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Keywords

astronaut training, sensory integration, visual skills, functional vision, visual tracking, binocular vision, cognitive skills, visual memory

In this conversation, Sam Berne discusses various techniques and methods used in occupational therapy, particularly focusing on astronaut training and its components, including vestibular activation, ocular motor skills, and auditory processing. He emphasizes the importance of visual skills in functional vision, including visual tracking, accommodation, and binocular vision, and how these skills are essential for reading and spatial awareness. The conversation also covers cognitive skills such as visual memory, form perception, and spatial orientation, highlighting their significance in learning and everyday activities.

Astronaut training incorporates sensory motor integration techniques.

Sound Bites

“It’s a wonderful sensory motor integration.”

00:00 Understanding Astronaut Training Techniques

Sam Berne (00:00.236)

So getting me to be able to focus and hold my gaze that improves my visual motor integration like hand-eye coordination or copying from the board stuff like that. And then the third component and the astronaut training is auditory processing integration. So you can use sound and rhythm to help the brain process spatial awareness. So

I find I like to do this with every kid, but especially with autism, developmental delays, autism spectrum, Asperger’s, brain injury, people with dizziness, vertigo, balance. So what you’re doing is either using a rotating board or you can use a chair, something you can spin and you’re monitoring the direction speed and duration.

To over stimulate. some of these kids if you try to do too much of the astronaut training it over stimulates them. Now you can use a pen light or moving objects or visual tracking tools and then also they’re listening something sometimes you can pair it with you know, by by urinal beats or you know some like in here.

We use the so cord. Now, the reason why we call it astronaut training is because in NASA and astronaut training protocols, they would work a lot with the vestibular system, especially in different gravity environments. So just as astronauts have to adapt to movements in space individuals and people with sensory challenges.

Sam Berne (02:23.085)

There’s different kinds of movements you can make. You can go forwards and backwards with the chair. You can go side to side with the chair and you can even go up and down. Okay, so each one of those is helping them with gravity awareness, postural control and muscle tone. So you’re working with what we call the postural reflexes.

They come after the primitive reflexes. So if you’re going to do the spinning, can do I like to do clockwise first then counterclockwise and

Sam Berne (03:40.383)

Sam Berne (03:53.525)

When you do this standard rotation, I like to do between three and five in one direction and then I pause for a few seconds. To let the person process it and then I’ll do three to five rotations in the other direction and I’m really monitoring the over stimulation. Like if they start saying,

I’m dizzy. I’m nauseous. I’m disoriented. I will do less on the next round. I do it slow. So it needs to be smooth. So you don’t want to jerk it. And what I also will have them do is focus on a target a visual target as they’re moving around.

I might have multiple targets in my room. Okay, look here and then they move now. Look at this target over here and then look at this over here. So you can add that but if again, if they start getting dizzy, sometimes I’ll just have them stop will stop and just do breathing because you’re going to find like with this child probably he’s going to get overstimulated pretty quickly.

so you may only get going around once or twice in each, you know, in each, direction and then you stop and that’s it. Now I tend to do the astronaut training for about a month and we just incorporated into our, you know, primitive reflex work, our gross and fine motor therapies, those kinds of things. So.

Sam Berne (05:53.245)

Functional vision, but we’re really talking about the visual skills. So what are What what does this mean? So developing functional vision in in it means enhancing visual skills and perceptual abilities. So we’re working more with advanced things. Okay, as opposed to say staying with you know, balance and primitive reflexes.

We’re now working with specific eye muscle skills and how those eye muscles are helping the person process information. Okay. Now as an example, one of the primary visual skills is visual tracking the ability to smoothly and accurately follow a moving object with one’s eyes. This visual tracking is so important with reading. So some of the behaviors will see

If there’s a visual tracking problem, if you’re, you know, tracking their their eyes, do they have to move their head or their body to track their eyes? That tells you something that tells you that reading is probably going to be difficult. And I when I’m testing, I don’t tend to correct or suppress the person. I’m just watching to see hey, follow this target.

Do I need to move my body? Do I need to move my head or can I just do it with my eyes? Ultimately, we’d want you to do it with the eyes and we have the pursuit movement. That’s the smooth movement and the saccadic movement jumping from one object back and forth. So both of them are important in the visual tracking. Now there are different ways to assess visual tracking. There’s a there’s a test.

Sam Berne (08:19.223)

paper and pencil oriented that gives you a lot of results based on age and it’s called the King Devic test. Kin G is the first word. D E V I C K and sometimes if I need to do kind of a test where we’ve got norms for certain ages because you’re basically reading digits on this.

cardboard book in this book and At first there’s lines that connect the numbers Okay, and then the next page there’s no lines and then the last page the numbers are really spread out Eradically and that’s harder to do so you can measure how many times they miss reading the numbers You know based on their age and so on

So you could do the King Devic test if you’re if you’re looking for that that level of accuracy. What I like to do is I actually just have to move an object. So I move the object I’m moving so it could be a pan light. It could be a ball with a metal rod with a metal ball on it called a wolf ball could be a kind of a tongue depressor with a

a sticker on it. And so you can use one or two of them if you’re doing saccades or pursuits. We do them in all the directions, you know, circular and you know, diagonal. And we’re looking for the accuracy of being able to hold on to the ball or hold on to the target while they’re fixating on the target. You’ll see kids sometimes do this will the overshoot

Sam Berne (10:21.953)

with the primitive reflex called the asymmetrical tonic neck reflex. So if I see an ocular motor tracking problem, I’m going to go back and test the asymmetrical tonic neck reflex because a lot of times that reflex is inhibiting the tracking to work well. visual tracking is really essential in terms of reading. Now, one of the fun exercises I like to do

physical vision therapy functional vision exercises called the alphabet ball exercise. So what I do is I write letters on a ball or even a balloon. That’s even more fun and I toss it to the individual and I have them call out the last letter they see before catching it. So again, you could do this with a Marsden ball. We have a Marsden ball with different letters and numbers on it. So while they’re hitting the ball

I might have them spell a word or I might have them, you know, just call out the letters or the numbers. Again, if you’re doing balloon volleyball, you can put letters on the balloon and they can call out the first or last letter. So there’s different ways you can also work with the visual tracking using a heart chart, which I think you know about with an eye patch and a metronome. I like doing auditory.

processing along with that as well.

Sam Berne (12:22.741)

do with both eyes together. kind of just mix it up and that’s what we do. All right. Now the second skill that we talk about is called visual accommodation. This means that the eye, the lens of the eye is able to change its focus between near and far distance objects.

And so one of the tests I use in that is have the individual switch their focus from an object like a 10 inches away, like a small chart of letters to one that’s 20, 10 to 20 feet away and noting any delay or difficulty in the adjustment of.

the visual accommodation. You know, there’s less of that today because kids are on the tablet a lot and they’re not using their desk and looking at the board. They’re just kind of at their tablet but visual accommodation comes into play a lot in sports.

It comes into play a lot with bike riding, you things where you have to kind of shift your focus. Now we’re in ski season. So with the borders, can they board and kind of do that near far focusing while they’re keeping their balance. So in terms of vision therapy, the fun, my functional vision exercise, you can do it with a thumb.

Sam Berne (14:14.675)

I like to repeat it for about five times to improve the accommodative flexibility. Sometimes I’ll use two heart charts on closer one farther away different sizes different setups of the heart chart with the letters. I also like to use the vestibular system as a challenge. So we might again be on some kind of a rotation or balance board. And then the other thing is the

The metronome I like the metronome at a slow speed like 40 beats a minute and we’re just you know, shifting our focus back and forth. All right. Now the third visual skill that I like to work with is what we call binocular vision. This has to do with both eyes working together and

I am really interested in the coordination between the two eyes. I’m going to stop here for a second. The coordination between the two eyes is critically important as it relates to depth perception judging things in space. You know, it’s such an important skill in terms of the

the spatial IQ, the spatial IQ of the person. And there were, there was some work done by some optometrists, developmental optometrists, where they actually measured IQ and then they did vision therapy on them and their, there’s their depth perception improved.

Sam Berne (16:16.085)

And what you’re doing is you’re having them look at a target, maybe about 14 inches from their face. So they’re focusing on the target and you’re covering an eye. Now, when you, as soon as you cover an eye, you want to watch the movement of the eye that’s uncovered. Does it move away from the target? Does it drift away out or away in? That’s going to tell you whether or not there’s strabismus.

and if there’s a lack of visual coordination. Now, the other thing you want to look at is when you take the cover away, what happens to the eye that was covered? Does it come back to look at the target? Does it drift away from the target? So we do both eyes. We have you cover the right eye. We say look at the left and then we go in the other direction and then we say cover the other eye. So we’re covering the right eye.

And we’re covering the left and we’re looking at the movement of the eye behind the cover. If the eye goes in then we know we’re in an exo response. If the eye goes out under the cover when you take the cover away, then that’s an ESO response up and down. Also, you might see an eye like you take the cover away. Whoop the eye is going up or the eye is going down. So the

The cover test is a way to do this. Another way to do it is with the red green test. We have them look at the red green bars and this test is going to show more general binocular vision possibilities or suppression. Because when there’s a binocular vision problem, two things can happen, double vision or suppression. So on the red green test,

Sam Berne (18:34.765)

Or the person might say, geez, the picture looks really flat to me. I can’t really see it. So that’s where I might do the red green test to see if they’re suppressing one eye or another. Now, one of the best exercises to develop binocular vision is the Brock string, which you are doing. You folks are doing these. And again, you attach one end.

of the string to a stationary object. And then the other end you hold it up to your nose and you spread the beads out equidistantly and you focus on each bead and you’re just converging at each bead and that’s a way for you to develop the binocular vision situation. So it’s such an important skill. Okay, we got it. We got a few more things. We want to talk about hand-eye coordination.

So this is how the eyes follow the hand reaching and grasping. There’s a primitive reflex called the grasp reflex. You probably know it. And so we want to observe the person’s ability to reach and grab grass grasp objects of various sizes distances and textures. And again, we’re doing the alphabet ball exercise.

to improve eye-hand coordination, keeping the ball, hitting it up at the balloon, for example, is a good eye-hand coordination. Catching a ball, Marsden ball, know, those kinds of things. Juggling with scarves, throwing the scarf over here on the right and then throwing it here on the left. So anything you can develop that eye-to-hand coordination is really helpful.

Sam Berne (20:56.919)

Test the memory and then their memory games matching card games. Concentration is a game. all use anything. You can locate specific images in a pair enhances visual memory. There’s also a whole body of work. I learned from a doctor wax Harry wax who was a developmental optometrist. He has a whole program working with parketry blocks.

and visual memory.

All right, the next is form perception, recognizing objects despite changes in size, position or context.

So how do you assess form constancy you present objects in various orientations and ask the individual to identify them? No noting any difficulties in the identification. I like doing tangram puzzles as a way to enhance form perception or form constancy where you engage the individual and assembling the tangram pieces to match specific shapes.

Sam Berne (22:38.317)

Techniques we use is utilizing puzzles where the individual must find objects hidden within a busy scene or enhancing visual figure ground discrimination by doing parts to whole relationship type parketry designs. And then the last one is visual closure and spatial orientation. This is important because spatial orientation tells us about being able to

understand where we are in space and where we’re going and understanding relationships is a key point. Now, this could be in sports. It could be just socially, but the key in spatial orientation is that what we want to do is we want to utilize different puzzles and worksheets where you must find hidden objects in a busy scene.

Okay. Now, we also talk about something called visual closure. This would be like doing dot to dot drawings. It could be doing something like we call the incomplete man test where we have a diagram of a man with like one arm, his face, maybe one leg. And so we give it to the child and it’s a