In Part 1 and Part 2 we addressed Barbara Arrowsmith-Young’s determination to address her own cognitive deficiencies, and in turn develop an educational environment that worked on rather than around these skills. In one sense, the Arrowsmith program is akin to educational boot camp. There are teens who enroll in the military to impose discipline and structure on themselves in a contained environment. This works well for the right individual at the right time. Arrowsmith’s techniques require a level of mastery attained through targeted drills in 19 cognitive areas of function. As Norman Doidge noted, some teaching techniques abandoned in the sixties as too rigid may be worth bringing back. If 19 cognitive areas are good, perhaps 41 are even better, as boasted by BrainWare Safari. The challenge of course is determining when sufficient progress has been made, and to what extent the skills being developed will transfer to today’s techno-savvy educational environments.
The photo that you see above is from an article about Arrowsmith in the September 2008 issue of Professionally Speaking, the magazine of The Ontario College of Teachers. What’s up with the girl wearing an eye patch? We know that optometric visoion therapy is steeped in neuroplasticity, particularly with regard to amblyopia, so is Arrowsmith tapping into principles of amblyopia therapy? The answer is sort of, depending on how one defines amblyopia. If we define it as a developmental disorder of spatial vision, characterized by crowding and spatial uncertainty and subject to improvement through perceptual learning, then the answer is a resounding yes!
Here are the 19 Learning Dysfunctions handled identified by Arrowsmith, with motor symbol sequencing deficits being the most commonly encountered. This capacity is involved in the process of learning and consistently producing a symbolic sequential motor pattern (e.g., writing out the alphabet, or numbers). All sequential symbolic processes involving input through the eye such as reading, output through the hand such as writing, and expression though the mouth as when speaking are impaired when there is weakness in this capacity. The primary exercise to improve motor symbol sequencing looks alot like Ann Arbor or Michigan symbol tracking.
In her book, Arrowsmith-Young elaborates: “The Arrowsmith exercise to address a motor symbol sequencing problem involves learning and producing motor plans using sequences of symbols. When students do this enough, the sequence will begin firing out the end of the pen without thought or hesitation. Over time, the plan becomes encoded in muscle memory, and when the student masters that plan, a new one is presented.”
This procedure is designed to be done for 30 minutes per day with one eye patched, 5 minutes with both eyes together, and to be practiced at home including weekends and holidays. What’s the significance of doing this with an eye patch, and why is the patch always worn over the left eye? Arrowsmith-Young observes (p.136) that the left hemisphere of the brain controls movement on the right side of the body. For the motor sequencing skill we want increased stimulation to the left premotor region of the brain. By using motor movements and guidance from the right eye in coordination with the dominant hand, we increase stimulation to the left-hemisphere motor area.
Anticipating objection from those would point out that one half of the information from each eye goes to each hemisphere, Arrowsmith-Young seems to be claiming that only information from the right eye goes to the left premotor hemisphere. I don’t quite follow the logic, as evidence from functional neuroimaging during visuomotor hand activity coordinated with saccades (the motor activity used in Arrowsmith symbol tracking) shows specific increase in activity within the dorsal premotor cortex at the junction of the ventral branch of the SPS (superior precentral sulcus) in both the left and right hemispheres. In addition to the crossover conundrum, hemispheric activation and integration will vary depending on the hand used.
I raise this issue not to question the Arrowsmith methodology, because I like it, but to lend a few observations to why it probably works so well when it does, and how in some instances more can be achieved.
1) In optometric vision therapy we always begin early phases with some patching activities, checking to see that performance with the right eye is equal to performance with the left eye. Regardless of whether the general Arrowsmith theory on patching is correct, there will be individuals who perform better when the right eye is covered rather than the left eye. The goal should be to approach symmetry with the two eyes in motor function, though they need not be perfectly equal. Equally important, we want to note that performance with both eyes yields a summation effect, and is better than with either eye independently.
2) The Arrowsmith program is now being used with children undertaking a dual curriculum in Hebrew and English. For these children, motor symbol sequencing proceeding from right to left is just as crucial as proceeding from left to right. We use Hebrew letter and word tracking sheets to attain mastery in right to left sequencing. As Arrowsmith-Young notes in her book (p. 129) Hebrew an even greater load on motor symbol sequencing because of the small dot symbol code used to phonetically modify the sound of each letter. In addition, any instability of print due to imbalance between the two eyes compounds the challenge.
3) I agree with Arrowsmith-Young that the majority of individuals with learning problems (LD), and particularly reading problems (RD), have great difficulty with motor symbol sequencing. For this reason we spend a great deal of time and effort, much like the Arrowsmith immersion, in these types of procedures at the beginning of therapy. Although it is tempting to lighten up on these activities at the outset because they are so difficult to master for the LD and RD populations, attaining mastery in this area is crucial to successful outcomes.