Objective:
To allow the patient to function more comfortably and safely by improving their ability to follow a moving object, make continuous adjustments in the position of their eyes while moving about and shift their gaze quickly and accurately from one object to another.
Activities:
Head shifts while maintaining steady fixation - this activity may be more appropriate for lower level patients who have difficulty following commands or those patients with apraxia.
Select a distant target approximately 6-10 feet away from patient at eye level. The target should be detailed enough and interesting enough to keep the patient's fixation throughout the activity (i.e. family members face, television screen, photograph, etc.) While the patient is viewing the distant target, the therapist shifts the patient's head position slowly to the right and to the left.
Rice and Tweezers - Materials needed: several medium to large grains of uncooked rice, one set of metal or plastic tweezers, container with 2-4 inch diameter opening.
With one eye patched, the patient is instructed to use the tweezers to pick up grains of rice and drop them into a cup as quickly as possible within a 3-minute period of time. The patch is then moved to the opposite eye and the activity is repeated. The therapist should count the number of grains placed into the container each time the activity is performed to measure improvement of speed and accuracy. The patient's appropriate near point eyeglasses should be worn at all times during the activity. If there is a possibility of a convergence problem, the patient should also perform the activity with both eyes open.
Filling in O's - Materials needed: Fine tip marker, newspaper or magazine, eye patch.
The patient is given 5 minutes to fill in as many letters that he/she can find that contain a closed symbol (o,b,d,g,p,q) with the eye patch placed on the right eye first, the patient is asked to fill in as many "o's" as possible. Then repeat with the eye patch placed on the left eye. If the patient has a tendency to neglect one side for the other, a pattern may be seen with the letters being darkened on the opposite side only. The patient may then be shown his/her completed activity pointing out that they have missed many more letters on one side than the other and encouraging them to scan first into their weaker field. This can improve the patient's ability to compensate for a neglected or hemianopic field.
Michigan Tracking - Materials needed: Michigan tracking letter paragraphs, eye patch, appropriate near point correction, pen or pencil.
With one eye patched, patient is asked to track from left to right beginning at the top left letter as if they were reading. They will search for the very first letter 'A' that they come to and cross it out. They will then proceed to the right looking for the letter 'B', then 'C', etc. When the patient gets to the end of one line, they must proceed to the next line without looking back to the line that they have just completed. If they perform the task completely, they should have all of the letters of the alphabet crossed out by the time they have reached the end of the paragraph. If they reach the end of the paragraph and have not found all of the letters, they must start back at the beginning looking for any letters they have skipped over. This activity should be timed for measurement of improvement in scanning. The task should be done monocularly using an eye patch to occlude one at a time, then binocularly using both eyes together.
Hart Chart Saccadic TherapyPegBoard Rotator - Equipment needed: One variable speed rotating peg board from Bernell (1-800-348-2225) colored pegs or golf tees, red/green glasses (for increased difficulty only).
Patient is seated within arms length of the peg board. The therapist initiates movement of the pegboard at the slowest possible speed in a clockwise direction and instructs the patient to place pegs into the openings along either the green or red lines. Once the patient is able to perform the task easily, have them follow the selected opening with the peg held an inch or two above the whole for one complete rotation before inserting the peg into the opening. To further increase difficulty, patient's can be asked to place the pegs into the peg board with the non-dominant hand or while balancing on one leg or a physio ball. If red and green colored pegs are being used, the therapist can incorporate red/green glasses to provide cancellation of one of the colors by each eye. This will help check for and eliminate any suppression that the patient may be experiencing. If the patient has a neglect or Hemianopsia, place the pegboard in the patient's weaker field to encourage standing into the missing field.
Flashlight Tag - Materials needed: 2 flashlights, colored acetate to make one light a different color.
The therapist and patient face a blank wall in a darkened room from a distance of 8-12 feet. Both flashlights are shined onto the wall and the patient is made aware of which light is theirs. The therapist moves their light quickly to one side and stops. The patient is asked to quickly locate the light and place their light on the other light. This is repeated in different directions giving prompting when the patient cannot locate the light. The therapist can then play "Follow the Leader" by moving their light slowly and asking the patient to keep their light on top of the therapist's light.
- Marsden Ball VT - Swinging Ball Procedures
Computer Tracking:
Saccadics - Arrows or Letters (See Computer Orthoptics Manual for directions.)
Computerized Pursuits (See Computer Orthoptics Manual for directions.)