At the end of the last blog piece, I promised that we’d launch into some specific therapeutic activities suggested by Dr. Wachs. The procedures can be found in Part II of the new book by Wieder & Wachs, which essentially is a Cognitive Vision Therapy Manual published by Dr. Wachs. You’ll have many of the materials required on-hand, but you may also wish to purchase the home VT kit suggested by Dr. Wachs available through Bernell Corporation, for the convenience of having the items he illustrates.
I know it seems like a teaser, but before you can fully appreciate the activities please consider the 19 guiding principles for use of the manual as related by Dr. Wachs. They’re great guideposts for any therapeutic program:
1. Get to know your child and family.
2. Establish a relationship.
3. Think developmentally – let the child’s actions and results dictate your next step.
4. Resist teaching – allow the child to explore and discover the solutions using experimentation and evaluation.
5. Be sensitive to individual differences.
6. Engage first, work next.
7. You may embark on preferred activities, but let the interaction be playful.
8. Identify the child’s functional, emotional, developmental level.
9. Consider foundational capacities supported by each activity and target these goals. Leaving the activity semi-structured helps the child develop competence.
10. Symbolic ideas (images) and objects that are meaningful and chosen by the child often make activities more interesting and pleasurable to the child.
11. Get the child to work on organizing the activity or symbolic idea. This could be as basic as searching for or selecting the material, bringing it to a work space, and returning it after the activities are completed.
12. Hold children accountable for space and time. One might say that motor planning should include a projection of the requirements for the framework in which space will occur and how time will interact, or at the very least pass. Make time matching as essential as space matching.
13. Obtain reflective supervision. Every therapy session provides crucial opportunities for observation. Something is lost if the therapist is looking elsewhere, distracted, engaged in conversation with others adults in the room rather than with the child, or is consumed with writing. The therapist should be consumed with observing the child and structuring discovery and learning.
14. Not all assigned activities have to be done on a daily basis. Include the child in selecting the activities. Records of assigned and completed activities should be maintained and reviewed. Is the parent clear on the assigned activities? If a therapist outside the office is working on these activities with the child, how do her observations match yours?
15. If an activity is difficult to perform, know when and how to modify it so that some measure of competence can be attained. But sometimes, you have to walk away from an activity and return to it when more building blocks to the activity are in place. As Kenny Rogers might say, gotta know when to hold ‘em and when to fold ‘em.
16. Children can learn to discriminate “same” and “not same” related to movement even before they understand directional labels.
17. Although all movements should be as complete as possible, do not demand perfection in every exercise. Fairly accurate movements can suffice, depending on the child’s needs and levels.
18. Every child should have a home program. Choose a quiet location in the house that has as few visual stimuli as possible. 15 minutes per day is generally recommended. Ideally both parents should be involved, even if only to discuss what the child is doing and praising efforts. The therapist must review what the child has done at home, and offer praise for effort as well as use that performance to shape further therapy.
19. For children coming to the office for ongoing therapy, the home program can be selective to optimize engagement at home. Home programs can be more elaborate depending on the circumstances.
SYNOPSIS: Engage the child, find the right level at which to work, and have fun!