The Developmental Eye Movement (DEM) Score Sheet
The DEM score sheet, detailing this little girl’s eye movements, posture, and fixation, uncovers the reasons behind her struggles to keep pace in class. This instrument is among several I employ to assist parents in recognizing their child’s tracking capabilities and comprehending the substantial effort required for their child to keep up in class.
Clinical Pearls
The Digital Eye Tracker
The DEM score sheet, detailing this little girl’s eye movements, posture, and fixation, uncovers the reasons behind her struggles to keep pace in class. This instrument is among several I employ to assist parents in recognizing their child’s tracking capabilities and comprehending the substantial effort required for their child to keep up in class.
Clinical Pearls
The Wilkins Rate of Reading Assessment
The Wilkins Reading Rate Test tracks a child’s eye movements during reading, requiring fixation on each word due to the absence of contextual clues for predicting the next word. This process causes the young reader to expend more energy than necessary, making comprehension tiring and hindering her academic progress, which leads to frustration for both the child and her mother.
Clinical Pearls
Therapeutic Prescription Glasses
The transformation in this young man’s handwriting from the day he first visited to the day he received his therapy glasses was remarkable. Without any therapy between the assessment and collection days, the dramatic change can only be attributed to the power of his therapeutic prescription. His departure from my practice was marked by sheer joy over his progress. It goes without saying that his parents were equally delighted. While there’s still a journey ahead in his remediation, we’ve established a solid foundation.
Clinical Pearls
Primitive Reflexes are Fundamental to Learning
Discussing Primitive Reflexes is crucial as they are fundamental to learning. These reflexes develop in utero and serve to protect an infant during the first few months after birth. Typically, within a 12-month period, Primitive Reflexes should integrate into the child’s nervous system, paving the way for Postural Reflexes. However, there are cases where one or more Primitive Reflexes do not integrate, known as Retained Reflexes, which can impede natural development and cause missed milestones. For instance, a child with a Retained Moro Reflex may constantly be in a “fight or flight” state, using considerable energy to maintain their sense of safety. This can manifest in their visual perception as poor eye tracking, skipping lines, letters, or words, incorrect copying from the board, and a short attention span, among other symptoms. Evaluating primitive reflexes can offer significant insights into the learning challenges a child may encounter.
Clinical Pearls
The Symmetrical Tonic Neck Reflex (STNR)
The Symmetrical Tonic Neck Reflex (STNR) can affect reversals in writing skills, especially in children. This reflex is crucial for coordinating the upper body, head movements, and visual tracking. If the STNR remains unintegrated or persists past infancy, it may disrupt fine motor skills and visual processing, leading to problems such as: 1. Difficulty Crossing the Midline: The STNR might make it hard to coordinate movements across the body’s midline, essential for writing smoothly from left to right, causing reversals of letters or numbers (for instance, writing “b” as “d” or “3” as “E”). 2. Visual Tracking and Spatial Awareness: An unrefined STNR can hinder visual tracking, complicating a child’s ability to accurately perceive and arrange letters and words on a page, which may also lead to writing reversals. Therapeutic approaches designed to integrate primitive reflexes can assist in overcoming these difficulties and enhance writing and visual tracking abilities.
Clinical Pearls
The asymmetrical tonic neck reflex (ATNR)
The asymmetrical tonic neck reflex (ATNR) is a primitive reflex that is crucial for the development of motor skills and vision. It is associated with vision in two main ways: 1. Eye-Hand Coordination: ATNR assists in the coordination of eye and hand movements. When the head is turned to one side, the arm and leg on that side stretch out, while the opposite side flexes. This reflex is vital for early hand-eye coordination, necessary for actions such as reaching and grasping, and later for precise motor skills like writing and drawing. 2. Visual Tracking and Spatial Awareness: ATNR contributes to the development of visual tracking skills. As the head turns, the eyes move in the same direction, which is fundamental for a child to learn tracking of moving objects. Inadequate integration of this reflex may result in difficulties with smooth tracking across a page, which can impact reading and writing abilities. The proper integration of ATNR is key for seamless visual-motor development, and if it remains active beyond infancy, it may interfere with tasks that require synchronized eye and hand movements.
Clinical Pearls
The tonic labyrinthine reflex (TLR)
The tonic labyrinthine reflex (TLR) significantly impacts visual development and coordination. Here are two aspects of its relationship with vision: 1. Postural Control and Visual Stability: TLR plays a role in a child’s posture and head control. Activated by tilting the head forward or backward, it engages specific muscle groups, influencing the body’s overall posture. This reflex is crucial for visual stability, as correct head positioning is necessary for a consistent visual field. Inadequate integration of the TLR can lead to challenges in maintaining a fixed gaze, which may cause difficulties with reading or following moving objects. 2. Depth Perception and Spatial Orientation: TLR contributes to a child’s spatial relationship judgment and depth perception. Initially, the reflex aids in developing balance and spatial awareness, essential for discerning the position of objects relative to oneself. A persistently unintegrated TLR may cause issues with visual-spatial tasks, like estimating distances or moving through space, potentially impacting reading and writing abilities.
