‘Visual perception plays an important role in the learning process, in this context distinction must be made between sensation and perception. Sensation refers to our immediate expertence of sensory processes whereas perception ts more complex, entailing the interpretation of sensations in the light of past experience. This distinction may be a litte too simple but it must be realised that perception tnvolves not only sensory processes but also behavioural responses. It involves a continuing set of transactions with the environment. So both learning and sensory processes play an important role In our perceptions. ‘The act of perception Is Influenced by 1. attention, 2. experience, 3. emotion, 4. duration of excitation, 5, method of stimulation. Perceptual development is a function of maturity, and. is important in enabling the child to detect in printed words clues which enable him {o read with speed, fluency and understanding. Visual perception can be stimulated. Perceptual skills develop from birth and reach a peak at the age of 8 years, When one reads a chart one may have 6/6 or 6/60 ‘vision’ [quotes are minel as a measuie of vistial acully. When the focused image leaves the retina it continues asan electrieal/chemnteal impulse by way ofthe eptie nerve and tract to Ue lateral geniculate body. Thence It passes to the visual cortex. From he occipital cortex Iimpulses pass to the parietal lebe tn partietsar the angular gyrus. From the parietal lobe stimu! pass to the frontal lobes where conception takes place. ‘Thus reading Is: 1. visual [reUno-ocepttal}: 2. perceptual {parieto-occipitall: 3. conceptual [frontal lobes} ‘There are three laws which underlie the development of readin, 1. ‘The law of object constancy. Here the object Is the ‘same regardless of its position. Thus we see a rocking chair regardless of the position in which the chair is placed. 2. The law of directionality. Ab’ has to be ab wit is In the correct direction. If not ab’ ean be a“d 3. The or lancy. Here a ‘e’ may be large or small but must be without the small hook which makes it a “Q". Ifwe ean differentiate these three laws we can become good readers. (English. K.P., Aust Journal Of Ophthal., 8/81 Vol. 9, No. 3 pp. 181-184) ‘The pre-eminence of vision in the sensory-motor. construction of the human action system ts reflected in input and output arrangements of retina and brain. ‘The retina, with ils mulUbillion sensitive points and polarities, Is receplive to an enormous range of npressions. Retina and brain are sensitive enough to, detect the light of a candle 21kms away. Speaking to a neurologist, McCulloch points out that the eye alone has more than 100,000,000 photoreceptors, each of which is elther signaling or not signaling at any given a Disabled moment. This means that the eye can exist In 21,000,000,000 states, each of which corresponds to a unique distribution of stimulation ... Each eye transmits as much Information to the brain as does all the rest of the body. It can send in a million impulses per millisecond. For the whole organism, including eyes, the Input has a maximum of three million signals per millisecond. (Gesell. A. - Vision - Its Development in Infant and Child, New York, New York, Harper Bros. 1949). Vision is an act of physico-physiologico psychological compleaty whereby an incvidual sces EE See oe ben we requires an observer, observed objects and radiant ‘energy linking it wth the observer. (Ronchi, V.- Optcs, the Science of Vision, (ranslated rom Hallan, and revised by Rosen, Washingion Square, NY. NYU Press, 1957). ‘The brain of man and higher animals is a double ‘organ, consisting of a right and left hemisphere connected by the Isthmus of nerve Ussue called the corpus callosum. (Cazzaniga, M. - Scientifie American, 8/67) From the foregoing It can be easily seen that the behavioural optometrist who is aware of clarity of sight. and, who is more vitally interested in efficiency of Information acquisition and processing must earry out an in-depth assessment of human performance. Whilst this Is espectally (rue of the learning disabled population, of course, {f carried to Its logical conclusion such a population includes every one of us, Perceptual learning then ts the development of the ability to extract information from stimulation in the environment by Increasing differentation of the distinctive features of the stimulus information. The peripheral mechanisms of perceptual learning are the “attentive” mechanisms or the receptors associated with sight, hearing and touch, To be involved in perceptual earning, a child must: L._expose the receptors to chosen aspects of the stimulus Information and select the Informative areas, He must attend, U, make sense organ adjustments in order to facta careful observation of the stimulus. He must look. lil. undertake skilled and systematic exploratory aclivily In order to attend to distinetive features. He must search. ‘That Is, peripheral attention which fs part of perceptual learning is attained. by systematic, active mantpulation of the receptor mechanisms and/or some internal attentive process. (Dwyer. J., - "Educational Assessment in the Optometric Consulting Room” notes handed out at Stephen Leslie seminar at Neweastle, 4788). Behavioural Optometry, Volume 4, Number 3, 1992One of the earliest moxels which was devised to simplistically cover Vision and Learning was Input, Put-Put and Output. “The Input depends on the receptors which are the peripheral mechanisms of altenuon, From a structural and functional point of view, they influence the quality land quantity of information availabe for perceptual input, Previous speakers have elaborated on the important contribution that Optometry can male here. Afterall, the majority of perceptual testing ts prolonged near point work and so one should always 3s fe Subjects wearing the appropria. Jenses io positively influence the quality and quantity of information available for perceptual input, Of course, I ould be wonderful ithe perceptual testing could be fone without and with the appropriate nearpoint CN eT, correlated tests or subtests. ‘Aller the Input comes the Put-Put where initially such distinctive features as form, size, orientation and structure are selectively observed and then higher level cognitive processes and decisions made regarding the Output such as eye-hand co-ordination and fine-motor dexterity in the copying tests. Faced with the mammoth task of the Examination Protocol for the Learning Disabled it seems that the key Is to be aware of just what tests are available and to be selective so that what ever the age of the patient {15 possible to arrange an examination that derives a wide Fange of normaon about thelr information processing Accordingly the following material Is cavered:- P-113- ‘Three Phases of Perceptual Development (2, Gelman, G.N. - Seminar materials) PIS - Cycles of Behaviour (d. Lowry RW. - Handbook of Tests for the Developmental Optometrist, Private Publish, Worthington, Minnesota) P16 - Vision (b. Kraskin, R. - Seminar material & c. Gordon, i.R. - Baby Learning through Baby Play, St. Martins Press) p.117~ Child Development Expecteds (e. Treganza, A. & Wold, RM, - Optometric Evaluation of Children with Academic Dysfunction, OEPF Curr If, Series 1, No 2.11/76) P.119- Cube Behaviour (d) p-119- Incomplete Man (a) P.120- Copy Forms (d) P.121- Piaget Right-Lert Awareness Test (e. Series 3 No. 5 2/79): Money Road Map Test (f. as e.) Reversals Frequency Test (g. Gardner, RA. Reversals Frequency Test, Creative ‘Therapeutics. Cresskill, NJ.) P.122- Developmental Profile for Determining Vistal Performance Levels (h. Child Vision Care Manual - OEPF 1980) p.123- Copy Forms. Three, Six, and Split Six Form Boards, Tactual Forms, Sized Blocks, Visual Recall, Visual Manipulation, Visual Auditory Iitegration, Circus Puzzle (1. Getman. G. N. Developmental Optometry, OEPF 1991) p.125- Times for Splitsix Form board (J. Solan ‘Seminar- Modified Perception Baitery- SUNY, ny) p.131- J Solan Seminar- Modified Perception Battery = SUNY, NY) p.192- Standing Angles-in-the-Snow, Chalkboard Circles, 3:3 Alternate Hop, Goodenough Draw a Person test, Circus puzzle, Pegboard test, p.138 p.l40 p40 pal pada plas p46 ‘Winterhaven Copy Forms. (k. Suchoff, LB. ‘Visual-Spatial Development in the Child, SUNY. NY} - Tests of Vision Analysis Skills & Auditory Analysis Skills (1. Dwyer Seminar Handout, Materials. Ovens Murray Visual Training Forum, 1981) ~ Visual Aural Digit Span test (VADS) (m. Koppitz., E. - The Visual Aural Digit Span Test, Grunne & Stratton, NY, 1977) - Wepman Auditory Discrimination Test ()) + VMI (n. Beery, 1 - Manual for the Developmenial test of Visual - Motor Integration, Modern Curriculum Press, Cleveland, 1982) ~ Southern California Figure Ground Test (o, ‘Treganza, A - Child Vision Testing by Optometric Aides. OEPF Assistants Papers, Serles 3 No, 9, 12/78) + Motor Free Visual Perception test (MVPT) (0. series 3, No. 6, 9/78 also p. Slosson Educational Publications, Inc. P.O. Box 250 East Aurora, NY, 14052) + Kirshner-Saroj Visual Perceptual Test (4. Kirshner, A & Saroj, S - AJO, 60, 305) Visual Three (d) p.147- Perceptual Evaluation - General Adjustment Responses, Echolalia, Auditory Analysis, Auditory Organtation Test, Split Formboard Test, Motor Test, Rutgers Drawing test (a & b forms), WRAT [Maths (r. Vincent, W Optometric Perceptual Testing and Training Manual, PerCon, Akron, Ohio, 1973) p54 WRAT test (p) pss. Purdue Perceptual Motor Survey (s. Roach, E.G. & Kephart, N.C. - The Purdue Perceptual = Motor Survey, Merrill, Columbus, Ohio 1966) P:157- Slosson Intelligence Test (SIT) (p) Jordan Left- Right Reversal Test, VADS Test. p-158- Illinois Test of Pscholingulstle Abilities (ITPA) (P); Gray Oral Reading Diagnostic Test (@) p.160- Simple Tests Developed to Diagnose Dyslexia (New York Times, 16/2/88) ‘This assignment was without end and the tests reviewed were those that the writer had personally experienced. However it 1s not meant to be restrictive and really is just to whet the appetite of the interested behavioural optometrist wishing to commence thelr fellowship process. Five separate overall analyses are presented: - Getman, SUNY. SUNY Modified, . Vineet, and Purdue. Behavioural Optometry, Volume 4, Number 3, 19923 Phases of PERCEPTUAL DEVELOPMENT The The PROPRIOCEPT uals PRECEPTUAL Phase Phase the child's The chines tide | mien PROPRIOCEPTUAL PHASE PRECEPTUAL PHASE ‘All About Me’ ‘All about MY world’ lup to 2 years of agel Internal Signals arising from: i ‘which are vistially and atiditorily sicered to Sell-determined Goals which are visu- ‘lly and auditorily chosen by Me! these Movements are described as: sta: to be ready to respond to ‘what Is about to happen to me. wre: to be able to relate to what is ning to every part of me. Manipulation: (6 be able to stay with what is happening to me. Transport: to get from one place to ‘another easily. lup to 6 years of age) External signals instigate use ‘and practice of inherent information gathering systems for ‘Knowledge of value to ME! Information Systems Manipulative Movements Taste Smell | Touch | Sight Hearing Speech wit notigeable difference Behavioural Optometry, Volume 4, Number 3, 1992 13The PERCEPTUAL Phase Integration the cha's outside worlds PERCEPTUAL PHASE ‘All about Me in My World’ Itorever! ‘Skill of discriminations: for the ‘combinations, contrasts and integrations of all systems for the most information with the least effort on MY PART ‘The Information gathering systems are then used as leans COMBINING, CONTRASTING ‘& INTEGRATING ‘Tasting-Smelling Secing-Touching ‘The Visual System also interweaves with Hearing and Saying Verbal/Visual - Visualisation Visual/Auditory - "ch" v "sh" Visual /Verbal - Reading | Reading is nothing more than Speaking | ‘wrote down’. ON Maturation ‘what happens to the individual in the comes in accordance with the onganisin's genetic nature = regardless of e's experiences Derelopment: what an individual does with the time allotted to him (perfection or deterioration of skills] - the resull of actions which bring out capabilities or potential, and bring him/her to a more advanced and effective level of performance. K.U. Smith, Psychologist, University of Wisconsin, said: ‘The entire human system has evolved as a result of its self-governed, and self-determined selectivities of motor activity. The total development of the child depends upon the degree of Supervision that riSion exercises over the activities that bring about neural integration within all information processing systems and their resulting performance. Behavioural Optometry, Volume 4, Number 3, 1992 a4Herbert Birch, Ph.D. Paediatrician, Albert Einstein Hospital, New York City sald: ‘It is clear that... one of the essential features in the development of so-called reading readiness is the organisation of a set of relations among the sensory systems wherein the visual system becomes hierachically ‘dominant. | Basia Premios ‘he Child's Potential Intelligence is. | NOT fixed at birth. 2, Manipulation of the Environment can produce significant changes in the Chile's witingness and abtity to learn, 3, The Child's development depends on the QUALITY of his interaction, | with the world around him — particularly In the early years of ite 4, The Child’s mastery of language ‘and other symbolié systems and the concepts they convey are especially vital to intellectual development Developmental preparation tor Cultural & Academic Demand 1. Practice in early visual-tactual integrations for communication through gestures and graphics. 2. Practice in the use of conversation for speech /auditory integration. | | 3.Practice in sequencing and grouping for | spelling and number concepts. 4. Practice in form constancy & size /form relationships as the background for spatial relationships, visual/motor perceptions, and figure /ground ratios. 5. Consistent Opportunities to Practice EVERY ‘one of the six D's of Cultural Development. Detention Diserimination Decision Doing DiseySsion | Drill) hytong tg st Bis rem | V Major Cultural Demands Reading 4s not just for word recognition skill: Teadliig is to acquire Information of interest and value to the reader. Ma ths: Is not Just for number fact skill: maths 1s for the appraisal, evaluation and manipulation of the physical world. Spelling & Writing are not just for etter sequence and penmanship skills; they are for ‘communication with peers on subjects of mutual interest & valu Behavioural Optometry, Volume 4, Number 3, 1992 us‘The foregoing material is a series of overhead transparencies that have been developed for use when talking with parents, nurses, teachers - itis a quick course in chiid development that was gleaned form attending several Jerry Getman seminars over the past 16 years - from 1972 onwards. ‘They are shown after the distinction is made between, sight and vision with the cow picture. It really is possible to see vision emerge irom the sight, becoming a very personal encounter for the participants if one waits Jong enough and attempts to draw it out of them. It really highlights the Kraskin definition of An Emergent resulting from the Processing of Information in an illuminated environment aimed at Deriving Meaning and Directing Action A series of overhead transparencies from the book “Leaming Through Baby Play (Gordon, St. Martins Press) are then shown to highlight what Is needed for appropriate development to occur. ‘The following summaries are included so that the informed optometrist can be aware of Just where a baby. should be developmentally as many optometrists feel inadequate when asked 0 examine thelr very young. patients. CYCLES OF BEHAVIOUR (c) ‘This a story about a very modem boy, not much higher than a table , who wore a pair of horn-rimmed spectacles. A kindly old Indy leaned over and asked him tactlully . “How old are you, my ite boy"? He removed his horn-rimmed glasses and reflectively wiped them, “My psychological age, madam, is 12 years: my social age is 8 years; my moral age is 10 years: my anatomical and physiological ages are respectively 6 and 7; but 1 have not been Informed of my chronological age. It is a matter of relative unimportance”. Thereupon, he restored his horn-rimmed spectacles. Although this boy has told us a great deal, we shall not really feel acquainted with him until he tells us how old he is; but on the other hand , we would know very itde about him If we knew only his chronological age. ‘There are six successive stages or cycles of behaviour that will occur from age 2 to 6. A more complete description, written specifically for optometrists can be found in Preschool Vision (American Optometric Assn, 1959) which includes various techniques to use in the examination and diagnosis of children’s vision problems. For our purpose here, we would like to offer a thumbnail sketch of these various eycles of behaviour, comparing these stages with a nationality. ‘The typical five-year-old would compare favourably to the SWISS - smooth, consolidated behaviour. Peaceful, not especially adventurous or daring. When ‘compared to his previous behaviour, so good and thoughtful that It comes to the point of being boring. ‘Visually, we would find him tight and symmetrical , very little ranges and very seldom showing any astigmatism, On certain tests he inay not answer at all - for FIVE ‘wants (o be right, AUFIVE and ONE-HALF to SIX we have a big chance ~ a break up of the previous good behaviour. This would be like the typical RUSSIAN behaviour. He thinks he's right - domineering, demanding - loving one moment, hating the next. Diplomacy doesn't help. He has real difficulty choosing between (vo alternatives, This bi-polar behaviour (I will” - “I won't) even shows up in the visual findings. The posture of the eyes is now unstable and shifting - while at FIVE the phoria didn't Fortunately, around SIX and ONE-HALF the behaviour is more balanced once again and now It would resemble the FRENCH. Rounded and balanced and no difficulty choosing between two alternatives - the frenchman would want both (for it has been sald that he has a wife and also a mistress). Behavioural Optometry, Volume 4, Number 3, 1992 16AU SEVEN years there occurs a definite inwardising ot experience, This withdrawn type of behaviour would feimost like ihe GERMAN. He isa stranger and walks by himelt He makes an impression and isnot close (0 anyone. Even his handwriting changes from the year Before lt would be quite small The seven year old docen't only withdraw emotionaly, but visually aa wel ‘This ls the frst marked emergence of myopia. Even the Rorschach the familiar ink Bot test, Child Rorschach Responses, Ames, Learned Metrnux, Waller, Hosber- Harper changes markedly here. AUSIX ths test Showed “movements, but now at seven the outstanding characterise would be “deta, With the SEVEN year Sid H'was the Impression that counted ALEIGHT impression changes to expression; typically AMERICAN. We know, that compared to the other countries, the American is typically vigorous, expansive and many times, out-of-bounds. Like a typical Texas, his handwriting would now be large. Visually, EIGHT shows a slight gain in hyperopla, His range of vision has again expanded and he now docs an expert Job of copying from the blackboard and transferring Il to the paper on his desk. The Rorschach would show, characteristically, a more comprehensive Interest or “global awareness.” Age NINE Is more determined, more poised, more responsible than he has ever been before. Like the ENGLISH, it will turn out (by age 10) that he was right all along, NINE is trying {o be the solid citizen, and he's also Lying to put his own house in order. One may see a combination of inwardised, outwardised, troubled or *neurotle” behaviour. NINE Is a great discusser and has a demand for realism. TEN Is one of the nicest ages there Is. This Is one of the last ages when he will take mother’s and dad's advice without quibbling, Although his behaviour ts in equilibrium, his vision [5 almost “falling apart”. Ifhe has. worn glasses previously he will announce that “I can see just as well without my glasses". Even with his visual symptoms, TEN doesn't scem to relate these problems ‘wit his own eyes. SCHOOL AND VISION PROBLEMS Only elghteen per cent of children come to school tage 6) with a vial disabity. By sixth grade (age 12) Simos elghty per cent will have a visual disablliy unless the proper approach and/or the proper school furniture is provided Seventy per eent ofall vision problems (acquired) originate tn poor posture. Ifa child allowed to change his body position with a writing task up toveighty per cent of the stress wll be reduce, Unbalanced posture In near tasks will even negate proper lenses. Behavioural Opton etry, Volume 4, Number 3, 1992 WOLD & TREGANZA'S COMPILATION OF CHILD. DEVELOPMENT EXPECTEDS INFANT EXAMINATION Pupillary Reflex - ipsilateral and consensual - is always present in normal, newborn and premature - unilateral absence suggests ipsilateral intra-ocular, optic nerve or visual pathway abnormality - unequal reaction has been reporied in the absence of localised disease. Nasopalpebral Reflex - tapping of the bridge of the nose ‘causes blinking of both eyes. Ciltary Refleg - touching the eyelashes produces a homolateral or bilateral blinking - absence is associated with a lesion of the fifth cranial nerve. Cocleopalpebral Reflex - a loud nolse produces a blink ‘and somellmes started reaction - this is the only consistent auditory reflex found in newborn infants and Is dependent upon a normal auditory conduction and neuronal system. Rotational Eye Movems is - when the Infant is held facing the examiner with the head and body in the same plane, rotation of the infant either clockwise or counterclockwise direct for several rotations produces movement of the eyes in the same direction as the rotational movement = upon stopping the eyes will move In the opposite direction - present at birth but disappears within a few days - asymmetrical eye movements may be due to abducens nerve damage, elghth nerve defect or abnormalitles of the labyrinthine Doll's Bye" Phenomenon - performed by turning the infants head to the right ore white tne ret of the body Is stationary ejesare observed lo stay fixed and ornot move wit dhe head» siallasly with Rexion and extension of the neck usually present forthe first ten days alle and disappears when good visual fallon fs achieved «abducens nerve paralysis remus tn symmetrical eye movements uring the test Opiokinetic Nystagmus - can be elicited by drawing a ‘tape measure before the Infant's eyes - depends upon, Iniact optic nerve - response Is generally absent in Infants with diffuse retinal or cortical damage or with depression of CNS function. MoCarthy Reflex - tapping the supraorbital area produces homolateral blinking on the side tapped - isappears between the ages of2 and 4 months. Blinking Reflex. - bright light flashed in an infant's face causes closing of both eyelids - varlable In appearance but usually evident by 6 mths. GENERAL OBSERVATIONS Month Stares vacantly at surroundings. Briefly follows ‘moving stimulus, Regards examiner's face momentarily. Quiets when gazing toward light of window or bright moving object. Fixes objects brought Into visual scope. Bye and head movements are not synchronised, Hands predominantly fisted. Qulets when picked up. Head predominantly rotated (o a preferred side Lles predominantly in TNR (tonic neck reflex. fencing position) attitude. 2.Months Holds head bebbingly erect. Eyes follow a ‘moving person and near object beyond the midplane. Vocalisation rather than crying. Lying supine, looks downward and sideward but not upward to follow retreating gue. Direct regard and facial response to 47person's face. Seeks light areas. Coordinate compensation eye movements well established, Retain rattle briefly. First begins to observe his hand in action. TNR starts 3 Months Lying supine, tits head backward and rolls eyes upward (o follow retreating figure. Eyes follow. moving objects in all planes (blinking and jerky eye movements). Searches for sounds with eyes. Regards own hand spontancously. Vigorous bocly movements. Anticipates feeding upon sight of bottle or breast with activity change. Cooing and chuckling. 4 Months Head rotates with inereasing freedom in Supine position, TNR begins to disappear. Hands engage at midline. Grasps peneil with both hands and holds briefly. Roils from side to site but not completely over. Enjoys play activity. Eyes move in active Inspection regards own hand, toy, surroundings. In sitting, holds head steady and set forward, looks down at table top, at own hand, and at an object. Fleetingly regards 7mm. pellet on table top - contacts it with outstretched fingers. No grasp. Imitates smiling and laughs aloud. 5 Months Holds ereet in sting. Grasps cube on conlact, Maintains attenon within area close to bod Sits with minimal support with stable back and head. its cup, Allempts to attain toy held beyond reach, Resportds to image In mirror. Rolls ver, supine to prone poslion. Localises course of sound when balis rung at Bide. Dilferentates stringers from farm. Babbles th more than two distinct sounds. ZMenths Manipulating objects, vigorously banging, Shaking transferring and mouthing. ene 8 Months Strong bilateral use of hands in approach, grasp. and manipulation and in simultaneous holding of two objects. Aware of surroundings, easily distracte: watches aclivity around him. Looks for toy he has had, ‘Tums object about in hands to explore visually. Holds one cube and manipulates another. 9 Months Uses thumb to help grasp tiny objects. Sits alone and can change position without falling, Feeds selfa biscult. Pushes one cube with another, Says ‘mumma’ or ‘dada’ Plays interpersonal games like peek- a-boo or pat-a-cake. Months Pulls self to standing position. Drops cube with clumsy or exaggerated release, Unilateral manipulation; other hand remaining passive. Increased mobility of eyes. Crawls to doors of room, and into another room if mother is there. Lins toys high and regards them. Probes holes and grooves, and points at, pellet in botde. Months Unilateral manipulation with increasing use of nondominant hand. Pivots freely while sitting. Tips head way back in ocular pursuit. Picks up cube and releases in vicinity of another. Plays serially with several toys. 12 Months Hands toy to examiner when requested to do 50, enjoys give and take games. Puts small objects into smaller ones, e.g. pellets into cup, and removes them, Retrieves hidden ‘oys. Stands with support and takes steps when supporied. Words (2 or 3) other than mumma and dada, Gives affection. Holds cup with assistance for taking fluids, 15 Months Walks without support, Stacks two blocks, Can scribble by imitation. Climbs onto stairs or low chair. Shows interest in picture books. Manipulates book and pats pictures, especially of baby or dog. Points to objects in surroundings, using “look and see” 18 Months Walks well and runs a lot. Can seat self and ‘limb into chair. Can walk with pull foy, pushes or walks backward to pull. Can go up and down stairs with assistance. Likes to be read to and Interested In books with piclures. Bowel training reasonably established. About 10 words in vocabulary. Handles spoon. reasonably well and feeds self partially. 21 Months Pulls and leads person to point out objects of interest. Clings to objects and often brings close to face to regard. Builds a lower of 5-6 cubes. Watches moveinent of others, and begins (o imitate. Squats in play. Walks downstairs with one hand held, and Upstairs holding the rail. 2Years Can deal with a few mechanical contrivances, ‘beginning to screw toys, turn doorknobs, (urn on tap, Can identity a few pictures by name; dog. cup, kitty, car, baby. Can throw or kick a ball. Walks up and down stairs alone; runs well. Asks for things, e.g. food, drink, toilet by a combination of words and gestures. Sits and “reads” little picture books, turns pages by scif. Makes little 2-3 word sentences. lmitates household tasks, Engages in play activities similar to those of playmates (parallel play}. Likes to watch movement of wheels, record player, egg beater. Regards own movement whilst scribbling. Likes Small objects: pebbles, Uny cars. Identifies familiar objects seen on T.V. Daytime bowel and bladder control established. Cubes: Tower of 6-7. Kicks a large ball on request. 2 Years 6 months Can imitate vertical and horizontal strokes on paper. Pushes toy with good steering. Can, repeat (wo digits can walk tip toe and stand briefly on one foot. Jumps with both feet: relates experlence In simple language, can (ell name and age (if taught). Uses pronouns. Helps (o dress and undress self. Perceives certain dangerous situations (not likely to walk into moving swing: aware of street as danger zone, Years Can copy a circle reasonably well. Can repeat $ unrelated digits (1 of 3 trials). Knows last name. Handles most of dressing: puts on own shoes. Can be ‘trusted in room alone for short periods. Can ride tricycle using pedals., Can understand sharing and (aking tums, Can play in one place and watch activity across the room. Confines painting to own paper. Makes bridge with 3 cubes: tower of 10 cubes. Adds two paris to incomplete man. Feeds self: spills litle. SYears 6 months Turns sideways to adjust to narrow opening. Watches another child's performance. Aware of the parts of a whole. Can make a circle and a cross, Stands on one foot for 2 seconds. Washes. dries hands and face, Drawing: imitates square. Hand tremor when fine coordination required. 4 Years Stands on one foot 4-8 seconds. Skips “lame ‘duck fashion” on one foot. Running or standing broad Jumps. Throws overarm. Imitates a 5 cube gate. Imitates ‘Square (vertical lines longer). Attempts to copy divided rectangle: 3 parts to Incompiete man. Obeys 4 prepositions (on. under, in back of, beside or In front of). Dresses and undresses self. Identifies several letters, SYears Stands on one foot for more than 8 seconds. ‘Skips using feet alternately. Builds 6 cube steps. Likes to colour within lines, to cut and paste simple things but is not adept. Adds majority of paris to Incomplete man, coples triangle. Behavioural Optometry, Volume 4, Number 3, 1992 1s“In the utilisation of this profile and others like it the practitioner should remember five developmental generalisations: 1. Development Is similar for 2. Development proceeds from general to specific responses; 3. Development is continuous; 4. Development proceeds at different rates: and 5, There Is no correlation in development. Ifwe accept the hypothesis that many of the children who fall to learn to read in first grade have a ‘maluraUlonal lag in development, iene would expect ‘ose skis which develop ontogenetially earlier (eg visual-motor, visual pereeptual, directional-spatial) to be delayed. Although the child ing in these early skills crilleal {o learning to ead (eg. pereeplial} mast of them eventually overcome these earlier lags but then lag in those sks whlch develop ontogenetcaly later. From a visual training standpoint this is very important - we do not treat academe skills. So a non-reader with binocular dysfuncuon before visual training remains a non-reader after - just more visually efficient in the right environment. (¢) CUBE BEHAVIOUR(A) ‘The growth of behaviour patterns is typlffed in the reactions of a child to a red one-inch cube as a stimulus object: REGARD 12 weeks Regards cube momentarily GRASP 16 weeks Looks from hand to cube without contact ‘TRANSFER 28 weeks Transfers cube from hand to hand (Binocular vision Is firmly established. Any wandering of an eye after 7 months should not be considered normal) 40 weeks Combines two cubes, one in each hand, in ‘opposition ONE-HALF 15 months VERTICAL- Builds a tower of two cubes HORIZONTAL, VERTICAL 18 months Bullds a tower* of three cubes HORIZONTAL, 24 months Builds a wall or tran* of three COMBINATION 36 months VERTICAL- Bullds a bridge* of three cubes HORIZONTAL, ‘VERTICAL- 48 months HORIZONTAL _—_Bullds a gate* of five blacks DIAGONAL 60 months Bullds steps? of six or ten blocks * The tower and train are first demonstrated by ‘examiner. The bridge, gate and steps are built by the ‘examiner behind a cardboard or paper screen. They are then exposed and the child Is given the appropriate number of blocks and directed to make one like it. INCOMPLETE MAN(d) ‘This test was introduced by Gesell in 1925 and shows manual skill, appreciation of symmetry. Proportion and orientation, There Is interest in the test up lo age ten PROCEDURE: ‘The pleture is presented with the question. “What is this? Then state: “Someone started this picture but did not complete it. I want you to complete Behavioural Optometry, Volume 4, Number 3, 1992 19EVALUATION OF RESULTS Age2.5 —Senibling stl strong, Development of arm 3 Adds leg ees, Serbling gives way to ws controlled marking. Closure (encircling) predominates, Foot to eh ‘Ages Leg, fot, arm added. All too Jong, Foot to tet Age4.5 —Umbilcus may show up fat this age oni) Poot to ght fe5 Completes body line. Hale usually “ fontinues around head: Earls lopped down, no shape. May add ve freee Age Byes are “dots, Legs correct. Doubling Kot of tice confit at atx Double lines for tege: arms may begin. Age7 Tes correct. Sees shape of ea. Uses craser self appraisal: Crossed eyes shown sto. ‘Age 8:10 Byes. Development toward symmetry: Hair recedes, fewer strokes and shorter. Ear moves up, ceases to overlap. Fingers: first, a circle, then extension of arm, finally three ines at correct angle and shorier. Leg placement and angle fairly good; leg becomes shorter. Foot turns from left to right and becomes shorter. Note the following: Pencil grip (minimum pressure?), motor overflow (wriggling, kicking, talldng?), posture (exaggerated head ti}, perseveration? A poorly formed concept of “body image” may be present in the ehild who is unaware of what parts make up his own body and how they relate to a two-dimensional picture, COPY FORMS(d) O+F 0A a From the point of child development, the Copy Forms. ‘Test {s a goldmine of information. It is a simple test from infancy to ten years; it shows lawful, orderly development; it reveals immaturity, superiority, combination and organisation: it picks out the child who passes minimum vision tests and yet needs optometric training: it will demonstrate improvement alter optometric training; it will demonstrate defective behaviour; itis a test of imitation, copying, size consistency, hand-eye coordination, and how the child ‘will organise on a page: and it takes just a few minutes and the children like It. Procedure An 8.5 x 11 inch sheet of paper and pencil is presented to the child. The examiner will ask the child to write his name, address and perhaps some numbers or letters (according to his age capability). If the child hhas confined this preliminary weiling (o the top of the Page, there Is no need to turn the sheet over, The optometrist will present the first form, the circle, and ask the child “to make one like this on the paper". Evaluation ‘The optometrist should record (or recall) how these forms are made by the child. This can be done on an additional sheet, or the direction marks can be made, In pencil, on the child's own product. Age 3 Can copy the circle. Some can't draw the form unill tis named. The clrele 1s drawn clockwise (CW) and from the bottom, ‘The cross may be split horizontally or vertically. The square is made as a circle. He is not aware of the corners. Age 4 Imitates the square, usually rounding the comers. The triangle 1s a poor imitation. It Is diffleult to make an oblique (very little astigmia Is seen In the retinoscope). May show a vertical square. There Is an ‘emphasis on the corners. The cross Is copled “as Is." A poor imitation of the divided rectangle. + Age 5 ‘Square nearly correct and in proportion. Obliques of tangle drawn on upstroke ‘with dificulty fastigmia) in relinoscope now Stating fo come and gp) reed rectangle may be done in vertical rtentatlon, C drawn from bottom, CW (boys) and from top (ACW anti-clockwise) for girls. Cannot draw diamond, May dravr forms from Inside of elrcle. “OQ ZA Age 4.5 Age 5.5 The divided rectangle is drawn with dot placed centrally. This form takes 2 or 3 fixations to complete. (10 fixations would show real trouble). A vertical form would show a 4-year-old pattern. +] Age 6 Interested in oblique directionality - he will ‘twist his body and shift his paper to various angles, The 6 year old has difficulty in holding fo a hortzonital line while reading. Behavioural Optometry. Volume 4. Number 2 1009>A ‘Age7 __Selferitical - he uses the eraser with frequency. He will recognise and correct reversals. His forms will be drawn with linked, continuous strokes. Can copy the diamond foest done vertically) (J 0 Forms usually larger than at previous year. Pencil becomes a tool - the 8 year old Jcosens up and is capable of longer school assignment. Begins to draw in perspective PIAGET RIGHT- LEFT AWARENESS TEST(D). ‘The Plaget Right-Left Awareness Test can be utilised to evaluate the child's understanding and awareness of right and left within him-self. Secondly, can the child Judge rights and lefts In relationship to other objects ‘out-side of himself? To administer the test, a penny, penell and key are needed. The examiner also needs to ‘wear a watch oF bracelet on his left wrist. Age 8 ‘The test form Is presented. It Is self-explanatory leaving no need to belabour It here. In scoring It 1s important to note that a child who misses any one question of a part falls that part of the test. The norms, fun from age 5 to age 11. This test can give the optometrist a “standardised” score for right/left awareness but does lite to change the therapy ‘strategy. Careful observation of the Keystone visual skills of responses on certain analytical examination {ests should already have produced the information as to whether of not the child knows his left side from his right and whether or not he Is consistent. 1. Show me your right hand. Now shou’ me your left hand. ‘Show me your right leg, Now show me your left leg. 2. (Examiner sits opposite Subject) ‘Show me my right hand. Now my left. ‘Show me my right leg. Now my left leg. 3, (Place a coin on table left of a pencil in relation to Subject) Is the pencil to the right or to the left? ‘And the coln-ts it to the right or to the left? (Have Subject go around to the opposite side of table and repeat questions) Is the pencil to the right or to the left? And the coin - is it to the right or to the left? 4. (Subject is opposite Examiner; Examiner has a coin In right hand and a bracelet (or watch) on left arm). You see this coin. Have I got it In my right hand or in my left? And the bracelet. Is it on my right arm or my left? (Subject Is opposite three objects In a row: a pencil to the left, a key In the middle, and a coin to the right.) Is the pencil to the left or to the right of the key? Is the pencil {o the left or to the right of the coin? Is the key to the left or to the right of the coin? Is the key to the left or to the right of the pencil? Is the coin to the left or {o the right of the pencil? Is the coin to the left or to the right of the key? Right-Leht Awareness Items (Piaget) TTEMS PASSED BY 75% of Age Age Age 6 Age 7 ‘Age 8 Age 9 Age 10 ‘Age 11 MONEY ROAD MAP TESTI. Another test that can be used to determine a standardised score for right-left awareness is the Money. Road Map Test. In this test the child is told, “This is a map of a city. Suppose that one day you go for a walk and follow this path. “The examiner follows the dashed nes from end to end with a felt pen. “Now you are following this path the same way the felt pen did. 1 want you to tell me, at each corner you come to, whether you turn to your right or your left as you are walking. “This is done first for the three turn walk, which is a trial, and then for the complete walk. (Money, J., A Standardised Road Map Test for Directional Sense, John Hopkins Press, Baltimore). REVERSALS FREQUENCY TEST(N). Execution: (See score sheet above for lines on which to draw numbers and lower case letters) 5.263.947 (7 Numbers). then heqfjbk/srdy.ptz/g.ae (17 letters) BAE AE RAB Syr to Syrl] 37 43 <1.6 6yr to Gyr] 33.8 15 0 Tyr to 7yrld 3 05, ° Behavioural Optometry, Volume 4, Number 3, 1992 yaaRecognition; (See score sheet following for questions asked - comparing pairs and then finding incorrect forms). BOYS: GIRLS BAE AE ‘AAB BAE AB ‘AA SyOtoSyll >35 24 <3 ByOlosyll —_>32 21 <10) By0toBy11 330 18.5 2 Gyotosyl] 522.513 <35 FyOto7yll 313.88 25 7yoto7yl1—>12 55 ° ByOto Gy] 57.7 37 ° toby] 35.4 26 ° Syotoeyll 36 3 6 Soiog 54824 8 TOyO to 10y11_ 34.7 2 ° 1dyOtoldyl) 33.4 17 ° 11y0 to 1lyll 36 3 ° LyOtollyl1 >5.1 23 ° 1290 to 12y11 33 15 ° 1zyOtol2yll 33 14 ° 13y0 to 13yl1>4 2 ° 1WyOtol3yl] 2.3 1 ° 1ayO to 14yl1 34.5 25 ° 1ayotoldyl1 32.8 12 ° -LOPMENTAL D PRFORMANCI Ss EREEDOM TO ABSTRACT AND SYNTHESISE © © « 0 o) Visual Form, Visual Size ‘Visual Space [Concept ~ [Book Visualisation Retinoscope Total form abstracts | Sequence and ‘Complete space matrix. [Draws voluntarily [Free reading level or synthesises into | combination. Can | Identifies all directional {Can bidimensionally [abstracts and synthe} wholes. utilize size in orderly [axes by name. Knows [represent ridmensio-|sises for full sequence in comb- [own spatial positions nal experiences. | comprehenston. ination to produce [andcan transpose. | Figure-ground time a size-constancy concept (past result -present-future), Direct form, Combinations only. | Partial space.(form | Draws reluctantly or | Instructional level. Matches form Visual relationships | location) Can identify Jean only copy or | Must evaluate, pro- to form but can't | and matchings. ‘own spatial position draw upon suggesion| cess and itemise. abstract silhou- | (dimensions). but cannot transpose JOmits depth and/or cttes. without processing or Jalze. ‘TYme concept is Memising. now only. Figure only, Partial forms. Visual size. Likes | Self direction (here- __|Imitates only. Form, |Lack symbol skill, Matches by seg- | and differences. _| there).Can only partially| size, depth and [Must revert to hand menting. details | (distance) identify own spatial [direction of move- | reinforcement or without relation- position. Can not ment all inadequate. | verification. ship or shape. transpose. No time concept Tactual or random. | Tactual size Non-166 14 <60 Begin 2nd >130 89 <49 End 2nd, >is 73 333 Behavioural Optometry, Volume 4, Number 3, 1992ometric observations of VISUAL MANUAL INTEGRATIONS: the pailents ability to translate manually obtained factual information into visual in ion through (actual imagery and visual imagery integrations. ‘The significance of tactual experiences, and thelr snfluence upon vision development, has been given considerable attention in this manual, As the individual progresses through the levels of the development Eontinuum the ably to visually interpret factual information, whieh Is aequired through mantal explorations, must become a consistent and rellable process. The infant spends many waking hours Inanualy exploring objects, and obtaining the concomitant visual information these objects an provide. Ithas been recognized, from the very earlest plomeiric stidies ofthese vstal-manual integration, thatthe probe know as TACTUAL FORMS could provide clinical data of great value (othe informed clinica Many of the studies ofthis probe were stimulated by the original work of Montessort in tne early 1900s. The result was the fo geometrie forms, grooved lato Smooth surface thatthe patent could manally explore ‘while as hidden from his, or he, view. Since this ‘Hsual-manual Integration ability ts just as important to dus asi is fo children some more complex palerns tere designed for use with other patientay These will be Gscussed here, All of this exploration and study has brought extended dlacuissions of the existence of actin! imagery” and “motor imagery" which Is also known as neo schemes" The protedures deseroed here have assisted the behavioural optometrist to recognise thatalthough visualisation abies are very dominant contributors to cultural performances ctu Imagery and motor imagery play very signifiant role inall visual development. Ths Is especialy true In he mastery of symbols in the handwriting activites. Optometric information sought In these procedures: a) Simply. can the patient know the “looks" of something by the “feel” of I? ) Has the patient achieved the manual-visual and visual-manual integrations essential for all that is Included in “eye-hand coordinatlons?™ ‘50 essential to classroom and occupation. ©) Can the patient then draw an accurate visible representation of the object, or form, that was. manually explored? oF The top four taetual forms are for younger patients, and the bottom three forms are samples of those tactual forms for older patients Watch for and record: ‘a) The manner in which the patient approaches this task. Is there repeated attempts to see the pattern that Is covered? b) Make careful and complete notes on how the patient manually explores the grooved forms. Does he, or she, need to make several circuits of each form to Identify the form, or, Is Identity achieved quickly with only a quick and rather casual exploration of the form? ©) Carefully note the patient's factal expressions. Do these express confusion, oF almost immediate recognition ofthe form belng manually explored? 6) Observe what the non-preferred hand is doing while the form is being explored. Does the patient dlso make the shape with tie non-preferred hand ‘while the preferred hand ts exploring the form? «) Does the patient then draw the shape qulcidy and accurately? Or, are there distortions of te forms as If there was an incomplete, or incorrect Impression of the form being achieved? 4) Dees the patient show a confidence in the pattems that have been drawn? @) Does the patient express the wish to see the grooved patterns (o make a check of his, or her. Srawings? h) Does the fact that the triangle was presented apex toward the patient cause any confusion’? 4) Is Uils apextdown triangle drawn correctly, ori 1 drawn apex up seemingly because the patient Iknows that trlangles are almost always seen this way? The question here Is: does the pallent draw Unis form the way itYeels” orin the usual orlentatlon for this form? J) Does the patient need to name each form before drawing? ‘Are these forms drawn in a fashion similar to the ‘way the Gesell Forms were drawn, or are these drawn as ifthe pailent had more confidence in his performance here? rs Optometric observations of VISUAL SIZE JUDGEMENTS: the patient's ability to make accurate visual Judgements of variously sized blocks, Although the ability (o make visual judgements of | size, and the constancy of this ability, has been previously discussed and observed. the SIZE BLOCKS provide further clinical data that Is erlllcal In the ‘optometric appraisal of vision development. Where this visual ability was previously evaluated by the paUent’s ability to copy the Gesell Forms, here the ability ts, explored while the patient is visually — and when necessary. manually — discriminating size likenesses and differences of three dimensional objects. This. procedure allows the patlent to fall back upon primary manual experience if his, or her, visual Judgements are not adequate for the decisions required here. Splometric information sought in this procedure: a) Can this patient make quick, accurate visual inspections and Judgements of the size of blocks that are only slighily different? Can these diseriminations be made without the need to manually explore the blocks for confirmations of the visual decisions? ©) Can his patient make visual decision on which small blocks to combine for a match with one bigger block? 4) Can the patient use these blocks to illustrate sequences of sizes from small to large, or from large to small? ©) Can this patient demonstrate the relevances between numbers and sizes? 9) Does this patient demonstrate the comprehension of visual size and its translations into numbers, The optometric observations of the patfent’s visual judgements of size likenesses, ‘Watch for and record: a) The speed and accuracy of each choice. b) Are the blocks chosen strictly upon visual inspections, or must the patient make manual comparisons — putting blocks side by side — to make correct size selections? ») Rohavinnml Qntametnr Valima a Nvensher ® 10809©) Make full notes on any apparent confusion in the choices. ) Make notes on incorrect visual choices that are no verified manually. ¢) Ifthe patlent picks up an incorrect block — for example: a #2 block with the #1 blocks — allow the patlent to complete the cholces asked for, and then ask him, or her, to “take another look at these blocks, please." If the wrong sized blocks are not visually recognised put those chosen on edge In front of the patient, and ask for another Inspection. DIAGNOSTIC CRITERIA ‘This procedure provides the most vivid observations of the entire visual - manual process, and all performance here is Judged entirely upon the ability of the patient to make visual discriminations of sizes with hands serving completely as the “tools” to complete the decisions. This procedure will permit the observer to appraise the development series. The quick.the “feel” of the heights of a couple of blocks ~- is the performance hoped for in every patient above the third academic category. If there is any dependance upon manual explorations for correct choices, the need for visual training is great. . The optometric observations ofa patient: lo jnake size combinations. Watch for and record: ‘a) The speed and accuracy with which the patient follows the instructions, and the accuracy of the choice of the “biggest block.” b) The speed and accuracy of the cholces of the two blocks needed to match the helght of the bigger blocks. ©) Carefully note the mismatches made. It is not necessary to delall each of the matches, Le., #9 = Gand 4; § and 2; 4 and 5. Its important that some record of any dilficuily Is made for later reference. If this task Is completed with ease and regular accuracy, all combinations are requested to observe the accuracy of the visual Judgements requlted for acceptable performance here. ) Make notes of any reinforcement techniques the patient might demonstrate. For example: does he, r she, lean over so sighting across the blocks is, possible Instead of manual explorations of the heights? ©) Make careful notes of any verbalisations the pailent makes. DIAGNOSTIC CRITERIA ‘The most significant clue here can come from the manner In which the patient checks out his, or her, choices of the smaller blocks. Does this paticnt find out, from the first cholces made, what fs needed to “correct” the size of the blocks needed? If he, or she. chooses two blocks that are (oo small, Is one of the two immedately replaced with one larger — and how much larger? Is the Second choice too big, and sUlll another choice must be made? Or, when the next size larger small block 1s needed, Is the correct choice immediately made? If there fg a continuing trial and retrial of many blocks, the diagnostic elue certainly suggests a lack of vistial stze const This may be a very important clue when ‘compared with other visual size Judgements here and in ‘other procedures. ¢ optometric observations of ‘visua ents of s ‘) How quickly and accurately each block in the sequence is picked and placed in position, b) Any confusion of sizes that are not immediately corrected and put into the proper sequence. ©) Any confusion on the number names for each block, especially when the patient is “finger ‘walldng" down 9 to 1 ¢) Any overflow, or other signs of frustration. DIAGNOSTIC CRITERIA All diagnostic clues related to visual size and sequences should be obvious to the examiner now. The developmental continuum levels should also be quickly and clearly judged by the observer. The significant clinical clue here lies in the speed and accuracy of the patient's choices of the sizes, and the placement of each block in tts position in the sequence. The next, and final clue to the visual-language ablity of the patient will come when the number names are given to each block. It will be significant if the patlent cannot give the proper number for each block even when the blocks are put into the correct sequence. This will espectally be true if the patient cannot count down while walking down from Stol. ‘aga, any need to complete thls task by he manual exploration of each block's size suggests @ critical need for visual training. Optometric observations of VISUAL RECALL and VISUAL MANIPULATIONS: the patient's ability to recall ‘and reproduce simple, meaningless, patterns presented for a very brief period of view, and the patient's ability to manipulate his, or her, visuallzations as if the pattern. were belng viewed from another position. Optometric observations of Visual Recall: the atient’s ability cate a briefly viewed, then removed, pattern. Behavioural Optometry, Volume 4, Number 3, 1992 127Optometric information sought in this procedure: ) Can this patient replicate the patterns which he, or she, viewed for a brief Ume, by drawing after the pattern card Is removed from view? Are the drawings accurate duplication of the card patterns? ©) Does the patfent draw the major pattern well but ‘omit details? Are the details included but misplaced or drawn in wrong orientations? For example: 1s a horizontal portion of the pattern drawn correctly, but drawn in a vertical direction? ©) Dees the patient have more difficulty where there g Memore patterns than one on a card? Carefully note any expressions of frustration and/or confusion, Does the patient need to verbalize the shape, or a description of the viewed paitern to succeed (10 any degree) in drawing the pattern? Does the patient need to draw the pattern “in the air” before drawing it on paper? 9) Are there any other reinforcements needed, that seem {o assist in completing this task? Watch for and record: a) Although the patient’s drawings are a record of the performance, make careful notes on how the patient approaches this task. by Does the patient turn to his, of her, reproduction ‘of the pattern with only a very brief inspection.? } Does the patient seem to need verbalization of the name, or description of each pattern before he. or she, can draw it? 4) Does the pattern try to draw over the lines of the pattern before he, or she, does the drawing? ) Does the patient improve in the performance here when praised or complimented on his, or her, efforts? ) Make careful notes on any evidence of confusion or frustration; or dissatisfaction with the drawings done. ®) Does the patient “look off into space” as he, or she, attempts to visualize what was viewed? h) Does the patient continue to look only at the paper In front of him, or her, with a blank expression suggesting no visual recall? 4) Are the patterns drawn quickly and accurately, with confidence and seeming enjoyment? J) Does the patient express relief when the procedure 4s finished, or tn contrast, a desire to do more of this sort of activity? DIAGNOSTIC CRITERIA, As has been stated so frequently here, any probe of visualization abilities demands performance at levels 5 6, or 7 on the developmental continutim, The visual ») = ILvisttal-manual levels then: INADEQUATE Any scribble without comparable forms. Recognizable replications on the first 3 patterns only. Any score that ts decidely below school grade level. ADEQUATE Poorly drawn replications that Improve as the patient continues. Any score (as per following table) that Is equal (0 school grade level. Raw Score Adequate For Grade Adequate For Age 9 K 6 10 1 z is 2 8 12 3 9 13.5 4 10 145 5 ret 15.0 6 12 155 7 13 16.0 8 14 16.5 9 15 17.0 10 16 175 u 17 18.0 2 18 lomettic observations of VISUAL MANIPULATION: atient's ability fo manipulate his, or her, visualisations as if being viewed from another spatial ‘postilon, Opto nformation sought in this procedure: a) Can this patient view a pattern and then mentally rolate it as if the pattern were actually rotated? b) Do either top-to-bottom or horizontal rotations. seem more difficult? ©) Can the patient make these mental/visual rotations without having to make changes in body postures which would seem to assist the patient in a change of perspective? 4) Are these mental/visual rotations made without confusion and/or hesitation? @) Does the patient need to pick up the pattern card and rotate it to assist in lus.or her, visuallsatlons? 1) Does the patent need to draw the pattern in the air in the process of visualising it in rotated positions? ) Does the patient use verbalisations to assist in the visualisations? So many adults have difficulty in this sort of visual task that the correct answers for each card are these: system must be playing the dominant role in the Question: VMI VNW2_Vwwa VW action, and the hand and voice system. Thus, all clinical Judgements of the performance must critique the degree [Toprow 2 3 1 1 of Visual skill that has been achieved by the patlent, Toprow 2 1 4 2 Qndrow 8 8 8 7 DEVELOPMENTAL, ESS: ardrow 11 MW 10 9 manual-visual perfor al levels below 6 then: INADEQUATE Drawing over card but no transfer to blank sheets. ADEQUATE: ‘Some success after drawing over pattern card. Note: This is only adequate in the very young, inexperienced patient, or when this manual action does permit completion of a drawing. Behavioural Optometry, Volume 4, Number 3, 1992 128