1. Prepared for MAER 4/26/2012

2.  Spatial perception is understanding the space we need to move through or manipulate objects within  Vision is the deriving of meaning and direction of action as triggered by light  Vision is the primary human spatial processing sense

3.  So what if? You can’t see? OR Can’t see like you used to?  Your visual attention may be the key!

4.  Sight Sight loss (eyeball and eyeball wiring hardware) is rarely total  Vision  Vision loss is never total that I know of  We can have vision without eyesight As many in attendance can attest to we see through our eyes (eyesight) with our brain (vision)  Mobility work depends on spatial processing (vision) in the brain not the eyes  Thinking in pictures (Visual thinking)

5.  Development Most are born seeing, but don’t understand what we see (vision) Vision is learned  Learned by bumping into reality with our sensory systems (with mouthing, touch, hearing proprioception and movement)  Learned by figuring out the patterns of reality well enough to even anticipate

6.  It is the last sensory system to fully mature  Complex environmental interactions or movement experiences are needed  Movement is essential to spatial perception  And visual development  Therefore Vestibular and Cerebellar function is important as well  When working well vision leads and guides, when not it interferes (John Streff OD)  When mature it can substitute for the sensory systems that helped it’s development  Vision has been said to be hands extended

7. Amblyopia (lazy eye), strabismus (wandering eye), and learning related vision problems are a lack of full visual development not usually a loss of anything  Lack of development  Truly successful cures require addressing improper development Most nearsightedness, astigmatism and farsightedness can also be viewed in a developmental light.

8.  Congenital (Never had) and acquired (had and lost)  Loss of eyesight is not the loss of vision  But, vision without eyesight is not the same  “Not the same” is the key issue

9.  Change is never easy for anyone at almost any time  What has changed with the loss of eyesight (hardware) is how you now will use vision with limited or different eyesight as a part of the visual process (software)  The role of automaticity or habituation

10.  Even with full visual capacity you cannot attend to everything all the time!  Also true for hearing, smelling and feeling (shoes?)  Selective attention is an important component of successful spatial processing  Changes to visual attention and how we use eyesight in visual spatial processing is what changes and needs to be addressed

11.  A visual cure is making vision function like it used to  Many losses of eyesight have no cure, but vision is still present  It is not bad or unusual to look/hope for cures  It is not always realistic to expect cures for many loss of sight conditions at least in the immediate future

12.  Hope to improve visual function with rehabilitation is more realistic and attainable  Getting used to changing the way you use vision is the key Silverware drawer example Practice over time Effort/habituation/ease of use

13.  Decreasing effort is the way to reduce eye strain (asthenopia)  Trying to use old software with changed (new) hardware is stressful and tiring  Learning to use what is left (pieces of eyesight, visual memory and spatial vision) with the least amount of effort is very important  Part of any visual rehabilitation

14.  Two approaches: 1) Limiting visual loss due to misuse or nonuse is important  Ex. peripheral vision Circling the wagons  Self limitation Lots of research on visual field (attention) restoration!

15. 2) Learning to re-write software  There is no substitute for hardware loss in any sensory system  There is a lot of brain plasticity research out there that tells us making new software to run different hardware is possible at any age  Doesn’t it make sense to use all of our sensory systems to rebuild dormant software or build new software just like our vision developed to start with

16.  Look Hard Look Soft procedure Ease eyestrain  Visual imagery/memory practice What you remember things to look like Visual closure-filling in the missing pieces Visual anticipation

17.  If you think you can or you think you can’t you are probably right! Henry Ford “The Secret”  Hope and faith are important  Learning is having the correct experience at the correct time  Expert guidance increases the odds new software can be developed  Acceptance of loss and getting support Psychology of loss Support groups Local Rehabilitation Team

18.  Loss of eyesight can cause one to feel unlucky, frustrated, anxious and/or depressed  There are no cures out there for many eyesight conditions  But there may be many rehabilitation treatments that are possible

19.  For those with eyesight or visual loss: You can do something! It is your choice It is your software and attention and only you can change it You are in charge of how you choose to use your eyes and your visual process 

20.  For the rehabilitation team: You are responsible for keeping abreast of new science, new development in your field You need to learn how others learn in order to use your knowledge about your field of expertise in a positive way You are responsible to use everything you know to help your patients improve the quality of life with eyesight or visual loss

21.  Rehabilitation is a process not a destination  Thank you for your attention today  Questions?