https://visiblepersoninvisibleproblem.blogspot.com/2018/10/october-24th-2018-my-timeline-of.html

October 24th, 2018 My timeline of progress

I decided to do a timeline - an interesting cognitive exercise, as well as visual - Early Sept., 2011 - wake up to terrible VERTIGO ...

Archive for February 2016

February 28th 2016 About my Feldenkrais Therapy....

People hear about traditional vestibular rehab therapy - VRT - fairly frequently when there is discussion about non-surgical treatment.  You also hear about VRT as an alternative to medication.  VRT works well for some people, but not everyone.  I feel it's really important to find whatever treatment is a good fit for YOU.  Vestibular disorders tend to be very individual, so treatment is NOT one-size-fits-all. 

My MAV and CI caused, and can still cause, similar symptoms: dizziness and disequilibrium (being off balance).  When I got sick, I developed - as do many people - coping and compensating mechanisms.  Unfortunately, the compensating isn't always good in the long run.  Some of my compensating habits were obvious and conscious - like how I sat when I first got sick - but a lot of it happened on a neuromuscular level.  So I'm sharing some info about Feldenkrais Therapy - FT - since that's the therapy (in addition to VT) that works for me. 

I work with a certified OT, Joyce, who is trained as a Feldenkrais Practitioner.  The Feldenkrais that Joyce does with me works on the neuromuscular level I just mentioned, re-training neuromuscular habits.   I found out about her from a friend of mine; Feldenkrais was never mentioned by any of the doctors I saw.  This is unfortunate. I feel strongly that those who are suffering should be made aware of all treatment options, both traditional or conventional, and otherwise.  Patients should be given info and allowed to make the choice of what works best for them. NOTE: this is what I've learned and experience thru FT,  and is not meant to be a full neurological explanation of FT.

FT involves movement; I am in the process of relearning/retraining my body/brain how to do things with better balance.  I think that all the movements send new, good messages to my brain, and my brain absorbs it over time, and with repetition. Some FT movement is done by Joyce, sometimes by me under her guidance.  When people think of movement, they tend to think of large, or obvious movement: bending over, sitting down or getting up, walking, etc.  But movement can be very small.  Joyce often says that for therapy, small movements are better because you can notice things that are easy to miss with large movements.  I have found this to be true.  If you think that small movements aren't relevant, picture a set-up of dominoes.  One very slight touch to knock one over starts a whole chain reaction.  The same is true for your body - there is a domino effect all throughout your body when one thing moves.

Joyce works with me on a low, slightly padded table.  I either sit, or lie down, and sometimes at the end of a session I walk around a bit.  Just as with Ann, I give Joyce an update before we begin.  I talk about how to do things, how to be functional.  Joyce often reminds me of how everything in my body is connected.   She looks for basic things like how well I'm aligned, how I move (or don't move), how I'm holding myself .  During the session, I tell Joyce how something feels, or ask a question, but there is usually less general conversation during my sessions with her.  At the end of a session, she may ask if anything feels different, about my visual resting point, and horizon. 


FT is also about body awareness.  For me, part of this is muscle tension.  I want everything serving its' intended purpose. The key for muscles is to be holding, functioning, but not over-working and tight.  Muscle tension affects my posture while I'm looking at the computer, which can make visual tasks more difficult.  My posture while standing can also be impacted by tension, which can affect my ability to maintain my balance, and my line of vision.  Muscle tension is also, I think, a trigger for migraines; in addition to my diet, FT has helped control my migraines. 

Breathing is another element of body awareness: important for oxygen (brain function), and muscle tension, which impacts balance.  Joyce talks with me, and works with me re breathing, and Ann sometimes reminds me to breathe while I work.  When I'm concentrating on a task, I may tense up, and not breathe well.  I'm slowly improving at noticing muscle tension before I feel really tight, or even pain. I have also learned through FT that sometimes movement NEAR the source of pain rather than exactly where the pain is can be beneficial.  Because everything is connected, movement as low as your hips can produce movement in your jaw, and impacting the area less directly can be easier on your system.

Finally, a few tips I've learned:

1) Re breathing - do a body check, and think about how you're breathing and where there's tension - if I notice something, I make a change,

2) Try to sit gently, using your legs to help you,

3) Standing can also be done using your legs - I'm steadier if I pay attention to how I stand

4) Don't hurry; I'm more likely to miss something in my periphery or have some other problem if I start moving quickly.  We live in a fast paced world, but moving slowly, with purpose is really OK.

5) Lastly, a bit of sway is OK; it's actually more natural to let yourself have some movement, than to try to be completely static.  Obviously you don't want to fall down, but I find it's easier to stay balanced if I don't try to be totally still.  If I feel like I'm working too hard, I try to touch something, or find a place to sit down.

Book by Moshe Feldenkrais  http://www.barnesandnoble.com/w/awareness-through-movement-moshe-feldenkrais/1111726550?ean=9780062503220#productInfoTabs

http://www.feldenkrais.com/

Basic explanation of Feldenkrais - see Wikipedia link below - not the best explanation, but some interesting pictures... Though it says "it is not known if FT is safe or cost effective," I see no way it could be harmful... it is far less intrusive than surgery, and the movement is far more gentle than most PT.  Insurance coverage would depend on the company and policy you own.



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February 25th 2016 Listening using Google Translate...

I've mentioned Google Translate in posts, and always suggest to use it to listen if you can't read what I post (like me), so here's an explanation just in case you need it :-)

I only use Google Translate on my desktop.
1) open Google.com, put Translate into search bar, and click on Translate... this opens Google Translate...

2) When GT opens, you will see there will already be a microphone icon and keyboard icon in the lower left corner of the box on the left of the screen, copy and paste the text into this left box of GT... you'll see a translation appear on the right, but ignore that...

3) a speaker icon will show up in between the mic and keyboard... they are all small icons... a small speaker icon that shows up on the bottom left of the box after you paste in your text ...

4) you just click on that little speaker, and a voice will start reading the text to you...


I use it ALL the time.... in fact I listen to what I type/keyboard to make sure I don't post mistakes... :-)  Occasionally GT gets glitchy, but overall it works really well - I'd say 80% of what I find online I can listen to if I choose to.

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February 19th 2016 Vision is so much more than 20/20....

Many people think they understand eye sight, and vision.  Until I got my vision disorder diagnosis - over a year and a half after I got sick (and one year after my MAV diagnosis) - I thought I knew what I needed to know.  I had had 20/20 vision for much of my life, which I thought was pretty cool since my parents and brother all wore glasses.  I had just started wearing low level reading glasses.  I now know - two and a half years into vision therapy - that when it comes to vision, it's a case of not knowing what you don't know. 


Anyone who reads - or listens - to my blog knows it's really important to me that this changes, that vision becomes understood.  Vision is just too important.  Your eyes are pretty cool, but it's how the messages get processed in your brain that's really amazing.  People need to know that vision is about comprehension, it's about processing all kinds of visual stimuli, about tracking... it's about your brain processing, integrating everything so you can function. 


Being able to focus properly - the term 20/20 acuity that we've all heard - is important.  No one wants to look at a fuzzy world.  Eye disease also matters; having something physically wrong with your eyes is very important info.   Whether you have something that can be fixed (like a cataract), or a degenerative disease (such as Macular Degeneration), you need to know. 


Having 20/20 eye sight only means that if you look at the something at a distance of 20 feet with one of your eyes, you can see it clearly.  It does NOT mean that you can see it clearly with BOTH of your eyes (that's eye teaming), nor does it mean that you can handle eye gaze switches, meaning switching from 20 to ten, and back again. 


Having 20/20 eyesight doesn't mean you can turn your head, look at something in motion, and not have a problem, such as getting dizzy or off balance.  This may have to do with your VOR, which I posted an explanation of in my last piece. 

Everything listed below may be due to a functional vision problem:

1) headaches,

2) motion sickness (feeling dizzy and/or nauseas) - for example, on car rides or plane rides,

3) inability to watch a movie in 3D, or see anything that requires depth perception,

4) reading comprehension - if you have to read something multiple times before it makes sense to you,

5) your child takes so long to do homework, or avoids it,

6) have trouble with your balance, and get dizzy doing ordinary household tasks, or have a conversation with someone - particularly if you're standing up.

This actually doesn't cover everything, but you get the idea.  Vision matters.  It matters a great deal.


80 percent of learning is visual, and I don't think learning stops when you're out of school.  Think about how much of the world is visual, and think about how that info mixes, or gets integrated with other sensory systems, such as taste or smell.  If one piece of your system isn't working properly, your sensory system as a whole isn't really working properly.  This can impact your life in a wide variety of ways.


Neural ophthalmologists and neural optometrist sometimes can correctly diagnose functional vision problems; problems that have to do with the neurological functioning of your eyes.  However, the best doctor, in my opinion, to go to for a complete eye exam is a Developmental Optometrist. They have the training not only to understand disease, focal acuity, and neurology, but also the functional elements of vision.  Most of them supervise various kinds of treatment, such as vision therapy, work with special glasses, and more.  If you have a balance and/or comprehension problem, get yourself checked by a neurologist to see if you have a vestibular problem, but make sure you also get your vision checked - go to a qualified Developmental Optometrist for a complete exam.

To find a qualified developmental optometrist near you, check the College of Developmental Optometrists at www.covd.org.



For a neurologist who can diagnose a vestibular (inner ear) problem, go to the Vestibular Disorders Association site - www.vestibular.org.



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February 10th 2016 Pieces and parts of my neurological rehab....

To Listen: Cut and paste into Google Translate, click on the speak icon. 

My daughter Cara saw me doing a VT exercise once, and asked me "how much can doing an exercise for 20 seconds do,?" and "shouldn't I try to do it for longer?"  The short answers are "a lot," and "yes."  The long answer involves 1) correctly titrated exercises, 2) flexibility, 3) stamina, and 4) integration. 

My main focus here is my vision therapy (VT), but I will talk a bit in part four about my Feldenkrais Therapy (FT), which is also key towards my improvement.  My diagnosis is Convergence Insufficiency with an impaired VOR, but those two systems are complex, involving multiple skills. 

Part 1 Correctly titrated exercises, and flexibility

The goal of VT is to retrain the neurological messages going to and from my brain, in the complex system of vision.   Convergence Insufficiency, a term I've used a lot, means that your eyes don't converge (work as a team) well enough (sufficiently). Since my diagnosis is CI, my VT teaches my eye muscles to get into the correct position, to work correctly as a team.  Getting this coordination right is really important because I want the messages going to my brain from each eye to work together properly.  It's very confusing if the info my brain gets doesn't go together well, because then my comprehension and processing gets compromised.  My MAV makes me very sensitive to light and noise, so my exercises are not only titrated for my particular vision Dx, but also so that my sensory system as a whole does not get overloaded. 

Part 2 Flexibility

Flexibility is another word that people are familiar with, but this brings to mind being able to stretch really well; touching your toes, etc.  For me, flexibility is about being able to shift gears - for example, looking at something close up, and then far away, or converging my eyes muscles and then relaxing  or diverging them - without having a problem.  There are SO many eye gaze shifts that people do all the time without thinking about it, so building up flexibility to be able to shift without fatigue is really important.  Eye gaze shifting is just one example - there are many ways in which we need to be flexible with our vision.

Part 3 Stamina

Stamina is definitely important. If I want to read a page in a book, or a page of sheet music, my eyes have to converge for more than 20 seconds at a time.  One big difference for me between Vision Therapy, and a physical exercise like push-ups, is that I'm not trying to build up muscle strength.  It's not only the amount of time I do a particular exercise that builds stamina; repetition helps build stamina.  I think the better coordinated my eye muscles are, the more easily my muscles will get into the correct positions, and the longer I'll be able to sustain a particular activity.  In terms of how my exercises are structured, research has shown that doing frequent small bits of brain retraining is better than doing long stretches.  This is why even during a VT session with Ann, or an FT session with Joyce, I take short breaks as needed, and why I do a total of four mini sessions at home (doing both VT and FT) - rather than one long one - throughout my day.

Part 4 - Integration

Integration, a word used a lot in neurological rehab, is a key concept.   Integration is really about living, about being able to do things without having to think about every part of what you're doing.  If you can't integrate different sensory input, various activities, and thus aspects of your life, become compromised.  If you have to put too much attention into, for example, standing while you are loading a dishwasher, washing a pot at the sink or taking clothing out of a dryer, that's a problem.  Having the attention and energy for the other elements becomes difficult.  Integration comes up for me for more focal activities as well, due to my vision disorder.  If I have to spend too much effort on converging or diverging, there isn't a lot left for comprehension.  For example, integration allows for literal tracking a line of words or music, knowing where you are in space,  AND comprehension. 

In order to work on more than one thing, and thus integration, I do a variety of VT and FT exercises.   My FT is very important for integration work, to build up skills on a neural muscular level, to replace habits that don't function well for me with habits that DO.  Doing exercises myself, while Joyce guides me, is different than when she does more of the work - it's different brain processing.  Making subtle changes in how I do something is also an important way for my brain to learn, to be retrained.  I need - and am fortunate to be able to do - both therapies, to pull it all together.  Integrating all of the pieces and parts is really important. 

www.covd.org  College of Vision Development



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February 3rd 2016 Vestibulo-ocular Reflex - VOR, and functional vision problems....

I've noticed some confusion about the VOR, based on feedback I've gotten to my blog posts.  So I'm posting some info below which is one of the better explanations I've found online.... this is taken from the Encyclopedia Britannica:

Alternative title: VOR





Vestibulo-ocular reflex (VOR), eye movement that functions to stabilize gaze by countering movement of the head. In VOR the semicircular canals of the inner ear measure rotation of the head and provide a signal for the oculomotor nuclei of the brainstem, which innervate the eye muscles. The muscles counter-rotate the eyes in such a way that a rightward head rotation causes an equal leftward rotation of both eyes, with the result that gaze direction stays stationary.
VOR works in conjunction with the optokinetic reflex (OKR), which is a feedback mechanism that ensures that the eye moves in the same direction and at almost the same speed as an image. Together, VOR and OKR keep the image stationary on the retina, with VOR compensating for fast movements and OKR for slower ones.


You can see from this explanation that the VOR (in combination with the OKR) is very important.  This is the main element - to my knowledge - of vision for which your eyes and ears work together so completely. 


It IS possible to have balance problems that are not connected to vision, AND it's possible to have functional vision problems that impact your balance that are not connected to your ears.  For more info on vision, a good place to start is the College of Vision Development - www.covd.org - which is an international institute that provides special training for doctors (Developmental Optometrists), and vision therapists. 


As I've said before, ophthalmologists and optometrists get little to no training re functional vision problems, such as Convergence Insufficiency and Strabismus, two very common diagnoses.  If you think that there's ANY chance you have a problem that does not have to do with your ears, or an eye disease - get yourself checked!



Based on my experience, neural optometrists and neural ophthalmologists can sometimes give a correct diagnosis re functional vision problems, but do not have adequate knowledge re vision therapy.  Again, in my experience, they understand the neurology but not the functional, developmental aspects. 


They may recommend VT, but often don't supervise it.  This means that the necessary individualization and titration of exercises may not be on target.  Finally, as with any doctor, there are less qualified folks out there - if you don't like who you're working with, keep looking!


I'll be posting a blog in the future that discusses flexibility, integration and stamina in relation to neurological rehab....
UPDATE:  here's a link to that piece  - http://visiblepersoninvisibleproblem.blogspot.com/2016/02/february-10th-2016-pieces-and-parts-of.html

For vestibular info - www.vestibular.org


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