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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
