What a great idea, as seen on the facebook page of our colleague from Kentucky, Dr. Dan Bowersox: It’s Skeffington the Therapy Dog! Therapy dogs have become popular as an aid to a wide range of patients with disabilities, including ABI. I’m not a fan of dogs in my office, but it’s something worth considering because of the comforts that a service dog can provide to our unique patient populations. Speaking of Skeffington, I stumbled across a self-published treatise by Dr. Earl P. Schmitt on Skeffington’s perspectives. Written in 2006, it’s title is The Skeffington Perspective Of The Behavioral Model Of Optometric Data Analysis And Vision Care.
I recall when I was first learning OEP Analysis (good thing I wasn’t absent on the day they taught it at PCO in 1975) that mention was made of a “C” type case, thought to be rare, which was held to be “toxic”. I haven’t gone back to my copy of Manas’s Visual Analysis to see if he lays it out this clearly, but Schmitt does a superb job. Skeffington’s premise was that most visual problems stem from nearpoint disorders, specifically interference in the interaction between accommodation and vergence, and accommodation is usually the culprit either in the accommodative insufficiency or B1 case type, or the accommodative excess or B2 case type. In most instances, high exophoria at near is an adaptive state that enables the patient to drive accommodation through vergence, foreshadowing the notion of the CA/C ratio. On p. 253 Schmitt notes: “Dr. Skeffington made the distinction by saying that a B-case mades adaptations, while the C-case makes concessions.”
Schmitt’s characterization of the “C” case type is elegant. He labels this as an Interactive Dysfunction, described as follows (p. 251): “Considerable effort is required to maintain fusion, particularly at the reading distance. Convergence does not support accommodation, and there is no reciprocal accommodative stimulus to convergence. Convergence appears to act as an independent entity. The C-Type case has trouble simply centering visually at the near distance. Other analytical models probably would label this as being an aggravated convergence insufficiency case, or one demonstrating a fragile binocularity. In reality, the patient does not have the intrinsic capacity to hold either accommodation or convergence at a near point plane with comfort, and can’t create any adaptive interplay between the two subsystems to help the situation.” Schmitt adds that neither lenses nor prisms are predictably effective for these patients, and any therapy must be rendered on a highly individualized basis.
Acquired Brain Injury is the 21st century C case type. Skeffington the Therapy Dog to the rescue!