Arrowsmith and Neuroplasticity: The Vision Connection – Part 2


I concluded Part 1 of the connection between Arrowsmith’s neuroplastic educational approach regarding motor symbol sequencing by citing the demands of the Hebrew language, in deference to the Arrowsmith program at the JEC School in Elizabeth, NJ.

As one of our faithful readers pointed out to me, the Chinese language poses similar demands and when you consider the symbols above perhaps bears even more resemblance to the figures often used in the Arrowsmith motor symbol sequencing procedure.

We talked about some of the considerations in theory about the use of patching the left eye during these exercises.  Judging by this photo there are other aspects of the visual system to consider in which optometric visual guidance might enable Arrowsmith approaches to have even more utility and impact.  One immediate consideration is visual hygiene in terms of the Harmon Distance.  There are accommodative, vergence, visuomotor and a variety of visual cognitive procedures in which Optometry has pioneered over the past 80 years that are complementary to Arrowsmith’s methodologies.  Many of these are reviewed in my textbook in the chapters authored by Dr. Sidney Groffman on learning theory and by Dr. Graham Peachey on cognitive schema.

While motor symbol sequencing is an obvious area that we work on in considerable detail in optometric vision therapy, there are other notable learning dysfunctions among the 19 that Arrowsmith lists such as Narrow Visual Span, Symbol Recognition, Object Recognition, and Spatial Reasoning.  These dysfunctions respond to cognitive exercises to improve comprehension, processing speed, logical reasoning, visual and auditory memory, non-verbal learning, and attention deficit.  Think of the neuro-learning impact of Circus Puzzles, Form Boards, G.O. Board Patterns, Groffman Tracings, Michigan Letter and Symbol Tracking, Parquetry Block Sequences, PTS II and Vision Builder software, and spice that up with BrainWare Safari, and you’ll get the gist of why Arrowsmith’s success is no surprise to us.

Consider the Arrowsmith definitions and examples for visual span and spatial reasoning:

Narrow Visual Span

“This is the capacity responsible for the number of symbols or objects a person can see in one visual fixation. When the span is restricted to below four symbols the following problems occur.

The person cannot see whole words in a single visual fixation. He must make three to ten times the normal number of fixations to read a line of printed material. This causes severe eye fatigue when reading and in severe cases can result in temporary blindness from overworking the eyes. [Note: temporary blindness may be a stretch here, but may related to Streff Syndrome in terms of the sequelae of visual stress]  People with this problem report that they cannot read for more than 30 to 60 minutes without taking a break to rest their eyes. The eyes become bloodshot as the eye muscles are overworked from making visual fixations.

Reading is experienced as jerky and errors occur when the eyes become fatigued and miss fixations. These types of errors also occur in clerical work.

Reading speed is slowed down due to the extra time required to make the increased number of visual fixations.

Navigating in the dark is difficult, e.g., finding a seat in a darkened movie theater or driving in the dark.”

Spatial Reasoning

“Spatial reasoning is the capacity to imagine a series of moves through space inside your head before executing them. The following are examples of weak functioning of this capacity.

The person has difficulty visualizing a pathway of movements inside his head. This would result in some difficulty in finding his way through space because the person cannot work out a map inside his head of how to get from one place to another. As a result the person frequently gets lost or takes much longer to get from one place to another. In some cases the person becomes phobic and avoids going anyplace new because of a fear of getting lost. This difficulty applies even to small spaces like tracing out pathways on circuit boards.

When map reading the person has to rotate the map to orient towards the direction he is going. He cannot rotate the map inside his head.

The person does not have a map of how space works inside his head. Several people with this problem report that they cannot imagine how streets connect with one another.

The person forgets spatially where he has left objects resulting in loss of the object or spending extra time trying to find objects.

The person’s workspace tends to be messy and disorganized with material stacked in various piles within line of sight. This is because the person cannot imagine how to organize his space. If he puts something away in a filing cabinet or drawer he later has trouble imagining in his head where it is.

The person has more trouble navigating in crowded space because he cannot map a plan of how to get around obstacles ahead of time.

In driving a car the person has trouble planning his moves ahead of time and also has difficulty anticipating the future movements of other cars on the road.

A person with this problem is poor at imagining moves ahead in a game such as checkers or chess. They tend to react to the other person’s moves as they happen rather than developing a series of planned moves.

In any sports activity requiring a spatial plan of movements (e.g., planning how you are going to ski from the top of the hill to the bottom, anticipating the movement of the tennis ball and planning where to place yourself on the court to hit it) the person is at a disadvantage.

There is difficulty imagining inside the head different ways to arrange furniture in a room. The person has to physically move the furniture in order to find the best arrangement.

There is difficulty in constructing geometric figures.”

Once again from these descriptions you can see how much much Arrowsmith methodology reflects the type of approach originated by Hans Furth and the developmental optometrist Harry Wachs in Thinking Goes to School and reflected in Harry’s chapter for the ICDL on Visual-Spatial Thinking.  Barabara Arrowsmith-Young was inspired by the Russian neuropsychologist and developmental psychologist Alexander Luria, whereas Furth and Wachs were influenced by the Swiss developmental psychologist and philosopher Jean Piaget.

Originating in Canada, the Arrowsmith program is beginning to permeate the United States, predominantly in Jewish or Christian private schools.  The Hebrew Academy of Long Beach (HALB) in New York was the first school in the U.S. to implement the Arrowsmith Program, in September 2005. HALB’s students worked on Within two months of starting in the Arrowsmith Program, parents at HALB noted significant changes in their children’s academic and social performance. Due to the successes at HALB, several other day schools implemented the program: .  Beth Jacob of Boro Park; Yeshiva Tiferes Yisroel, Brooklyn, NY ; Jewish Education Center (JEC), Elizabeth, NJ; Toras Emes Academy of Miami; Yeshiva Degel Hatorah, Spring Valley, NY; and Maimonides Academy, Los Angeles, CA.  Christian schools importing Arrowsmith include one in Sucsassuna, NJ, and a couple of schools in Michigan, There was a program in Berekely, CA, but it closed. Here is a complete list of current school locations.

I particularly like this interview of Tara Anchel, Assistant Director of the Toronto Arrowsmith School by Cheryl Jackson, who cuts to the chase.

Consider these points:

1) The program doesn’t teach academic subjects, or do academic drills [contrast this with the brand name franchised learning centers in the U.S.] but targets areas of cognitive weakness that underlie difficulties in learning academic subjects.  Once these readiness skills are in place, then it is fair to the child to re-enter an academic curriculum and anticipate success instead of struggles often leading to failure.

2) It’s important to address learning deficits as early as possible.  However, changes can be made later in life due to residual neuroplasticity and even adults participate in the program.

3) The Arrowsmith program isn’t more widespread yet because they wanted to grow the program slowly so that its integrity can be maintained.  [In her book, Arrowsmith-Young notes that new teachers come to Toronto in August for a three week crash course in Arrowsmith.  In her book she is also forthcoming about personal challenges she had to overcome before getting back on track.]

4) The program entails a significant cost [Apx. $12,000 per year per child with a minimum of 12 families to enroll].  Public schools have serious budgetary constraints, which has slowed the adoption of alternative approaches such as Arrowsmith.

5) A paradigm shift has to take place before the program can be adopted.  This program understands the learner very differently than traditional education.  Current educational approaches are based on largely outdated models.  We used to think that you couldn’t change the brain, so you had to change everything around the learner. We now believe you can change the learner’s brain, enable the individual to become more independent, and not have to rely on modifications and accommodations.  [The program acknowledges it is not oriented toward individuals on the autistic spectrum or who have had traumatic brain injury.]

6) Is there anything parents can do at home if they suspect their child has deficits or disabilities and they can’t get them to Arrowsmith?  They can advocate to bring the Arrowsmith program to their schools.  It has come largely from dedicated parents and educators who have sought out a different way, and brought it to their communities.   [Think of Richie's parents who I wrote about to introduce this topic - though Richie's dad literally went to school with him in Canada, he was instrumental in bringing the program to New Jersey.  There are facebook drives to bring Arrowsmith to communities.]

Reflect on these points and you’re realize why successful VT that results in a more effective learner parallels the Arrowsmith approach.  We aren’t educators, but we specialize in learning,  and vision itself is a learned process.  We want to guide visual development as early as possible, but patients can experience meaningful visual changes at any age owing to visual neuroplasticity.  Many of us are cautious about opening satellite locations because it takes a considerable amount of effort, energy, resources, and training to do what we do well in one office.  Parents seek us out because they recognize the paradigm shift we represent over the outdated notion that vision has little if anything to do with learning.  Or that if the eyes are fine [i.e. 20/20 and healthy] there is nothing further to consider.  We are not apologetic about fees. In this business of learning, you get what you pay for – and when working with children who have delays or disabilities, the challenges and resources required are significantly greater.  Ms. Anchel doesn’t say that Arrowsmith is accessible for every child and family as it takes a significant financial and time commitment on the part of the families and the providers.  In Optometry we know that applying quick fixes may reduce costs, but aren’t likely to achieve adequate and lasting outcomes.  I see the potential for great synergy between Arrowsmithians and Developmental Optometrists.

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