#147 OT and Vision in Schools with Jaime Spencer

When you look at the intersection of vision and reading in schools, the gaps are impossible to ignore.

Consider the data:

• Two-thirds of American fourth graders cannot read at grade level.
• One in four school-age children has a vision problem.
• School vision screenings miss up to 75% of children with vision problems. 

To make matters worse, standard school vision screenings frequently miss the functional vision deficits—such as convergence, accommodation, and visual perception issues—that directly impact a student's ability to sustain near-work in the classroom.

As occupational therapists, understanding how vision impacts functional tasks like reading, writing, and navigating the classroom is central to our holistic approach. We have the foundational textbooks, the clinical frameworks, and the training to address these challenges.

So why isn't the full skillset of OTs being utilized to support functional vision in schools?

In this course, we sit down with Jaime Spencer, an OT who has been at the forefront of successfully integrating vision into school-based practice. Together, we explore the systemic barriers she has encountered and the practical solutions she has proven to work—from assessment and direct intervention to teacher education.

This course is designed for any school-based professional who knows the current system isn't working well enough, and is ready to explore how OTs can deliver deeper, more impactful support for struggling students.

See full course details here:
https://otpotential.com/continuing-education/course/ot-and-vision-in-schools 

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Transcript

SPEAKER_00 0:00

When you look at the intersection of vision and reading in schools, the problems are impossible to ignore. I personally was flabbergasted by these three data points. One, two-thirds of American fourth graders cannot read at grade level. Two, one in four school age children has a vision problem. And three, school vision screenings miss up to 75% of children with vision problems. And to make matters worse, standard school vision screenings frequently miss the functional vision deficits that directly impact a student's ability to sustain near work in the classroom. As occupational therapy professionals, understanding how vision impacts functional tasks like reading, writing, and navigating the classroom is central to our holistic approach. We have the foundational textbook, the clinical frameworks, and the trainings to help us address vision issues. So why isn't the full skill set of OTs being utilized to support functional vision in schools? Today we sit down with Jamie Spencer, an OT who has been at the forefront of successfully integrating vision into school-based practice. Together, we explore the systemic barriers she has encountered and the practical solutions she enacted, from assessment and direct intervention to teacher education. We have a lot to cover today, so let's dive in. You are probably listening to this podcast on a free podcast platform, but to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform. You can go to OTpotential.com to learn more. Okay, here we go. As I mentioned at the top, joining us today is Jamie Spencer, MSOTRL. Jamie is a practicing school-based occupational therapist who is passionate about education and advocacy. She has a bachelor's in occupational therapy, a master's degree in special education, and holds specialty certifications in assistive technology, handwriting, and puzzle art. Jamie has authored a number of books, including the Handwriting Book, The Scissors Skills Book, The Toilet Training Book, Functional Visual Perception, and Teaching Handwriting in Groups. Jamie helps other practitioners, teachers, and parents through her website, missjamieot.com. As a financial disclosure, Jamie does offer her own courses on vision, so she is vested in this topic. But since Jamie is both a practicing OT and an educator, I just thought she was uniquely poised to speak to this topic, and I can't wait to learn from her today. So without further ado, we will patch Jamie into our live studio. Welcome to OT Potential, Jamie. It's so great to have you. Hi, good morning. Thanks. It's so great to be here. Jamie, I am so excited for this conversation today. This summer, I have been seeing myself a vision OT and a neurooptometrist. And it has just really opened my eyes to how many visual skills there are, how amazing it is, how we can really isolate a lot of them. And then how effective therapy can be at really practicing certain skills and targeting those. It's amazing what can be done, what the eyes are doing. I love vision. But on the other hand, it is so hard to get support for anything vision. Like I've had this difficulty for my eyes for a decade. I'm a huge advocate for myself. I'm like bugging doctors. And I could not get the help that I needed until literally an OT near me opened her own practice focused on vision. So even like highly knowledgeable people with that big drive have troubles getting the vision help that they need. And the whole time I'm doing this, I am just thinking of kids in schools who might have visual differences or deficits and how easy those are to be overlooked and the huge impact that they have on their school functioning and just life functioning and how amazing it could be if we could get more support to them. So I am excited to just learn all about what you're doing today. I want to start with just your story. I'm so curious how you got interested in this topic in the first place of vision and OT in the schools.

SPEAKER_02 4:49

So I was a full-time school-based occupational therapist. I had a full caseload. And as I was working with my students, I noticed that some of them just weren't progressing the way I wanted them to. And my spidey sense was like something's going on with their vision. And I really didn't feel confident or competitive in figuring out exactly what the problem was or even knowing if that was within my role. So what I did was, and I'm such a dork because it was the very first day of summer when I noticed that there was a vision course in where I live. Robert Constantine was teaching a vision course on the very first day of summer. And I signed up to go and I was like laughing at myself, who does this on the first day of summer? But I love to learn and I was really intrigued about this topic. So Robert is a specialist. He works with an optometrist. So his course was for all populations, not just children and not school-based, but I learned so much. And it was very, you know, eye-opening. And I really left that course feeling like I need to combine what he knows, what a school-based occupational therapy practitioner knows. And I approached him about this because I was already doing Miss Jamie OT. I had a blog and a website, and I just felt like this would be the most amazing course specific to school occupational therapy because I'm not working with stroke patients. I'm not working with traumatic brain injury patients. And I mean, that's not to say that a school-based OT wouldn't or couldn't, but that's not the majority of who we're seeing. We're seeing children with learning disabilities and children with motor delays. And, you know, I wanted to know how to help my students. And I wanted to make sure that I wasn't overlooking a major piece of what was impacting their participation at school. So I approached Robert to make the course. We made the course. And since then, we've helped thousands of school OTs learn how to assess, how to, and it's not about, you don't have to be a specialist. You don't have to be, you know, a complete expert, but just to have the awareness to get that spidey sense of something's up and it's this student's vision that's really causing the issue, to be able to educate teachers and parents and to follow through with the parent to have that child go get an eye exam. That's what my goal was. And I think that it's such an important part of helping students.

SPEAKER_00 7:13

Jamie, I just love hearing your story. Vision is so integrated with the other systems that we work with as OTs, like the motor system. And when we've talked about vision on the past, it just seems like therapists come to this work because without looking at vision, they know that they are missing something. And also there is just not enough access to vision services. I'm curious as we zoom in on school OT specifically, what did that look like in your school practice? Like, what are you doing today with vision for the students on your caseload and the students at the school more broadly? Well, you know, I it was the first day of summer.

SPEAKER_02 7:55

So I left the course just honestly feeling a little guilty. Like, have I missed this in so many children that aren't on my caseload anymore and they're still struggling? I felt really terrible about that. So I started just including a vision screening in every child that I was doing an initial avow on. That was first of all. And then I started looking at it on the students that were already on my caseload. And just a simple act of screening a student's tracking, you know, can they follow a moving stimulus? Can they keep their eye focused on something? Again, you don't have to be a complete expert at it. Just start doing it with your students and you'll notice, ooh, this kid has something going on compared to the rest of my students. And just a heads up the students who are going to be on an OT caseload, the majority of them will have vision issues because most diagnoses have a comorbidity of some kind of a vision deficit. So the students who have vision deficits are very likely on the school-based OT caseload. So definitely including some kind of a screening. I like to do a teacher checklist and really check in what are you seeing in the classroom? And a lot of red flags that will pop up are not things that you may necessarily think are a flag of vision. But a student who's very clumsy in the classroom, who's bumping into things, they may have something going on with their vision or a field cut or things that we wouldn't think of. Student with difficulty converging and diverging their eyes is going to have difficulty catching a ball. So things like checking in with the physical education teacher, how is this child? You know, they may be able to skip or do a jumping jack, but can they do something that requires near and far focusing and tracking left to right? So a lot of working with the teachers, asking parents, has your child has an eye, have they had an eye exam? And really kind of stressing that bringing them for their annual to the physician and the physician giving them the e-chart, that's not a comprehensive eye exam at all. And those quick like looks miss the majority of the common vision deficits that our students have that are impacting their learning. So it's really not about do they need glasses? It's about are their eyes working together smoothly and functionally so that they can participate in what they need to participate in at school.

SPEAKER_00 10:22

There are so many skills for us to work on in this area. I think there's so many things that OTs can do to help. And part of kicking off this conversation is I wanted to highlight a specific uh research article for people who are interested in just getting more oriented to the topic and reading more about it. The article that uh I'll have in the show notes and is a great read is called Exploring Performance Skills in the Occupation of Learning to Read. It came out in 2025. The author is Ellen Modlin. And what this article says, um, it gives us intro that uh, as I mentioned at the top, a lot of students are not at grade level for reading. And the scores have really stayed stagnant in reading in the United States for the past decade, which is really surprising because there is so much emphasis on reading. Um, so even though we're doing a lot, it isn't helping to the degree that you would almost expect. Like something perplexing is going on. And one of her hypotheses is that um we just might be missing this visual perceptual piece and not screening for it enough, not really understanding the impact on reading. I like how she says, like, response to intervention usually just means more intensity of the same reading interventions. But if it isn't work, like if there is a foundational visual perceptual skill deficit, um, more intensity of the same thing probably isn't going to help. So she did this study that was just correlating visual perceptual skills with um education um achievement scores. And she found this significant relationship between visual perceptual skills and the skills recruited for word recognition. She used the test of visual perception and the Kaufman test of educational achievement. Um, and overall, uh the takeaway was just that this study highlighted the role of visual perceptual skills in reading development. I loved reading this article and thinking about vision and academic performance and really how it feels to me like we're just at the beginning of really understanding this and what we can do to help impact it. I'm curious with your expertise, what stood out to you in this article?

SPEAKER_02 12:50

I love that this article was published first, because there's really nothing like it out there. And I feel like in the field, we're starting to have that increased awareness that occupational therapy has a role in literacy. And we do, whether it's with visual tracking skills, visual perceptual skills, because we look at the whole child, we are uniquely positioned to support students who have difficulty in reading. So I loved that she did the research on this, and I loved that she found results. The quote that stood out to me was she said, reading relies on areas of functioning that are currently overlooked in existing instructional methods and in assessment methods. I find a lot of OTs, and especially the certain OTs who are really overworked and they've got to get a lot done in a short time, we fall into our patterns. These are the tests I use if I'm doing an avow. And we don't necessarily have the time or the materials to really kind of differentiate what we're bringing and do the background research of what is the student struggling with? Okay, I better bring this assessment. When we are able to do those things, we have such a better result and we're able to really look at what's impacting our students' functioning. So I think that's an important takeaway as well that our instructional methods, like if we just do the VMI in a student or the MVPT or the TVPS without looking at their actual vision, we're missing the boat. Like we're we're skipping over what the child needs. It's the vision, visual perception that means they need to have their vision intact. So I just think it's really important that that's a big takeaway that we all include a vision screening, even if it's a quick, short vision screening to say, I think this student has something going on. I better let the parent know so they can follow up with an eye care professional.

SPEAKER_00 14:51

We've only been talking for 15 minutes, and I'm already like blown away by how one, how big the need is in our schools for more attention to this area. And two, all the things that OTs can do. And we're in all these schools. It just feels like we're really positioned to be a help in this area. But even though there's a need and we have a lot of the skills, there is a ton of barriers, um, I think to uh helping provide these services. I know you've been boots on the ground doing this. I'm curious the barriers that you've encountered. Um, I do want to say from our comments, uh something that someone said was just the lack of eye professionals in their area. Like I really resonate that being from small town Nebraska, I had to drive multiple hours to get into a neurooptometrist. And I'm an intense advocate for myself and like found that person and got myself to that person. Um, but uh just saying that out loud is one of those initial gaps. What are more that you've experienced?

SPEAKER_02 15:58

Yeah, for parents, that's very often a gap, whether it's the fact that they don't know where to look, they may not have the insurance to follow through or the or the funds to follow through with the therapy. Sometimes they're just, you know, busy with four other kids and they can't get there. One thing Robert always taught me to say is that any eye care professional is better than no eye care professional. So even if we're just getting a child a pair of glasses that they need, we're still helping them toward their success. So it's better if we can get them the developmental optometrist that can really do a thorough comprehensive eye exam. But anyone looking at their eyes is better than no one looking at their eyes. But access is definitely a barrier in many locations. Like you said, you're from a small town where I'm from, we have a lot more access, but it's still not great. It's it's tough. So that's one barrier. Another barrier in general, I think, is the awareness of the school community. And some OTs included don't really realize that OT is within our scope, vision is within our OT scope of practice. We're often pigeonholed as, you know, the handwriting people or the sensory people, but we're really the whole child people. And that's what we're experts at. We're experts in child development. And, you know, looking at a student and recognizing that they have, you know, weak arms and weak fingers is really no different than recognizing that they have weak eyes. And we need to have the skills and the confidence to do that. And it's okay if you don't, but ethically, we want to feel if I'm lacking in a certain area and I feel like I may be missing something, we want to do the work to kind of learn a little more. And there's a ton of free videos out there on YouTube and even Instagram to, you know, this is a quick way to look at tracking or a student's ability to stay focused on a visual stimulus. These are all really important tasks in terms of learning. And also there's a big misunderstanding about the classification of visual impairment. So there are 13 classifications for special education and visual impairment, including blindness, is very often misunderstood. So those children are often just like, oh, those are the blind students or the students with very low vision and they can't really see well. They need glasses, they need a walking cane. But technically, according to the Office of Special Education and Rehabilitation Services, an ocular motor dysfunction, such as convergence and divergence issues, difficulty tracking or maintaining fixation, those kinds of diagnoses are qualified under a visual impairment as long as they adversely impact a student's learning. So I found a document that proves this, and I've been kind of showcasing it all over the world. Like, look, it's it's not true. You can't, you have we all have to stop saying that these kinds of issues aren't able to be treated by special education within the schools because here's the letter from the federal government that says that it can be. So I think that's an important takeaway as well. There's a really huge focus on literacy and math, but 80% of learning takes place through vision. So if we're missing that, we're kind of really missing a huge piece.

SPEAKER_00 19:24

Can you share that document with me, Jamie? And then I will include that in our show notes too. Absolutely. It just seems so obvious that vision and visual skills impacts academic work. It does, right? Do you think we have too narrow of an uh idea of what vision is? Like I think as OTs, we kind of naturally think that vision is a ton of different skills that are all interrelated.

SPEAKER_02 19:56

I don't think we yeah, I don't think we OTs have too narrow of a scope, but I think the general population, the community, the school community and the school administrators, they're the ones who are making these decisions. And, you know, the focus right now is reading and math scores and the high influx of children with dyslexia and dysgraphia. And they're kind of skipping over that foundation. When we look at the pyramid of learning, what do the students need to have in place to really support their development? And school administrators aren't schooled in this, as far as I know. I mean, I've never taken the administrator coursework, but I feel like they go to the end goal, kind of the top-down approach always. Whereas OTs, we look at things from the top down, but also the bottom up. And we realize that vision is a huge part of learning, but I don't think the general school community knows that. And that's where OTs can really are positioned really well to promote that and be advocates.

SPEAKER_00 20:54

I'm just thinking, I'm like, oh, that feels like something I definitely want to help on in creating resources and just helping people understand uh the different visual skills that there are and uh what can be done to work on them. Even as an OT, I feel like I'm still learning those and still getting the language and could use a cheat sheet myself.

SPEAKER_02 21:18

I think like if we back up a little and we think about, okay, we work on visual motor all the time, but visual motor is vision and motor. So if the motor skills are impaired, the visual motor integration is very likely to be impaired. If the vision is impaired or the visual perception, you know, it all as OTs, we kind of know that it all goes together, but sometimes you got to take a step back and be like, oh yeah, that makes so much sense. And and it's more clear that we need to tease out the pieces to see where exactly the students are struggling.

SPEAKER_00 21:52

So in your work as a school OT, how do you get looped in when there is A concern about vision. I can imagine all different kinds of layers of that happening. What does that just typically look like for you? Okay.

SPEAKER_02 22:10

So in my particular role, I my district has six elementary schools and two middle schools. Me and one other OT do most of the initial OT evaluations. If we get backed up, then an agency will take them. But that's where I will most likely encounter that the student has a vision issue. But in terms of getting looped in, it depends. Most often the teachers will say, oh, he's struggling with this, he's struggling with that. But they don't necessarily say, oh, I think there may be something going on with their vision. They may say he's avoidant, he doesn't want to do any work, he gets up the minute it's time to read. And that could be a behavior, but it also could be a sign of eye stream. So I really just listen to what the teacher is reporting to me. And I think it really comes down often to the school problem solving team. So if the student is receiving an initial OT of L, I will include a screening in my OT of L. And then I'll include that information and then follow up with the parent of, I have some concerns. You know, I have my like signature phrases. A lot of OTs are very concerned. I don't want to get in trouble. My school said I can't say anything because then we're gonna have to pay for the child's therapy. And it's it is a hard thing because we don't want to get in trouble at work. But ethically, if we're seeing something that's impacting this child, we can't not mention it either, right? So I kind of look at it as it's no different than saying, I think the child may need orthotics. You know, I think the child may need to follow up with an optometrist. I'm seeing some red flags. I often say to the parents, I just want to rule this out. I just saw this, and it would be great if it's just a quick fix. So let's rule this out and see that maybe this is why they're struggling with reading or this is why they're, you know, avoiding near work. We have to be aware as educators that if a student is, you know, constantly straining and it hurts, or they feel a pulling at their eyes, they're going to look away. It's like asking someone to stare at the sun and do a good job.

SPEAKER_00 24:21

I had a question in the comments that loops back to that qualifying condition and then also relates to getting looped in for these services. I'm just going to read it. Mary said that the statement that Jamie made about vision as a qualifying condition, my school district personnel haven't expanded that. So I need to know more about how to advocate for that. Jamie, if there wasn't a site qualifying the student, could the vision issue be pushed enough by the OT for a 504, since OT isn't a standalone qualifying service?

SPEAKER_02 24:55

So that's an awesome question, Mary. To advocate for it, number one, I think it's really important to have the document from the Office of Special Education and Rehab Services. Um, I actually have a handout on my website for free, too, that I'll give to Sarah that she can give out to everybody that explains that vision does not mean low vision and blindness. It doesn't exclusively mean that. There are other things. If it's adversely impacting the student's learning, if their visual perceptual or visual ocular motor skills are so poor that it's impacting the student's ability to participate in physical education, participate in reading, anything like that, then it should be something where the child can be classified. The problem about the 504 is, in my experience, that is a district by district decision. In my district, we don't provide occupational therapy services under a 504 because they go with the caveat of a 504 is for accommodations, not for services. But that said, you could take the diagnosis and put it for a 504 and provide that student with accommodations such as enlarged text, working on a slant board, vision breaks, and things like that. I hope that makes sense.

SPEAKER_00 26:19

Super helpful. I'm curious the assessments then that you tend to use with students, like you've been looped in. I'm curious both about uh you mentioned an initial screener. Is that a screener you've created or a standardized one? And then if there's any uh standardized assessments that you tend to use when you're digging a little deeper and just what that battery of assessment looks like for you.

SPEAKER_02 26:48

So for my initial eval, I cho I base my assessment tool on the report that I'm getting from the teacher. Um, you know, if they're saying, oh, sensory issues, sensory issues, I'm of course going to do the sensory profile. If they're saying motor, a little bit of this, a little bit of that, I may go to the bot three. It really depends. I don't generally on my first initial assessment bring a tool like the visual skills appraisal or the developmental eye movement test. I have used those in testing my students further. Like if now the student's on my caseload and I really want to get more information. And, or if the student isn't qualifying and I need to kind of get a little more information, I'll use those assessments. They're not my first layer. I find often enough, if I include the information about what I saw in an informal screening, I do, I do have a screener that I kind of made myself with Robert for school-based OTs, but it's it's very general. It's not rocket scientists. It's really looking at the student's range of motion. Can they move their eyes in, you know, you think of the Brady Bunch or the Tic-Tac Toe board. Can they move and maintain their eyes in each of the cardinal gazes? Are they able to keep their eye on something for a sustained period of time? Are they able to track across and keep their fing their eyes on the item? You'll see the students who struggle with crossing midline, when they get to the middle, they look over here or their eyes skip. And to some degree, depending on the child's age, that's very normal. And I think as you start to do it with every student you see, you notice when it's, ooh, there's something here. And that's when you put it into your report and tell the parent, I really, if you could, I'd like you to follow up with an eye care professional. I saw some red flags. He really struggled to track from left to right. I wonder how that would impact his reading, you know, because we're not eye doctors, we're not vision specialists where we look at the whole body. And in doing that, we looked at this. Once I do want to dig a little deeper, I will use the visual skills appraisal and the developmental eye movement test. Those are my two go-tos. But I find just the informal screening of looking at what their eyes can do is generally enough to give me, you know, the meat and potatoes of what I need to say to the parent.

SPEAKER_00 29:13

Yeah, having just been to a neurooptometrist, uh, she also did a lot of having me uh follow her finger, just a lot of really seeing my eyes in action. Even though that feels less formal, I think there is just a ton of information to gather from that.

SPEAKER_02 29:34

Absolutely. And it's like when you first become an OT and you start, you first start working on something and you, you know, you do something with every single kid, and you're like, okay, that you you get your baseline of what is looking okay. And then you have a child who completely struggles with it, and you just you just know it's your gut because now you have so much to compare to. So that would be my first recommendation to anybody who's kind of getting their feet wet with it. Just start, just start looking at that tracking and getting an idea of what eyes look like at different ages. By the age of 10, a child should really be able to smoothly track across midline and back and forth without skipping, without fatiguing, you know, without you you see when they start to kind of squint, they look away, um, they start blinking, they might start like giggling a little bit. I don't know where the giggling comes in, but it does. Um, and you just start to see those little red flags of I think there's something here.

SPEAKER_00 30:34

That helps me understand uh the assessment screening piece. I'm curious then thinking about your interventions, what is typical on your caseload? What does that look like with students?

SPEAKER_02 30:52

I think very often we're working on vision without knowing we're working on vision. And it's one of those things, you know, when you take a course and you come back to work and you realize every single child has sensory issues or every single child has attention issues, whatever you just learned about. Often what we're doing is working on vision. So I always try to incorporate a lot of different things at once into what I'm doing with my students. And often we're already doing that without even trying. So I do a lot of ball skills, a lot. Um, I took the ball of Viz X course. Do you know that course?

SPEAKER_00 31:27

No, uh-uh.

SPEAKER_02 31:28

It's really interesting. And it it was a lot of like, you know, incorporating rhythm with hearing, with balance, with vision, with bilateral skills, like all together. So I try to come up with a lot of activities like that. But even the simple activities of having a child practice throwing at a target and letting it bounce back and catching it. Like we're working on eye hand coordination, you know, grading how hard they're throwing, working on actually throwing. Like there's so many things that we're working on. So I definitely try to combine a lot. Plus, we only have 30 minutes. If it's a pullout session, we don't get to see the child a lot. So I like to teach the kids fun games that they can practice at home, things like dribbling and then passing it under their leg, dribbling and then throwing it at the wall, dribbling, catching it, throwing it up in the air, catching it again, and of course, incorporating things into that. Like let's, you know, as the child's cognitive level allows, let's incorporate something that they're doing with their curriculum, like catch the ball, A, throw it up in the air, B, let's change it for something harder, catch the ball, apple, throw it in the air, banana, throw it at a target, just to keep all those kind of pieces moving and working together. But even when we're working on something like convergence and divergence, and you know, OTs are so good at making an activity out of, you know, whatever is in their backpack, you know, just some straws and some toothpicks or straws and a pipe cleaner. I've done where I had a student who had weak oral motor skills. And I, though that was not a goal. I'm, you know, I wasn't the one working on the students' oral motor skills, but our students who have low tone all over their bodies also have low tone in their face and their tongue and their lips, and it's impacting their speech. So I'm working on convergence and divergence. I'll maybe have that child have um like a pipe cleaner or a straw or something in their mouth sticking out, and then they can loop things on it. So they're working on out and in, but also working on keeping that thing not falling down, you know, but it's fun. And the easier it is for the child, the the more you can grade it, you know, that you can have them do it in a certain sequence, or you can have them do it to a metronome, you can have them do it with a rhythm or following a pattern. I like to do cut a pool noodle in half and write letters on it and then have them put a ping-pong ball on it and they have to track it back and forth to spell the words that they're learning this week. Easy things like that. I always try to incorporate a balance component if possible. So whether I have them do it on a swing or stand on a wobble board, if they can. You know, you're always grading it and, you know, making sure that it meets what the student can do. Um, but I try to incorporate toys and fun things that they like because then it's less strenuous. You know, they may say, I'm getting tired, or my eye, my eyes starting to hurt. Then we, of course, take a break from that, but I'll then start my next session with it again and say, okay, last time we got to um, you know, I I had my custodian draw, um, drill holes in my paint stick from Walmart. You know, I get I'm always stealing all the paint sticks, taping them together, and and um I have them hold it to their nose or in their mouth if they can, if it's just their paint stick, and put little light bright pegs in it. And, you know, how many can we get to? And how are we gonna peel them? Now we're gonna put them out. And, you know, they're I'm watching their eyes in and out and difficulty focusing, and are their hands going past where the peg is or not? And the next session I'll say, okay, we did it, we did it twice. Let's see if we can do it three times, and then we'll move on to our other thing that we're working on. I just try to really incorporate it into whatever their other goals are.

SPEAKER_00 35:13

I have multiple questions. I want to ask one from the comments. Someone was just hoping you could repeat the name of the ball course that you did, and I'll link to it too.

SPEAKER_02 35:23

Yes, it was called Ball uh Vizacs. It's it's balance, auditory, vision. I don't remember what the X stands for, but it combines all those things. And um, there's some really cool videos on YouTube about it. You could just kind of check it out and see what it's about. But it's I just thought the premise behind it was really interesting.

SPEAKER_00 35:43

I want to squeeze in two more questions to this part on intervention. One, during the assessment, someone noticed the importance of looking at gross movements too, along with visual movements. And then as I'm hearing your intervention, they're so activity-based. And um, my son also got vision therapy this summer and saw this neurooptometrist. And I was really surprised in her office how much coordination things she also did, like would have him tap his knees as he's spelling a word backwards, looked at uh primitive reflexes, and then the therapy that she recommended was really similar to what you're saying, where it really incorporated vision, motor skills, and cognitive skills all at the same time. What's the importance of doing all those things at the same time?

SPEAKER_02 36:40

Well, because they need to work on all those things, number one, but number two, you it's impossible to use one without relying on the other. You know, it's not the student is a whole child and all of these pieces are integrated. But, you know, vision and balance have so much to do with each other. You know, you'll notice uh when I test a student's balance for my initial OT eval, I ask them to stand on one foot on, you know, how long can they go? I do the other foot. I'm looking at is their left leg weaker than their right leg? Do they have balance that's age appropriate? But then I have them do it with their eyes closed, and you'll see often a marked difference in how they can do it. And it shows you that they're relying on visual feedback in order to have balance. So we need to be looking at all those things. But the other piece is the proprioception, you know, to be having a student. Um, let's say I'm having a student sitting on a swing and I have a ball on a string, a Marzin ball swinging at them and having them touch it. And, you know, they're they're learning where their body is in space and they're learning that spatial map of where they are in the world. And they need that to stop bumping into everything and to, you know, really understand where they are in relation to other things. So I think that was Mary that said that. And that's it. Absolutely true. You've got to watch everything. You'll see too when they're, you know, trying to track and their whole head is going. And when the child is five, it's normal. They're just learning how to separate their eye movements from their head movements. But as they're getting older, they should be able to move their eyes without their whole body kind of, you know, going. So we want to keep an eye on that as well.

SPEAKER_00 38:18

My one other intervention question. Um, and sorry, I'm relying so much on my own personal experience. I was really surprised just watching my son who was working on things like smooth tracking, like throwing the ball from one hand to another. Um, I was so surprised once that skill was isolated and he worked on it specifically a couple of times. I felt like he improved so quickly.

SPEAKER_01 38:46

Yeah.

SPEAKER_00 38:47

Is that something that you see too?

SPEAKER_02 38:50

I do, but I also think there's a whole nother piece to with the influx of technology and after COVID, especially, that our students are doing so much near work. You know, everyone has a Chromebook now. They're all doing this all the time, and they're not outside as much throwing and catching and playing kickball. And and those gross motor games are working on far vision. And I think, you know, they the research has shown that since COVID, there's a big increase in myopia, nearsightedness. And that's because those are the exercises, those are the muscles that our students are using. So I think it's both. I think it could be a vision issue, and maybe in your son's case that was the case. But I think with just general kids, my own daughter, and that's like embarrassing to say because I'm pediatric OT and I feel like I'm pretty good. Like we go to the park all the time and we work on stuff, and I don't let her be in front of the TV all the time, but they're just not outside as much as they as we were. You know, my mom used to be like, get outside and don't come back until dinner. And things just changed. So there, I think the kids aren't just practicing with a ball like they used to. So I always encourage that. Right before summer's out, right before school's out, I always send a message to my parents like, just remember, any time spent playing with a ball, whether with you or by themselves, is working on a multitude of skills. Teach them how to dribble, teach them how to throw a ball at a wall and catch it, teach them how to, you know, throw a balloon in the air and bat it with a left and then a right. Like anything like that is working on those skills.

SPEAKER_00 40:27

It feels very obvious to me that visual skills impact reading. These other more like divergent skills that you're talking about that we're missing practice on, it seems to me that those also probably impact reading, but it's not as obvious. Do you agree with that overall? Definitely.

SPEAKER_02 40:46

I mean, it definitely there's are it, you know, just the way the classroom has changed. It used to be almost all that the teachers are at the in the front of the room on the smart board and the kids are watching from far away, and then they have to, you know, shift not only from far to near, but also from vertical to horizontal. And now it's it's changed where very very often what they're working on is right in front of them, just 10 to 15 inches away. So they're not getting as much exercise in all of the things that we just spoke about.

SPEAKER_00 41:21

Shifting to thinking about education, I would say, and lump education into parents, uh, teachers, and even what you're teaching your students about their own vision. What information are you typically providing? I know I just said multiple different audiences, but what are the things you tend to say over and over to people?

SPEAKER_02 41:40

I I definitely gear my communication to the population. So for parents, they just want their child to do well in school, right? For admins, they're worried about the reading scores. They're worried about the budget, they're worried about how much they're spending on in explicit reading instruction. So I go with what does this person care about? And how can I make the information I have to offer matter to them? So for admins, like I said, I actually recently approached my own assistant superintendent with the information that I feel we're really missing the boat with our children's vision screenings. And she was kind of like, what? Her thing is reading, reading, reading, reading. All she cares about, not all she cares about, but she she's so focused on getting the children reading, book love, all these reading initiatives. And I just said to her, you know, I love that we are offering our students all this specialized reading in Orton Gillingham and, you know, the specialized phonics instruction and small groups, but many of them are getting this instruction until they're 19 years old and they're making minimal gains. I think we're missing the boat here. And I would like permission to train the reading teachers and the nurses in vision screening. I want the nurses to learn more about the physical aspect of looking at reading eye movements, because I, you know, this test that the nurses do misses the majority of what the most common vision deficits are. The nurses don't look at binocular vision. They're looking, does this child need glasses to see far? But most of what our kids doing is looking near. So let's have the nurses spend just a few more minutes with each student. And if she can catch three to four kids, which I think she'll catch more because it's one in four children that have an undiagnosed vision issue. So we can have that first line of defense and just incorporate a little more into the nurses' screening. What an amazing service we're doing to our district, to our kids, to our budget, to our reading scores, to all these things. When I say things like that, the admins listen because it's like, how simple. How long will it take you to do this training? Jamie, I'm like, I need an hour with the nurses and an hour with the reading teachers. That's it. That's it. You know, and maybe a refresher or something like that, where some documents that I can give them to look back at. Um, or if needed, I can go on the day that they're doing the first grade and looking at their vision and point out things that I want them to notice. Those are the kind of really hands-on, like wow lessons that we should be educating other educators about. And I think that it would be a huge, I'm really excited to see if my admin lets me do it. I think she absolutely will because I I saw her, I saw like the light bulbs, like, oh, hmm. You know, and I was like, yeah, it doesn't, it doesn't need to be that we're giving everyone vision therapy, that we're doing all this stuff, or we're bringing an eye doctor in. It's just, let's increase awareness and follow up with those parents. Because luckily, where I live, most of the parents do have insurance and we do have eye care professionals in the area that can help. So, like, let's get on it. For parents, they just want their child to stop struggling. They want their child to feel successful. They want their child to be successful. So I go with the common phrases that I've said earlier, like, you know, I noticed that he's kind of struggling. His eyes were unable to stay fixed on my finger for very long. And I wonder how that impacts his reading. I don't know if you could possibly, you know, could you possibly follow up with an eye care professional? And one thing I did that I definitely recommend to other school OTs is to do the research yourself and find the school, find the optometrists in your area that do a comprehensive three-component model of vision exam. Not just uh, do they need glasses? Is it a visual acuity, but looking at their visual perception and their binocular vision. Find the couple of doctors that do that in your area and make a handout. And you will use that handout a million times. I know I have in where I live. I'm always like, no problem. I can send you a list of the ones in the area. It just saves the parents a step and makes it less cumbersome by providing them with that information. And then I think you also asked about how do I teach my students. Oh, yeah. Um I definitely educate my students about what's going on because I find that the vision difficulties impact the kids' self-esteem greatly. And it impacts how they feel about themselves as a learner. Um, they may think like, I'm not good at reading, I'm not a good athlete, but it might not necessarily be the case. It's that because we need to strengthen your eyes a little bit, that's why you're struggling with the dribbling piece. So I educate what is happening and that, like, listen, remember when it used to be hard for you to write more than a sentence because we had to work on those putty exercises to get your hands a little stronger? It's the same thing. We need to continue to do these eye movement exercises, and your eyes are gonna get a little stronger, and then catching a ball will be easier for you. And, you know, it's not that you're not a good athlete. It's that we just need to tighten up these muscles and then you'll be, you know, participating just like everybody else. So I think that's an important component because the research shows that people with poor reading skills really struggle and it impacts their whole school career.

SPEAKER_00 47:25

That self-esteem piece is definitely the piece that I think about with difficulties with vision and kids not knowing it's their vision, not knowing that they're seeing difficult, like seeing differently, right and how demoralizing that is than on multiple fronts. Because that's what they've always seen. Yes. Yep.

SPEAKER_02 47:45

And the interesting part I uncovered also is that when you think about that self-esteem piece, then the student feels like, well, uh, I'm not smart. Um, and then that increases the school dropout rate. The research shows that the amount of children who drop out who have significant reading difficulties is like extremely high. And it just makes sense. Why would they want to be there when they're continually being unsuccessful? And this also then directly correlates to the people that are in prison. There's a high, high percentage of people that are in prison that have significant undiagnosed vision deficits. And it really goes to show it impacts our whole, our whole school community, our whole community, starting with the school.

SPEAKER_00 48:27

Yeah, I'll try to dig up those specific data points. I've seen them too about the dropout rate and people in prisons and share those for us because yeah, it does just make you think about this uh issue differently. It's alarming. It's alarming. I want to for sure ask about the role of the generalist school OT versus what you feel like might need special training. I know when I started having just my own vision issues and was thinking more about vision, I would just like see it, like I would go to my son's baseball game and I would just really key in on differences and batting and just, yeah, once you see vision, you just like start to see it in more of your students. And I can imagine that happening just with generalist OTs. Um, what do you think is the role of the generalists versus what do we need special training for in this area?

SPEAKER_02 49:24

So I mean, I think a school-based occupational therapist, a generalist, can really just start looking at ocular motor skills within what they're already doing. And just to be aware, that's the most important thing is that we are vision aware. We don't need to be, you know, we're not doing vision therapy. We're not vision therapists, we're occupational therapists. But to be aware of that, this may be something that's impacting your ability to participate and follow up to get the parents on board to follow up with an eye exam. That's what I think a generalist OT can do. But they should also know that they are already working on ocular motor skills. If they're working on ball skills, they're working on ocular motor skills. If they're working on handwriting, they're working on near vision. They're already doing these things. It's just more to like look at it through the lens of how is vision taking part in this student's ability to participate in what we're doing. And then when it comes to having special training, I think the more you educate yourself in how the eyes are impacting what the student is able to do, the more you're able to kind of gear your treatment towards that. But the things that I mentioned to you, you know, the dribbling and the tapping and using a metronome or, you know, doing something with the eyes where we're moving something towards the mouth, a generalist OT can do those things. It doesn't necessarily need to be specialist training. It's just getting that competence and comfortability in what you're really seeing.

SPEAKER_00 50:56

We're coming down into our final minutes of this course. We have about seven minutes left. I want to divide those seven minutes between my first question, which is just what needs to change in this area? Like, what do you want to see in the future of vision in schools? Where do you want to see us go?

SPEAKER_02 51:16

I think before we talk about the future of vision in schools, I think we have to talk about school, the vision, the future of school occupational therapy. So right now, occupational therapists are not allowed to be leaders in most states. We're not allowed to be principals, you know, assistant principals, assistant superintendents. And I think once those barriers are removed, we will have such an easier time educating the general public about vision and about the awareness and about occupational therapy's role. Research shows that our role is very often understood, misunderstood by school administrators. So if I could wave a magic wand, those barriers to OTPs being in leadership would be gone. And I think the trickle-down effect would be that we could educate everybody about our role. I would love to see school OTs doing MTSS and RTI. There's the research shows that we're facing a lot of barriers, even doing that. And Essa said that we should be doing that in 2015. So it's now 2026, and we're often still barred from doing those kinds of things. So I think it's really important that OTs feel strongly, that they know their stuff and that they advocate for our role as OTs, but also for our students. And to not feel scared. Don't be don't be silent. You know a lot more about this than everybody else. So speak up, show what you know. You're doing yourself a service as well as our profession, but most importantly, the children.

SPEAKER_00 52:56

And then thinking about this conversation that we've had today, we've touched on everything from like where we need to go to the specific of assessment to education. What's like the final thought and takeaway you want to leave us on today?

SPEAKER_02 53:15

I want school OTs to know you don't have to be an expert in vision. You just need to be vision aware. Just be, just start looking at all of your students. Look at their eyes, look at the way their eyes are moving, the way their eyes are impacting their ability to participate. And we are the only professionals in the school setting that have vision within our scope of practice. The nurses do and they do a quick screening, but they're not working with the students on learning. We are. So we are uniquely positioned to assist in this area. So we can really impact a student's entire life by being the one who picks up on what's really causing their difficulty. So I think that's what I want people to come away with. Vision is within our scope of practice, and you don't have to be a vision expert to start looking at it.

SPEAKER_00 54:09

Jamie, I'm so inspired by this conversation about all the things that OTs can do. Um, I'd love to just keep collecting resources so more of us can be looking at these things, both in the schools, in hospitals, in nursing homes, in all of our settings. There's so much we can be doing with vision. You have been such a leader for our profession in highlighting this work and most importantly, to be in doing the work yourself. Like you are boots on the ground, doing this in your school, really understanding it. Thank you so much for your unique role of wearing both hats, of practicing and educating. I know how hard that is. Uh, when I look around the country, you stand out to me as thank you. Um, just someone who's doing both. I know how hard it is. So thank you for that important work and thank you for being here to share with us today. I just really appreciate this conversation.

SPEAKER_02 55:07

Me too. Thank you for allowing me to share. I think it's a topic that I'm really passionate about. So I'm really happy to be here.

SPEAKER_00 55:14

Oh, well, thank you again, and hopefully we get a talk again soon. Thank you for joining us on the OT Potential podcast. To earn one hour of AOTA approved continuing education for your time today, you will need to sign in or sign up at OTPotential.com. Once you're in the OT Potential Club, you will find a five-question post-course quiz connected to this episode. When you pass the quiz with a score of 75% or higher, you will be able to download a PDF certificate that certifies your completion of this course. Okay, I want to thank you for joining us today, and we'll see you next time.