What is Visual Scanning

visual scanning examples with graphic of word search, mirror, crowd of people, mismatched socks, and text reading "what is visual scanning"

Visual Scanning is a component of visual processing that is crucial to everything we do! From taking in visual information, to using that information in making decisions and enabling actions…visual scanning is an oculomotor skill that is sometimes an area of difficulty for those struggling with visual processing skills.

Below, you will find information about visual scanning, including what this oculomotor control component looks like, what visual scanning really means, and why scanning as a visual skill is needed for learning, functional tasks, social emotional skills, executive function and other cognitive abilities, and just about everything we do!

What is visual scanning

To work on visual scanning in the classroom or clinic, you may want to grab this free 17 page visual perception worksheet packet that promote oculomotor skills like visual scanning as well as visual perceptual skills!

What is Visual Scanning?

Visual scanning is an aspect of visual processing that impacts daily functional tasks, learning, safety, and everything we do. Visual scanning looks like…

  • Visual scanning is noticing a car parked on the corner when you try to cross the road.
  • Visual scanning is finding last night’s homework in a cluttered backpack.
  • Visual scanning is locating a matching shoe in a bin at the bottom of the closet.
  • Visual scanning is finding a pair of pants in a dresser to wear on a cool day.
  • Visual scanning is setting the table.
  • Visual scanning is looking for a lost parent on a busy playground.
  • Visual scanning is doing a word search puzzle.
  • Visual scanning is copying homework from the board and moving the eyes back to the place on the paper every time the eyes shift from the board to the paper.
  • Visual scanning is leaving a crowded place to find a bathroom, searching for the restroom in a hallway, finding an open stall, searching for the soap dispenser location, identifying where the paper towel dispenser or air dryer is in the restroom, searching your face and image in the mirror for anything out of place, and then back in the crowded space, locating your loved ones in the crowd.

Visual scanning is a lot of things! Rather, visual tracking is USED and REQUIRED in a lot of tasks. Scanning is needed to be independent, stay safe, make decisions, stay organized, help others, be a vital part of a workplace, succeed in school, learn and grow as an individual, and SO much more!

Many of these tasks are automatic and we scan our eyes, filter out information, and identify what we are looking for without even thinking about it.

Oculomotor Control

Visual Scanning is a part of the oculomotor system that allows the eyes to take in information. Here is more information on oculomotor dysfunction and activities that can help address this area. Scanning makes up a piece of the visual-receptive components of the visual system.

The oculomotor control that allows us to take in information includes visual pursuit, or tracking, and saccadic eye movements, or scanning. The muscles of the eyes control these movements in a voluntary and reflexive capacity.

saccades and Visual Scanning

A visual saccade is the movement of the eye toward visual stimuli. This movement of the eyes in visual scanning allows the eyes to focus on the most important part of the visual stimuli.

This allows us to notice a specific word, phrase, or topic in a body of text. You can see how scanning is needed for reading comprehension and writing essays in the school environment. In fact, visual scanning is a part of reading difficulties.

Check out this resource for more information and specific scanning activities for reading.

Visual Scanning Looks Like…

That precise focus of our eyes on a warm pair of clothes hidden in a closet provides safety and important information to drive executive functioning and decision-making.

The ability of they eye to focus on detail allows us to notice and locate our lost child in a busy store. These motor actions of the eyes are happening with both intention and in an automatic way so we are safe, locating the visual information we need, and safe.

At the same time, unnecessary information is negated, allowing the information we are looking for to be received and therefore processed for use in visual motor tasks, eye hand coordination, and function.

Here are activities to improve visual saccades.

Visual Scanning and Visual Perception

You can see how scanning works together with visual perception. As we scan, we need to discriminate, pull out the necessary information from background information, utilize visual closure, and sustain visual attention.

Visual discrimination is one key component. This requires visual perceptual skills of visual figure ground, visual form constancy, visual memory, and other underlying skills in order to determine differences in visual input and match it to a file from the mind’s visual memory to match similarities and differences. This is true for every item that could be discriminated from others, including by classifications such as form, size, color, or other features.

Visual closure is another component of visual processing and impacts visual scanning because when we read, we automatically “close” of visualize the whole word without identifying each letter of a word. This allows for reading speed and automaticity. Then, we need to comprehend what we’ve read. For the child with visual scanning challenges, we can see difficulties with speed, comprehension, and keeping up with grade expectations as information is consumed and understood.

Visual attention is another component of visual scanning because when reading or writing, we need to attend to the location in the sentence. When copying from a model, we need to remember where we left off. This is a component of visual shift and brings us back to oculomotor skills and visual shift. Read about near point copying for more information.

Likewise, to access the information, visual perceptual skills require the ability to scan the environment.

Visual scanning activities

Try the visual scanning activities listed below.

Visual Scanning Activities

We love the visual scanning activities below because they are hands-on and play-based. These components make visual scanning activities fun and engaging for kids, and most importantly, meaningful for kids because of play being the primary motivator and occupation in kids.

There are many visual scanning exercises out there in the form of worksheets (and these have their place in vision therapy as well), however sometimes a play-based vision activity or a game is effective and fun in supporting visual scanning needs.

The vision scanning activities below do just that.

  • Here is a visual scanning activity that includes a motor component. The eye-hand coordination couples with and requires visual scanning, visual perceptual skills, and the motor integration of that information for a task.
  • This visual scanning activity is a low-prep activity that can be used with a variety of themes or to address various levels.
  • For more easy activities that address a variety of visual perceptual and visual motor skills, you’ll love these visual scanning activities.
  • This Bubble Wrap Math Maze is a fun way to work on visual scanning as well as other skill areas. Kids will love the auditory and proprioceptive feedback, too.
  • Tangrams and finding correct pieces of puzzles like the ones tangrams support area  great way to encourage visual scanning as well as the perceptual and motor components of visual processing. These Cardboard Tangrams are a frugal and fun way to play and develop skills.
  • This Letter Seek and Find activity is a low-prep and quick activity that can be used with various ages and levels. Attach handwriting tasks to make it perfect for older kids. Younger kids can work on letter recognition while addressing oculomotor skills, visual perception, and motor components.
  • Work on visual scanning with a tasty feedback, using letter cookies or crackers! This Letter Cookie Seek is a great way to work on the visual skills needed for so many areas.
  • Look for a specific letter in a word search.
  • Visually scan for objects on a wall or hidden around a room like these wall bat templates where you can use a flashlight to scan for the correct bat (or use any shape or image like shapes, colors, or templates).
  • Do a count and color worksheet.

What is visual scanning? Visual scanning is the eyes movement from point A to point B, needed for reading, games, activities, play, functional tasks. Scanning or saccades, are an oculomotor visual skill.
 

 

Visual scanning is needed for reading and learning. Here are activities designed to build visual scanning in kids.
 
Some of our favorite visual scanning activities support eye movements and the oculomotor control that are used in reading, writing, and everyday functional tasks…and they all include play.

 

Visual scanning is needed for functional tasks, using saccadic eye movements from one point to another. Here are activities to help with visual saccades.
 
Visual scanning activities support eye movements.
 
Free visual processing email lab to learn about visual skills needed in learning and reading.
 

 

 

What is visual scanning? Read more information about visual scanning or visual saccades that are needed for reading, play, and everything we do!

Feel free to use this visual scanning graphic on social media, and please link to this blog post for reference.

Looking for more visual scanning activities for the kids?  Try some of these:

More visual processing activities

For even MORE visual scanning activities to use in your occupational therapy practice, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.

In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂

Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!

Click here to learn more about Visual Processing Lab and to sign up.

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Free Visual Perception Packet

Free visual perceptual skills worksheets

These free visual perception worksheets are just the resource you need to work on visual skills like form constancy, visual discrimination, visual closure, and more. Visual perception is an area that drives so much of what we do. For kids who struggle with visual perceptual skills, so many areas are impacted. Visual perception impacts reading, writing, learning, comprehension, visual motor skills (including copying written materials), fine motor work, gross motor skills, eye-hand coordination, and even social emotional skills! It’s amazing how this one area can impact so many areas of a life and functioning. Because some f our popular free visual perception worksheets have been used by so many therapists, I wanted to pull these resources together into an easy to access visual perception worksheet packet! This is it! Your 17 page packet of free visual perception worksheets can be accessed below.

Use these free visual perception worksheets to work on so many skills kieds need for reading and learning: visual attention, visual perception, visual closure, form constancy, spatial relations, and more!

Free Visual Perception Packet

Visual perception is made up of several areas that are crucial to development, learning, and functioning. Visual attention, visual spatial relations, visual closure, visual discrimination,

That’s why I wanted to bring to you a valuable resource when it comes to understanding visual perception AND visual processing skills.

Below, enter your email in the form box and the visual perception worksheets packet will be delivered to your inbox. I need to send it via email as the packet is a large file. This one form will get you the entire 17 page packet, where the other forms on the other pages in this packet will deliver just one page. I am working behind the scenes to edit all of the other posts in this series of free worksheets so they deliver the big packet. 

I wanted to pull all of the worksheets together (along with a few new ones added to the bunch) to create a 25 page packet of visual perception worksheets.

In the packet are a few themed visual perception worksheets. You’ll find reproducible sheets to address figure-ground, form constancy, visual discrimination, as well as oculomotor skills like saccadic movements.

Visual Perceptual Skills and worksheets

Some of the worksheets included address:
Visual Figure-Ground
Visual Attention
Form Constancy
Visual Discrimination
Visual Memory
Sequential Memory
Visual Closure
Visual Spatial-Relations

…as well as eye-hand coordination needed to complete pencil control exercises.

All of the worksheets are similar in style, making them a great collection for YOUR therapy toolbox!

For now, grab your visual perception printables, and start working on those visual skills!
Enter your email to get the worksheet packet and BIG NEWS on an upcoming visual perception resource.

Be sure to watch for more news on an upcoming visual processing resource. It’s going to be BIG!

I’m so excited to share more information with you very soon. It’s going to be gooooood!

More Information on Visual Perception Worksheets:

For more information on the worksheets in this free packet, check out these posts describing some of the worksheets included in this packet of free visual perception worksheets:

Monkey Theme Visual Perception Worksheet

Flower Theme Visual Perception Worksheet

Space Theme Visual Perception Worksheet

Outer Space Theme Visual Perception Worksheet

More visual perception resources:

If you are looking for more visual perception worksheets, you’ll love everything in the Visual Processing Bundle!

The Visual Processing Bundle has everything you need to work on underlying visual processing skills so you can help students with classroom tasks like copying written work, letter reversals, and messy handwriting in fun and engaging ways!

  • Over 235 pages of workbooks, worksheets, e-books, handouts, activity cards, tracking tools
  • Classroom accommodation ideas
  • Checklists
  • Multi-level visual-motor integration workbooks
  • Pencil control worksheets
  • Classroom and therapy activities
  • Activity cards
  • Specific and open-ended activity cards
  • Visual tracking guide

Click here to access the Visual Processing Bundle.

More visual processing activities

For even MORE information on visual perception and activities to use in your occupational therapy practice, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.


In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂


Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!


Click here to learn more about Visual Processing Lab and to sign up.

Free visual processing email lab to learn about visual skills needed in learning and reading.
Use visual perception worksheets to work on visual perceptual skills like figure-ground, visual discrimination, visual closure, visual attention, and other skills needed for handwriting, reading, and learning.
Add these free visual perception worksheets to your therapy toolbox to work on visual processing skills like visual spatial awareness, figure ground, form constancy, visual closure and other perceptual skills in kids.

What You Need to Know About Depth Perception

Depth perception information and activities

Depth perception is a pretty amazing thing. It allows us to see the world in three dimensions; for us to crawl, navigate stairs, play catch with a ball, drive and many more activities. But what happens if our depth perception is impaired? These activities become exponentially more difficult, and may be even impossible. Read more about visual problems here.

Need information on depth perception? This visual skill is important for reading, moving, and completing tasks. This article explains what depth perception is and how to improve this visual skill.

 

What is Depth Perception?

Depth perception is a visual processing skill that allows us to perceive visual input in multiple dimensions. The American Academy of Ophthalmology describes depth perception as the ability to see things in three dimensions (including length, width and depth), and to judge how far away an object is. Read here for more information to understand this visual skill

When Does Depth Perception Develop? 

We are not born with the ability to perceive depth. In the beginning, we are only able to see two dimensions, making everything appear flat, for the first 6 months of life. During this time, our eyes are not yet working together and monocular vision is predominant. 


Around 6 months of age, our eyes begin to work together, and binocular vision, the use of the eyes together, becomes a dominant pattern.  Binocular vision patterns is what allows our brains to perceive depth and view the world in a three dimensional way.  This is because both sides of the brain are receiving input, and interpreting that information in synchrony. 


However, our depth perception must grow and develop over time as new challenges are presented.


As we move through gross motor development from rolling, to sitting, crawling and walking, our depth perception and binocular vision is constantly challenged to meet our gross motor needs. 


As the left and right sides of the brain begin to strengthen communication through the reciprocal motor patterns of crawling and walking, our binocular vision, neck strength and neck control is also then indirectly developed. 

Impact of Impaired Depth Perception

Impaired depth perception can leave a child with significant challenges in life. Individuals with impaired depth perception may struggle with sports, navigating familiar and unfamiliar spaces, and may even struggle with driving. These are just a few areas that may be impacted, but in reality, all areas of a person’s life are affected by impaired depth perception. 

Signs of Impaired Depth Perception

The signs of impaired depth perception are often very subtle and may be missed at a young age or passed off as “slow” to develop, with serious concerns being caught at an older age. 


Signs of impaired depth perception include: 


 Late to crawl or walk 
 Hesitancy or fear of surface changes 
 Resistance to going up and down stairs 
 Exaggerated stepping over lines in the floor or parking lot
 Frequent falling 
 Inability to catch/hit a ball—early anticipation or late response 
 Runs into furniture, walls or items in a familiar environment that have not changed position 
 Difficulty anticipating turns or space needed to navigate playground equipment and use ride on toys 
 Overshoot or undershoot when reaching for an item 
 Heavy footsteps or stomping up down stairs and over items/changes in floor surface 
 Frequent falling up or down stairs

How is Depth Perception Assessed? 

Due to the complexity of monocular and binocular vision, your therapist may recommend an evaluation with a developmental optometrist if they note any of the signs of depth perception impairment above. Chances are that your therapist has also noted other vision concerns during a vision screening that has lead them to suspect poor or impaired depth perception. 

Depth Perception Treatment

Depth perception impairments are treated in vision therapy as directed by a developmental optometrist or an occupational therapist with special training in vision therapy. Treatments provided by either professional utilize special equipment, lenses and activities that challenge binocular vision directly. 

Final Note on Depth Perception

Poor or impaired depth perception can be identified and addressed at any time throughout childhood. Like many vision impairments, there are a wide variety of presentations and levels of severity in which your child may present with. If left unaddressed, your child may continue to struggle with self care, sports, driving, and many other tasks later in life. If you have concerns, ask your OT for a vision screening and to discuss your concerns. 

What if you suspect vision problems?

Now what?  When vision problems are suspected after a screening by the OT, it is best practice to refer the family to a developmental optometrist.


A developmental optometrist will complete a full evaluation and determine the need for corrective lenses, vision therapy or a home program to address vision concerns.


As occupational therapists, it is imperative that we rule out vision problems before treating handwriting or delays in visual motor integration, to ensure the best possible trajectory of development and success for the child.

Occupational Therapy Vision Screening Tool

Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Our newest Visual Screening Tool is a useful resource or identifying visual impairments. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care.
This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings.
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR

Wondering what is depth perception? This article explains information about depth perception and includes strategies to help with visual processing skills.

Classroom Accommodations for Visual Impairments

Visual Impairments such as convergence insufficiency, impaired visual saccades, or other visual problems like blurred vision can present as a problem in the classroom. Students with visual impairments will flourish with effective classroom accommodations for visual problems. Below, you will find strategies that school-based occupational therapists can use as accommodations for addressing visual needs while meeting educational goals.

These classroom accommodations are strategies to accomodate for visual impairments that limit learning or interfere with classroom participation.

Visual Impairment Accommodations for the Classroom

The fact is, vision impacts learning. When visual problems exist, it can be be helpful to next address what to do about those problems to maximize learning. Often times when vision is discussed as a concern, a parent or caregiver may push back saying that the child has had their vision checked, and that they can see fine. Despite education, and handouts, the parent still resists getting a more in-depth vision evaluation for their child. Now what? Good news is that there are some accommodations that can be made in the classroom to assist the child. These strategies are also great for kiddo’s who already have glasses but are still struggling.

What are accommodations for visual problems?

Accommodations are strategies set forth that allow a student to change the method of how learning happens. Accommodations for visual problems can address visual needs through changes in seating, presentation of visual information, test information, or classroom activities without modifying what is tested, completed, or taught.

The visual accommodations listed below are means for addressing visual problems without changing classroom expectations for learning.

Preferential Seating

Preferential seating means a lot of different things to every professional. Typically, it mean that the kiddo is placed at the front of the room, closest to the teacher where they can receive an increased level of support from the teacher. However, this is not necessarily the best for a child with vision deficits. There are a few keys points to preferential seating for kiddos with vision deficits that should be considered.

● Proximity to the board
● Direction in which the child is facing in relation to the board or main work area
● Level of visual distractions around the room including posters, boards and other children
● Is the goal of seat work and need for use of board to achieve completion of work?

Proximity to the Board

Being closest to the board is not necessarily the best position for a child facing vision challenges particularly if they are not acuity based in nature.

For instance, a child that is struggling with saccades and tracking may not succeed in a front and center position. This would challenge their eyes constantly to look in all directions for information. A better position for them would be to the left or to the right in the first 2-3 rows. This would limit the amount of tracking to either side that would need to be completed.

This position would also benefit a child with who struggles with filtering visual information and needs information to be limited on one side.

When recommending a seat based on proximity to the board, it is important to think about what challenges the kiddo is facing visually and to recommend a seat that promotes success.

Face the Front

Is the Child Facing the Board?

There are a lot of classroom set-ups these days that have children not facing the board or at an awkward angle. This is okay if the child is not expected to copy work from the board or utilize information from the main learning space.

When it doesn’t work, is when the child needs to utilize this information. It is best to have the child facing the board straight on or with a slight angle if they are not seated in the center. Limit turning of the head over 45 degrees to prevent eye strain and an increased chance of the child losing their place when copying.

There are times that it is appropriate to have the child’s back to the board and main learning space. I will get to that in just a moment.

Reduced Visual Distractions

Limiting visual distractions and over stimulation is a large part in helping kids with visual deficits. If there is too much information in front of them or around them, they are more likely to get lost visually, leading to more time needed to complete tasks and increases in errors when copying or missing written steps.

This is one of the few times that it is okay to have a child’s back to the board or main work area. Especially, if the child does not need to see the main area. Typically, this is the case for lower levels of education such as kindergarten through second grade, or when the curriculum begins to focus on board directed teaching.

Other ways to limit visual distractions are to keep the main learning space clear of extraneous posters, charts or decorations, along with conscious choices for seating the child. Having the child’s back to busy walls and a large portion of their peers can be helpful.

Most people think that windows are distractions for kiddos, but for a child with vision deficits, sitting near or facing a window can give a much needed visual “break” from stimulation. So don’t rule out a window seat yet!

Use these visual impariment accommodations to help kids with vision problems flourish in the classroom.

Increased White Space

Worksheets can be very overwhelming for a child with a visual deficit. They may have a hard time reading a busy worksheet, completing a math worksheet or miss parts of multi-step directions.

One way to help avoid this is to provide increased white space. White space refers to the amount of blank or void areas on a piece of paper. The higher the amount of white space, they less likely a child with vision deficits is to struggle.

This means limiting the number of math problems on a page from 6 to 3 for example. Or utilizing the Handwriting Without Tears lined paper versus traditional triple lined paper.

Sometimes changing the handout or worksheet is not an option and other strategies need to be utilized. The use of an extra sheet of paper to block out extra information can be helpful in creating the white space that is needed.

Decreased Visual Distractions

I touched on this in preferential seating section in regards to the overall placement of the child in the room. However, visual distractions can also come from items in the child’s work space. Distractions may include name tags, behavior systems, letter lines, a peer across from them and even work to be completed. These visual distractions may cause the kiddo to feel visually unorganized leading to the appearance of sloppy work and poor time management, and even signs of anxiety.

One way to help eliminate visual distraction within the workspace is to limit what is on the child’s desk. Keep the kiddo’s work space limited to a name tag and one other item. If other items are needed on the desk or workspace, have them arranged so that they are not in the child’s direct line of sight while working.

For instance, crayon boxes and utensils may be shared at a table or grouping of students. Have the items place to the left or right of the child so that their direct line of sight is clear.

Also limit that amount of ‘work’ that is place in front of the kiddo. I say ‘work’ lightly as most ‘work’ for kids are worksheets and craft projects. By presenting one item at a time, it can help the child’s visual space remain clear and help them stay visually organized and on task.

Visual Structure for Reading and Writing

Sometimes limiting visual distractions is not enough support for visual organization. Sometimes, the child needs even more structure to support successful learning patterns and work completion.

One strategy is to provide the child with graph paper to write on. This is very structured and provides concrete boundaries for letter orientation, sizing, and spacing. It also provides visuals for completing math problems in straight lines.

Other forms of visual structure include colored lines to indicate top and bottom of the lines for writing, along with highlighted “spacer” lines for completion of longer work.

Color coding can also be a helpful tool in providing visual structure for older children. It be as general as a different colored folders/notebooks for each subject to allow the child to quickly scan and find what they need, to as complex as writing parts of a math equation in different colors. Or even going as far as to writing the parts of a paragraph in different colors.

Visual structure can be as simple, or as complex as it’s needed to be to meet the kiddo’s needs.

Use these classroom accommodations to help kids with visual problems succeed in the classroom.

Final Thoughts on Visual Impairment Accommodations

Each child is different and finding the right visual supports is a trial and error process that takes time and patience to work through. Evaluating the child’s weaknesses will help to determine the best supports and path for success in the classroom despite their visual challenges.

More resources that can help with understanding and advocating for visual impairments:

What is Visual Processing and Visual Efficiency?


Visual Saccades and Learning


What is Visual Tracking?


What is Convergence Insufficiency?

What if you suspect vision problems?

Now what?  When vision problems are suspected after a screening by the OT, it is best practice to refer the family to a developmental optometrist.


A developmental optometrist will complete a full evaluation and determine the need for corrective lenses, vision therapy or a home program to address vision concerns.


As occupational therapists, it is imperative that we rule out vision problems before treating handwriting or delays in visual motor integration, to ensure the best possible trajectory of development and success for the child.

Occupational Therapy Vision Screening Tool

Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Our newest Visual Screening Tool is a useful resource or identifying visual impairments. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care.
This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings.
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR
Visual accommodations like preferential seating, facing the board, and other visual accommodations can help a student with vision problems succeed in the classroom.

How Convergence Insufficiency Impacts Reading

This article describes how convergence insufficiency impacts reading. Have you ever stopped to wonder exactly how does convergence insufficiency impact reading? There are many ways that visual skills affect reading and learning in general. This article discusses areas like vision relates to decoding skills, reading comprehension, and visual attention in reading.

Convergence insufficiency impacts reading that interferes with reading comprehension, reading decoding skills, reading fluency, and other areas that impacts how a child reads.


How Convergence Insufficiency Impacts Reading

Reading. It’s one of the primary tasks school aged children complete EVERY DAY. We all know that child who hates reading, says it’s hard and avoids it all possible costs. We also have met the child who loves to read, but has poor comprehension and can’t tell you what they just read. Both of these kids may be experiencing difficulties with convergence insufficiency.


Here are some classroom accommodations that can help address visual problems in the classroom.

What is a Convergence Insufficiency?



Convergence Insufficiency is when a child’s eyes are unable to converge inside the midline, or are unable to maintain a position of convergence for an extended period of time. This can be due to eye muscle imbalances and weakness, weak supporting muscles in the neck and core, or neurological concerns.


Here are activities to improve convergence insufficiency.

Convergence Insufficiency, Blurry Vision and Reading



Avoidance of reading tasks is often a sign of an underlying vision deficit, with convergence insufficiency at the top of the list. Kids who avoid reading recognize the task is hard for them, but may be unable to tell you why.  Some red flags that a convergence insufficiency is affecting reading skills may include avoidance of reading tasks, poor comprehension of what has been read, sleepiness, headaches, blurred vision, poor recall of familiar words and letters, and poor decoding skills.


Most kids don’t know what they should be seeing, or that they are seeing differently than everyone else, as they don’t know it any other way. To add to the vision deficit, description words of what they are seeing such as “blurry” or “fuzzy” are abstract concepts for kids to understand. Especially, if they have only ever seen “fuzzy” or “blurry” letters and items.

 

Convergence Insufficiency Results in Poor Decoding Skills

Convergence insufficiency impacts reading that interferes with reading comprehension, reading decoding skills, reading fluency, and other areas that impacts how a child reads.

These patterns of “fuzzy” or “blurry” letters may result in difficulties with recognizing familiar words, letters and phrases, or being unable to decode the words on the page. Even when you know that they know the word or letter, and that is has been drilled frequently and consistently over time.


Unfortunately, despite drilled letters and sight words, if the child is not seeing them correctly, or consistently each time, their abilities to recognize them in various fonts, sizes and presentations significantly decrease. This further adds to a child’s resistance or avoidance of reading tasks. They are aware they should know the letters or site words, but are unable to recall them due to poor vision.


These difficulties can lead to overall low self-esteem with reading tasks and avoidance as a way to prevent further damage to their self-esteem.


Here is a screening tool to address visual processing needs related to handwriting.

Poor Reading Comprehension Due to Convergence Insufficiency



Convergence insufficiency symptoms are sometimes inconsistent may vary throughout the day and be exacerbated by overall general fatigue. Symptoms may result in headaches, blurry vision or strain of the eye muscles.  Inconsistency of symptoms is typically due to lack of strength in the eye muscles and like other muscle groups, performance is significantly impaired when fatigue sets in.


These patterns of inconsistency significantly affects a child’s abilities to recognize letters, words and phrases in a variety of fonts, sizes, spacing and process visual information on a page.  As fatigue increases, symptoms such as “blurriness”, “fuzziness”,  letters moving on the page or poor overall focus increase also, resulting in poor overall comprehension.


Children with poor comprehension typically enjoy reading, but because of the convergence insufficiency, may not get the most out of their reading experience.


Related Read: This is an insightful article on visual saccades and learning

Convergence Insufficiencies Can Present as Sleepiness While Reading



Yawning, rubbing of the eyes, and nodding off when reading can be the result of a convergence insufficiency. The sleepiness the child may be experiencing is due to the high level of concentration and muscle strength of the eyes that is required to read for extended periods of times.


When sleepiness occurs during reading tasks, the child may not be able to make it through age appropriate content for class-work and homework. This results in poor comprehension as the child typically attempts to compensate with speed reading, skipping key words, partially reading the content or dozing off throughout the reading task resulting in missing sections of the work.


Here is more information on visual processing and visual efficiency in reading and learning.

 A Final Note on Convergence Insufficiency and Reading



Whether the child is avoiding reading tasks, falls asleep when reading or has poor comprehension, it can be a sign of an underlying convergence insufficiency. Due to convergence insufficiencies inconsistent patterns and various presentations, it is imperative that these patterns are monitored closely by therapists and educators, and that referrals are made to developmental optometrists if a vision concern is suspected.

Reading problems can be a result of visual skills such as convergence insufficiency.

More visual processing activities

For even MORE information on oculomotor skills like convergence and divergence, to use in your occupational therapy practice, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.

In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂

Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!

Click here to learn more about Visual Processing Lab and to sign up.

Free visual processing email lab to learn about visual skills needed in learning and reading.

 

Screening for Convergence Insufficiency



Looking for more information on vision? Check out my OT Vision Screening Packet for helpful handouts and a screening tool.


This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings. 

 
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR

Looking for more information on visual convergence?

Click on the links below to read more about visual processing and convergence insufficiency:
   
  
Convergence insufficiency impacts reading that interferes with reading comprehension, reading decoding skills, reading fluency, and other areas that impacts how a child reads.

Eye-Hand Coordination Letter Match Activity

This hand-eye coordination activity is one that uses an item we had in the house (and you may too!) We love to use recycled and upcycled materials in occupational therapy activities and this eye hand coordination activity is no different! Working on the coordination skills needed for tasks like handwriting, self-dressing, managing clothing fasteners, and other skills. 
 
This hand-eye coordination activity doubles as a learning activity while matching letters and working on visual motor skills needed for tasks like handwriting, management of fasteners, coordination, and many functional tasks. Looking for more eye-hand coordination activities? 
 
For younger kids, this hand eye coordination activities for toddlers is a great resource,

Hand-Eye Coordination

This hand-eye-coordination activity is one that kids can use to work on the hand-eye coordination skills needed for motor planning, fine motor skills, and functional tasks like handwriting and other fine motor tasks.

 
First, let’s define hand-eye coordination. Coordination between the visual input our eyes perceive and process and the coordinated motor movements are an integration of the visual and motor systems. This is eye-hand coordination as it is used in functional tasks. Eye hand coordination is necessary for every functional skill. 

Hand-eye coordination activity

Amazon affiliate links are included below. 
 
This activity used a recycled cookie cake pan that we washed out and used in a bilateral coordination eye-hand coordination activity. Besides the cake pan (save that lid, too!), we used just two other items:
 
Small foam ball (A sports ball works great, but a ping pong ball would work for this activity too.)
 
Can’t find a pan like we used? A disposable container with a clear lid (like this one) would work too!
 
Related: Need some indoor bilateral coordination activities like this one? Try our list of Winter Bilateral Coordination Activities that kids will love!
Use a disposable cake pan to work on hand-eye coordination in occupational therapy activities to work on visual motor skills, bilateral coordination, visual skills and so many other areas of child development.

How to set up the hand-eye coordination activity:

1. Peel the stickers from the sticker sheet and randomly place them around the cake pan. 
 
2. Place the foam ball in the cake pan and pop the lid into place. 
 
That’s it! This is a super quick set-up and an activity that can be used by so many clients or students to work on a variety of areas.
Kids can use a recycled cake pan to work on hand-eye coordination and visual motor skills needed for reading, writing, and many other functional skills in occupational therapy activities.
Kids can use this eye-hand coordination activity to work on fine motor skills, visual motor skills, bilateral coordination and other areas in occupational therapy to work on tasks like handwriting, reading, writing, and so many other areas.

Hand-Eye Coordination Activity with Letters

Ask students to roll the ball from letter to letter as they look for specific letters. 
 
Roll the ball to letters in alphabetical order or ask he child to spell out spelling words. 
 
Older students can spell words in sentences. 
 
Call out random letters as students roll the ball as they visually can for each letter.
 
Roll the ball from one letter to another to match letters.
 
Incorporate handwriting by asking the child to roll the ball for 4 seconds. When a timer goes off, they child can write a list of words starting with that letter.
This ball and letter activity helps kids develop hand-eye coordination needed for tasks like handwriting, reading and other occupational therapy activities.
 
 

Hand-Eye Coordination Activity for Kids

This eye hand coordination activity addresses so many other areas as well:
Gross motor skills
Form constancy
Visual discrimination
 
Looking to work on the visual skills that play into motor output, motor planning, and eye-hand coordination activities? Our Visual Screening Tool may help.
A simple occupational therapy activity uses just a ball and letter activities to work on hand-eye coordination and the visual motor skills needed for reading, writing, math, functional skills and so many other areas.

More on eye-hand coordination skills:

For even MORE information on eye-hand coordination and the visual skills needed to complete visual motor and eye-hand coordination, or to better understand visual processing, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.

In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂

Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!

Click here to learn more about Visual Processing Lab and to sign up.
Free visual processing email lab to learn about visual skills needed in learning and reading.
 
 
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.

 
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
 
Use a visual screening tool like this occupational therapy screening tool to address visual processing skills like visual convergence and to guide visual convergence activities in therapy.
A hand-eye coordination activity for kids that helps with visual skills like convergence, visual tracking, visual scanning, and motor components like bilateral coordination, precision, and motor planning needed for the eye-hand coordination that are worked on in occupational therapy activities.

Saccades and Learning

Read below to learn about visual saccades and learning in kids, including how saccades affect learning, more about what are visual saccades, or visual scanning, and what saccadic movement looks like. You’ll also find information on saccades and smooth eye movements and the visual processing needs that impact learning. This information on vision can be helpful for the occupational therapist working with a child or student with vision related learning challenges as a result of visual saccades.

Visual Saccades and Learning


Saccades and saccadic eye movements have a huge impact on learning and reading.

 

For more information on saccades, check out this post on what exactly is visual scanning.

As therapists, we are often asked to provide consultation services to a child who cannot copy from the board, from one paper to another, frequently loses their place while reading, and has frequent errors in spelling and writing tasks, along with sloppy handwriting. These children are typically in first or second grade, maybe even third. They are good students who appear to be struggling for some unknown reason.  An underlying vision concern may be the culprit of these student’s difficulties, with the underlying concern being impaired saccades, or visual saccadic movements. 

What are visual saccades? Saccadic eye movement is so essential for reading and learning!




What are Saccades?

Saccades Definition: 

Saccadic movement, or more commonly known as saccades, is the ability of the eyes to move in synchrony from point A to point B rapidly WITHOUT deviating from the path. 


Typically, we look for these patterns to be established in left/right and top/bottom patterns as they are the easiest to identify. 


However, if the saccadic movement is not impaired, the eyes should be able to move in all directions in synchrony between two or more given points. 

Saccades and Pursuits



Before moving on, I want to clear up the difference between saccades and smooth pursuits. 


These two are often confused, but are really very difference. Saccades and smooth pursuits are the two parts of eye teaming. 


Smooth pursuits allow visual tracking of a moving item while saccades allow synchronized, rapid eye movement between two or more given points such as in visual scanning.

Impaired Saccades



Impaired saccadic movement is when the eyes do not move in synchrony in a designated pattern such as left/right and top/bottom. 


They may jump randomly or move in uncoordinated patterns that can lead to confusion of where the child was previously in reading and written work. 

What Do Problems with Saccades Look Like?

Below is a simple passage that we would expect a first grader to be able to read and what they might read with an impairment of saccadic eye movement.


The black cat sat next to the pumpkin. 
The black cat liked the pumpkin. 
The black cat meowed at the pumpkin.


This is what a child with impaired saccadic eye movement may have read:


The cat sat to pumpkin. 
The black cat liked pumpkin. 
The cat meowed the pumpkin.


This example is a demonstration of the “jumping” that may occur when reading or copying a sentence. While the child was reading, they may have stumbled and corrected themselves realizing they were not in the right spot and missing words along the way. 


Children who present with impaired saccades ofen times are shy when reading out loud to peers and adults because of this. 

Identifying Saccadic Impairments



Impaired saccadic movements are very difficult to see in screenings. The most common presentation of impaired saccadic movement is slight jerks, or jumps at the midline or outer edges of field of vision. They are so small, that they can be missed or mistaken for a twitch. Despite their small outward appearance, impaired saccadic movement can have significant impacts on the child’s learning.


In therapy or a classroom setting, having a child read the letters of a simple word search from left to right and top to bottom can provide an indication if they are unable to follow structured patterns with supports such as pointing with a finger, or covering up the lines under the one the child is looking at.


Here are some helpful strategies that can accommodate for visual problems in the classroom.

What Causes Saccadic Impairments?



It is unclear what causes saccadic movement impairments in children. It is clear however, that the child’s eyes have not learned to move in structured patterns between two points rapidly, which can significantly inhibit the learning process.  

Signs of Saccadic Movement Impairments in the Classroom



Like many underlying vision concerns, screenings alone cannot determine impairments. 


Some supporting signs that a child may have a saccadic movement impairment can be found below: 


• Difficulties copying work from the board to a paper without errors or omission of words
• Difficulties copying work between two papers without errors or omission of words
• Difficulties reading passages of work—specifically 2 or more lines of text
• Losing place when reading frequently
• Utilizing a finger to track when reading 
• Frequent errors when spelling
• Poor spacing and orientation to the line when writing 

Final Note on Impaired Saccadic Movements



Saccades plays a crucial part in eye teaming, reading and writing. When it is impaired, the child may experience high levels of frustration, embarrassment and difficulties with their daily reading and writing tasks.  Like many underlying vision deficits, impaired saccadic movements has many variations in presentation, and should be monitored closely by therapists and educators to ensure referrals to the developmental optometrist are made when necessary. 

More information on saccades:

For even MORE on visual saccades and the impact visual skills play in learning, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.

In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂

Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!

Click here to learn more about Visual Processing Lab and to sign up.

 

Free visual processing email lab to learn about visual skills needed in learning and reading.





Looking for more information on vision? Check out my OT Vision Screening Packet for helpful handouts and a screening tool.

Occupational Therapy Vision Screening Tool

This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings. 

 
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
Saccades and learning, read more to find out what are saccades, how to screen for visual saccades, and what saccadic impairments look like.
More Visual Processing Posts you will love: 
 
 
 
 

Activities to Improve Convergence Skills

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. The fact is that visual convergence skills impact reading, writing, and so many aspects of functioning. We have more information on this in our resource, how convergence insufficiency impacts reading skills. Having a few visual convergence activities on hand to support these needs is key.

 
These activities to improve convergence skills are ways to improve convergence insufficiency and visual motor skills needed for visual processing activities including fun occupational therapy activities for kids.

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 behavioral 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. These types of vision specialists can support specific needs.


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 of Convergence Skills

Getting a better handle on what causes things like skipping letters when reading, trouble with depth perception, trouble tracking objects, and other convergence red flags, is tackling the foundations of visual convergence. 

Let’s first discuss what causes convergence insufficiency. Then, we’ll cover convergence activities to support these needs.

 

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 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. 


Therapy Ball- 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.   

Convergence Activities

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. ​


Related Read: 
Looking for information related to Visual Saccades? Here is information on Saccades and Learning.

Activities to improve convergence insufficiency can include occupational therapy activities for visual motor skills like swing and therapy ball activities along with the brock string and other visual convergence activities kids love!

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

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. 

The purpose of a Brock String is to help and enhance the coordination between the eyes and the ability to shift vision to different distances quickly, accurately, and effortlessly.


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.

 
 
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.

 

Use a visual screening tool like this occupational therapy screening tool to address visual processing skills like visual convergence and to guide visual convergence activities in therapy.




A little about Kaylee: 
 
 
Related articles you may be interested in:
 
 
 
 

What is Convergence Insufficiency?

As therapists, we often times see clients with vision needs that impact functional skills. Visual processing is a complex topic and convergence insufficiency is just one area. Read below to find out more about convergence in kids, to understand exactly what is convergence insufficiency, and how convergence plays into functional skills and learning.

**DISCLAIMER** I am not an optometrist, ophthalmologist or vision therapist. All information in this post is informational in nature only and should not be utilized in place of the appropriate professionals treatment and evaluations.

Convergence insufficiency is a vision problem that many kids experience when struggling with learning or reading. This article explains OTs role in vision problems and also what is convergence insufficiency, screening  tools for convergence, how to identify convergence.

What is Convergence Insufficiency?

Vision is a hot topic among therapists these days. It’s a foundational skill that we often overlook, or don’t have a clue where to start even if we know that we need to address it. When our vision is impaired, so is our learning.

Need help addressing visual problems in the classroom? Here are classroom accommodations for visual impairments

Vision screenings done in the school nurses or pediatricians office only addresses acuity, resulting in other underlying vision concerns being missed.

These concerns can go unaddressed for long periods of time until the child has received remediation services, OT and other services to address the child’s deficits. By the time we realize that vision needs to be re-addressed the child is struggling and does not find academic work enjoyable.

Underlying vision concerns are often hard to detect, with convergence insufficiencies being one of the most common issues.

What is Convergence

Before we can talk about convergence insufficiencies, we need to address what typical, intact convergence patterns look like.  Simply put, convergence is our eyes ability to smoothly follow a moving target as a team, from a distance to a very near point, such as the tip of our nose.

Convergence is not only an active motor pattern, it is also a sustained motor pattern. Sustained convergence is utilized for the completion of near point work tasks. Intact convergence skills allow us to read, write, draw and catch a ball, and similar tasks with relative ease. When the system experiences difficulties, it can result in a convergence insufficiency.

Convergence Insufficiency

A convergence insufficiency is caused when the dynamic system of convergence/divergence is impaired or experiences stress. The impairment hinders the child’s ability to move their eyes in synchronized, coordinated, and smooth movements from a far point to a near point or near point to far point.

The ability to assume, and maintain sustained convergence patterns may also be significantly affected.

Causes of Convergence Insufficiency

Impairments to this system can stem from several different causes, with the most common reason being an eye muscle imbalance or weakness. Muscle imbalance and weakness can occur in one or both eyes. It is very dependent upon the child.

Other causes of a convergence insufficiency may be due to congenital neurological reasons, traumatic events, or other physical impairments that affect the eye. These are ​NOT​ the usual suspect for why a child experiences a convergence insufficiency and  should be ruled out by an optometrist or ophthalmologist if there is a reason to believe this is the case.

Screening for a Convergence Insufficiency

The most recognizable form of a convergence insufficiency found during a vision screening, is when the child is unable to follow the tracking item to within one half inch of their nose. When this happens, the child’s eyes may appear to “bounce” or “snap” back to a midline position despite the child’s best effort to find the item. This can happen with one or both eyes, and it is important to note in your screening what happened. In more severe cases, the child is unable to move their eyes to follow the tracking item to their nose.

More commonly, the child may be able to complete the convergence/divergence patterns, but experiences headaches, complains about their eyes hurting or frequently rubs their eyes with sustained convergence activities such as reading and writing.

It is also important to note, if the child is unable to sustain convergence at the end of the convergence/divergence pattern screening for more than a few seconds. This can also be an indicator that the child has a convergence insufficiency. This is one of the hardest skill deficits to identify as it is very subtle and difficult to see at times. If you suspect a convergence insufficiency, look for other red flags to support your observations.

Red Flags of Convergence Insufficiency

A convergence insufficiency is often hard to identify in screenings alone. Below are a list of skills that may be affected if a child is experiencing difficulties with convergence.

● Frequent headaches
● Rubbing of the eyes
● Covering one eye consistently
● Red or bloodshot eyes
● Distress with reading tasks
● Distress with near and far point copying tasks such as copying from the board
● Difficulty with catching a ball
● Use of a finger to track their place when reading
● Sleepiness or fatigue during near point work
● Motion sickness
● Blurred and/or double vision
● Words appearing to “jump” or “move” on the page

If the child is experiencing any of these signs, have their vision checked by an optometrist to rule out an eye muscle imbalance that may be causing a convergence insufficiency.

Treatment of Convergence Insufficiency

Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. It is important to note that an OT cannot diagnose a convergence insufficiency. She/He can only report their observations and recommend follow up with the appropriate health care provider.

Upon seeing an optometrist, corrective lenses or vision therapy may be recommended based on the child’s needs. It is ​VERY​ important that the child wear his/her glasses and complete vision therapy if recommended as prolonged convergence insufficiencies can result in permanent eye strain and damage.

Once the child has received their corrective lenses, and if vision therapy has not been recommended, OT can help provide foundational skill remediation and exercises to promote the development of the child’s convergence skills.

One way to identify any convergence issues is with a screening tool like the Visual Screening Packet. This resource contains tools for occupational therapy practitioners to identify visual convergence challenges. The therapy provider can then offer activities and supports for any issues that are identified. The screening resource can then be used to assess improvements following therapy sessions.

Be on the lookout for my next post, ​Activities to Improve Convergence Skills​ to further fill your vision tool box. Also be sure to check out my OT Vision Screening Packet for useful forms and handouts to help you identify convergence insufficiencies and other vision concerns.

Occupational Therapy Vision Screening Tool

Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care.

This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings.

This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR
Wondering about convergence insufficiency? This article explains what is convergence insufficiency, the definition of convergence, how convergence is used in vision tasks like handwriting, reading, catching a ball, and learning as well as red flags for convergence and visual processing skills and screening tools for convergence insufficiency.