Sunday, December 8, 2013

Vision Therapy Loading

'Loading' is a term used in Vision Therapy meaning the unconscious application of visual skills consciously acquired during therapy while doing other activities. The idea is to not only be able to point your eyes at the same place at the same time but also be able to do it by default in daily life. In other words, integrate visual skills that so many take for granted but that strabismics have mastered only after x amount of training. Personally it took me one year and eight months just to align my eyes in a rested position and now another year and four months later I can increasingly accomplish this feat also while moving and doing things. However long it took, it's exciting. Tracking cars while walking, tracking birds, being able to sit through an evening and make saccades from face to face without having them go double or being completely exhausted afterwards and so on. This is just the beginning!

Needless to say I wasn't in great shape when I started VT because of a number of reasons I won't go into right now. At the age of 21, I was completely burned out, fighting a serious infection I still haven't gotten completely rid of, etc... So in case anyone was wondering, if not handled right strabismus has the potential to grow into a 'full blown' brain injury even though no one in your environment might realize or accept it. That's the dangerous part. Managing other people in this situation took up all my time and energy which wasn't particularly helpful. I had to rest a lot after going in the red for a very long time and ever since 'energy management' has been an important factor in my VT. I'm still not at a normal 24 year old functional level but it's getting better. Dealing with all the exterior and interior constraints, I have found a way to live my life allowing me to recover my vision which isn't evident at all. You have to be patient with people even though they are hurting you, sometimes without knowing it. Fortunately the storm died down over time. My life consists of rest, visual and physical training and productive activities like there are writing this blog. As time goes by the portion dedicated to resting is slowly declining and time to work is increasing. Later on in the process, work and visual training will start overlapping and then I will be in 'the safe zone'. Workable vision will allow me to gain more independence so I won't have to rely on other people to do the right thing.

Using these hard earned new visual skills and keeping in mind energy management, I've been able to enjoy some good vision  therapy loading activities. It has to be noted that this is written by someone with compromised suppression of his strabismic eye and suppression is even less when I move around. This is relevant because strabismics who are master-suppressors have a hard time knowing whether they are using both eyes while doing activities like these. I generally know when I am using both eyes and I'll explain you why later. If a master-suppressor teaches himself to switch off his suppression more easily, he can do these activities with red green anaglyph glasses as a control to make sure he is using both eyes. I know it might sound weird but I'm way passed shame and I have made public appearances with those anaglyph glasses. You gotta own your issues, I say!

- Running:
To better understand how running might be good vision therapy loading I want to cite one more extract from the book 'The story of the human body'.
Unlike walking, running is a jolting gait that causes your head to jerk around rapidly enough to blur your vision if unchecked. To appreciate this problem, watch a runner with a ponytail: the forces acting on the head oscillate the ponytail in a figure-eight motion with each step even as the head remains fairly still— evidence of unseen stabilizing mechanisms at work. Since humans have short necks that attach to the center of the skull base, we cannot flex and extend our necks to stabilize the head as quadrupeds do. Instead, we evolved a novel set of mechanisms to keep our gaze steady. One of these adaptations is enlarged sensory organs of balance, the semicircular canals of the inner ear. These canals function like gyroscopes, sensing how fast the head pitches, rolls, and yaws and then triggering reflexes that cause the eye and neck muscles to counter those movements (even when your eyes are closed). Since bigger semicircular canals are more sensitive, animals like dogs and rabbits whose heads encounter lots of jiggling tend to have larger semicircular canals than more sedentary animals. Fortunately, the skull preserves these canals’ dimensions, so we know that they evolved to be much larger relative to body size in H. erectus and modern humans than in apes and australopiths. One more special adaptation for damping your head’s jiggling motions is the nuchal (neck) ligament. This strange bit of anatomy, first detectable in early Homo but absent in apes and australopiths, is like a rubber band that connects the back of your head to your arms along the midline of your neck. Every time your foot hits the ground, the shoulder and arm from that side of the body fall just as your head pitches forward. By connecting the head to the arm, the nuchal ligament allows your falling arm to gently pull your head back, keeping it stable.
In short, my vision does get blurry and my gaze doesn't remain all that steady. Those reflexes aren't functioning all that well because of my abnormal visual history which includes a few teenage strabismus surgeries. However, this has increasingly been improving. First while walking and now also while running. Another test I use to check these reflexes is to simply make circular movements with my face and see whether things start jumbling around or not. The disturbing 'landslides' are making way for an increasingly stable world.

I've always been a very good runner until this strabismus brain injury became an increasingly serious problem. So a few weeks ago, I got carried away a bit and violated my usually cautious energy management ideas. Sure enough, that  infection started showing its head again and I had to ease off... Generally though, I do get that 'post-exercise high' again rather than mind crushing exhaustion so I'm on the right track.

- Basketball
With regards to the energy management issue I have found basketball an excellent VT loading activity. In my neighborhood there is a public basketball court so I go there to throw some baskets. This might come as a surprise for a strabismic but I never was particularly bad at football (soccer) or basketball. In this respect too, I'm curious to see what might happen over the next few years.

This is my favorite VT loading activity because it has all the elements you want to incorporate: unexpected movement, physical interaction with objects, reflexes and hand eye coordination. I know I am not suppressing while playing because when the ball comes to me from the side it is sometimes doubled. Extreme sideways viewing, especially on my right hand side, is still somewhat of a weak spot. I also notice it in more subtle ways which are hard to describe. Movement really takes away more of the residual suppression and after a while I do get tired so then it gets harder to single out my vision or see clearly. When that happens I just call it a day and go home. The work you do one day will pay off over the next couple of months and years if all goes well, so I go home satisfied knowing I am one day closer to normal functioning. The best thing about basketball is that it makes me realize that I move my eyes in sync unconsciously and I am starting to take 'not having double vision' for granted.

- Balance Board
Something I also do, but less frequently, is balancing on a bongo board. It took a while to get it down but now I can keep my balance. That doesn't necessarily mean it's helping my vision yet. There's so many things I can do by circumventing my bad binocular vision. It's fairly 'easy' to keep balance when keeping my head steady, so now the trick would be to execute circular head movements while standing on the board without falling and having my vision go double. That's the definition of loading, I suppose. Once you can do a combination of skills reasonably well, add one!

- This list is not finite
Any activity allowing you to incorporate good eye movements without having your vision go double or jittery while moving and without collapsing of exhaustion are good VT loading activities. It's no rocket science as long as you have some way to know you are not suppressing. That might be an issue for some strabismics. It's really fascinating how every strabismic is different, even though we 'are the same'. We are pursuing the same goals but often travel by different roads.

Aside from these activities and regular VT exercises, visual hygiene at all times is important of course. I'm enjoying tons of audio books lately. Thank god for the English language and all the great material that becomes available once you master it. Personally, I have always valued intellectual achievement over physical achievement so not being able to read well and have it gradually taken away even more over the years was devastating. But when considering this from a (visual) neuroscience point of view, the distinction between physical and intellectual achievement is thin if not nonexistent. That reminded me of something Steve Jobs, known for his frantic integration of hardware and software, once said: 'If you really care about software, you have to care about hardware.' When it comes to the human body, our hardware (body and brain) IS the software. By doing these gross motor exercises I'm working my way up to finer eye movement tasks such as reading. I often wonder how easy graduating from Uni must have been without uncontrollable double vision. Can't wait to really enter the zone.

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1 comment:

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