accommodation she developed inward squint after a few weeks at a time when she started to accommodate.

Eye-hand-coordination can be assessed from the age of a few weeks when the infant first hits objects hanging within reach and then starts to reach for and to grasp them. Visually impaired infants use mouthing of objects later than normally sighted infants because their tongue and lips give more exact information about details than the blurred visual images do.

Visuotactile materials are important in helping the infant to combine visual information with tactile and haptic information and should be available on loan if the family cannot afford to buy them.

During the evaluation one needs to constantly keep in mind that responses may be affected by either changes in the image quality or irregular visual associative functions or both. By using test materials of different sizes, colours and contrast, the role of the disorders of the eye on image quality can be assessed.

Assessment of higher visual functions requires repeated observations by family members, therapists and early intervention specialists supported by the findings from the clinical examinations.

Assessment of toddlers
As soon as a child develops the concepts 'similar' and 'different' these concepts can be used to train for visual acuity tests. The test forms can first be matched based on their colours, then on their black-and-white three-dimensional forms (the LEA Puzzle), then comparing the forms and pictures of the same size and finally comparing either the puzzle pieces or the large pictures on the key card to smaller and smaller test pictures.

When testing is possible using the high contrast pictures, low contrast pictures of the same test symbols can be used to measure form perception at lower contrast levels.

Binocularity tests like Worth 4-dot test become possible at the age of two years and stereo tests like the TNO slightly later. At this age, visual adaptation to lower light levels often becomes delayed in retinitis pigmentosa and can be tested with the CONE Adaptation test as the first sign of abnormal retinal function.

Children with suspected brain damage need a thorough evaluation because it is possible to measure crowding phenomenon and observe the child's ability to perceive size of objects, directions of lines and movement and to assess his/her eye-hand-coordination.

Observation lists developed in Scotland by Gordon Dutton and in Nordic countries by Lena Jacobson and myself should be discussed with parents and day care personnel to learn about difficulties in the use of visual information. It is of utmost importance that communication difficulties are diagnosed and treated early so that the child can develop communication skills using compensatory techniques if (s)he is functionally blind in group communication.

Too many of these children who do not recognise faces or expressions are diagnosed as autistic based on their failure to function in a group of children. Likewise it is important to understand the child's difficulties in spatial orientation or lack of perception of objects that stand still or those in motion. The observation list can be like the following:

Typical behaviours of children with problems in cognitive vision:
· Variation of visual functioning is the most common feature
· early development of speech as compensatory function
· the child prefers talking with an adult to playing in a group of children
· effective use of memory as compensatory function
· the child dislikes crowded places, clings there to the parents; beaches and swimming halls are worst if recognition of faces is difficult
· the child starts drawing and painting late
· colours are used for coding more than by normally sighted children
· little interest in TV and comic series
· the child may show signs of spatial interpretation problems, stops at thresholds and shadows
· the child may learn letters and numbers early but does not learn to read except short words
· the child uses siblings and adult persons as helpers when there is a demanding visual task
· the child may become angry when someone moves her/his playthings or clothes even minimally.

A child may have one or several of these behaviours depending on which higher visual function(s) is/are are lacking or weak.

This same list of behaviours can be used through all preschool years. Milder difficulties in different visual perceptive functions become recognisable when the child grows and the demands on the different skills become greater.

Since the number of children with brain damage related visual impairment is steadily growing, proper diagnostic skills need to be created for early diagnosis and intervention. Children with problems in motor development, children with intellectual disabilities and children who were born as small premature babies are groups that should be examined and observed particularly carefully.

However, cognitive visual impairment may be present in children with no other problems in their development and may affect only one single perceptual function.

Assessment of school children
In many countries visually impaired children are in local mainstream schools where there is little knowledge about special learning techniques and how to teach them. Therefore the visual functions of the child should be described so clearly that the classroom teacher and the teacher's aid can understand them.

It would be of great help if the functional assessments were to be carried out by the itinerant teacher during her/his visit at the local school. Most of the tests can be used after rather short period of training. Interpretation is sometimes difficult and requires analysis of the video made during the assessment by the diagnostic team responsible for the services.

During the assessment one needs to remember that responses may be affected by changes at three different levels of the visual system (Figure 4.):
1. in the eye and/or the anterior visual pathway,
2. in the pathway between lateral geniculate nucleus and/or the primary visual cortex and
3. in the cortical or subcortical brain functions.

Disorders of the anterior pathway affect the quality of the visual image, those in the posterior pathway cause visual field defects and increased crowding but may not damage the tectal pathway, which then transfers information to cortical functions bypassing the primary visual cortex and the usual form analysis.

Disorders in the visual associative cortices are often patchy affecting specific visual subfunctions, recognition of persons by facial features, recognition of facial expressions, perception of objects on a patterned background, perception of size or directions, eye-hand coordination, orientation in egocentric and allocentric space, evaluation of surface qualities, place, movement and/or speed of objects.

Figure 4. Visual pathways have two major routes, the retinocalcarine pathway from the retina via the optic nerve (ON), optic chiasm (CH) and the lateral geniculate nucleus (LGN) to the primary visual cortex (called also calcarine cortex) and the tectal pathway via the superior colliculus (SC) and the pulvinar (P) to the associative cortices. Visual pathways transfer information through different neural pathways. The largest path (approximately 80% of the nerve fibres) is the parvocellular pathway that transfers all colour information and high contrast black and white information.

Its nerve fibres are thin and transfer information relatively slowly. The magnocellular pathway (10% of the fibres) transfers all motion related information and low contrast black and white information. Its fibres are thick and have high speed of information transfer. From the primary visual cortex information flows into two main directions, toward the parietal lobe as the dorsal stream (DS) (the 'where' functions) and toward the temporal lobe as the ventral stream (VS) (the 'what' functions). There are effective feedback loops at all levels of the pathways; the visual pathways are 'two way streets'.

Before the functional assessment we need to collect all available information from the clinical examinations and laboratory tests. These are summarized by the ophthalmologist and the neurologist with special attention on findings in each of the three parts of the visual pathways.

In some hospitals the clinical examination contains detailed description of oculomotor functions and most of the measurements of sensory functions required for functional assessment:
· visual acuity at distance with a single symbol test and with a line test,
· visual acuity at near with single, line and more tightly crowded test
· contrast sensitivity with a low contrast visual acuity test, possibly also with a grating test
· colour vision with a quantitative test
· visual field with confrontation, with Goldman perimetry and as the reading field
· visual adaptation to lower luminance levels.

These measurements are repeated at the school (except Goldman perimetry) to find out variation in the measured values in different environments.

Refractive errors and glasses are also reported by the ophthalmologist and the optometrist as well as all visual devices prescribed by them.

Disorders of higher visual functions may not have been assessed before or were assessed more than a year ago, so the list of the typical behaviours is discussed with the parents and the day care personnel.

Mild losses of function may not be detected before school age if the child has been in a small group of children with well-structured activities. Some children have developed effective compensatory strategies using siblings and adult persons as helpers in problematic situations.

Specific problems in mathematics, reading and writing are often noticed first at school. The cognitive vision tests including observations on motion perception and spatial awareness complete the functional assessment.

If the child makes errors in reading, testing with texts of different size reveals whether the errors are caused by small scotomas or distortions in the image. Thorough assessment of vision and hearing is always necessary when need of special education is considered.

What should the classroom teacher know about the child's visual functions?
1.Does the child have anterior visual impairment, posterior visual impairment or a combination of these two impairments?

2.Motor functions:
: fixation, is it stable, too short or not present, central or eccentric; nystagmus with/without null position?
: are the saccadic movements accurate; compensated with head movements?
:how regular are the tracking movements; compensated with head movements?
: are there any involuntary eye movements during spasms or epileptic activity?

3.Sensory functions:
: visual acuity, all 4-5 measures with optotypes; smallest and optimal text size
: contrast sensitivity, at least visual acuity at 2.5% contrast
:colour vision, confusion areas, which colours need to be avoided
:visual field for orientation and for reading
:visual adaptation, speed of adaptation, any effect on walking to school in twilight; can the child go out during breaks on sunny days when using his absorptive lenses?
:does the child recognise people by their facial features, if not which compensatory techniques have been used for recognition?
:does the child see expressions?
:motion perception; does the child see objects that stand still as well as those moving?
:does the child perceive size, length or does (s)he need haptic confirmation?
:does the child see directions of lines?
:does the child see details in pictures with many details?
:can the child play with age appropriate puzzles?
:eye-hand coordination, use of pencil and pen, drawing

4.Vision for orientation and mobility, what needs to be considered in physical training?

5.What kind of vision the child has for sustained near work? Glasses, devices. Motivation and skills to use them; new devices to be considered during the term?

6.Illumination at the desk and the black board, in the classroom and the corridors.

7.Which devices should the school purchase, which come from other sources?

8.Does the child have symmetric, normal hearing? Any other functional difficulties, disorders or diseases that might affect functioning at school?

9.Prognosis: stable or progressive condition.
This information is given to the classroom teacher and the child's assistant and therapist and discussed again after a few weeks when the child has become accustomed to the new school situation. When the tests are made at the school in the presence of the teacher and the assistant they understand the test results much better than if the results were only described.

They can repeat some tests later and make observations that they report to the child's family doctor and to the intervention team.

Since the tests can be used by all personnel categories, the assessment becomes a true transdisciplinary activity. In the beginning it often requires assurance by the ophthalmologist or by the psychologist because it is quite deep rooted a belief that only doctors or psychologists may use vision tests.

The child's teacher and assistant need the information on the child's strengths and problems in learning more than anyone else and thus are usually motivated to take care of the repeated assessments, especially visual functioning related to reading. In interpretation of observations they need help by special teachers who are experienced in assessing visually impaired children with other impairments.

When a child's functional situation is described, all major functional areas need to be described: how much vision there is for
1.communication,
2.orientation and mobility,
3.activities of daily life and
4.sustained near vision tasks.

In each of these four functional areas the child may use either techniques typical to blind persons, techniques typical to persons with low vision or techniques typical to normally sighted persons. If the techniques of blind persons are given 3 points, low vision techniques 2 points and techniques of normally sighted 1 point, we have a variation between 12 and 4 points, which is large enough a range for administrative purposes.

However, it should be explained that there may be variation in each of the functions at varying luminance levels (Table 1.)

Table.1. This graphic way of describing visual functions of a child with visual impairment is often best understood by administrative persons. It also clearly shows which kind of services the child needs and where special techniques need to be taught.

This child has retinitis pigmentosa and must use techniques typical to blind people when the luminance level is low, like when coming to school early in the morning or when working in a poorly illuminated corner of a classroom.

Yet when he is reading at his desk he uses techniques typical to his normally sighted classmates, except when looking for something under the desk. (From Hyv&auml;rinen L: Assessment of Vision for Educational Purposes and Early Intervention, Part I)

( In the German text the students preferred following table with similar content. You will find out which way of describing the situation works best in your case.)

Functional assessment is based on thorough clinical examination including measurement of refractive error, prescription of glasses (and explanation whether they under- or overcorrect the refractive error and if so, why), description of the structure of the eyes and optic pathways and what changes in them may mean to the use of vision (MRI, Ct, VEP when available).

Combined with observations during school and recreational activities they help us to understand a child's strengths and weaknesses and help us to choose proper teaching techniques.

Whenever there is a discrepancy between clinical findings and a child's behaviour all tests need to be repeated at school and reported to the child's ophthalmologist and neurologist so that the need of further clinical examinations can be evaluated. Some present clinical findings do not depict functional vision and thus observations are important at school, at home and during recreational activities.

Low vision may improve during the early years at school if it is not caused by a progressive disorder. Follow-up of the progression of the disability (or as the new ICIDH describes it, 'how much the disorder affects activities') and the development of compensatory skills becomes well structured if each of the functional areas is assessed in detail (Table 2. see PDF-file below). This table needs to be modified to adapt to each child's functional profile, environment and cultural background.

In the left column one writes down the degree of effect of the disorder on the function and in the right side the level of developing compensatory functions. The former often changes little; the latter should improve if teaching meets the needs of the child.
誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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[size=large]VISUAL ABILITIES, VISION THERAPY,


If your child is struggling with reading even though you know he or she is smart and does well verbally, it could be the result of a hidden and undetected visual skills deficiency.
Poor visual skills are the most overlooked reasons why a child struggles in school.

Your child may have 20/20 eyesight with or without glasses, but poor visual skills. The difference is critical. An eye exam by most eye doctors and all school vision screenings ignore 9 out of 10 visual abilities necessary for a child to achieve full potential in school.

Very few eye doctors have the interest or specialized training in detecting and treating these visually related reading problems. Don't assume that all eye exams are the same.

Hidden visual difficulties are common. According to the American Optometric Association, almost 1 out of 4 children suffer from inadequate visual abilities. While many of these patients have refractive error (nearsightedness, farsightedness, or astigmatism) commonly treated by glasses or contacts, some have additional problems in the functioning of the vision system that are most appropriately treated with optometric vision therapy.

About 40% of all Americans have functional vision deficits. Children with vision disorders rarely complain or tell others, because they don’t even realize they have a problem.

About 75% - 90% of what children learn in the classroom comes through their visual system. A study has shown that 80% of children who are reading disabled have a deficiency in one or more basic visual skills.

What is ironic is that most of these children passed the annual school vision screening or the pediatrician’s eye chart.

It is rare for eye doctors to test for more than eye health and the presence of refractive error. This means an exam by the eye doctor may only test for eye disease and the ability to see 20/20 size eye chart letters, with or without glasses. Although it is very important to test and to treat these two concerns, it is the basis for the "most dangerous assumption" a parent can make regarding a child's visual system.

This assumption is that the 9 other visual abilities vital to reading achievement are optimally developed. This assumption holds true in about 4 out of 5 cases of all children and therefore causes no problems. Perhaps this is why the assumption is so common.

"erfect" 20/20 eyesight merely means you can see something 20 feet away. Eyesight and vision are vastly different. Vision is the ability to take in information through our eyes and process the information so that it has meaning. Eyesight has little to do with how the brain is integrated; information is processed, or is understood.

The ability to understand and interpretation what is seen is referred to as visual perception. Visual perceptual skills are one of many factors important to successful learning.

Visual perceptual disorders are associated with glitches in the neural pathways that connect the eyes and the brain. The visual system itself is estimated to interconnect to 65% of the brain. So if you were to change how the visual system functions, this will change the way that the brain processes information.

Unfortunately pediatricians, teachers, psychologists or reading tutors and most eye doctors are not trained to diagnose, recognize or treat learning related vision disorders.

The academic curriculum is designed on the assumption that children possess certain visual abilities, as well as other skills, by certain ages. Is your child truly visually ready for school?

THE VISUAL ABILITIES

The Visual Abilities are the skills which give us the power or means to take in information through our eyes. The visual sensory system is considered to be composed of 20 visual abilities. To simplify, these skills have been grouped into 11 separate abilities and divided among 3 categories.

VISUAL ACUITY

1. Visual acuity - the sharpness of sight. Visual acuity is what is measured by the Snellen "Eye Chart" at school, the pediatrician’s office, or the eye doctor's office. Optical aberrations such as nearsightedness, farsightedness or astigmatism reduce visual acuity.

Eye diseases such as cataracts, glaucoma or retinal degeneration can reduce visual acuity. Eye diseases have not been found to cause learning difficulties. Fortunately eye disease is rare in children.

MECHANICAL SKILLS

These are neuro-muscular abilities controlled by the muscles inside and outside the eye networking with the brain.

2. Accommodation - the ability to change focus, as well as maintain focus in order to see clearly at different distances.

3. Binocularity - the teaming of the two eyes together so they can converge and point to the same place when reading.

4. Ocular Motor Fixation - commonly referred to as eye "tracking". This is the eye's ability to direct and coordinate movement as it quickly and voluntarily shift from one target to another.

5. Eye Hand Coordination - the ability of the visual system to steer fine motor movements as in handwriting.

PERCEPTUAL SKILLS

These visual information processing skills allow the brain to organize and interpret information that is "seen," and give it meaning.

6. Peripheral Vision - the ability to see or be aware of what is surrounding us, our side vision.

7. Visual Form Perception – consists of four visual abilities called figure-ground, form constancy, visual closure, and visual discrimination. Figure-ground is the ability to recognize distinct shapes from their background. Form constancy is the ability to recognize two objects that have the same shape but different size or position, identify or recognize a symbol or object when the entire object is not visible.

Visual discrimination is the ability to discriminate between visible likeness and differences in size, shape, pattern, form, position, and color.

8. Spatial Relations - the ability to judge the relative position of one object to another (directionality) and the internal awareness of the two sides of the body (laterality). These skills allow the individual to develop the concepts of right, left, front, back, up, and down.

9. Visual Memory - the ability to retrieve or remember a picture in the mind that has been seen in the past.

10. Visualization - the ability to create or alter new images in the mind.

11. Visual-Sensory Integration - the combining of visual information with movement, touch, balance, hearing, and other sensory data.
The following are explanations of these visual abilities. Also included are common symptoms caused when these abilities have not developed adequately.

If your child has any of these behaviors, he or she may have a hidden visual skills problem totally unrelated to good eyesight. This may cause your child to struggle unnecessarily with a vision related learning or reading problem. Single instances of these symptoms may be seen in almost any child.

Only when these symptoms are repeated can the assumption be made that there is a visual skill inadequacy.

It must be kept in mind that visual problems can exist without signs or symptoms, because a child or adult who avoids use of his/her eyes enough will not be subdued by a visual skills inadequacy. These are most often the students who because they are very intelligent and excellent "listeners" can absorb the information necessary to score well on tests.

Furthermore, children who experience visual difficulties most often do not realize it is abnormal; therefore, they do not complain and rarely tell anyone. It can be helpful to ask your child if she/he is having these symptoms, or you may have him/her check off this list too.

1. ACUITY
Visual acuity is "sharpness of sight". It is measured by the Snellen Eye Chart. Reduced visual acuity can result from myopia (nearsightedness), hyperopia (farsightedness), astigmatism, or an eye disease such as retinal degeneration, glaucoma, or cataracts.

If my exam reveals significant nearsightedness, farsightedness or astigmatism, glasses to compensate these optical aberrations will be recommended. But contrary to popular belief getting and wearing glasses prescribed, rarely eliminates a reading problem with school age children.

Numerous research studies have shown very little correlation in improvement in reading after correction of nearsightedness, farsightedness, and astigmatism unless the amount is extremely high.


Reduced visual acuity can lead to:

Blurred distance or near vision
· Having to get close to board at school
· Eye strain or discomfort
· Red or teary eyes
· Excessive blinking, frowning, or squinting

2. ACCOMMODATION (eye focusing)
Just as a camera must be "refocused" to take clear pictures at different distances, so must the human eye accurately adjust to create clear images for different viewing distances. This occurs in the human eye as a result of a change in curvature of the lens inside each eye. This ability to change the shape of the lens of each eye to focus at different distances is called ACCOMMODATION.

This focal change is a result of a change in contraction of the internal eye muscle. To see clearly far away, we relax accommodation. In fact, when the human eye is looking at something 20 feet away or further, no work is required of this focusing adjustment system. However, to see clearly closer than 20 feet, accommodation must be activated.

The closer the target we point our eyes at to see, the more accommodation must occur.

Accommodation is usually rather well developed by age three. This function then begins to deteriorate very slowly starting at about 8 years of age. By about 42 years of age, we need reading glasses or bifocals to replace the lost focusing. Normal developed accommodation allows clear, automatic and effortless focusing when pointing the two eyes from across the room to a word on a page 14 inches from the eyes.

This focal change is usually instantaneous and we are not aware of it.

Unfortunately, many children never fully developed this automatic focusing ability. You my be able to lift a chair with one hand for a few seconds, but does that mean you can hold it at that height for thirty minutes?
NO! Likewise, a child may be able to focus long enough to read a few lines of print, but he may not have developed enough focusing stamina to complete many pages of reading effortlessly. Excess energy must now be spent during reading in an effort to compensate for the dysfunctions and to keep the print clear.

This extra effort is most often involuntary and without the child being aware of it. This is energy that could have been used towards the mental processing necessary to extract and retain meaning from the printed page. This reduces comprehension.
Other symptoms of accommodative insufficiency are:

Avoids reading. Unwillingness to read at school or voluntarily for pleasure.

· Headaches if child reads long enough.

· Child is a better reader on the first pages, starting out fine then squirms, counts pages left, or wants to get away.

· Short attention span- cannot sit still or stay on tasks.

· Frowning, scowling, unusual fatigue, restlessness, twisting body, or other signs of frustration and tension while reading or writing.

· Complains of sore, itchy, tearing, redness, or burning eyes when reading.

·Younger children rather than complain, may rub their eyes, blink, or squint excessively or merely avoid reading.

· Was prescribed reading glasses and they didn’t help enough.

· Holds book very close or moves book or head closer, then farther away as if to clear print.

·Complains of blurred vision even though eye exam indicated "good vision."

·Things look blurry when suddenly looking up and away after reading, but then clear up.

These last three symptoms occur because the person with accommodative insufficiency has to consciously or unconsciously work so hard to get the focusing muscle to keep the print clear, that the focusing muscle often spasms and over focuses.

When he shifts his eyes from the page to across the room, the focusing mechanism inside the eye is very sluggish to change. The board at school is therefore blurry.

3. BINOCULARITY (eye teaming ability)
There are no parts of the body which must work together with more precision than the eyes. The two eyes and all their 12 reciprocating muscles work as a team so that both eyes point precisely at the same object (or the same word or letter in the case of reading.)

When both eyes are accurately aimed at the object being viewed, the information coming from the two eyes will be combined in the mind as a single image. When we read, the two eyes must converge such that both eyes point at the same place on the page.

Some people never developed the ability to effortlessly converge.

About 10-15% of children have poor eye teaming abilities. In these children and adults, the eyes do not automatically and easily coordinate together. This creates stress and also reduces comprehension. In some children it is so poorly developed that words "go double."

The eyes are not crossed but slip almost imperceptible amounts when reading and the child sees the words "run together." This would certainly make someone want to avoid reading. Eye teaming difficulties often result in the loss of binocularity.

Since the visual system is more efficient having one eye work alone rather than two eyes working against each other creating stress, the visual centers of the brain will often ignore input from one eye. In this situation, the person is only using one eye. Tests are performed to check for the "suppression" of vision. Symptoms of poor eye teaming are:

·Headaches if child reads long enough.
·Covers or closes one eye when reading.
·Holds book far to one side, turns or tilts head to one side, or rests head on palm when reading so that one eye "happens" to get covered.
·Complains of words, letters or lines going fuzzy or blurry, "running together," "jumping around" or double vision.
·Eye discomfort or strained feeling during or after reading.
·Cannot read for as long as would like. Child begins reading well but all too rapidly begins to loose interest.
·Poor reading comprehension or memory for what was read. Has to reread same material over again.
·Becomes tired and sleepy when reading.

4. OCULOMOTOR - FIXATION
Fixation is the ability to direct and maintain steady, central visual attention on a target. This basic skill is developed in infancy and refined through the early years.

Ocular motor skills are neuro-muscular control skills developed to point the visual system on target and move it to either follow a moving target or jump from one object to another. The infant reflexively turns the entire upper torso toward the direction of a noise, and then gradually learns to turn only the head to guide the visual system.

Through the toddler years the individual refines this movement system by learning to use eye muscles to replace head movement - an achievement important in visual readiness for school.

Eventually vision becomes the dominate sense.
When reading a line of print in a book, our eyes need to make many small changes in position to move the eyes to the end of the line and to make the long return sweep back to the left to start the next line. Each eye must make quick and accurate "jumps" from one group of letters on the line to another set of letters.

Some people call these eye movements "tracking." People need precise eye movement and fixation whether they are keeping their eyes on the ball in sports or looking from word to word when reading.

Unless eye movements are accurate, mistakes will be made. This observation is based on a simple fact: if you are not looking directly at something, you cannot really see it. When reading, it normally takes only five or six eye movements per line before you get to the end of the line. Some persons make twelve or fifteen fixations per line, many of them inaccurate because of under or overshooting the target. If eye movements are slow, clumsy, or uncoordinated, and the eyes jump, miss, or lose their place on all instructional materials, then the information obtained by the child will be reduced.

Symptoms of poorly developed oculomotor (eye tracking) ability can include:
· Loss of place when reading.
· Skipping words or whole lines.
· Reading words out of order.
· Using finger or marker to help keep place.
· Excessive head movement when reading -appears to move head rather than eyes, to track across the page.
· Little words such as of, as and is, or small beginnings and endings of words are misread or confused, or omitted.
· Loss of place when copying from board to paper.
· Difficulty comprehending because of an inaccurate eye movement.

5. EYE HAND COORDINATION
Eye Hand Coordination, also called visual motor integration, is the ability of our eyes to guide our hands.

There is more to eye-hand coordination than coloring, cutting, writing, and catching a ball. This coordination demands more than a normal eye and a normal hand. Proficiency in this area is dependent upon the combined use and practice of the eyes and hands as paired learning tools.

From constant use of the eyes and hands to feel, explore and inspect a child’s world, the child realizes that what he sees and touches are the same.

The use of actual manipulation is no longer necessary to identify something. Inspection can then be accomplished using vision in order to determine size, shape, orientation, location, and distance. This skill is developmentally essential and preparatory to both reading and writing.

Practice must start at a very early age and develop through thousands of opportunities during the first 8-10 years. In the preschool child, it is quite normal for movement and touch cues to reinforce eye aiming (hands guiding the eyes).

By 1st grade he should developmentally shift the relationship so the eyes guide the hands. Every child is expected to come to the classroom ready for the writing task, a very advanced act of visual-motor integrations.

Signs and symptoms of poor eye hand coordination are:
· Poor pencil grip.
· Sloppy drawing or handwriting skills.
· Poor organization on written page.
· Difficulty completing written assignments in allotted period of time.
· Poor spacing and inability to stay on lines.
· Excessive erasing.
· Difficulty writing numbers in columns for mathematical problems.
· Avoids sports or exhibits poor eye-hand coordination – trouble hitting, throwing, or catching a ball.

6. PERIPHERAL VISION
Peripheral vision allows you to stand at one end of a room, stare straight ahead at a point and without moving your eyes up, down, left or right, detect other parts of the room.

Nearly all sports demand good, if not superior peripheral visual awareness. Studies dating back to 1941 concluded that athletes had larger vertical and horizontal visual fields, than non-athletes. All ball sports require the player to localize a ball moving in their periphery quickly in order to make appropriate movement responses.

All eye doctors are aware of the visual field reductions caused by glaucoma, stroke, head trauma, or brain tumors. These are called pathological visual field defects. In 1936, Dr. Thomas Eames, a physician at Boston University, reported in the Journal of Educational Research that many children with learning disabilities had smaller visual fields than children without learning disabilities. In my office, every person gets their visual field size tested.

It is not uncommon for the visual field of some youngsters to be only one inch across! Trying to read with such constricted visual fields is comparable to reading with a drinking straw over each eye. This tunnel vision effect often explains why a child looses place easily, skips words or whole lines and can’t seem to relocate the target.

Recently, the effect of stress on vision was confirmed in a series of studies by Mark Anderson, Ph.D., of Beloit College and Jean Williams, Ph.D., of the University of Arizona. Their studies found that stress directly affects the peripheral field of vision, thus reducing how much we see. They discovered that as the degree of stress increased, so did the likelihood that an individual’s field of vision would contract when required to respond to a visually demanding task.

The most visually demanding and stressful tasks appear to be school work in general and reading in particular. It is difficult to say whether the academic stress that these children were under caused the visual field constrictions, or vice versa.

A child who has reduced peripheral vision may have the following symptoms: easily distracted, decreased attention span, poor comprehension, poor eye tracking, poor athletic performance, and/or clumsy; falls and bumps into things often.

School activities such as reading, writing, and copying from the board can also be adversely effected.


7. VISUAL FORM PERCEPTION
Four visual abilities are part of visual form perception. These are figure-ground, form constancy, visual closure, and visual discrimination.

Figure-Ground is the ability to recognize distinct shapes from their background, such as objects in a picture, or letters on a chalkboard. Form Constancy is the ability to recognize two objects that have the same shape but different size or position.

This ability is needed to tell the difference between "b" and "d", "p" and "q", "m" and "w". Visual Closure is the ability to identify or recognize a symbol or object when the entire object is not visible.

An example would be a design that is half completed. Visual Discrimination is the ability to discriminate between visible likeness and differences in size, shape, pattern, form, position, and color.

Such as the ability to distinguish between similar words like "ran" and "run".
A child who has a Visual Form Dysfunction may have the following symptoms:

·Confuses similar colors.
·Confuses minor differences or likenesses.
·Confuses words with similar beginnings or endings.
·Trouble recognizing letters or numbers past the end of kindergarten.
·Using hand and finger manipulation to determine similarities and differences in shapes or objects.


8. SPATIAL RELATIONS
This is the ability to judge the relative position of one object to another (directionality) and the internal awareness of the two sides of the body (laterality).

These skills allow the individual to develop the concepts of right, left, front, back, up, and down. This ability is needed in reading and math.

The development of orientation starts in the prenatal period stimulated by gravity reflexes which help the fetus orient in utero. This development continues through varied learned experiences in our lives.

Interferences in movement activities involving vision and neuromotor relationships limit the development of orientation.

At three years old, or even younger, a child should have grasped the concept of top and bottom, and right side up or upside down (even though still looking at books upside down). Until a preschool child is introduced to the world of letters and numbers, an object is the same no matter which way it faces. Learning numbers and letters is the first time in his life that the directions of objects are important.

When the letter p points to the left, it’s a q, and when a d points to the right, it’s a b. A four-year-old child will reverse his shoes as he tries to put on his own shoes.

Some four to five year olds may print numbers and letters from right to left. At these ages, this is a normal stage of developing orientation in children.

When a child is mature enough, usually by age six, he should be able to have an internal awareness of the two sides of his body. The primary method by which a child learns how to distinguish between his right and left is through bi-lateral integration/ gross motor coordination.

Bi-lateral Integration/ Gross Motor Coordination is the visual guidance of body movements and the coordination between both sides of the body.

Walking, running, swimming, and riding a bike are all activities that develop a sense of balance and lateral awareness.

Although most children master the concept of directionality by age 8, this confusion in orientation may continue in some people all their life. Reversal errors that persist beyond second grade are considered abnormal and are usually associated with reading disabilities.

The specific causes of these errors remain controversial. Several possible factors have been identified and include laterality and directionality, visual form perception, eye-hand coordination, visual memory, and language deficits. If necessary, a vision therapy program will include specific procedures to reduce the tendency for “reversals”.

The following are symptoms and signs of a visual-spatial dysfunction:
·Poor athletic performance.
·Difficulty with rhythmic activities.
·Lack of coordination and balance.
·Clumsy; falls and bumps into things often.
·Tendency to work with one side of the body while the other side doesn’t participate.
·Difficulty learning left and right.
·After second grade, reverses letters and numbers when writing or copying.
·Writes from right to left.

9. VISUAL MEMORY
Visual Memory is the ability to recall and use visual information from the past. This skill helps children remember what they read and see by adequately processing information through their short-term memory, from where it is filtered out into the long-term memory.

Children with poor visual memory may:
·Struggle with comprehension.
·Have difficulty remembering what a word looks like or fail to recognize the same word on another page.
·Sub-vocalize, or softly whisper, as they read in order to help compensate for weakness.
·Have persistent difficulty learning to spell.
·Copy assignments slowly because they must frequently review the text or the blackboard.

While there are good spellers who do not have good visual memory, good visual memory can be a real asset to spelling. The person who can easily remember the picture of a word as it is correctly spelled and can then write down what he is seeing in his mind has a real advantage over the child who has to try to spell each word “as it sounds”.

An example of spelling a word as it sounds would be “enuf” for enough and “nashun” for nation.

Because it is frequently possible to develop a child’s visual memory, this ability can then be used by the child to spell even if he has been unable to master phonics or cannot “hear” the spelling of the word in his mind.

As the number of words which the child can spell through memory increases, the ability to recognize those words when reading also increases.


10. VISUALIZATION
Visualization is the ability to create and manipulate mental pictures of an object or concept on the basis of past visual experience and memory. It is essential in reading and playing sports.

When reading, a good reader will create mental images. Remembering pictures is much easier than remembering sounds or words. Good comprehension and understanding are dependent upon good visualization.

For instance, if a child is reading a story about Africa in which a lion was chasing a zebra, it would be better to understand and remember the story if he could create a picture in his mind of the lion and zebra.

Visualization is also important for good listening skills. If a student cannot visualize what is being heard, then auditory input has very little meaning. One cannot listen effectively if visualization is not taking place.

Symptoms of poor visualization are:
·Poor comprehension – difficulty remembering what was read.
·Difficulty following instructions.
·Difficulty recalling what was done or what he saw during the day.
·Poor spelling.
·Difficulty with mathematical concepts.
·Whispers (sub-vocalizes) when reading silently.
·Difficulty anticipating next step in a sequenced task presented to him or her such as gymnastics, dance, or karate routine.


11. VISUAL-SENSORY INTEGRATION
After visual data is gathered, it is processed and combined in the brain with information from hearing (auditory-visual integration), balance (gross-motor/bilateral integration), posture, and movement (visual-motor integration).

This process is called visual-sensory integration. Underdeveloped visual skills do not stem from improper parenting. They are more the result of conditions we do not yet understand well. Heredity, genetics, nutrition, environmental toxins, stress, problems at birth, or insufficient sensory stimulation has all been blamed.

Poor visual abilities occur without regard to race or socioeconomic status.


WHAT CAUSES POOR VISUAL SKILLS
Underdeveloped visual skills do not stem from improper parenting. They are more the result of conditions we do not yet understand well. Heredity, genetics, nutrition, environmental toxins, stress, problems at birth, or insufficient sensory stimulation has all been blamed.

Poor visual abilities occur without regard to race or socioeconomic status.

VISION THERAPY
The good news is that the visual abilities necessary for optimum reading are LEARNED skills. This means that they are developmental in nature and can be improved through an optometric specialty called vision therapy.

As defined by the American Optometric Association, optometric vision therapy is a treatment plan used to correct or improve specific dysfunctions of the vision system. It includes, but is not limited to, the treatment of strabismus (turned eye), other dysfunctions of binocularity (eye teaming), amblyopia (lazy eye), accommodation (eye focusing), ocular motor function (eye tracking), and visual-perception-motor abilities.

Please note that scientific research has not proven that vision conditions such as nearsightedness, farsightedness, astigmatism, and presbyopia can be successfully treated with optometric vision therapy.

My optometric vision therapy program does not treat these vision conditions.

Optometric vision therapy is based upon a medically necessary plan of treatment which is designed to improve specific vision dysfunctions determined by standardized diagnostic criteria. Treatment plans consist of a set of procedures that are individualized and prescribed by an optometrist to teach a patient how to improve a weak or nonexistent visual skill or processing skill through the use of lenses, prisms, occlusion (eye patching), special computer programs, and other appropriate materials, modalities, and equipment.

Vision therapy is best explained as a learning process where the visual system is trained to respond and adjust to visual material, such as print, in the appropriate manner. Through various standardized
vision therapy procedures, the visual system and the visual control centers of the brain learn a new habit of how and when to respond.

During therapy, a therapist will help the patient become aware of his weak visual ability; teach him how to improve this visual ability; and have him practice certain procedures until his visual system automatically functions efficiently. Some individuals refer to vision therapy as “physical therapy for your eyes".

The vision therapy program that Dr. Toler may prescribe is an individualized treatment plan. Dr. Toler will estimate the length of the program, which can typically range from 20 to 45 sessions. These one-on-one therapy sessions are done in the office with a vision therapist.

The optimum frequency is two office sessions per week with a day between. Home activities are recommended for days that therapy is not scheduled. Patients, who regularly practiced their home activities at least two days per week with their twice a week in-office therapy sessions, generally make the progress as expected and in many cases are able to shorten the estimated length of their treatment.

Vision therapy is not a direct treatment for dyslexia, learning disabilities, or attention deficit disorder. However it does treat vision dysfunctions that are often mistaken for these problems. For an individual who is Learning Disabled, Dyslexic, or has Attention Deficit Disorder, he/she faces yet another obstacle when poor visual abilities are present.

People with learning problems may require help from many disciplines to meet the learning challenges they face. Optometric involvement constitutes one aspect of the multidisciplinary management approach required to prepare the individual for lifelong learning.


BENEFITS OF VISION THERAPY

The goals of vision therapy are to improve the patient's visual function, relieve associated signs and symptoms, meet the patient's needs, and improve the patient's quality of life.

Probably the most commonly asked question is "Is the improvement that comes with therapy permanent?" Therapy gains do remain! One research study indicated that over 98% of gains made in vision therapy remained when retested 1 year later.

This study did of course take into account the gains expected by 1 additional year of maturity. Our own retesting experience has demonstrated that these skills typically do not deteriorate, but continue to improve. In a long term research study, patients who were treated with vision therapy for a poor eye teaming ability remained symptom free with normal clinical findings when retested 5 years later.

In a questionnaire given to parents after vision therapy, one of the common changes reported is that the child is able to stay on task. The child’s concentration has improved because their visual system is working more efficiently. The second most noted change is how much faster a child does an activity.

Vision therapy helps develop processing speed, the speed at which a child performs an activity. Every vision therapy activity constantly encourages the child to handle more information in less time. An average child after vision therapy has improved his visual processing abilities by 2.9 years.

The number one change parents report is an improved self esteem. Through each vision therapy activity that a child has successfully completed, he became aware of what he can do rather then what he can’t do. Children feel good about the improvements that they have made in their visual system.


THE HISTORY OF VISION THERAPY

Physicians in the mid-1800s originally introduced many of the techniques that are used today in optometric vision therapy. Modern Optometric Vision
Therapy was pioneered in the United States in 1928 by optometrist A. M. Skeffington. Dr. Skeffington used the principles of orthoptics (the science of correcting defects in binocular vision without surgery) and expanded upon many of the theories about vision and learning.

Throughout the years, vision therapy’s concepts have expanded using principles from psychology, education, neuroscience, physical and occupational therapy sciences.


WHY CAN'T THE SCHOOL TREAT POOR VISUAL ABILITIES?

Just as there are eye doctors who have very little training or interest in detecting or treating poorly developed visual abilities, teachers do not receive training in this specialty. Also, teachers have the education of the class as a whole as their main priority.

It would be impossible to single out a child and give him the individual attention necessary for visual skills enhancement. Unfortunately, many teachers are not aware of the help that vision therapy can provide because so few optometrists offer this specialty.

Numerous parents of students with reading difficulties have been made aware of the services I offer through resource teachers or tutors who have witnessed the improvement vision therapy made in one of their students. Some teachers who are aware of this service would like to refer a child out for these services, but are inhibited by "school politics”.

Teachers and administrators have a policy of not referring children to "outside" private sources. It is not because they don't care.

Public schools, being a tax supported enterprise, consider it a conflict of interest to support private business. Teachers and administrators fear that by recognizing a specific weakness and referring the parents for outside help, the parent may hold the school system responsible for resolving the problem since the school "diagnosed" the problem.

With school system budgets across the country strained and hard pressed for funds, the money is just not available to provide the services, in or out of the school. The school and administrators don't want to risk being accountable.


WHAT IF NO TREATMENT IS DONE?

Parents often ask "If nothing is done, will my child outgrow these reduced abilities?" Accommodation (Eye focusing) and eye teaming don't improve with age. The other visual skills improve with age, but unfortunately not fast enough to catch-up with children of the same age who don't have reading and learning difficulties and reduced visual skills.

The effect of reduced visual abilities worsens because as the child gets older, school work becomes more visually demanding. The child remains handicapped and educational deficits become harder to overcome.

Therefore, early diagnosis and treatment becomes extremely important.


GENERAL INFORMATION
Dr. Toler and the vision therapists work as a team. Before a patient first starts a vision therapy session, Dr. Toler and the therapist will decide what techniques and methods will best help reduce the patient’s visual problem. This is based on test results and the consultation.

Vision therapy is individually programmed to meet the patient’s specific needs. As therapy progresses, Dr. Toler and the therapist will discuss the patient’s progress and make modifications in the program in order to expedite success. Dr. Toler will see the patient again for a mid-way and final evaluation.

The importance of the mid-evaluation is to make certain that visual abilities are improving as expected. The mid evaluation also will indicate what sub-skills need continued work and which ones no longer need emphasis.

Although improvement in test scores is important, our ultimate gauge of success is the patient, parent or teacher reporting reduced difficulties in reading or learning. This almost always occurs before the mid-evaluation. Unless most of the vision therapy program occurred during the summer, we will have the added benefit of feedback from teacher, parent or patient on school and homework performance.

For every hour spent on direct vision therapy and contact with the child, the therapist will spend at least 15 minutes programming the activities of the next therapy session. This is similar to the school teacher who plans the next day’s lessons the night before.

The result is that no time is wasted during the therapy session figuring out what to do next.
A frequently asked question is, "At what point in the treatment should results or improvement become apparent?" Based on our experience significant and noticeable improvement has been reported from the parents and/or patient by the mid-way point in about 93% of cases. Even after given this success rate, parents or patients often and understandably ask, "What if no obvious improvement is occurring with my child by the halfway point?"

First, I must emphasize that success is dependent on several factors. Frequency of visits is important. If visits are missed and the patient is not doing home activities, it becomes difficult to make gains and permanent changes. Success in a vision therapy program is also highly dependent on the attitude, motivation and hard work of the patient. The therapist merely coaches and instructs the patient on the techniques and activities that the patient performs. It is not necessarily something that is "done to them".

If all these criteria are met, and by the mid-evaluation, retest scores have not improved and there has been no noticeable change in the patient, as gauged by the patient, parents, or teachers, then I would recommend discontinuing therapy.

So often I hear parents say that they can't let vision therapy interfere with their child's baseball or soccer because it’s so important for their child’s self esteem. Vision therapy needs a certain level of priority. If after school activities such as sports, karate, dance or others will keep you or your child from maintaining the minimum frequency of office sessions, the desired results will be difficult to achieve or come very slowly. You may want to reconsider your priorities.

Children do not outgrow poor visual abilities. Consider what effect will this have in the future as reading assignments become more difficult, when homework takes longer and the frustration continues to grow?

誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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睡覺


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28#
發表於 06-3-24 11:29 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

搞錯左添... :mrgreen:
誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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Re: ##人格心理資料庫..(發up瘋..)

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Alfalfa


禁止訪問

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Re: ##人格心理資料庫..(發up瘋..)

提示: 作者被禁止或刪除 內容自動屏蔽
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小孩子的天空


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Re: ##人格心理資料庫..(發up瘋..)

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Re: ##人格心理資料庫..(發up瘋..)

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大宅

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33#
發表於 06-4-4 09:08 |只看該作者

Re: ##人格心理資料庫..(發up瘋..)

:mrgreen:
誰會直率地說出所認識的真實？有所認識的少數人，愚蠢地不隱蔽自己充實的心，向愚民們說明他們的感情和見識，他們總是被人磔死或燒死。 歌德 <<浮士德>>入來做下test，不同的人對事情有不同的看法和感受﹗
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