We made reference last week to the new book by Dr. Kaplan, subtitled: Transforming the Lives of People with Cognitive, Emotional, Learning, or Movement Disorders or Autism by Changing the Visual Software of the Brain, and I had a chance to digest it fully over the weekend.
It is interesting to see how much of the material overlaps another recent book, Visual/Spatial Portals to Thinking, Feeling and Movement by Wachs and Wieder. The principal difference is that Kaplan’s approach is heavily weighted toward yoked prisms – what he has dubbed ambient prism lenses, supported by a vision management program. The management program appears in many instances to be out-of-the-office prescriptive procedures that are implemented by others under the doctor’s guidance. A difference which may or may not be semantic is that Dr. Kaplan refers to his model of vision being perceptual in nature whereas Dr. Wachs has staked his career on his model being cognitive. Whereas Wachs was heavily influenced by Jean Piaget, Kaplan attributes his influence to Arnold Gesell.
Dr. Kaplan’s previous book, Seeing Through New Eyes, was oriented more toward children. This book cuts a wider swath among patients of all ages, and shares a number of insights and assesrtions:
1. The clarity with which people can identify objects in their world has a limited influence on their behavior. Though some would quibble with this as a blanket statement, it is certainly true for a high majority of the patient population we see in vision development and rehabilitation. As an aside, Kaplan notes that some patients who exhibit what is conventionally known as “crowding” – for example responding better to isolated letters that a whole line on the eye chart – have spatial anxiety, a term he uses to describe the stress that people with usual perceptual problems experience when exploring their environment.
2. By transforming light, yoked prisms alter visual stimulation from the environment, in turn transforming perception and cognition. Both points #1 and #2 speak to one of the themes of this book, that conventional lens prescriptions primarily address the “hardware” of the visual system or what is rooted more at the level of the eyes, rather than the “software” of the visual system rooted more at the level of the brain and the body.
3. Referring to conventionally prescribed prism, Kaplan describes this as a de-yoking that interferes with normal mapping. He writes: This can actually exacerbate the problems of a person with visual dysfunction, worsening symptoms such as abnormal posture, tunnel vision attention problems, and anxiety. His experience is that low magnitude yoked prisms facilitate a remapping of visual surroundings improving spatial organization and orientation, reducing the number of eye, head, and body movements needed to make in order to collect information.
4. Both low and high magnitude yoked prisms create perceptual illusions. The real world remains the same, but but my patients react to the perceptual illusion. Kaplan goes on to explain the difference between patient responses with low-magnitude prisms, ranging up to 5^, which typically act in bottom-up fashion, with no or little conscious awareness of change other than improved stability and certainty in performance, and in some instances clarity. This in contrast to disruptive prism, often as high as 20^, used to wedge posture, balance, and movement. For example, if a patient’s head posture tilts left he will use yoked prism bases left, and to counteract toe-walking he applies base-down yoked prisms.
5. Anxiety can also affect the eyes, causing a person’s pupils to enlarge. Eye movements may become excessive, and the person’s blink rate may increase. In addition, anxious people may often change their posture and gait – for instance, tiling their shoulders forward and up, tilting their head or full body, or tow-walking. In planning a patient’s therapy, Kaplan chooses a “bottom-up” or “top-down” therapy depending on which approach allows a patient to reach a goal of relaxed attention faster. He contrasts a 30 year-old schoolteacher for whom he felt disruptive yoked prisms would lead to deeper psychological problems and went with low magnitude yoked prisms, with a 49 year-old schoolteacher experiencing depression and anxiety for whom high magnitude yoked prisms resulted in an immediate sense of euphoria.
6. When I’m designing a visual management program for people (like Justin), I address their issues by focusing on two questions: “What do you see?” and “What do you feel?” In cases where the person is nonverbal, I answer these questions by looking at how the person performs prior to treatment and what response I see when I apply yoked prisms. Kaplan presents his Nonverbal Test Battery in a hierarchical fashion, initially focusing on visual perception in isolation, then progressing to tasks requiring coordination of visual, vestibular, proprioceptive, and gravitational input.
Well this has gotten rather lengthy so we’ll save the rest, including the Battery itself for Part 2.