Wednesday, August 28, 2013

Book Review: The woman who changed her brain - Barbara Arrowsmith Young

To give you an idea of how mind-bending this book is I will start out by telling you the following... Even though I sort of knew what to expect because of the references to this story given in the book 'The brain that changed itself' I read earlier and watching a TED talk given by author Barbara Arrowsmith Young, I continuously thought to myself 'this is so important! people need to know this! this can alter and save tons of lives!' while listening to this book. So after listening to the book once, I listened to it again, summarized and basically studied it.

Just as our brain shapes us, we can shape our brain. This book is about a woman who saved her own life doing 'just' that. This is all the more amazing if you know she did it in a time neuroplasticity wasn't even an established fact among neuroscientists. Through her own compelling autobiographic view along with many case studies the author describes a dozen neurological deficits, more commonly known as learning disabilities, and how to remediate them with cognitive exercise targeting a specific cortical area. By the looks of it, this book isn't much about vision. However when in a chapter on a deficit called 'motor sequencing deficit' (more on this later) people started describing how by fixing 'the mechanical aspect of reading and writing' they gained stereopsis I was completely sold. If you are familiar with Vision Therapy the exercise she devised doesn't so much impress, but rather the fact that they  'accidentally' acquired it while trying to improve other cognitive skills. Knowing that vision is a sensory and motor processing activity in the brain this makes sense, but you have to be made of stone not to be awed by how the human brain works.

Nowadays neuroplasticity is the latest buzz word but still there is a lot of resistance to change in the realm of education and health care to methods drawing on this idea. Even though we know better now, there is still a lot of neurological fatalism around because people don't know how to practically implement this principle. Sadly a paradigm shift does not happen overnight. Many educators are still telling parents learning deficits are lifelong and suggest compensatory methods rather than nipping the problem in the bud. Compensatory methods don't come close to the functionality of a cognitively repaired brain and just aren't realistic for day to day life. Depending on how severe the deficit(s) is even compensatory methods and unlimited amounts of effort will be of no avail. This will make for a lot of broken dreams and broken lives. Dysfunctional brain patterns won't go away as a child gets older unless addressed structurally through cognitive exercise. If not, they will lead to learning difficulties, job problems, depression, substance abuse, ...

I can relate to this on a personal level. Even though my neurological deficit or functional vision problem differs from the author's neurological deficits, many of the quotes and even life events in this book were familiar. A few piercing quotes:

I was clinging to a cliff by my finger nails and I was asking myself when will I fall and who will catch me? The answers were 'soon' and 'no one'.

I couldn't go forward. I couldn't go backward. There was no place for me in the world.

Many other citations from this book went straight to my heart and hit a home run. Yet in the interest of writing an informative and complete review I will attempt to give a brief overview of the neurological deficits described in this book rather than focusing on its emotional value.

1. Symbol relations problem: Difficulties with relations, abstractions, irony, jokes, grammar, figurative speech, considering alternatives, logic and reason. This results in an overwhelming feeling of uncertainty and problems in communicating thoughts and feelings leading to social isolation. Russian neurologist Luria called it semantic aphasia or a loss of meaning. The problem resides in important association areas of the cortex.
Exercise > Clock exercise
Improvement in this area means things start to make sense and one can connect the dots.

2. Symbolic thinking deficit: Weakness in the prefrontal cortex which is crucial to executive function and judgement. Difficulties with mental initiative, problem-solving, organisation, setting goals, foreseeing consequences, strategising and an inability to learn from past mistakes. A problem located in this 'recruiter of the brain' also means one easily gets distracted. A symbolic thinking deficit can be likened to an army without a general or a company without CEO. Someone with this deficit wants to be independent but is unable to and gets constantly into trouble by making bad decisions.
Exercise > Reading fables and extract meaning and morals/ Problem solving
Improvement in this area of the brain enables one to learn from his/her mistakes and to take initiative. Vital to get anywhere in life.

3. Predicative speech deficit: This deficit makes for a lot of mumbling and an inability to pronounce or write full sentences. Language beyond simple naming is not possible meaning poor or no syntax and consequently an inability to convey complex messages. This cortical weakness not only affects outward speech and writing but also internal speech and ultimately memory.
Exercise > Listening to slowed down speech
Changes will be improved spoken language, richer vocab and understanding. This in turns ends social isolation and makes for a happier and relaxed kid/person.

4. Artefactual thinking deficit (also dubbed 'social deficit'): This deficit finds its root in a weakness located in the right prefrontal cortex. It consists of an inability to read facial expressions and body language and to adjust own behavior accordingly. Someone with this deficit is impeded to learn 'the vocabulary of social movement'. Faulty interpretation of situations and acts leads to what is perceived as asocial behavior but the sufferer is simply unable to pick up social clues. To imagine living with this deficit the author proposes a trip to Japan without previous knowledge of the culture. The difference in social rules and interpretation will soon get you in trouble.
Exercise > Examining narrative art and extract meaning and social relevance. Exercise is similar to the one for symbolic thinking deficits which is also located in the prefrontal cortex but on the left side instead of the right side.

5. Object recognition deficit (prosopagnosia or face blindness is its most well-known form): This deficit includes not being able to recognize friends or family out of context. One might not be able recognize, even in context, the face of a familiar person or be able discriminate between unfamiliar faces. Sometimes someone with this deficit is not even able to distinguish a face from an object. In severe cases that person cannot even recognize himself in a mirror. Often this disability not only limits itself to faces but also to object and places.
Exercise > Find discriminating features of similar but different pictures.

Reading is a very complex process and many areas of the brain are involved in reading. Being able to read comfortably is not a luxury but without structural cognitive training, poor readers will remain poor readers. Based on her many years of experience and the neuroscientific material available the author has tried to determine which areas are critically involved in reading and what deficits they might produce. This quest has produced three main reading deficits which lead to poor reading performance.

6. A Broca area deficit: Impaired auditory speech discrimination and trouble connecting a symbol to a sound. Improvement will not only result in better reading but also better speech.
Exercise > Discriminate between phonemes and listen to sounds.

7. Symbol recognition deficit (word blindness): Difficulty with visually remembering sight words and a limited visual vocab library.
Exercise > Study Arab or Urdu. It's not about learning how to speak those languages but about remembering the shape of the symbols. This strengthens visual memory and makes reading English or the Latin alphabet comparatively easy.

8. Motor symbol sequencing:  An inability to smoothly track words and sentences with the eyes. This leads to a lot of misreading, being easily tired and quick loss of concentration. Weakness so powerful it can impair speech, spelling and signature. With this deficit speech often does not completely reflect ones thoughts. Those kids write slowly, sloppy and with poor spelling. Needless to say that for those people grades fail to reflect their intelligence.

"Of all learning disabilities treated by Arrowsmith, difficulties with the mechanical aspect of reading are most common and take longest to deal with."

Exercise > With intent to stimulate the left prefrontal motor region they always patch the left eye and focus on writing smoothly (motor skills). Doing this some people with a weaker right eye have acquired stereopsis which is magnificently described in the book. I do have some questions however about what she would suggest in cases of a weaker amblyopic left eye such as myself. But this exercise isn't so much about vision as it is about writing. Seemingly reading and speech just improved along with it. So it influences the visual 'only indirectly' unless you really have a lazy right eye. Regardless of my visual problems my own writing is pretty okay at that so it does make sense.  In the end I wasn't so much impressed with the exercise as with how clearly all those functions and vision are intertwined in the brain.

Personal note: I do have some reading difficulties of my own and clearly no two reading problems are the same. I liked this analytically view of how the brain reads and it confirmed a couple of things for me. It is pretty clear my reading problems are entirely originating from the mechanical aspect of reading. A Broca deficit makes it hard if not impossible to learn a second language so I can erase that from the list. Furthermore I think that symbol recognition is one of the ways I compensate for poor eye muscle control. I need relatively little visual information to recognize a written word, even upside down. So in a sense this is good news. If I keep improving my eye movements, I should be able to overcome this as so many others have. It was also affirming to see that of all deficits described in this book this one takes longest to deal with. The testimonials of this deficit were particularly familiar and poignant from my point of view. I would like give examples but this review will be way too long if I do.

9. Kinestetic deficit: Problems with the mental body map or proprioception meaning that you have trouble knowing where your body parts are in space without visually seeing them. This deficit may for instance also lead to a situation in which one feels pain at the left side of the body but has to visually search for its source. This deficit often causes uncoordinated body movements. In short, it puts you at odds with your own body.
Exercise > Stop visual compensation methods and execute precise movements with eyes closed relying on other sensory input.

10. Primary motor deficit: Interferes with the speed, strength and control of muscle movements. This deficit is more commonly known as low muscle tone.
Exercise > Fast and controlled transitions from one muscle position to another

11.Spatial awareness deficit: Excessively getting lost and an inability to creating mental maps or visualize three dimensional items or situations. This weakness may for instance make it hard to estimate when an approaching car will reach you. A strength in this area enables some Hockey players to mentally visualize the field of players from above and predict their  potential movements.
Exercise > Tracking exercise in a spatial configuration

12. Memory for information deficit: Memory is intricately linked to our identity and allows us to write our own autobiography so a deficit in this area is therefore especially painful. The sieve that is their memory has unusually 'big holes' leading to poor long term retention. In severe cases major life events cannot be remembered, oral instructions can barely be followed and making lists becomes essential to survival.
Exercise > Listen to songs until one can repeat the lyrics. Start out with very easy songs and gradually move on to more difficult lyrics.

13. Quantification deficit: Difficulty with time and numbers. Some people are for instance incapable of differentiating between 8, 80 and 800. Mental math and the relativity of numbers eludes people with a quantification deficit. This causes them to get in financial trouble, be chronically late and be bad at scheduling.
Exercise > Repeated and progressively more difficult mental calculation: addition and subtraction.

14. Auditory speech discrimination deficit: One isn't able to distinguish between similar words and has a hard time discriminating speech form other sounds. With this deficit listening to your own language becomes like listening to a foreign language. You can hear the sounds but it's hard and fatiguing to make sense of them.
Exercise > Listening to speech sounds in unfamiliar languages (Swahili, Kurdish, and Bengali, to name a few). This way listening to the sounds of your own language becomes relatively easy.

Keep in mind that the exercises are brought back to a customized level empowering the student to stimulate the impaired brain area without being overwhelmed. This makes it possible to gradually pursue normal functioning in that area or number of areas. The Arrowsmith program currently assesses and treats 19 deficits so not all of them were explained in the book. Even if they were, this list is not an exhaustive and can be further refined over the years. Nevertheless I am already sure this is the future of education. Aside from just providing content, education should be about making a brain susceptible to that content. Vision therapy is a great example of such cognitive interventions and so is the Arrowsmith program. Once you enable a student's brain to learn, that student will soar on his own.

The Arrowsmith program is increasingly implemented accross Canada and the United States and recently expanded to New Zealand. More information on and

Sunday, August 25, 2013

"The wife as family doctor" - A 1951 home guide to medicine on strabismus and double vision

Previously I blogged about my stereophile granddad on my mother's side and his stereo toys. But it turns out my grandmother on my father's side also had something in her possession indicating an alternate solution to my problem. She recently moved to an old people's home and we found this amazing book while clearing out her house. Don't feel bad for her by the way. She's much happier to be living with her homies and getting reacquainted with old friends who are already living there. The book we found is called 'The wife as family doctor' and was published in 1951. It counts a thousand pages and provides practical information on how to deal with countless child and women's diseases.

A book dedicated to women
A reviewed and improved publication

An overview of heath care and family medicine
Mainly concerning child and women's diseases, child birth, and child care

It's a Dutch translation of a book written by German doctor Anna Fischer (1856 - 1917) called 'Die Frau als hausärtzin' which was first published in 1901.  The use of language is archaic and I'm sure much of the information might be outdated. I was curious what it had to say about strabismus.

Strabismus: Deviation of the gaze meaning that one eye fixates on one point while the other eye is pointed in another direction. This condition can result from a shortened muscle or paralysis. In case of the former surgical intervention can force the deviating eye to follow the other eye in a normal fashion. One shall always consult a very good eye doctor in order to cure this marring ailment.
Given the time of writing and the general mind set of ophthalmologist this didn't surprise me. Then I leafed a bit further through the chapter on eye disease.

Double vision: Many eye sufferers are bothered by the fact that they perceive all objects in their vicinity as double. When light rays bouncing from an object reach the retina on different ... (see next picture)

locations, then different reactions will result from this and this is the cause of double vision. However, when one trains himself to see well and use both eyes simultaneously, and his sight gets used to this, if the brain has normal anatomy, then double vision is completely excluded. This defect very often coincides with strabismus, but can nonetheless be radically overcome by the execution of customized exercises. (literal translation)
This just made my skin crawl! This 1951 publication already mentioned some sort of visual training which has never been mentioned to me by any eye doctor! GOOSEBUMPS

Friday, August 16, 2013

Free anti-suppression Tetris

A while back I discovered an inspired programmer and blogger had tried to build an anti-suppression Vision Therapy tetris game. Upon finding it I was very excited and set out to try it with my red green anaglyph glasses. The game itself is a normal tetris game and I suppose the coloring had already been changed but it still wasn't suited for anti-suppression play because I could 'cheat' my way through the game using only one eye.

Before I'd also tried squinty Josh's anti-suppression solitair game. He applied the right colors in order to make his solitair game 'uncheatable', meaning that you are forced to use both eyes. So similarly I made the Tetris blocks look red and blue and made sure the background was black so you can't even cheat using the edges of the blocks. Of course, red green anaglyph glasses are required.

You can download the anti-suppression Tetris game with a plain black background here.

For some people the black background has proven to be stressful to start out with. Because of this a more tech-savvy VT friend  of mine named Aaron added a couple of sliders at the top enabling you to adjust the background color to alleviate frustrations a little and ease into the game.

You can download the anti-suppression Tetris game with adjustable background here.

It's definitely good anti-suppression practice. I'm still very insecure about positioning my blocks!

To keep things interesting and visually more challenging you might want to turn around your glasses every so often (or interchange the colors in the html file). That way the eyes switch color and the amblyopic eye takes on different roles within the game.

Demo video

PS: If you have enjoyed or benefited from this and other blog entries, consider supporting my work of proliferating Vision Therapy as a vital treatment option for amblyopia and strabismus by donating an amount as small as 5$. There's no better feeling in the world than knowing that your hard work is being appreciated. In addition, I can use some encouragement and financial support to do an even better job and get through my own visual rehabilitation.

Last but not least, share this article on your favorite social network and give it a +1 on Google if you think other parents and patients should be have access to this low cost vision therapy exercise.

Good luck in solving binocular vision problems!

Other articles you might like:
- Free anti-suppression Solitaire

Tuesday, August 13, 2013

Time to reset

By the end of the month I will have reached a total of a thousand days (2 years and eight months) of visual training and counting. I admit some days I am really getting anxious and impatient about wanting to see even the slightest bit of stereo. On the other hand I have to remind myself, aside from being twenty years behind on schedule, I'm pretty much on schedule given the circumstances under which I started out on this mission. Thinking back about how after the surgeries the angle of my visual axes uncontrollably varied while trying to track an object, about how I couldn't even hold a stable gaze so let alone align my eyes, about how I had double vision 24/7 and about how utterly hopeless the situation seemed my current state is already light years removed from that. More than one mountain has been moved to get to this point. According to my optometrist I have already exceeded his expectations various times but if you ask me this ain't over until it's over. Unless I've experienced some stereo vision, I haven't changed anything structurally.

Having read various case studies or success stories of people with similar histories it seems to me that 3 years is the period of time often quoted to overcome their affliction. Having come this far already this is actually good news. I'm going to try forget the fact that I've been doing this for a 1000 days now and take on the last stretch with the same boundless motivation I set out with. A lot of things have changed and happened during that time but it doesn't matter. As long as I can get the this thing done nothing is lost. After all, it must be right around the corner about now. No time to start diminishing efforts. Once more I'll be and remain Mr Pragmatism.

So I started rethinking my current visual situation. What remaining barriers are holding me back from acquiring stereo vision?
- My left, traditionally amblyopic, eye is still lacking a bit of speed in its movements to really be a swift part of the binocular team. Mind you, compared to my starting point a thousand days ago it's already quite supersonic but it's not sufficient yet. (Motor fusion)
- I am aware of both input streams coming from each individual eye but I don't feel they are reaching the same space in my head and add up. Subjectively I feel like the two input streams aren't merging yet although I can superimpose them by aligning my eyes. It's like trying to mix two distinctly coloured fluids but instead of getting a true mix of both colours (a new third colour), I just get an unstable ensemble of the two initial colours in one flask. Even though the input from my left eye is never completely absent, the overall impression while using red green anaglyph glasses is that the right eye is still quite dominant. (Binocular rivalry, no luster fusion, partial suppression, limited sensory fusion)

Notwithstanding the fact that I am to some extent binocular, there is still a power struggle going on between both eyes or more correctly stated the neurological setting behind them. I'd say my left eye counts for 30% of vision while the right eye takes on the other 70%. But what's worse, the left side of things (but the right hemisphere of the brain) isn't involved enough to have proper binocular summation. That's the core problem even after all this time. So I'm going to shake things up.

1. In a previous blog entry I once mentioned that I applied RYSER filters on my glasses to blur out vision coming from my right eye in order to put my amblyopic left eye in the drivers seat. That entry was a year ago. Back then, I couldn't sustain this kind of situation very long for several reasons. Long story short, I experienced it as too exhausting and hence destructive overall. Now however I think it might be the ideal tool to push me over the edge.

It's still pretty tiring but now I feel like it is, instead of destructive, very effective. It really forces my visual system to adapt and makes both eyes change roles. Important to note is that I do not occlude my right eye completely which would take away all binocular stimulation. This way of partial occlusion puts my normally dominant eye in a disadvantage making the left eye take the lead for a change while light is still entering both eyes.

It's important to note that they are not stickers. You can reuse them endlessly.

They stick to the glass just by wetting them and stay there.

2. I'm going to do another four weeks of intensive 30 to 40 minutes of syntonics a day. I've been doing it before and it accelerated my ocular movements among other things. I stopped doing it for a while because of diminishing effects and circumstances but I'm going to do a second round.

Along with my 'usual' VT routines this is going to be my renewed offensive the upcoming month. It's a little more 'aggressive' but I think it might pay off at this point in time.

Thursday, August 8, 2013

Visual Impediments to Learning: What's it going to be? Your health or your education?

Somehow I have always felt discriminated. I could never really put my finger on it but it seemed like the normal rules didn't apply to me. Things always were a little bit harder on me. Now it's totally obvious this was because of a motor and sensory brain issue. Of course, kids don't think about their brains. What is striking though is that over the years people have been jumping through all kinds of hoops to make things even harder on me. Parents, educational and medical system alike. Now, I have been fairly fortunate still. However hard it got, however frustrating, however cruel, I always clung to trying to learn and master new skills, even after the debilitating surgeries. This has saved me in the end but has come at a high price in terms of health. I graduated with a masters degree in Economics at the age of 21 and speak four languages but by the time I obtained enough English language skills to find out about Vision Therapy I was already well on my way to disability. At uni it's still fairly easy to hide the fact it is getting increasingly hard to function because of an eroding nervous system. I didn't hide it, but I didn't make a big thing out of it either. No wonder nobody understood the problem when my visual system had collapsed under the increasing study loads and consistent medical sabotage. Double vision? Visual learning disability? What?

The main problem with binocular vision problems and strabismus is that it forces you to make a choice between health and education. I'm pretty masochist so I chose for (some kind of) education at whatever cost. Basically, the current eye care system demands one to suffer through education with poor visual skills, requiring tremendous amounts of energy and stamina, and on the side out-study ophthalmologists after you discovered they haven't told you the whole truth by saying surgery is the only option.

Another nasty thing to consider is that poor vision screening methods used by most mainstream ophthalmologists CREATE the binocular issues in the first place. Hyperopia or farsightedness will not be detected using a Snellen eye chart at a distance of 10 meters. Because, guess what, farsighted people have no problem checking things out at long distance. The problem occurs at close distances where most learning and work happens in modern society. Not detecting and consequently not prescribing glasses for hyperopia puts binocular stress on the visual system often causing accommodative strabismus or it's less visible form called convergence insufficiency.

Click to enlarge infographic

This is a HUGE issue. This deprives a person of normal visual brain development and opportunities later in life. I have lived through this and I had theorized that this must be having great consequences for tons of people. So when I read Dr. Boulet's paper on 'Visual Impediments to Learning' and the immense impact poor detection of hyperopia has in terms of lowered socio economic success and heightened criminality and mental illness among those people, it was a very emotional experience. On the Vision Help blog Dr. Boulet formulated an equally poignant comment:

This (the proper detection and treatment of binocular vision issues) is not simply a matter of best practice, but is truly the balance between social equality and the maintenance of suppression of people and populations. The lack of initiative in this area is nothing less than another implicit form of Jim Crow. Disallowing children to participate fully in democracy by the vehicle of education is an unconscionable abuse of basic human rights and fully incompatible with fiscal conservatism (timely treatment would make for lowered tutoring costs, lowered health care costs, lowered social security costs and most importantly lowered opportunity costs for the person losing the chance to be included and contribute to society).

I hope you will read this 'must read' paper which only counts nine pages. If considered by policy makers, doctors and educators proper detection and treatment of hyperopia and binocular vision issues can make a tremendous difference in peoples lives. A link to a pdf version of the paper can be found here.

Another great study by Patrick Quaid showing the high corelation between uncorrected hyperopia and binocular vision issues and how these affect acadmic performance is this one. "Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls"

Related articles on this blog:
- Book Review: Suddenly Successful: How Behavioral Optometry Helps You Overcome Learning, Health and Behavioral Problems