Thank you to COVD for writing this piece. COVD Link:
I sat down slowly and closed my eyes. I took a deep cleansing breath in the hope of slowing my racing heart. I opened my eyes and with the biggest smile I could muster and the hope that I was hiding the terror that was coursing through my body, I turned to my son and said, “Are you ready?”
“Yes,” my son said as he climbed into the driver’s seat and clicked his seatbelt.
I thought I was in the clear. I handled the crawling, the walking, the sleepless nights, the lost teeth. Nothing prepared me for the fear and anxiety that would accompany the question, “Can you teach me to drive?”
So many thoughts began racing through my brain. How do I do this? How do I teach him to pay attention to so many things at once? How do I make him confident and comfortable? After I sufficiently whipped myself up into frenzy, I decided to take a step back, take a deep breath, and think. How would I do this if this were a therapy activity? When we do VT how do we break things down and then make it harder? How do we make the transfer of automaticity into the real world?
I started making a list to organize my thoughts and in the process found that I might be able to apply some of the concepts from the therapy room to the task at hand.
- Identify—What skill needs to be taught?
Globally in this case it was driving, but I had to break it down into small attainable pieces such as starting the car, steering, accelerating, and braking. In the therapy room, globally it might be oculomotor skills but the small attainable pieces might be fixation, saccades and pursuits.
- Goals—My goals and his goals.
My goal is for him to be an alert, efficient and safe driver. His goal is much simpler; he wants to get the car to move without crashing into anything. In the therapy room our goal may be for efficient eye movements, but the patient’s goal may be to avoid being made fun of when asked to read out loud in class.
- Teach—How can the identified skill be taught?
I have the advantage of knowing my son for his whole life. I know his learning style and how to present things to him. I decided on verbal instruction and demonstration followed by hands on experience with verbal support. In other words, we talked about all the steps needed before starting the car, the steps once the car was started and reviewed where all the controls were. Then he got behind the wheel and drove around an empty parking lot in circles.
With our patients it’s a little bit trickier, it takes some time to learn what makes them “tick”. Is the patient high energy? Or does he or she prefer a quieter and gentler approach? What are some of the patient’s favorite things? Can we incorporate that into therapy? What tools and methods do we have to teach the skill?
- Mastery—Add appropriate challenges and practice, encourage awareness and thinking about the skill.
For driving, practice was driving in circles; the challenge added was navigating the empty driveways surrounding the buildings. I started with giving clear directions on where to go and instructions regarding acceleration and braking. I then added, “Where do you want to go next?” He had the challenge of a decision to make! I had the challenge of not throwing up.
At one point we were driving and he took a curve a little too quickly, overcorrected and stopped a little too harshly. “What happened there?” I asked while hiding that my stomach felt like it contained a family of angry, wrestling squirrels.
“What can you do next time?”
Angry squirrels aside, mistakes are opportunities for learning both in and out of the therapy room. As therapists, we have to learn to ask the right questions to lead our patients down paths to discovery.
- Automaticity—“the ability to do things without occupying the mind with the low-level details required, allowing it to become an automatic response pattern or habit. It is usually the result of learning, repetition, and practice.”
So now we’ve mastered the driving skills, how do we make it more automatic so he can drive safely when also trying to pay attention to directions from a person, or a map? (I maintain it is important to know more than one way to figure out a route to get somewhere unfamiliar, as on occasion my GPS has encouraged me to turn into a cluster of trees or a body of water.) I may be one of the only parents in my town that makes her son recite his ABC’s while driving or gives him math problems to solve.
In the therapy room this may manifest as putting a patient on a balance board, verbally distracting him or her, or adding a cognitive task while the patient practices a particular skill.
Through all these steps, I tried to remember to praise his efforts and praise specifically instead of globally. “I like how you’re braking more smoothly now,” instead of “Great job!” In the therapy room, it might be, “I like how you took your time and worked so hard to get that target single,” instead of “Great job!”
After our latest excursion we stopped for Chinese food. Enjoying my time with my son, sitting in the quiet restaurant, I took a few moments to ponder how our professional and personal lives can sometimes overlap. I was grateful that I could use some things that vision therapy has taught me in other aspects of my life. I opened my fortune cookie, it said, “Teachers open the door, but you must enter by yourself.” That fortune is now hanging on the bulletin board in our therapy room.
Thanks to Jennifer for contributing this inspiring story to our blog! Being a vision therapist means working to understand a patient’s learning style and supporting them to achieve their best. Could your child be struggling with an undiagnosed vision problem that can be treated with vision therapy? Start with our online Quality of Life Checklist tool to evaluate their symptoms!