Summary
Occupational therapist Franchesca Cox and speech-language pathologist Megan Williams, both based in Houston, Texas, discuss pediatric therapy on their podcast Little Brain’s Big Steps. They explore topics like the vestibular system, its role in balance, spatial awareness, and movement coordination, and its connection to other sensory systems. They highlight research showing vestibular dysfunction is common in children with conditions like cerebral palsy, autism, and traumatic brain injuries. They emphasize the importance of early intervention, therapy techniques, and educating families on how sensory processing affects daily life.
Resources
Sensory Processing Impairments in Children with Developmental Coordination Disorder
Abnormal Vestibular–Ocular Reflexes in Children With Cortical Visual Impairment
Transcript
Hi there, I’m Franchesca Cox, an Occupational Therapist based in Houston, Texas.
Over the years, I’ve had the incredible honor of working with children who have neuromuscular conditions, rare genetic disorders, and developmental delays.
Using approaches like DMI therapy and TheraSuit, I’ve seen firsthand the resilience and strength of these amazing kids and their families.
Each day brings new lessons, and my passion is to empower families with the tools and knowledge to support their child’s journey.
And I’m Megan Williams, a speech-language pathologist, also based in Houston, Texas.
I specialize in feeding therapy, and I’m an MNRI core specialist.
I’ve worked with children facing feeding challenges and sensory processing issues, using reflex integration techniques to support the brain-body connection and help children thrive.
My mission is to guide families through the often complex world of feeding and communication, empowering them to support their child’s growth with confidence.
Together, Megan and I are here to share insights, practical strategies, and heartfelt stories that can help you navigate the unique challenges and joys of raising a child with special needs.
We know every family’s journey is different, but our goal is to create a supportive space where you feel seen, heard, and equipped with the knowledge to help your child reach their fullest potential.
So, whether you’re looking for therapy techniques, expert advice, or just a sense of community, you’re in the right place.
Let’s explore this journey together, filled with hope, growth, and endless possibilities.
All right.
Welcome back to our newest episode of Little Brains Big Steps podcast.
In this episode, we’re going to be talking about vision.
So we’re covering the different sensory systems, and today we are going to break all things vision down.
So initially, I think a lot of people hear the word vision and they think, oh, it’s just eyesight.
But today, we’re going to talk more about what goes into your visual processing system, how it impacts development, and some things that can be done at home to help if you feel like your child might have some issues.
As therapists, I know a lot of times, Franchesca, we talk about going to the optometrist and getting our eyes checked, our little ones as soon as they can, and making sure that all pieces of the eyeball kind of look intact.
And optometrists are great at being able to help us see that kind of stuff.
But as an OT, what do you initially think of when you think of vision?
Yeah, that’s a good question.
A lot of the patients that I see, I see a lot of visual issues, but it’s not the acuity that we’re focused on.
It’s more how does our brain interpret that information?
And so I know we’re going to dive deep, but I think a lot about what is the brain doing with the information that the eyes are receiving?
Yeah, and it’s a piece that I think it’s really hard to track and to see what the brain sees.
Whereas if we are looking at when we look into the little machine and we tell which one looks better, like this one or that one, and they can kind of see what our eye is doing, how our lens moves and bends and things like that.
But I just don’t know when we’ll have that kind of technology to really be able to map the process of what happens from the time, because we know what happens when the image goes into our eye and then how it’s turned upside down and then part of our eye anatomy flips it for us.
But then what happens to it?
Like, what’s happening there?
Is there a breakdown?
Because there’s so many places that it can break down.
And we see that happen a lot with our kiddos.
And it presents in ways that I think is really interesting, because I can even look at things and say, I don’t think this person sees the thing the same way I do.
And it’s like how, you know.
Yes, and even like the same colors, you know, like blue and purple and red and orange, or there’s just some gray area that I really believe no two people see the same things, exactly the same.
Yes, I mean, I feel like there’s a lot of male versus female.
Like, I look at one thing one way, like literally, not figuratively, but then I think my husband can look at something and he is visually processing it a different way.
And so I’m very interested in how people see things.
I never assume that I ever see anything the same way a child does.
And a lot of times if I see them, and we’ll probably talk about this later, they’re trying to use their vision in a certain way, then I will jump down there and I will get on their level and try to see, because I’m like, well, what do you see that I don’t see?
So anatomically, where does vision happen in the brain?
So we know it starts, like I said, with the eyes seeing.
And the eyes are considered to be kind of like cameras, send pictures to the brain, and the brain is the computer that figures out what those pictures mean.
I really like that analogy.
Yeah.
It kind of makes sense.
So the part of the brain for our kind of like anatomy deep dive that we’re looking at is the occipital lobe.
It’s where vision is mainly processed.
And so that’s at the back of our head, just above our neck, which I think is a very smart strategic location.
Just from where the information comes in through our eyes, it would make sense that it would just be processed further back.
Straight back?
Straight back.
We don’t have to get, you know, it doesn’t have to travel very far.
So the main vision center of the brain and the occipital lobe will help us recognize shapes and colors.
We perceive movement, people, objects, and where things are in space, so the depth and distance.
I always think whenever I think about that part of vision, whenever I am in a dimly lit room, or if I’m trying to walk to the restroom, and I’m really trying to judge where things are, and like into the bed or the door frame, and when I think my vision is, you know, better than what it probably is, and then I accidentally stumble into something, and it’s like, oh, I thought I had that.
Kind of hurts my pride, I think.
But if we have children that have visual processing issues, we may see that they have trouble with their vision, even if their eyes, like I said, are healthy from the optometrist’s point of view.
So a lot of times I’ll ask families when we first start working with them, I’ll say, you know, do we have any kind of reports about any vision issues?
And most of the time, even with evidence of a brain injury, they’ll kind of say, oh, it’s questionable, we’re not really sure, possibly CBI level, you know, whatever, but it’s most of the time they get a report of like, oh, the eye is perfectly healthy, that the nerve is intact, it’s all good.
Like the pressure within the eye is all right.
And so it’s like, okay, that’s really good.
But like I said, we need to dig a little deeper.
And so what is actually happening when the brain is processing vision?
What does that look like?
Yeah, yeah.
So the brain, like you said, the eyes are like the cameras.
So the brain processes that vision and the light enters the eyes.
The eyes are sending that information to the brain through the optic nerves.
And then that information is processed in the occipital lobe.
And so it’s like we’re putting pieces of the puzzle together.
And when, like you said, at any point from the time that information enters the eyes, all the way to the optic nerve and occipital lobe, something is happening with these children who have visual processing issues.
And like you, most of the children, it blows my mind that they get it all clear from the doctor, from an eye doctor.
But like you said, I think they’re just looking at it from a medical standpoint.
They’re at that homeostasis level where everything’s good.
Nothing’s anatomically wrong, but there’s definitely a processing issue.
And I think that’s what we’re going to dive deeper into today.
So when it comes to some visual processing challenges, what are some signs that you see and know about?
So I know that we have kids and adults that experience hypersensitivity.
So I have blue eyes or lighter colored eyes.
And so I’ve read that children and adults who have lighter colored eyes struggle more with the bright light.
So transitioning from a dark environment to a light environment is not just a pupillary reaction.
It can actually be harder.
So sometimes when I work with kiddos, if they have really light colored eyes, then I’ll try to be a little bit more sensitive of overhead light.
They can also have hypersensitivity that looks like having cluttered visuals.
So maybe things kind of like don’t have distinct outlines or shapes.
They just kind of blend or merge.
And then sometimes the actual piece of making eye contact can be uncomfortable just because it’s such an intense.
If you look back at like nonverbal communication and the way we use our eyes, it can be uncomfortable for some individuals to maintain eye contact with another.
Even that it just seems like a very innocuous kind of like thing to maintain eye contact.
It can feel very intense for some.
And then we also have hyposensitivity.
So kids who have poor tracking, so they don’t respond very well.
If you are referencing something across the room and you point to it, and their job is to follow your gaze, they lose it.
They just kind of, they don’t have that joint attention.
They’re all about what’s up close and it doesn’t matter.
They’re just always, always going.
Yes.
They may have difficulty recognizing letters and symbols.
And then they also can misjudge distances.
So back to that idea of like that visual spatial of knowing how far something is from their arms length or from their face.
Right, right.
That is, yeah, it’s interesting.
And when you said about the eye contact, it made me think of one of the children that I used to see years ago.
And they were so aversive to eye contact that they would even turn their little action figures away so that they didn’t have to look at the eyeballs on their characters.
And they lined them up, you know, as a child with autism.
But I thought, man, there’s something going on there, you know.
And so he overcame that.
But it was interesting that it’s a real thing.
It’s a real thing.
And it seems like invisible, this just looking at each other’s eyes.
But we know that, like, if you’ve ever taken any kind of public speaking or, like, persuasion speaking or any kind of, like, debate or any, you know, thing, that’s one of the pieces that they’re like, you know, make strong eye contact.
And that’s the power move, like maintaining strong and being intimidating.
You can visually intimidate somebody.
And so, yeah, I think it’s always, yeah, I try to be really patient with individuals and not assume that if they’re not looking in me and my eyeball, they’re not listening.
Right, right.
Some of the children, actually, many of them listen better when they’re not making eye contact and they’re doing their own little thing, whether it’s a puzzle, a little fidgety toy or something.
Yep.
Some other challenges that I wanted to mention that are things that OTs typically look for, as well as a few other specialists, are visual tracking, which is the ability to follow a moving object in a single plane.
As OTs, we’re testing for horizontal, side-to-side and then vertical, up and down.
Then poor visual tracking, I’ve noticed, is often observed with poor vestibular movement or skills too.
The children that have that poor visual tracking, and a lot of times it’s on one side, they will also be aversive to vestibular movement in that same plane.
It is something that I like to test together and treat together.
Another skill that I often see, a delay in is saccades, and that’s the ability to quickly move your eye or jump it from one location to another.
We’re going to look over here at the window, and then you hear a sound and you’re going to go look and see what it was over here.
You’re not processing any information between this side and the other side, and that’s saccades.
That’s another skill.
It helps your child quickly visually assess their environment from one point to the other and gather information quickly.
An accommodation is the ability to focus or change focus between things that are close and then far away.
And then that’s often a skill that children need in the school setting for copy work from the board, from the whiteboard, or whatever.
They might be looking at listening or looking at the teacher and then going back to their paper or their Chromebook.
And that’s a skill that if they don’t have that visual processing skill, that basic schoolwork is going to be very difficult.
At a lower level, we often see that with children that are younger, they may not have the symmetrical tonic neck reflex integration, or they may have had a brief period of crawling, or have skipped crawling all together if they have difficulty with accommodation, because the accommodation is usually acquired when the children are learning to crawl.
Do you have anything to add to any of those?
Yeah.
I mean, I remember with accommodation, I can remember still in second grade, you know, because this will show my age, but we had chalkboards whenever I was growing up.
And in second grade, our job was to be able to start copying down information from the board.
And I can still remember doing that, like looking up at the board, trying to figure out where the new information was, because, you know, as she’s writing the information, she’s erasing the old information, our teacher was, because, you know, we’re all about efficiency.
And so I was struggling with keeping up, because I would look up and then I would look down.
I would look up, I would look down, and I would have to use a finger or something to keep my place on the page.
But then, I know my STNR is not integrated, and so that constant struggle in feeling like I was missing out on information was really, like I can still remember that.
In second grade, I can see the classroom, I can see my teacher, I don’t know what we were learning about.
You just remember the anxiety.
I remember that panic feeling and like, if I don’t get this, I’m going to be behind.
Second graders shouldn’t have to feel that, but well.
Yeah, yeah, that’s crazy.
I remember the chalkboards.
Chalkdust, the erasers, the sound of chalk on the board.
And you were just hoping like her nails didn’t scratch the board.
Yes.
I hated those chalk things, the little things that held the chalk, so you could draw lines, smooth lines across the board.
No.
Kids these days don’t know about that sensory.
No.
My hands were sweating thinking about that.
Me too.
Me too.
Well, let’s talk a little bit about how the visual system affects learning and development.
I’ll start off with the cognitive and motor learning piece, and we know that we’ve touched on it a little bit, how we obviously need the visual system for reading, writing and copying from the board.
But, you know, the visual main job is to see, but we often take for granted how complex the interpretation of what we see actually is.
Our eyes are constantly taking in new information and filing it within the brain to help associate it where it belongs.
It’s almost like it’s filing every little visual thing into the filing cabinet that is in our brain.
And so that happens without us realizing it throughout our whole day, as well as, of course, our children.
It’s happening with them from the time that they can start to see and process information visually.
And when it comes to reading, some children have extreme difficulty, not because of poor visual acuity.
They see perfectly fine from a doctor’s standpoint, but their processing is just not there, not fully developed.
And they see letters as basic symbols.
And actually, one of my children had this issue, and his ability to read was so delayed, and it was so difficult.
I could give him one letter and give him another one, but and he knew what the sound was, and he knew what this the other sound was.
But to put them together was just like reading another language.
And so it was just processing, not just the symbol and this sound, but also matching or comparing it and combining it with another sound to read a word.
It was just very difficult.
And so they’re just it’s just a processing issue that I think a lot of times we overlook the children.
Maybe it gets labeled as dyslexia when it was it’s not really even dyslexia.
And I know we we need to talk about dyslexia at some point.
But this is its own visual processing issue as far as just deciphering letters on a page as what they are.
And one thing about the English language that’s extremely difficult that I think is worth noting is we have a name for a letter and then we have a sound for a letter.
And that is just reading so complex.
And I didn’t know there was I’m learning another language right now.
And I did not know like the letters, name and sound is the same thing.
And I thought that would make English so much simpler.
But anyway, I digress.
Another big area of motor learning that exists with our children who have poor visual processing is body awareness.
And of course, we touched on this in one of the past episodes when we talked about proprioception, but their visual processing delays also affects how they view and feel their own body in space.
And so a lot of times these are going to be the clumsy kids.
They’re going to be having difficulties with sports, keeping up with their peers.
They’re going to have skinned up knees.
And ask me how I know, because I was one of these kids.
They’re going to have really difficult time with activities that require agility.
They’re going to actually prefer not to partake in them.
They might take a longer time to get that skill like riding a bike or just navigating their environment with ease.
Walking might be a little bit difficult.
They might take a longer time to walk as a baby or an infant or even a toddler.
The vision gives us feedback on our surrounding and how much space we take up and that reinforces that visual information.
It reinforces the proprioception sense in our own bodies.
Another area affected by poor visual processing is depth perception.
This goes into like when we’re walking up and down stairs, uneven terrain, stepping off of a curb, riding a bike.
Those are all areas where we need that depth perception, that quality of visual processing to tell us how far something is, how much pressure we need to put down, to maybe lift our body up the stairs or down the stairs, even getting on and off the couch or on and off the bed.
Those are all things that require depth perception.
Even smaller tasks like if your sink is white and your soap bar is white, where is that soap bar if it falls into the sink?
So that depth perception can really throw kids off, especially if they’re learning like at school, like if the desk is white and the paper is white, and if they don’t have that high contrast, that depth perception sense is very important.
With poor visual processing skills, you might also see nystagmus, especially with children that have neurological and neuromuscular condition, and nystagmus is an involuntary, often jerking movement of the eyes when they are overstimulated, and so we’ll talk more about how to help that.
But the last thing I wanted to mention was visual processing skills also work hand-in-hand with the vestibular system, and so I talked a little bit about this earlier that I like to assess and treat both at the same time, but the visual system is constantly processing information for the brain as we move through space, so we feel regulated and adjusted instead of dizzy.
And when the visual system is not coordinated with the vestibular system, we often see children with a dysregulated vestibular sense.
They avoid movement they can’t control, and they may even act out or maybe overreact to some people.
They might perceive it as overreacting if they’re pushed on a swing or pushed down a slide without them asking for that.
And so, yeah, it’s just really interesting how that visual system, it doesn’t act alone, just like the other senses.
It very much works in sync with the proprioception, the vestibular and probably other ones too.
So the vestibular system, it says, we’re moving forward and the eyes respond by saying, I see the world moving past us.
So they’re constantly hand in hand.
The vestibular might say, we’re tilting our head and the visual system is going to respond, let me adjust the picture so it stays upright.
And then the vestibular says, we’re spinning and the visual system is going to respond, okay, it’s time to help me focus my eyes.
And so they’re constantly helping one another keep that child or that person in homeostasis where they’re not dizzy, they’re regulated and they’re able to learn and move through their day.
So that’s kind of that cognitive and motor learning piece.
It’s a really good example of like how the vestibular system is processing one thing and our vision system is literally sending a different message.
It can be when they don’t get along, when there’s an imbalance.
That’s when we feel that car sickness or motion sickness or whatever that we can experience.
As adults, children also experience that too.
And I like how you give that like clear delineation of one message versus the other message.
And they’re trying sometimes to help each other.
Oh, yeah, for sure.
And that’s where the breakdown kind of happens.
I’ve heard somebody say before that these vestibular ocular and ocular vestibular reflexes are like, you’re watching a movie and the camera operator is not on one of those smooth tracks.
Like, we are constantly walking and so our vision is bobbing and things like that.
But our brain is trying to process it as a smooth film.
And so these reflexes have to work together.
These systems have to work together so that it’s a smooth cinematic journey versus choppy and like a home video program.
Yes, that’s a, yeah, I’m glad you brought that up, the vestibular ocular reflex and that’s really what that is.
It’s those two working in sync and so.
And it’s, it can get confusing, like trying to understand, but that was a perfect, your example is perfect for that.
Thank you.
What about speech and language?
Yeah, this is how vision works with speech and language and feeding.
Yeah.
So some of these are kind of obvious, but then some of them are pieces that I learned along the way.
And have, they make a little bit more sense once you think about it.
So our babies start to learn how to produce sounds in their native language.
And there’s a lot of different varying research and beliefs, but a baby born in any environment, no matter where they are in the world, has the ability to speak just about any language.
Like we’re not predisposed.
It’s what we are surrounded by.
So that’s what makes our native language, what our parents speak, what we are exposed to.
And as soon as babies develop that visual, I guess, accommodation and they’re tracking, and mom or dad is holding baby just, you know, a few inches or, you know, a foot from their face, and they’re making faces, and baby imitates starting to stick their tongue out, and mom smiles, and so baby smiles.
We’ve all seen this example of, like, how this vision visual imitations starts, and that’s how we start learning how to talk, how to produce certain sounds that are native to our dialect or in our language.
And so, vision is that key factor that turns on immediately, and when there is something going on with vision, that doesn’t get to happen so smoothly.
You’re also starting to see that bonding start to happen between the parent and the baby, because if I’m watching somebody produce facial expressions and I mirror those expressions, it becomes endearing, and it’s like we’re on the same page, and so all these warm fuzzies start to be produced.
Vision is also important, as the brain has to coordinate what it sees and what it hears.
So this is an example of how your auditory and visual systems have to work together, so that, again, if you’re watching a movie, if the sound is off and it’s not matching the movements of the actor’s mouth, you can tell when those don’t line up, and it’s kind of hard.
It’s hard to focus.
People are like, oh, this is annoying, but that can be sometimes people’s reality.
When babies begin to visual track, they, as toddlers, they can notice what we’re pointing to or what we’re looking at, even across the room.
That’s when joint attention is turned on.
So like if I’m sitting and we’re playing on a rug, and I may point to a ball that’s rolled away, and I’ll say, oh yeah, let’s grab the ball, and I might even sign for a ball, and I’ll point to it, and I may even lean towards it, because I’m wanting to teach a child that thing I’m talking about is a ball, and I want you to look at it, maybe even move over there and grab it.
This is how our kiddos start learning and associating words with objects, actions, even people.
So, you know, dada.
Look, dada is in the room.
Hi, dada.
And we have that joint attention happening.
Vision is important.
You touched on it, Franchesca.
Symbolic understanding is what we need to use for language comprehension and reading.
So all that means is that we’re looking at gestures.
In a certain language, we have gestures, so we wave.
We have gestures that we show when we’re upset.
We have agreed-upon actions that mean things.
Then we have signs.
So stop signs, yield signs, signs that tell pedestrians, you know, things, and then drivers, different things.
Then we have printed words.
These are all things that visually we have to be taking in and understanding their meaning.
We will rely heavily on our vision for social communication because we always give visual cues like facial expressions, body language, eye contact.
And if we’re missing those cues, we’re missing a lot of what’s being said or not being said.
So if I’m being very sarcastic and I’m like, oh, it’s a wonderful day, and I roll my eyes, you know, you have to be able to take in all that information to really understand that what my message is, is not what it really is.
Babies, when they’re learning how to eat, they rely on vision because they watch us and they try to copy us.
I think we’ve all seen the videos or maybe been that parent who, like, we show a baby like, oh, I’m eating a lemon, it’s delicious, this is wonderful.
And we try to get them to want to eat it too, because we know what’s going to happen.
And they’re watching us and they’re like, wow, you’re really selling me on that.
And so then we give them a lemon wedge and they’re like, how dare you, this is horrible.
So they’re watching us and they’re trying to learn from us.
Again, if there’s a vision issue from a birth injury or developmental issue, that’s not there.
And they’re having to rely on different sensory systems to learn how to eat.
Self-feeding requires that we have that visual spatial processing to figure out how do we get food on a utensil up to our mouth.
Sometimes when I’m working with kiddos and that is a continuing issue that comes up, sometimes we will even just take our hands out of the equation and we will just put our face down close to the table or the plate because it’s easier to modulate maybe how close our mouth is to the food.
And yes, we look like an animal eating from a trunk.
But you know what?
Sometimes if that fosters exploration and curiosity, you know, so be it.
And then a lot of kids rely heavily on their vision.
If they are picky or have restricted feeding practices, the reason why a lot of kids really like packaged foods that are commercially processed and things like that, they always look the same.
Until they don’t.
Some companies, like, will decide we’re going to be new and improved.
We’re going to change the way it looks, the color of it.
Or maybe it doesn’t have the same kind of cheese dust on it anymore.
And those children who have used their visual system, their visual processing to kind of be their crutch, so to speak, like, they will give up a whole food.
Like, they will stop eating certain foods if they look different.
Well, of course, when we make food at home, like, my green beans, fringe cut green beans, are not probably going to look the same every time.
Sometimes they’re going to be over sautéed, and they’re going to be kind of limp and sad looking.
Well, sometimes they may be fresh and crisp, and very bright green, and there’s not much I can do to control how they look.
And so that can be a big factor for kiddos who are considered, like I said, picky eaters.
I have feelings about that label, but that’s not there.
That is a good point.
I never really thought of that.
They like their everything the same all the time because they don’t like surprises.
What’s the word for it?
They like consistency.
They don’t like spontaneity.
And that’s what a lot of big processing like Nabisco and Kellogg’s, all these companies, they really are able to consistently produce things the same way until, like I said, they choose to change it up a little bit.
Some of our little friends are like, no way you can’t pay me to eat it.
It doesn’t look the same.
They can tell.
And sometimes you say, oh, well, then I’ll just take it out of the packaging is changed.
I’ll just present it to them outside of the package.
They know.
They know.
So, Franchesca, what are some strategies that you have found to help children with these visual processing issues in the home and outside of the home?
Like what can be done?
Well, yeah, so there’s a few specialists.
I like to start there because it’s good to get just a baseline.
All the information that we give parents, it’s just information, but it is good to seek out a professional who can evaluate and give you some real life strategies.
So some professionals that you could seek out as an OT, they do visual processing evaluations or developmental optometrist.
And that’s where I decided to take my own son to weed out what was going on with his reading in second grade.
And they were phenomenal, phenomenal.
I cannot recommend developmental optometrist enough, even though I am an OT at the time I was not an OT.
But other specialists who can also help with visual skills are orientation and mobility.
And usually children can get them through the school system as well as vision teachers through the school system.
So I think with an IEP, maybe a 504 plan, at least in the state of Texas, you should have access to orientation and mobility and vision teachers.
Let’s talk about some strategies at home though.
Like, let’s say we know there’s visual processing issues.
What are some strategies at home that you know about?
So I’ve seen a lot of infant toys.
We’ve seen the ones that are black and white, high contrast.
They seem boring when you first look at them, but then if you kind of look at the science behind it, that high contrast is needed to help develop these, our little babies’ sense of vision.
Not all their toys have to be like that their whole life.
There’s a market for like the beige toy.
I don’t know movement.
Yeah, later once their vision is improved and they can see more colors and variations, we can start giving them those really bright colorful toys.
But also you’ll see a lot of times like red, blue, yellow, I think are some of the accent colors.
And then a lot of them have patterns, which I really like.
I’m a pattern person.
And so all the different contrasts that they use, I think is really cool.
The next one kind of goes along with it, which is like just keeping things simple and uncluttered.
And so like if you’re working with a child, you want to take into account what is behind the visual thing that you’re trying to work with.
So if you’re trying to work on, let’s say, buttoning a shirt or a puzzle, what’s behind the puzzle?
What’s in front of the child?
Is it a window with lots of distractions?
Is there a lot of sunlight coming in?
Are there people coming back and forth in the background?
Because you may be able to filter out as their parent or teacher or caregiver that background noise, so to speak.
But visually, everything is on the forefront if there’s a true visual processing deficit or delay.
So we want to minimize those distractions, those visual distractions, and even taking into account the other stimuli, the auditory things and the tactile things that might be going on on the floor with their feet on the chair.
So just reducing that noise for them to help them to concentrate on that visual thing that we want them to work on.
Yeah, even sometimes I’ve heard of kiddos who have super hyperacuity.
Just having sunlight stream in and you can kind of sometimes see like the just fuzz or like lint, like whatever dust is in the air and sometimes that can even get in the way and make things really hard for kids to visually process, which is like that blows my mind.
Yes.
We want to make sure that we give kids extra time and that can be tricky in some academic settings when they’re standardize practices, but when we can give kids time to slow down and let their eyes take the time to process what it needs.
I think it’s really hard for me sometimes as an adult to slow down and give the child enough time because it’s, you know, it’s easier and we have to get more of this done.
And do, do, do, do.
Well, even like if you have a 50-minute session and you know the child needs a regular time or an extended time to do an activity, you feel a little guilty giving this one activity this much time, but that might be what they need to get more efficient and better at it.
So that’s a good point.
Also using other senses that are stronger, like touch, sound, auditory or movement to support what they see.
So let’s say they may have poor or low vision or poor visual processing, but we know that they can hear really well, or maybe they like movement.
You can pair an auditory thing with that visual stimuli to help strengthen the weaker sense, which is their visual processing.
So you’re going to pair something strong with something weak because we know what wires together fires together.
And so we’re using that neuroplasticity quality to help that child improve their visual processing sense.
Yeah, and then also just giving a child a visual break.
So anytime I’m working on visual tracking in STNR or anything that can be taxing, I’ll have them pause and do silly blinks or something and I’ll model for them to like squish their eyes closed and then slowly open them.
Something just to model, you know, because some kiddos don’t even really know how to close their eyes.
Some kids get scared if we put our hands, my hands over their eyes.
Maybe sometimes we model it for them and just a lot of times in my workroom, I might not even have the overhead lights on.
Maybe I’m using light streaming in through the windows.
We have nice kinds of blinds that we can really control how much lights come in.
Sometimes if we’re looking at a child becoming hyper stimulated by a visual, removing it completely, so like it going night night or something, I don’t know, like in it leaving their field of vision just so that they can regroup and collect themselves, I guess.
Yeah.
Because even though we’re seeing excitement, that is one of our things that we want to look for.
We want to make sure that we are not reaching that hyper excitation.
Yeah.
Then also remembering that our visual system has a total of 12 muscles that control all these tiny ocular movements, and a muscle is a muscle anywhere in the body.
It can become fatigued.
Yeah.
I can remember getting glasses whenever I was in third or fourth grade because we were doing a lot of accelerated reading program things and reading small print on pages.
My vision was quote unquote good, but my continuous movement from, what do we read, left to right?
Yeah.
Doing it over and over and over fatigued my eyes a lot, and so they gave me readers at a very young age to really strengthen.
Yeah, they were not cute.
But yeah, I now know that reading puts me to sleep because again, that constant movement puts me to sleep and so audio books are, if I’m wanting to read for knowledge, I will get it on audio book because that’s my stronger processing system.
I go to sleep, I try to stay awake and read and I cannot.
It just puts me to sleep.
It could be the best book and I may try to stay up and read more chapters, but most of the time, yeah, it just fatigues my eyes and so I have to take a nap, I fall asleep, go to sleep.
The last one is just to repeat.
Repetition is key when it comes to anything that we’re trying to teach a child.
And just to remember that the visual system is wired by the brain and with repetition, the visual system can be strengthened through neuroplasticity.
Keep your routine for visual processing simple and consistent and you will see results.
Lots of repetition.
And like you said, it’s kind of hard to, whenever you have to slow down and you want to get lots of repeated exposure, it’s got to be, you’re doing better to have good exposure versus I guess not.
Like just rushing stuff.
That’s one of the things I try to tell parents a lot.
And I tell myself that too, a lot.
Less is more, right?
Less is more, yeah.
So let’s talk a little bit about, we always do some research and kind of talk about what’s out there, what do we know about visual processing for children.
And a recent systematic review that was done in 2022, which always makes me happy and excited to read about newer research.
Yes.
That’s in, you know, closer to this year in time.
So this review included 10 articles that found a link between sensory processing and motor coordination difficulties in children with specific developmental coordination disorder, or DCD.
All of the studies indicated a significant, significantly lower visual integration process with this DCD diagnosis.
When comparing the level of sensory processing in six areas of the children, so looking at six specific areas, maybe on their tests, on the battery of tests that they gave.
As a result, it was concluded that sensory processing was recommended for children with DCD, and we’ll have a link to that research article in our show notes.
I think it’s really good when a systematic review is published that finds this clear indication that gives us research that supports that we need to look at the visual system in children with developmental coordination disorder.
Yes, I think that that would maybe be one of the lesser common areas for even, you know, therapists that are treating the children to even look at.
And so I’m really, I was really happy to see that in a systematic review, like you said.
Yeah, it’s I think it’s because it’s just one of the sensory systems that is real, like we talked about, it’s really hard to quantify and to identify the differences.
I mean, so many of the kids that I work with, I don’t even realize that we’re not seeing something the same way until there’s a glaring, you know, example.
And so, yeah, I think that a lot of times, I mean, as a speech therapist, we, we, when we’re doing an assessment of a new kid that walks in, we always ask on the intake paperwork.
When was the last time they had their ears checked?
When was the last time the vision checked?
And parents usually will say, they’ll have a date and they’ll say it was fine.
And then we’ll just report that in our report and we’re like, check, check, all right, we took care of that.
Everything’s fine.
There’s no way any of this could be a factor for delaying speech and language or feeding issues.
Well, maybe, because I get older and do this for a long, longer.
I’ve learned along the way that maybe that’s not the case.
For sure.
For sure.
That makes me think of, they come in for, maybe they have a delay in crawling or walking or whatnot, and they favor one side and the parents telling me, well, they may have torticollis.
They had a little bit of this, a little bit of that.
And then you realize that there is that.
And it’s like the chicken and the egg, which came first.
Is it the middle processing that caused them to not be as coordinated on one side as the other, or is it the torticollis feed dot visual processing delay on that side?
Because I’ll have children that just are not aware of half of their visual field or a quarter of their visual field.
And so there’s just so many pieces to it.
And then it’s usually I have to spend a little bit more time with a child before I realize, okay, they’re either neglecting one side, or they’re just not aware of that side, or they’re using the peripheral vision for their central vision, and they don’t have any central vision.
And so there’s just so many pieces to it.
It is very refreshing to have newer research for sure.
Another study in 2021 was conducted with 20 children.
And the conclusion was that the vestibular ocular reflexes are commonly impaired with children, with cortical visual impairment.
And we talked a little bit about CVI, and we’d like to do a deeper dive on CVI.
I think it’s worth its own episode probably.
But consequently, these children may lack important visual compensatory mechanisms to stabilize their gaze during head movements.
And what does that mean?
That just means that they’re not going to be able to keep up with visual stimuli as they move through the world, and movement, sudden movement is going to be really scary.
Their eyes are not going to be able to keep up with the movement that they’re making or that they’re being pushed through.
And this will make movement more challenging or even aversive and even nauseating at times.
And this reinforces the understanding that the vestibular system and the visual system work in sync and rehabilitation in one should include the other.
So and we’ll include the link to this article as well.
So what are some final thoughts and takeaways from this episode?
So we want to really reiterate that vision is not just about eyesight.
It’s probably a small percentage of or a small part of the ratio.
The way we can see things is really just part of it.
It’s more about how we’re able to track, focus, turn our attention to certain stimuli, turn off attention to certain stimuli, process the depth that something is from me.
These are all huge pieces that should be considered more than just, is their vision good?
Yes, for sure.
It’s a lot more than just what we see.
Also, we discussed where vision happens in the occipital lobe, which is in the back of the brain right above her neck.
It’s the main visual center.
We also discussed how vision works.
What happens from the time that our eyes take in information?
Where does it travel?
What can and sometimes from what we see usually is happening, that’s incorrect.
For sure.
We also talked about some visual processing red flags, what to look for and how we know and what to test for whenever we’re looking at visual processing.
Specifically, in regards to development, we’ve looked at cognitive and developmental feeding, speech, language, body awareness, depth perception, how vision plays into all these areas and domains that our kids are working through.
Yes.
We discussed how the visual system works with the vestibular system for balance and for movement.
We went on to talk a little bit more about the speech and feeding aspect of where vision plays into imitation and learning from us as adults.
Sure.
We also shared some basic strategies that could help.
Yes.
Specifically, in regards to research, we were able to find that children with DCD have weaker visual integration systems, which means it needs to be a big flag for us to look at and not overlook.
Also, we know that children with CVI often have vestibular ocular reflex issues that we need to look at while we’re factoring in about their balance and eye stability.
So even I just had a thought of when we’re looking at using eye gaze devices and things like that, we need to take into account.
Yeah.
Their visual stability so that they can even be able to track across an eye gaze page on their talker.
Yes, and that affects their communication abilities, right?
Through their eyes.
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Please remember information provided on this podcast whether from the hosts, sponsors or guests is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment.
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