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NOTE/CLARIFICATION:
I said in my previous post that my first diagnosis was BPPV. The BPPV test that a vestibular rehab
therapist (VRT) does with goggles is NOT the same as what a Developmental (or
Behavioral) Optometrist (DO) does to check for functional vision problems (such as CI, Strabismus, etc.). The BPPV test does NOT show functional
problems. My experience has been that
DOs, who supervise VT (and the vision therapists that DO VT) have far more
experience and expertise regarding the wide spectrum of functional vision
problems than a VRT does. Finally, you
can have a functional disorder WITHOUT having nerve damage.
Some people have never heard of Feldenkrais Therapy (FT),
named for the man who invented it, or Vision Therapy (VT). Or
they've heard of them, but only by name.
Both of these therapies are appropriate for my diagnoses, and work well
for me. FT works far better for me than vestibular
rehab therapy did. I know that a number
of factors can impact what choices you make (i.e. money, insurance coverage,
etc), but hopefully sharing this info will be helpful for some. I also encourage you to Google videos and
articles - there's some good TED talks, etc. out there. One difference between FT and VT is that FT
is what I think of as a combo therapy.
Sometimes when I go, because of whatever has been going on, I'm more
focused on getting back to my baseline.
Other times, I can be challenged more to make progress.
So, with all of that stated, a little bit about VT. I saw a good TED talk recently in which the
doctor talked about eyes working as a team.
That is the basic goal: for my eyes to learn or relearn how to work
together. For example, how my vision is
involved in helping me keep my balance, because my balance comes from more than
my inner ear. I use, among other things,
various games, computer software programs, and orthoptic tools - some that look
ordinary and some not - to work on these tasks.
Sometimes I sit and sometimes I stand, or even move around a bit. I
always give Ann an update before we begin, and there's a fair amount of
discussion with Ann throughout the process.
Sometimes this is to answer my questions, and sometimes I talk about
other things so I don't get too fixated on the visual task. Sometimes concentrating is good, sometimes
it's over thinking, at least for me, which isn't helpful.
Now for FT. FT
involves movement and body awareness, sometimes done by Joyce, sometimes by me
under her guidance. 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. 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. During
the session, I tell her how something feels, or ask a question, but there is
less general conversation during my sessions with Joyce. At the end of a session, she usually asks me if
anything feels different, where my visual resting point is, and about my visual
horizon.
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.
I listened to an article my friend Michael sent me regarding how other
muscles get in on the act when eye muscles aren't doing their job. This is true; if one part of your body (eye
muscles) isn't doing its' job, your brain/body will involve something else. This is what compensating is all about. Unfortunately, the compensating isn't always
good in the long run. Regarding vision,
and therefore balance, this means that muscles work too hard, and often get
very tense and tight. This tension goes
in both directions because everything is connected: when my eye muscles don't work properly, it can
create tension in my jaw (which causes pain), OR muscles that tense up in my
shoulder or neck can cause tension in my eye muscles.
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. There is work that
Joyce does with me during my FT sessions that works on that level which I
really can't explain. But I do know
that I don't want to make things any harder, so muscle tension matters. 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 makes visual tasks
more difficult. Also, if my posture while
standing isn't good due to tension, this affects my ability to comfortably
maintain my balance, and affects my line of vision. In
addition to posture, muscle tension is, I think, a trigger for migraines; one
reason my migraines are better controlled, besides my diet, is because of my
FT.
Breathing is important for oxygen, obviously, and greatly
affects muscle tension, and thus balance.
Joyce talks to me a lot about,
and works with me on breathing, and Ann will sometimes remind me to breathe. I'm less likely to feel dizzy and/or
off-balance when I'm reasonably comfortable, and breathing well. When I am concentrating on doing something, I
may tense up, and not breathe well. I
don't always notice muscle tension before I feel really tight, even pain, but
I'm getting better at this. When I feel/notice
pain, I do three things:
1) Body check - what do I notice? Is there anything I want to change?,
2) Breathing - how am I breathing? Do I suddenly take a huge breath when I
pay
attention?
3) Do I need to get up and move around?
One more thing regarding muscle tension/pain: I have 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.
During a VT or FT session (or when I'm working at home),
I sometimes feel dizzy or off balance.
But whether it's part of a session, or on my own, it's OK. My exercises are, and continue to be,
titrated to me, and Joyce and Ann both know me and my body well. So I know I need to push through in order to
get better. I should add that this
"pushing through" ability on my part has increased as I've made
progress.
Glasses, something everyone is familiar with, are an
important tool for VT. There are a number
of kinds of glasses that are used. For
me, low level reading glasses and sunglasses are both tools. My reading glasses have a slightly blue tint,
my sunglasses a darker blue tint. The
tint color was something I gave a lot of consideration to, as well as the type
of frame. Neither of these
considerations are an unusual part of VT.
Even non prescription glasses change the way light (and thus images)
come into your eyes, so ANY glasses will affect your visual perception. There is also the distraction of the edges
(whether you wear rimless or not) of the lenses, and how your brain deals with
images as you move.
All of this comes
into play when I wear glasses for reading text or musical notes. I also have to practice wearing sunglasses; I
put them on and go outside, learning to navigate steps, and movement. Mobility is a multi-processing task. When I walk outside, there are a number of
elements that my brain needs to process as I move - some of this is inner ear,
some is sensory messages from my body, and some is visual - and it ALL gets
processed by my brain.
I do FT and VT exercises everyday now - being able to do
more on my own was a definite sign of progress - but FT and VT are also in a
sense incorporated into my day through all my activities. Doing a body check, breathing, writing this
article is all part of my rehab. The
specific exercises I do are a more focused way for me to make progress, and are
important, but it's really everything working together - exercises and
awareness as I move through my day - that makes it all work.
