Improving Visual Attention & Processing with Visual-Only IM Presented by Amy Vega, MS, CCC-SLP, IM Clinical Education Director

Course Objectives Identify patients who will benefit from use of visual-only IM to rehabilitate visual processing skills; Demonstrate evidenced-based practice through appropriate use of objective assessments to measure visual-only IM treatment outcomes; And demonstrate use of an appropriate IM treatment hierarchy to remediate visual processing skills.

In Search of a Remedy to Improve Outcomes Highly specialized outpatient brain injury rehabilitation Variable outcomes in visual attention & processing with IM as compared to auditory attention & processing After IM treatment via combined auditory – visual modalities, impairments persisted in: Visual attention Cognitive speed during visual tasks Executive functioning

Example of Auditory-Visual Performance Discrepancy after IM

Auditory: Pre & Post Test Comparison PRE-TEST Sustained attention 10th percentile Attention – switching <1st percentile Selective attention Divided attention POST-TEST Sustained attention 75th percentile Attention – switching 50th percentile Selective attention Divided attention 35th percentile

Visual: Pre & Post Test Comparison PRE-TEST Sustained attention 5th percentile Attention – switching <1st percentile Selective attention Divided attention POST-TEST Sustained attention 9th percentile Attention – switching <1st percentile Selective attention Divided attention

Contributing Factors? Reliance on stronger modality during IM (auditory)? Not really engaging visual attention and processing? Visual modality is more passive during IM in some patients?

A solution? Improve timing & rhythm in better/preferred modality first (auditory)? Then “force” use of visual modality by turning off the sound? Measure outcomes to see if approach works.

Expected Outcomes Reading Safety Functional independence Visual attention Visual processing Visual memory Executive functioning

Supporting Research

Neuroplasticity Schwartz and Begley (2002) The Mind and the Brain: Neuroplasticity and the Power of Mental Force. “A consistent factor in laboratory and clinical studies of neuroplasticity is that to obtain reorganization of the neural system, cognitive input must be present and many repetitions are required.

Role of Attention in Visual Processing Vuilleumier & Driver (2007) Modulation of visual processing by attention and emotion: windows on causal interactions between human brain regions. Visual processing is not determined solely by retinal inputs. The internal attentional state of the individual can alter visual processing of the same stimuli. This can influence visual cortex, boosting neural responses to an attended stimulus.

Role of Attention in Visual Processing Vision therapies focus on: Perception Tracking Focus Eye teaming

Role of Visual Attention in Reading Solan, Larson, Shelley-Tremblay, Ficarra, & Silverman (2001) Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities. Eye movement therapy improved eye movements and also resulted in gains in reading comprehension. The results support the notion of a cognitive link among visual attention, oculomotor readiness, and reading comprehension.

Role of Visual Attention in Fall Prevention Hyndman & Ashburn (2003) People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Sustained and divided attention deficits correlated with functional impairments and falls, highlighting that attention deficits might contribute to accident prone behaviour and falling.

Candidacy for Visual-Only IM DEFICITS MAY BE PRESENT IN: Visual attention Visual memory Spatial orientation Processing speed Concentration Executive functioning DEFICITS MAY IMPACT: Reading Writing Driving Safety Etc

Guidelines for Visual-Only IM First, combine auditory & visual modes Guidelines for Visual-Only IM First, combine auditory & visual modes. Achieve best performance possible. Patient hears the IM …And patient sees the IM

Assessing Outcomes of Visual-Only IM Woodcock-Johnson Tests of Cognitive Ability III Test of Everyday Attention Visual Object and Space Perception Battery Bender® Visual-Motor Gestalt Test Behavioral Inattention Test Stroop Color & Word Test Symbol Digit Modalities Test

Assessing Outcomes of Visual-Only IM Trail Making Test – Parts A & B Rey Complex Figure Test Gray Oral Reading Test Gray Silent Reading Test Woodcock-Johnson Tests of Achievement Boston Diagnostic Aphasia Exam – 3rd Edition Nelson-Denny Reading Test

Critical Elements of IM Timing stimulus (reference tone or center flash, a visually-based metronome stimulus) Timed movements (IM exercises, other activities based on your creativity) Feedback (guide sounds, visual mode, a visually- based guidance system) Intensity (repetition, repetition, repetition)

And so much more… Check out the full presentation for more great tips on using IM training for visual attention and processing. Also included: Extended Research Sample Exercises Case Studies Parent testimonial

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