Eco-Optics Part 8

In Part 7 I alluded to why a set of procedures like Infinity Walk was powerful in therapy.  It seems increasingly we work with patients who have some sort of visual-vestibular integration issues.  If they have undertaken any sort of vestibular rehabilitation therapy (VRT) they may have come to us having been prescribed a form of Cawthorne-Cooksey exercises to undertake at home.  These are also relatively simple looking procedures that tap into the complexities of visual function, and are sometimes described as gaze stabilization exercises, as depicted here.


We find that many of these patients have had difficult doing these procedures because they lack the underlying visual abilities reflected in procedures such as thumb tracking and rotations, or four corner wall saccades.  Of ours the inverse can be true, where patients experience instabilities because their unaddressed vestibular issues are limiting their ability to handle the flow of the visual world.  Much of this can be addressed with slow changes initially in terms of degree and rate of movements, and the changes in angle of gaze or rotation.

A colleague, Dr. Gary Williams, pointed out that the current discussion of eco-optics reminded him of a book I recommended quite some time ago entitled Active Vision: The Psychology of Looking and Seeing, co-authored by two gents from the UK.

Active Vision

One can define active vision as an analysis of visual space that involves eye movements, head movements, and movements of the body.  It often involves optic flow fields and motion parallax.  I haven’t looked at the book for quite awhile and sure enough, when I pulled it off the shelf, it was littered with colorful stickers I used at the time to highlight important points.  One of them was Findlay & Gilchrist’s constructive criticism of J.J. Gibson’s ecological optics theories for placing too much emphasis on the environment and not merging it adequately with what was known about the eyes and vision.  Fair enough, and we’re doing our part to bridge this gap.

For our talk this Friday in the UK, Sue Barry picked out this quote from A.M. Skeffington, the principal architect of behavioral optometry:  “He who is insecure in his space world is insecure in his ego”.   One of the premises that we’ll be elaborating is the interaction between what the patient is internalizing and externalizing in her visual processes.  We’ll delve into this next ….

12 thoughts on “Eco-Optics Part 8

  1. A question, Dr. Press – often times we will focus on these type of activities (VOR and See Sick) when a patient presents following a head injury, or similar type insult. I’m finding more and more that by involving VOR integration activities, other non-TBI related visual anomalies can be addressed, and seem to remedy much faster. My sample size is small, and certainly purely observational, but my sense is the overall visual integration happens faster when approached from different angles. It seems to be simple concept, and perhaps a touch of common sense, but incorporating VOR challenges may not be as close to the forefront of “everyday VT” as we’d like. My solution in the past has been the marriage of collaborative and judicious OT and VT. Wondering what your thoughts are here?

  2. Excellent observation, Robert. My thinking now is that VOR/See-Sick type activities should be part and parcel of every VT program, at least to pay it a “courtesy call” to make sure that these abilities are functioning well. At the very least, they are essential in therapy for strabismus and amblyopia, where it is more likely that they have been compromised. Frankly the idea of VOR/See-Sick is more part of VRTPT than it is OT. I see the judicious import of OT/VT more in the vein of what is essential for children with more diffuse developmental delays.

    • Thanks, Dr. Press. In recent years, we’ve been seeing more and more patients suffering from TBI related symptoms, and perhaps out of pure habit, have been incorporating VOR/See-Sick activities into the program of ALL patients. The idea being to, as you have suggested, ensure the abilities are functioning well. This evolution has been slower than we’d like, hindsight being 20/20, but at this stage of the game our VT has become much more effective with our addressing these issues; or at the very least, ruling them out early on. It’s been a shift in thinking for all involved, but the end result has been fantastic!

      Thank you, again, for these posts. They have been quite enjoyable!

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