1. Vision problem  Definition  Ocular disease and disorder  Occupational therapy evaluation  Signs and symptoms of visual problem  Occupational therapy intervention  Effect of vision problem on…

2. The Eye – How sight occurs???

3. Definition: Visual impairment : loss or deficits in visual function (vision, visual perception; interpretation of visual input ) due to pathology or processing problem in one or more component of the visual system (structure of the eye, visual pathway, and the brain) that limits the individual ability to engage in participation in daily occupation.

4. Ocular disease and disorder ConditionAffected areacauseVisual affects Degenerative myopia Elongation of the eye; cornea steeply curved; stretching of the posterior of the eye. HeredityDecreased visual acuity in the distant things Photophobia; light sensitivity Down syndromeVarious parts of the eye heredity Chromosome no 21 Trisomy 21 Decreased visual acuity Retinal detachmentRetina separates from the back of the eye Numerous, including diabetes, Degenerative myopia Visual field loss, color defect Achromatopsia (total color blindness) Retina (cone malformation ) heredity Decreased visual acuity.. Visual fields are normal

5. conditionAffected areacauseVisual affect CataractsLens becomes cloudy and less transparent Heredity and agingblurred vision, nystagmus, decreased visual acuity, visual field is normal RubellaVarious parts of the eye Virus transmitted to the fetus by the mother during pregnancy Congenital glaucoma, congenital cataract, decreased visual acuity, and constriction of the visual fields HemianopsiaPosterior portion of the brain; optic tract Most common causes: stroke, brain tumor, trauma Central and/or peripheral visual fields in one or both eyes

6. Occupational therapy evaluation Occupational therapist focuses on …. Depending on the client’s age and needs:  Participation on play (especially children)  Self care  School occupation  Preparation for work

7. Occupational therapist evaluates  Performance skills that support or limit the client’s ability to engage in specific activities in the following areas:  Activity demand  Client factor  Context, in which the client performs these activities Occupational therapy evaluation

8. Data collection methods Occupational therapist can gather information about the child's temperament, self- regulation capacities, sensory processing, sensory modulation behavior & interaction with caregivers through: – skilled observation – parent or caregiver questionnaires

9. Signs and symptoms of visual problem CategorySigns and symptoms physicalEyes are not able to follow moving objects, eyes are not in alignment, blurred vision or double vision, sensitivity to light behavioralTurn or tilt head when looking at details, become tired after work, poor attention span, cover or close one eye when looking at details, excessive head movement PerformanceAppears clumsy, difficulty learning left and right, read slowly SocialLack of interest in the environment, anxiety, social isolation, decreased self confidence

10. Occupational therapy intervention Occupational therapist often provides service to achieve the following goals:  Develop self care skills: OT may consult with and educate those who work with the child visual impairment to identify skill levels and explain problems affecting the child's development of self care skills. -Modification and adaptation to the environment. Examples???

12.  Enhance the postural control and movement in space.. The child can use push toys, riding toys, etc.  Develop body awareness and spatial orientation.  Develop tactile- proprioceptive perceptual abilities, the child with visual impairment needs to maximize tactile discrimination abilities to learn about the features and properties of objects; to adjust grasp according to the size, shape, and weight….

13.  Improve manipulation and fine motor skill  Encourage acceptable behavior skill (be active NOT passive)  children with visual impairment are at disadvantage in asocial situation, particularly at school, where typical children are active and often participate in a variety of physical games.

14.  Strengthen cognitive skills, such as cause and effect, object recognition, and ability to match and sort.  Maximize use of functional vision  OT should always facilitate the child's use of whatever vision is available during intervention and every day activities. Dynavision technology (video)

15. Effect of vision problem on  Ocular motor control  Visual motor integration  Visual spatial relationship  Visual form constancy  visual figure ground discrimination  Visual closure  Visual memory_ sequential memory

16. Vision & ocular motor control What is it? Vision is the act or power of sensing with the eyes. The visual system is a neutral network that consists of two information-gathering device (the eye) which must co-ordinate effortlessly to obtain a single unified and clear image for transmission via the optic nerves to the visual cortex.

17. Conti… Why is it important ? Links bet. The ocular motor system & the tactile & proprioceptive system also provide accurate spatial information to allow correct and efficient body posturing and motor control. What are the implications?  Students with vision and ocular-motor problems may have difficulties with:  Visual stress (headaches; eye strain)  Discomfort with close work  Fatigues  Distractibility when work  Abnormal postures when reading or writing often with very short working distance

18. Conti…  Blurring and\or doubling of print – particularly when tired.  Poor copying, either from book to paper or from board to paper.  Poor reading comprehension or accuracy.  Handwriting – poor spacing.  Slow spilling.  Poor coordination in ball games, team games or in spatial awareness.

19. Remediation activities for ocular motor control :  Looking up, down, left and right with the eyes only and no head movement (10 times at the start of a lesson) to stimulate simple eye tracking.  Reading first and last letters on every line of a page of text or the first letter of every word to develop eye movement needed for reading.  Encourage pattern copying. Using increasingly complex shapes to develop visual analysis skills.  Word searcher, pattern games.  Experiment with different colored overlays to minimize visual stress.

20. Visual motor integration What is it? Visual motor integration is the degree to which visual perception and finger ـ hand movements are well co ـ ordinated in order to translate visual information into a motor response. Why is it important? It is the foundation for the development and refinement of handwriting and graphic skills.

21. Conti… What are the implications? Students with visual motor integration problems may have difficulties with:  handwriting and recording tasks although verbal skills are good.  copying either from book to paper or from board to paper.  graphics and drawing tasks.  spacing and staying on lines.  presentation of work, e.g. labelling diagrams and maps.

22. Conti… ـ inaccurate erasing of own work. ـ performing practical activities, e.g. using scissors or microscope, building models. ـ manipulating instruments. ـ Physical exercise, e.g. ball skills, team games, handy work.

23. Remediation activities for visual motor integration ـ origami, paper folding, craft activities. ـ copying drawing and locating grid positions. ـ find the shortest route on maps/maze. ـ tracing activities. ـ word searches.

24. Visual spatial relationships What are they? Visual spatial perception provides us with information about the position of two or more objects in relation to self and each another. Why is it important? Some students experience difficulty in appreciating and processing spatial information from their environment. Inadequate spatial perception has an impact on a student learning

25. Conti…. What are the implications ?  Student with visual spatial relationship problem may experience difficulties with:  Managing stairs, curves, etc.  Moving in space.  Learning left\right.  Reversing letters \ numbers.  Horizontal and vertical scanning.

26. Conti…. Remediation activities for visual spatial relationships:  Mazes, dot to dot, word searches.  Copying activities.  Drawing simple maps.  Reading grid references on maps using vertical and linear scanning.  Using 1 cm squared paper to draw lines from one point to another, gradually reducing the size of square.

27. Visual form constancy What is it ? Is the ability to recognize the fact that a shape remains the same despite changes in size, direction orientation and distance, Visual memory, figure ground skills and visual discrimination may all contribute to establishing form constancy. Why is it important ? It represents the ability of the individual to interpret the environment consistently and accurately regardless of changes in presentation of the information.

28. Conti….. What are the implications?  Student with visual form constancy problem may experience difficulties with:  Categorizing and classifying object\shapes\materials;  Sorting, especially when orientation and shape changes  Transferring from printed to cursive writing.  Copying from a book.

29. Conti… Remediation activates for visual form constancy :  Present the same word in many different styles, type, colors, fonts together with other word. Encourage student to underline the same word presented in many different forms.  Frequently demonstrate how horizontally presented material looks when presented vertically.  Use orientation of objects visual cue cards to identify objects seen from different angles. E.g. from above, behind, in front,

30. Visual figure ground discrimination What is it? Visual figure ground discrimination is the ability to identify relevant information from a background that contains irrelevant or distracting objects\image. Why is it important? It is the ability to screen out irrelevant visual material in order to concentrate on the important stimulus.

31. Conti… What are the implications?  Student with visual figure ground discrimination problem may experience difficulties with:  Attending to task.  Ignoring what is irrelevant.  Shifting attention appropriately.  Keeping place when reading, completing a worksheet or copying work from book or board.  Completing all sections in written assignments.

32. Conti…..  Remediation activities for visual figure ground discrimination :  Circling the same word in a text.  Word searches.  Puzzles.

33. Visual closure Definition: is the ability to see in the minds eye the whole of an object when part of it is hidden. Why is it important? It is a foundation skill for fluency and speed in reading and spilling. What are the implications? Student with visual closer problems may experience difficulties with :  Identifying a visual object from an incomplete or unclear representation.

34. Conti…  Putting parts together to form a whole.  Spilling pattern.  Mathematical calculation and multiplication tables.  Categorizing time and space. Remediation activities for visual closure:  Manipulating and rotating shapes\objects when discussing their properties.  Finishing incomplete pictures gradually reducing given prompts  Drawing a picture\shape\object then rotating it through 90 degrees – drawing it upside down highlight lower half,.  Transferring a design shape from one grid to another.

35. Visual memory\sequential memory Is the ability to remember what is seen and to recall visual images of objects, shapes, symbols and movement. It is the term used to describe how memory activity processes visual information from short- term recall into long-term store. Why is it important ? It is foundation of all learning and essential for accuracy in copying tasks.

36. Conti… What are the implications? Student with visual memory\sequential memory problem may experience difficulties with:  Remembering visual sequences and letter shapes.  Orientation of letters or numbers.  Organizing work.  Making note.  Remembering the sequence from a practical demonstration.

37. Conti…. Remediation activities for visual memory \ visual sequential memory  word searches\ find the differences.  Timed exercise copying from board to paper.

38. Games with children #visual discrimination Can you find 10 differences in these two pictures?

39. Visual Memory

40. Figure Ground How many horses in this picture?

41. Visual Closure Can you recognize the animals in the following picture, even though most of the lines in the picture have been removed? If you can, it means you have good visual closure skills!

43. Lab Exercise Split in groups Develop your own visual perceptual worksheets: – Visual form constancy – Visual sequential memory – Visual figure-ground – Visual closure – Visual spatial relations – Visual motor integration – Visual discrimination