Below you will find information about convergence, including convergence insufficiency, and activities to improve convergence skills. These activities can be used by occupational therapists in treatment as indicated by vision screening and based on the individual needs of the child as determined by assessment.
Activities to Improve Convergence Skills
**DISCLAIMER** I am not a developmental optometrist, ophthalmologist or vision therapist. Activities presented in this post are within the OT Scope of Practice. A developmental optometrist or vision therapist should be consulted prior to completing any activities in this post to rule out the need for corrective lenses and vision therapy.
Disclosure: Amazon affiliate links are included in this post.
Oculomotor control is a fine motor skill, that without the correct supports, is unable to function as it is intended. Like any other fine motor skill, a strong core foundation is imperative to the development of skills. As visual deficits are particularly hard to identify by themselves, this is an important piece of the puzzle.
Foundations for Convergence Skills
What causes convergence insufficiency?
Convergence insufficiencies in young children is most commonly caused by an eye muscle imbalance. This eye muscle imbalance can be made more pronounced if the child does not have adequate core and neck strength.
When a child lacks core and neck strength, they may adjust their head position, or cover one eye to compensate to provide increased support and stability to their eye muscles.
This pattern of compensation is similar to the one we see when a child has a fine motor delay, and utilizes their scapula, elbow and wrist for support for increased dexterity.
Activities to Improve Convergence Skills
The following activities Address Foundational Areas Related to Convergence Skills:
Gross motor activities to support convergence skills should focus on balancing core muscles and strengthening of the neck, in particular, neck extension. Below are a few of my favorite activities to address core and neck strength with a focus on convergence skills.
Supine Flexion and Prone Extension Activities
While Supine Flexion and Prone Extension are not fun activities to complete on their own, it provides the therapist with an understanding of where the child’s muscle imbalances lie. These are also very easy activities for parents to build into their daily routines and in which progress is easily monitored. Add interest to these exercises by incorporating ball kicks or hit in prone or vertical ball toss in supine.
Play in Prone on a Platform Swing
Complete games such as Operation, simple interlocking puzzles and tangrams in prone on a platform swing to help develop sustained convergence skills.
Adjust the swing so that the child’s elbows are at 90 degrees to allow maximum levels of movement, and appropriate distance to encourage use of convergence skills. Place game pieces in 180 degree arc and call pieces out for them to find moving back and forth from the game board. Looking for pieces within the arc give the child’s eyes an opportunity to go into divergence for a short period of rest, and then back into convergence.
As the child’s skills increase, have them complete the activities in prone over a therapy ball. This requires increased core, neck and eye muscle control to complete the task at hand.
Upright Bolster Swing Play
For many kids, the upright bolster swing is a true challenge. It requires core engagement, along with vestibular and visual integration. These activities also challenge the child’s active abilities to converge and motor plan simultaneously.
The first activity is to have the child attempt to grab items off the wall or structure within the gym space. The goal is for the child to watch his/her hand all the way to the item and grab it during “free” swing. “Free” swing refers to the child just being pushed and allowing the bolster to swing freely without direction from the therapist.
This activity can be graded as necessary for each child to provide the just right challenge.
The second activity builds upon to the first activity. The activity is completed in the same fashion on the bolster swing, but adding having the child throw the item (I like bean bags), into a bucket or barrel. As the child’s ability to converge in motion increases, so will their aim and timing.
Many OT activities for visual motor overlap with convergence strengthening activities. It is important to ensure that breaks are built into convergence activities to prevent eye strain.
If a child reports eye fatigue or is rubbing their eyes, have them sit up and look at a point in the distance for a few minutes.
Looking for information related to Visual Saccades? Here is information on Saccades and Learning.
More Activities to Address Visual Insufficiency
Below is a list of activities that OT’s can utilize in therapy to support convergence skills if the child is not already receiving vision therapy.
Maze Activities to Improve Convergence Skills
Maze activities are great for working on sustained convergence and teaming skills.
Complete them in a vertical plane or surface to encourage the neck and eye muscles to work correctly as a team, and to prevent the child from compensating with postural corrections.
Start small and large, moving into more complex mazes that are smaller in nature.
Use a Zoom Ball to Improve Convergence Skills
The Zoom Ball is great for active convergence/divergence. The child has to watch the ball all the way to their hands prior to opening them.
As they develop convergence skills, their timing and speed at which they can play with the Zoom Ball will increases.
Watch for decreasing abilities as the activity continues. This may indicate fatigue of the eye muscles and need for a break with the activity.
Word Searches and Letter Searches to Improve Convergence Skills
Similar to the maze activities, word searches and letter searches work on sustained convergence and teaming skills. Without good teaming skills, convergence tasks are hard to complete.
Utilize simple word/letter searches to begin and advancing the level of difficulty as the child’s endurance skills increase.
Have the child look for words OR letters in isolation. Make sure that they are using left to right, and top to bottom patterns when completing the activity. Utilizing this pattern helps prevent random eye movement around the page that does not encourage convergence and teaming skills.
These are simple activities for parents to complete everyday at home, and chances are you are probably working on letter recognition in therapy. Two skills with one activity!
Related Read: Need help addressing visual problems in the classroom? Here are classroom accommodations for visual impairments.
Pencil Push Ups Activity to Improve Convergence Skills
Pencil Push Ups address sustained and active convergence skills. Much like the convergence portion of a screening assessment, have the child watch the end of a pen or pencil with a topper, from 18 inches away, into their nose and back out again.
Be sure to have the child stop before their nose if they are seeing double. They may not realize that they are seeing double, so be sure to ask along the way.
They may begin to see double as fatigue increases with the activity. Seeing double defeats the purpose of the activity, as the goal is to help the eyes work together to see ONE image.
Complete this activity for several repetitions before taking a break and having the child look at a point in the distance. This can be used as a warm up activity to sustained convergence activities.
Popsicle Stare Activity to Improve Convergence Skills
This visual convergence activity addresses sustained and active convergence, and can be done in a bunch of different ways!
The idea is to hold something small, like a popsicle stick with a sticker or funny face at the end, approximately 10-12 inches from the child’s face. The goal is to have them stare at it maintaining clear focus, and then look away. These farm animal popsicle sticks are a fun DIY tool you can make.
This cycle is completed several times to help the child’s eye muscles become stronger as a team.
Brock String Convergence Insufficiency Activity
The Brock String is something that you may be familiar with from school if you had a unit on vision. This activity has the child looking at various points along a fixed route.
Points should be stabilized starting at approximately 4 feet, 18 inches and 12 inches. Tie a string to the end of the door knob or chair with beads placed at the above mentioned point. Have the child hold the string to their nose, and look at the beads from the farthest point, to the nearest point, focusing on each point as they go.
The goal is to see only ONE bead as you move up and down the string. This activity is difficult for younger children, and should be utilized only if they are able to follow directions and verbalize what they are seeing or any discomfort to you. Limit the number of repetitions of this activity and utilize breaks as needed.
This is also a good warm up activity for sustained convergence activities.
For a fun twist on the Brock String, try asking the child to thread beads on a string when it is taped to a wall. Upside down beads are an even bigger twist!
A final note on Addressing Convergence Skills
OT and Vision Therapy overlap in many ways. It is important to note that an OT who has received specialized training for vision therapy, has many more tools and equipment available to them. They may utilize high tech computers, and lenses to address convergence insufficiencies more directly.
The activities in this post are to be utilized to support the development of convergence insufficiencies, but should not be utilized in place of vision therapy or referral to a developmental optometrist.
If you are unsure when to refer or having a hard time getting a parent on board, check out my OT Vision Screening Packet for more information. It contains a screener for therapists and useful handouts for parents on why addressing vision is important to their child’s success.