Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This single-subject case study examines the impact of visual interventions on the school occupations of a 9-year-old female with oculomotor insufficiencies. At the conclusion of 15 treatment sessions, the client showed significant improvement in visual abilities and in school occupational performance. These findings indicate the potential benefit of improving occupational performance of school-age children with oculomotor insufficiencies through targeted oculomotor interventions.
Primary Author and Speaker: Katherine Clark
Additional Authors and Speakers: Hannah Tolson, Rachel Petty, and Hannah Moser
Contributing Authors: Hannah Tolson, Rachel Petty, and Hannah Moser
PURPOSE: This research project aimed to determine if visual interventions have an impact on occupational performance related to scholastic skills in a 9 year old female with oculomotor deficiencies. Studies have shown that oculomotor insufficiencies are often mistaken or misdiagnosed as attention or behavior disorders. Previous research has been conducted suggesting links between oculomotor capabilities and academic performance, but more evidence is still needed as this is an emerging area of research.
DESIGN: This was an exploratory single-subject design methodology, focusing on one nine-year-old client over a period of 15 one-hour treatment sessions. The participant was selected through meeting criteria of having below average oculomotor abilities and below grade level academic performance.
METHODS: The client was tested to obtain her near point of convergence (NPC) and near point of accommodation (NPA) to determine oculomotor ability. She was also administered the Developmental Eye Movement Test (DEM) to determine oculomotor ability and correlated academic performance. The Wold Sentence Copying Test (WSCT) was administered as an indicator of academic performance. Qualitative data collection included responses from caregiver and client interviews regarding occupational challenges and success related to school performance. All evaluative measures were recorded both at baseline and at the conclusion of 15 one-hour treatment sessions. The client received occupational therapy in 1 hour sessions twice a week, in which therapists led occupation based interventions that solely focused on improving oculomotor and visual ability (saccades, smooth pursuit movements, convergence, accommodation, and left-right awareness).
RESULTS: At the conclusion of 15 treatment sessions the client's NPC had improved from 9 cm to 3 cm (normal NPC is <6 cm). Her NPA had improved from 8 cm to 3 cm in both eyes (normal NPA is <4 cm). The results of the DEM test showed that she improved from 2 standard deviations (SD) below the mean for her age level to 1 SD below the mean in all three of the testing categories (vertical, horizontal, and ratio scores). Her performance on the WSCT improved from 17 letters per minute (3 SD below the mean for her grade level) to 47 letters per minute (1 SD below the mean for her grade level). Parent interview data indicated noteworthy improvement in the child's ability and desire to participate in school occupations.
CONCLUSIONS: This case report demonstrates that visual interventions aimed at improving oculomotor performance have the potential to positively impact scholastic occupational performance in children with oculomotor deficiencies. The findings support the theory laid out in Mary Warren's Visual Perceptual Pyramid: function of the higher level skills requires lower level level skills to be intact in order to integrate visual information effectively for ideal occupational performance. These findings also support data gathered in previous studies suggesting a link between oculomotor performance and academic ability. Although these findings cannot be generalized, they provide preliminary evidence supporting the effectiveness of this approach.
References
Sheiman, R. G. (2008). Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children. Archives of Ophthalmology, 126(10), 1336. https://doi.org/10.1001/archopht.126.10.1336
Scheiman, M., Chase, C., Borsting, E., Mitchell, G. L., Kulp, M. T., & Cotter, S. A. (2018). Effect of treatment of symptomatic convergence insufficiency on reading in children: a pilot study. Clinical and Experimental Optometry, 101(4), 585–593. https://doi.org/10.1111/cxo.12682
Cooper, J., & Jamal, N. (2012). Convergence Insufficiency--A Major Review. American Optometric Society. https://doi.org/10.1111/j.1475-1313.2011.00821.x
