Hi Hi Case Study Case Study � Why publish? Why publish? � � Where can I get Where can I get � the full paper? the full paper? � History, History, � symptoms, initial symptoms, initial assessment. assessment. � THE RESULTS. THE RESULTS. � Improvements in Performance Improvements in Performance Poster, Paper – Poster, Paper – email email candahurstoptics@aol.com candahurstoptics@aol.com following Optometric Vision following Optometric Vision Therapy in a child with Dyspraxia Therapy in a child with Dyspraxia Hurst, Caroline M. F., Hurst, Caroline M. F., Van de Weyer, Sarah, Van de Weyer, Sarah, Smith, Claire & Smith, Claire & Adler, Paul M. (2006) Adler, Paul M. (2006) Ophth Ophth. and Phys. Opt. . and Phys. Opt. 26 26 (2), (2), 199- -210. 210. 199 1
O.T. Referral – O.T. Referral – Subtle dyspraxia Subtle dyspraxia Praxis Praxis � Means Means ‘ ‘action based on will action based on will’ ’. . � Poor Poor proprioception proprioception, , � � � From the Greek meaning, doing, acting, From the Greek meaning, doing, acting, � � Delayed bilateral Delayed bilateral deed and practice. deed and practice. � integration, integration, � Poor visual Poor visual � Primarily the planning of a motor act. Primarily the planning of a motor act. � � perception. perception. � Requires knowledge of action and objects, Requires knowledge of action and objects, � plus motivation and intent on the part of plus motivation and intent on the part of the person. the person. Dyspraxia Dyspraxia Apraxia Apraxia � Motor planning defects that are Motor planning defects that are � developmental rather than acquired. developmental rather than acquired. � An inability to perform An inability to perform � a learned action, or a learned action, or � An impeded ability to An impeded ability to � learn a new action, learn a new action, in the absence of in the absence of paralysis, sensory loss paralysis, sensory loss or disturbance of or disturbance of muscle tone. muscle tone. 2
Skill Difficulties in Dyspraxia Skill Difficulties in Dyspraxia Skill Difficulties in Dyspraxia Skill Difficulties in Dyspraxia � Difficulties in manipulative skills e.g. writing Difficulties in manipulative skills e.g. writing � A continued misjudgement of distance and A continued misjudgement of distance and � copying, drawing, dressing and eating, copying, drawing, dressing and eating, � time e.g. bumping into objects / people, time e.g. bumping into objects / people, failing to catch balls etc, failing to catch balls etc, � Slow reaction times, and inefficient, poorly Slow reaction times, and inefficient, poorly � timed movements lacking rhythm, timed movements lacking rhythm, � An inability to co An inability to co- -ordinate complex ordinate complex � movements for sports e.g. running, kicking, movements for sports e.g. running, kicking, � Poor physical fitness, and are often less Poor physical fitness, and are often less � catching and throwing, catching and throwing, physically active, physically active, � Poor balance and postural control, Poor balance and postural control, � Poor fitness can prevent optimal Poor fitness can prevent optimal � � performance and can compound movement performance and can compound movement difficulties. difficulties. � Low self esteem and confidence. Low self esteem and confidence. � Sam’ Sam ’s difficulties s difficulties Sam Sam’ ’s difficulties s difficulties � Losing his place when reading, especially in the Losing his place when reading, especially in the � Copying from the board Copying from the board � � middle of the line. middle of the line. � Sequencing days, months, alphabet and Sequencing days, months, alphabet and � � His handwriting, with poor use of the line, letter His handwriting, with poor use of the line, letter � can’ can ’t do multiplication tables. t do multiplication tables. crowding, and frequent reversals. crowding, and frequent reversals. � Unable to use graph paper. Unable to use graph paper. � � Spellings are both difficult to learn, and to Spellings are both difficult to learn, and to � use when writing. use when writing. 3
Initial Assessment Initial Assessment Initial Assessment Initial Assessment Convergence – – near pt near pt 10 cm Convergence 10 cm effort needed effort needed Effort ++ Effort ++ Fusional Reserves Blur/Break/Recovery Fusional Reserves Blur/Break/Recovery Accommodation Accommodation Distance – Distance – base in base in - / 6 - / 6 Δ Δ / 4 / 4 Δ Δ - amplitude amplitude R 10, L 10, Bin 10cm - R 10, L 10, Bin 10cm Distance – Distance – base out base out - / 4 - / 4 Δ Δ / 2 / 2 Δ Δ - facility facility R 9, L 9, Bin 7 7½ ½ cpm cpm - R 9, L 9, Bin Near – – base in base in - / 15 / 15 Δ Δ / 12 / 12 Δ AC/A AC/A +1.00 on 7 +1.00 on 7 ∆ ∆ /DS /DS Near - Δ +1.00 off 5 5 ∆ ∆ /DS /DS +1.00 off Near – – base out base out - / 8 / 8 Δ Δ / 6 / 6 Δ Near - Δ -1.00 on 1.00 on 4 4 ∆ ∆ /DS /DS - -1.00 off - 1.00 off 2 2 ∆ ∆ /DS /DS Initial Assessment- - Maples + DEM Maples + DEM Initial Assessment Initial Assessment Initial Assessment Pursuits Ability Pursuits Ability 5 5 Accuracy Accuracy 1 1 Head Movement 1 Reading N5, age 6/7 6/7 Head Movement 1 Reading N5, age Body Movement Body Movement 1 1 (Maclure ( Maclure chart) chart) Saccades Ability 5 Saccades Ability 5 Physiological Physiological Poor Poor Accuracy Accuracy 1 1 Diplopia Diplopia Head Movement 1 Head Movement 1 Body Body Movement Movement 1 1 Brock String Brock String Not aware of where Not aware of where DEM DEM Vert Vert Perc Perc Rank Rank 25th 25th he is looking he is looking Horiz Perc Perc Rank Rank 25th Horiz 25th Ratio Ratio Perc Perc Rank Rank 40th 40th 4
Retained Primitive Reflexes can Retained Primitive Reflexes can interfere with:- - interfere with: � Control of gross and Control of gross and � fine motor skills fine motor skills including eye including eye movements. movements. � Kinaesthetic and Kinaesthetic and � proprioceptive proprioceptive senses. senses. � Timing, rhythm and Timing, rhythm and � the understanding of the understanding of space and time. space and time. � Vestibular integration. Vestibular integration. � � Visual perception. Visual perception. � Primitive Reflexes Primitive Reflexes Primitive Reflexes Primitive Reflexes Retained primitive Retained primitive The primitive reflexes involved with reflexes therapy – – The primitive reflexes involved with reflexes therapy a reflex inhibition a reflex inhibition visual development are :- visual development are : - programme of physical programme of physical � Moro Moro stereotyped stereotyped � movements, practised movements, practised � Tonic Labyrinthine Reflex (TLR) Tonic Labyrinthine Reflex (TLR) � each day, to give the each day, to give the � Spinal Galant Spinal Galant brain a ‘ brain a ‘second chance second chance’ ’ � to register the reflex to register the reflex � Asymmetric Tonic Neck Reflex Asymmetric Tonic Neck Reflex inhibitory movement inhibitory movement � (ATNR) (ATNR) patterns that should patterns that should have been made at the have been made at the � Symmetric Tonic Neck Reflex (STNR) Symmetric Tonic Neck Reflex (STNR) � appropriate stage of appropriate stage of development. development. ( Goddard 1996 ( Goddard 1996 ) ) 5
Retained Primitive Reflexes Retained Primitive Reflexes Primitive Reflex Inhibition and Primitive Reflex Inhibition and Integration Programme – – 3 months 3 months Integration Programme Initial Post Reflex Initial Post Reflex 13.12.02 13.12.02 18.9.02 18.9.02 Moro 0 0 Moro 0 0 TLR TLR 4 4 0 0 SG SG 1 1 0 0 ATNR ATNR 4 4 1 1 STNR 3 1 just STNR 3 1 just Optometric Vision Therapy Optometric Vision Therapy Optometric Results Optometric Results 8 months 8 months Fusional Fusional Initial Initial Post Reflex Post Reflex Final Final Reserves Reserves 18.9.02 18.9.02 13.12.02 13.12.02 15.8.03 15.8.03 Distance Distance - - / 6 / 6 Δ Δ / 4 / 4 Δ - - / 6 / 6 Δ Δ / 4 / 4 Δ - - / 12 / 12 Δ Δ / 10 / 10 Δ Δ Δ Δ Base in Base in Distance Distance - / 4 - / 4 Δ Δ / 2 / 2 Δ - / 15 - / 15 Δ Δ / 6 / 6 Δ - / 20 - / 20 Δ Δ / 15 / 15 Δ Δ Δ Δ Base out Base out Near Near - / 15 - / 15 Δ Δ / 12 / 12 Δ - / 15 - / 15 Δ Δ / 8 / 8 Δ - / 20 - / 20 Δ Δ / 15 / 15 Δ Δ Δ Δ Base in Base in Near Near - - / 8 / 8 Δ Δ / 6 / 6 Δ - / 20 - / 20 Δ Δ / 15 / 15 Δ - - / 25 / 25 Δ Δ / 20 / 20 Δ Δ Δ Δ Base out Base out 6
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