Hello, hello. How's everyone doing? Can I ask you a question? Maybe. Before I get started.
I was doing the workbook and it asked the question, like, what does FIM stand for? FIM. Yeah. I couldn't find it anywhere. Why do I not know the answer to that either?
I don't know, but that makes me feel a little bit better. Let's see. For which seminar? The neurodiversity one from last time. I have no clue, but I will get an answer for you.
Oh, okay, thanks. Like I, A, no one's ever asked me that, and B. Okay, I'm like, well, if it was in the workbook, it must be important, but I couldn't find it anywhere.
And then can I ask you another question? Of course. Okay. So I've been working with the same couple of kids, especially the one like this whole time and have developed, you know, you get close to them and whatever. Well then now that we're kind of like heading toward the end, they're like, what are we going to do?
And there isn't any service. Like I've talked to the county people and they don't cover still to communicate because they think speech therapy you should cover it. Right. So what, what do you do?
Like, I don't, I don't want to just be like, nope, sorry, we're done. And I know I won't do that, but like, if they can't. Are they, and I think you kind of said this, but how close are they to you?
Like geographically? Like one of them's a half hour away. One of them's 10 minutes. Oh, not bad at all. So we actually, during the wrap-up seminar, we spend a lot of time talking about like, people have a lot of questions about businesses and stuff.
Sorry, I'm trying to plug my computer in so I don't die on you. It depends practitioner by practitioner. So I do have some families that are considered lower income where I only charge them a quarter of my rate, but our sessions are only 20 minutes. So it's technically cheaper than anything else because I don't want them to lose that access. But there's also like the Speller Access Fund gives.
family scholarships for sessions okay um and then for you're talking about like from a money standpoint right yeah and like I mean I would love to continue to do it not charge anything but I know I don't know if that's even not prep like not ethical but I don't know what the right word is like if well she gives them for free and this person has to pay and if like we have to charge like a certain amount or how that works You guys have like free reign over what you charge. Then I would say the normal for practitioners, like newly graduated practitioners would be around 80 to 90 per session. I do mine per hour. So if I have somebody that's only doing a 15 minute session, they're not being charged the same as somebody who's doing an hour long session.
So you're allowed to set your rates. and I I talked to Evie about this a few years ago because I was in the same boat where I'm like, these families need access. And she's like, well, you need a way to live and pay your bills. So everyone's kind of in the same boat.
There are resources like scholarships that you can give out. I'm a little bit more flexible with my pricing for lower income families. Thank you. Of course. And in our wrap-up seminar, our wrap-up seminar is basically you guys ask me any other burning questions that you have.
And then the majority of the time, I feel like it pertains to business. But yeah, the wrap-up seminar is just us talking for an hour and a half. It's not actually a video. Hello, everyone. I don't know if you came in late, but it's only 7.02.
So I don't think you came in that late. But we were just talking about like charging once you're finished with the cohort and what that might look like for families who might have trouble paying for sessions. I also know some practitioners that do, like my friend Mel does packages where you can prepay for X amount of sessions. And because you're prepaying, you get them at a discounted rate.
but like you have the freedom to really do whatever you want once you graduate. Yeah, everyone wonders that. I get that question all the time. And I was just saying our wrap-up seminar is like, is it our last seminar?
But there's no video that goes along with it. So it's really just talking about the cohort and then you guys have the chance to ask questions that are burning. Normally they have to do with owning your own practice though.
Okay. Okay. I'm in a group with these practitioners that have been working for seven plus years.
And I said, anyone know what FIM is? It's in the cohort workbook. And I have no clue. One girl responded who was a cohort leader for like five years.
And she said, no idea. I will try to find an answer though. Alrighty.
So I got our grade book. hold up real quick. So let me take some attendance. If anyone else has any other questions or anything you want to share.
Yeah, Lori, that's pretty normal. The most, I started at 90, but I had been spelling for three years by the time I became a practitioner and I charged 90. Now I charge 115. Per session. Meg Parkinson is like the first practitioner. She's like patient zero.
And I think she charges $125. So it's entirely up to you. That's just like the typical range that people charge. Oh, I love Crimson Rise. I also...
just absolutely love Lakshmi. She's really cool. And I know she's there. Is she there now? She has like the most soothing voice.
Oh my God. As soon as I met her, I was like, I'm so grateful to be here. And I just like melted. Her voice could literally put you to sleep. Sometimes I want to be like, can you just like record a voice memo or something?
And I'll just play it on repeat. Alrighty. I'm glad you're enjoying it though.
Well, I hope you're enjoying it. Yes, you said it's the coolest ever. I'm like, okay, I wasn't sure if you said it was cool or yet or not.
All right, let me get your attendance real quick. This is Allison. I just wanted to, I sent you an email. We had a windstorm here, so our Wi-Fi is out.
So I'm on cell phone data, but, and I'm driving because there's like no cell phone reception where I live. So I'm sorry. Okay, if I cut out for a bit, I'm going to try my best to get back on. It's just, it's iffy. I just wanted to let you know that.
Yeah, no worries. Thanks for letting me know. Okay. I hope you make it back home. Thanks.
Okay, this is like a shorter seminar. I think there's a lot of good room for discussion. But since it is a little bit shorter, we do have time to answer any questions or if you guys have anything exciting that you would like to share.
That's cool too. And I will get our video pulled up. So if you have anything to share, feel free to shout it out, put it in chat. and then we'll get going.
While I'm pulling this up, I got chickens last week and so I'm starting my little hobby farm. I got four chicks and I don't eat eggs so I don't know what's gonna happen once they like start producing. So if you're in a place where you can't find eggs, I don't know if I can ship them to you. All prior knowledge, what was the question? Not super crazy, but just if you knew how many years was in a century.
Still. Yeah. But it was like, I am heavily, still heavily prompting. And I just did the number and he just was like, one zero zero.
Just no problem. I was like, what just happened? It was very fun. That's really cool. And I'll tell you guys, like the prior knowledges, the opens, they never, ever, ever, ever get old.
It is just the most fun. I did like my first open-ended with a guy last week and it was about interoception. It's a lesson written by Stacey Mason. It's excellent.
lesson. And it's about, there was this guy who's a scientist and he said that no amount of scientific evidence would ever prove to him that humans have more than the five basic senses. And so the question, I made it into a one word response. I was like, give me one word to describe someone who wouldn't change their mind on something, no matter how much evidence there is proving otherwise.
And his first ever open word was moronic. And I'm like, yeah, that's a good one. Well, awesome. Thanks for sharing. That's exciting.
I hope you guys have so many more in the future. Okay, so tonight's seminar is on Ocular Motor. In my opinion, I think this is going to be, or I think it is the most beneficial. It's my favorite seminar. And I also think that every time I show this one, people have the most amount of like aha moments when they're watching it.
The eyes are often forgotten and you guys probably already know that they're a really big part of what we do with our clients. So yeah, I absolutely love this seminar. So let me get it playing. And then as always, if you have any questions, feel free to put it in the chat or just shout it out.
Hi everyone, I'm Caitlin Ballou. I am here to present the Ocular Motor Seminar. I am an S2C practitioner as well as a certified occupational therapy assistant.
All right, so today we're going to take a look at the ocular motor system to get a deeper understanding of how it works, how difficulties with it can affect our spellers, and what you can do to help. So what is ocular motor. The ocular motor system is the part of the central nervous system or CNS. Its function is to maintain visual stability and control eye movements.
So let's look at some ocular motor skills. Ocular motor skills are the movements and control of eye muscles. So difficulty with this skill can impair visual tracking and fixation. Vision and ocular motor skills are two different things. So visual acuity is defined as the sharpness of vision measured by the ability to discern letters or numbers at a given distance according to a fixed standard.
It is only a small part of how we see. So the fovea which you can see in the image here which has it has the highest visual acuity on the rest. Sorry it's really but it can only discern an area with the size of a quarter held out at arm's length. So to gain precise and clear vision, the eyes must be directed precisely at an object of interest and held in a stable state. Otherwise, it will cause blurred vision or diplopia if the eyes do not properly align with each other.
And then we have visual perception, the brain's ability to receive, interpret, and act upon visual stimuli. So the who, what, where, when, why, and how. And we have visual motor integration, which is the ability to interpret visual information and respond with a motor action.
The motor actions are driven by visual attention. So there are three basic types of eye movements that we'll be focusing on. So we have fixations, smooth pursuits, and saccades. Fixations are where we hold a gaze on a stable object without moving off target. The normal for doing this is seven seconds or more and it is in opposition to the orienting reflex which is where the eyes move towards inauditory stimuli so you're actively ignoring that and fixing your gaze on something for at least seven seconds to have normal fixations.
Pursuits are tracking a moving object. Normal would be smooth and accurate as you're tracking that object. An abnormal would have leaves moving. faster than the object, lags, moving behind it, or intrusions.
Cicades is where we switch gaze between two different objects. So you're looking at two things and you're switching back and forth. Normal would be fast and accurate, but expensive as far as the energy output that is needed.
Cicades can really wear a speller down quickly. And abnormal would be undershoots, so their eyes not making it all the way to the object, overshoots, moving past them, and poor initiation, actually initiating that eye movement between the two. So what are some stress symptoms that you may see in your clients?
Go ahead and pop those in the chat. All right. Stress movements specifically relating to eye movements or vision.
Closing their eyes, blinking, for sure. Not looking. And the not looking one is really hard to decipher because looking at something, like me looking at the screen right now, takes purposeful motor.
However, if... they're looking at the same place over and over and over again, there's a really good chance that it could be an ocular motor loop. But yeah, we might see blinking.
We might see them, yeah, rubbing their eyes, rolling their eyes can be a loop as well. It could be any number of things, but you guys hit the nail on the head. Great.
You probably mentioned some good ones, like they may be rubbing their eyes, closing their eyes, having more trouble than usual, maintaining their gaze on the boards, things like that. So now we're going to talk a little about the anatomy and physiology of the eyes. So you've previously learned about the different cranial nerves.
And if you recall, the ocular motor nerve is cranial nerve number three. It has three main motor functions, innervation to the pupil and the lens, so autonomic and parasympathetic or involuntary, innervation to the upper eyelids, which is somatic or involuntary, and innervation of the eye muscles that allow for visual tracking. and gaze fixation.
This is also somatic or voluntary movement. There are two primary functions of the autonomic parasympathetic or involuntary ocular motor nerve. It constricts the pupil or meiosis by innervating the smooth muscle, which is the synctropupulae near the pupil. It also innervates the ciliary muscles, and these muscles connect to the iris to the choroid.
Contraction of the muscle alters the curvature of the lens, which allows individuals to focus lens on near objects. So the ocular motor nerve helps to adjust and coordinate eye position during movement. And several movements assist with this process. Cicades, smooth pursuits, fixations, accommodation, vestibular ocular reflex, and optokinetic reflex.
So the ocular motor nerve does control several muscles. You've got the levator palpebrae superioris, which raises the upper eyelid. The superior rectus muscle, which rotates the eyeball backwards, so when we're looking up. The medial rectus muscle adducts the eyes, so looking inward towards your nose.
The inferior rectus muscle rotates the eyeballs forward or looking down. The inferior oblique muscle rotates the eyeballs backwards when the eye is adducted. Okay, so back. up and in.
The ciliary muscle controls the lens shape to focus on up close objects and the sphincter pupil constructs the pupil as we talked about. Control of other eye muscles is by the trochlear or cranial nerve number four and abducens, cranial nerve number six. The trochlear nerve is the fourth which is the fourth cranial nerve as I said controls the superior oblique muscles that rotates the eyeballs forward when the eye is affected. And the abducens nerve controls the lateral rectus muscle.
So it abducts, excuse me, abducts the eye. So looking towards your ear on the same side and your eye is going to go out. So six of these muscles that I mentioned, the superior rectus, the medial rectus, the inferior rectus, inferior oblique, superior oblique and lateral rectus muscles are extraocular.
So they're outside the eye. that control the physical movement of the eyeball. So that is 12 muscles that have to work in unison to control the movement of the eyes. You will come across many students that have ocular apraxia. It is a lot to coordinate just like coordinating the fine motor skills within our digits and articulators that we need for communication.
This is where the need for eye prompting comes into play. So you will hear the term binocular vision. This simply means seeing with two eyes together. Using two eyes is essential for the brain to allow us to see in 3D and judge distances and depths.
And seeing with two eyes is better than using one eye at a time, as the combined image from the two eyes has a quality that is superior to that of a single eye. So, what happens when there is difficulty with this? Not seeing with both eyes can lead to issues with double vision, eye strain, inaccurate depth perception and disruptions to balance, feeling of dizziness, or nausea.
When something goes wrong with binocular vision, the brain is not using both eyes. and this can lead to any of the following significant vision problems. Amblyopia, strabismus, convergence excess or insufficiency, and divergence excess or insufficiency.
This condition occurs when visual input from both eyes isn't equal, to the extent that it affects the brain's ability to combine the information from both eyes into a single cohesive image. This causes the brain to start to ignore signals from the weaker eye. So amblyopia usually occurs as a result of untreated visual issues in childhood, such as a significantly higher refractive error in one eye over the other or a constant eye turn, which is strabismus.
Conditions that deprive one eye of sight for an extended period can also result in amblyopia, as it causes the deprived eye to become significantly weaker than the sighted eye. So patients with amblyopia will display some or all of the following symptoms. learning or reading difficulties, reduced visual motor skills or depth perception, inaccurate focusing skills, and reduced contrast sensitivity. Strabismus is a condition where there is an eye turn, also known as wall eye or squint, where one eye faces either inward, outward, or higher than the other eye. This can also be accompanied by amblyopia, and strabismus can either come and go.
or be constant. So people experiencing constant strabismus may have difficulty developing proper binocularity and lack depth perception. In most cases they will also have developed certain sensory compensations to prevent double vision. So those with intermittent strabismus may experience problems such as double vision, words seem to move on the page, or eye fatigue. Convergence refers to the eye's ability to focus from far to near and converge together on a single point in space to produce a consistent image to send to the brain.
We depend on this visual skill for near work activities such as desk work at school, working on a smartphone type device, or even in sports when catching a ball. In the case of convergence excess, and on this the slide you can see you know examples of what this looks like. The eye turns inward too much when focusing on an object at near distance. Overconvergence can cause symptoms including double vision, blurry vision at close range, difficulty with near work over long periods, and frequent headaches. A person with convergence insufficiency struggles to turn their eyes inwards, such as when reading or using a digital device.
So symptoms for convergence insufficiency include discomfort with close work done over long periods, Words seem to move on the page while reading, double vision, and also frequent headaches. Divergence is the opposite of convergence, and it is the ability to turn two eyes outward to look at distant objects. We depend on this skill for distant activities such as reading the board at school, driving, and watching TV. Divergence insufficiency is the inability of the eyes to properly and fully diverge.
The opposite of divergence insufficiency is divergence excess. Divergence excess is an over-divergence when attempting to look at distant objects. And divergence excess or insufficiency may cause symptoms such as seeing double at near or far when viewing an object. And common symptoms include headaches, blurred vision, double vision, eye strain or fatigue, sore or watery eyes after a near or far task, words moving about on a page while reading, and frequently losing your place while reading. So there's a lot of different things that can affect the eyes and have a lot of similar symptoms that you may see or that your spellers may experience that can impact their ability to get their eyes up to their letter and their ability to progress on the boards even if they're really having difficulty with their eyes.
So here's an example of some visual symptoms with binocular vision problems. So we've got diplopia or double vision which can make it difficult. difficult, especially when you're accurately trying to accurately aim for a smaller letter, let's say on the 26th board.
You might be a little bit off and your pencil hits the board instead of in the letter. And then we have suppression. This is a cortical phenomenon characterized by a decreased sensitivity to visual information from one eye under binocular conditions. So this can cause spellers to see letters in a different location than they actually are.
They may be consistently off by one letter to the right or to the left and this can even change from day to day. So you might see those patterns. patterns emerge. How might these things show up in your sessions?
Go ahead and pop it in the chat. So if someone were to have double vision, the second one where they're overlapped, I can't remember what the name of that one is. They have convergence or divergence problems. What might we see when they're spelling trouble with accuracy? Poking the letter next, poking closely, but not directly related to the letter.
Yeah, we're not seeing a lot of accuracy. Something that I also see, which there's no way for me personally to know if this is the case because I'm not an eye doctor, is on the sensory boards hitting the middle of the boards where it's just cardboard and not a letter. I have one guy who's always hitting underneath the letters, which could be that, could be a sensory thing.
I don't know. But you guys got it again. Great, so let's look a little bit at some research. The visual system is our dominant sensory system and we rely upon the precise timing and accuracy of our eye movements to rapidly update our knowledge about our social and physical environment and to coordinate our physical actions such as reaching for a moving object. Another research study looking at apraxia and ocular motor control and autism says the increased variability of timing and decreased accuracy of eye movements in autism spectrum disorder or asd suggests poor ocular motor control these deficits are associated with apraxia suggesting that a generalized praxis defect contributes to ocular motor control deficits and another study found that children with autism have less accurate saccades winding up farther from the tight target than controls do They also require more saccades to shift their focus and take longer to initiate these eye movements.
So why are ocular motor skills so important? Developing strong ocular motor skills is going to help with accuracy on the letter boards. That skill has allowed the following eye tracking study to be conducted, showing that spellers are getting their eyes to the letters, then poking, all in a time span that is not long enough to allow for hitting cues, which you may hear.
We'll say that we're, you know, giving some sort of small cue prompt to get a student to their letters when they're open communication and this study debunks that. So take a look at this intro video for it. This is a letter board. For many autistic people who can't speak, the letter board is the most effective means of communication, but it's also a controversial one.
The problem is that the letter board is usually held by another person. That introduces the possibility that the assistant could unwittingly influence the individual's message by cueing them to point to certain letters. Now, a new study using eye-tracking technology suggests that the letterboard allows for genuine communication and can be a powerful tool for some autistic individuals who struggle with speech.
Researchers from the University of Virginia's Department of Psychology outfitted nine autistic individuals with eye-tracking glasses. and investigated how quickly and accurately they looked at and pointed to letters when answering novel questions. Each participant had at least two years of experience using a letterboard to communicate.
If individuals were receiving subtle cues from their letterboard assistant, that influence would be evident during testing. For example, one participant was asked to name something he had to wait for. He responded by spelling, waiting for my dream girl. Subtle cues are hard to detect and easily confused.
So, if the assistant had cued participants, the researchers would have expected participants to spell slowly, to misspell words frequently, and to look at several letters before finding the one signaled by the assistant. The researchers observed the opposite. Participants spelled quickly and accurately, pointing to about one letter every second, making only a few spelling errors, and looking at the next letter in the word about half a second after pointing to the previous letter.
The researchers also identified two patterns similar to ones observed in non-autistic individuals. Participants looked at and pointed to letters within words faster than between words, and they responded to the second letter in common letter pairs. faster than the second letter in less common letter pairs.
E after H, for instance, versus E after J. The letter board, it should be noted, won't be the most effective option for all autistic individuals who struggle with speech. And further work remains to be done to explore the various settings in which the letter board is used.
Still, the study's findings offer an important response to critics of this widely used communication tool. Under certain circumstances and for certain individuals, The letter board can enable genuine and intentional communication. So who can support ocular motor and vision disorders?
We've got optometrists, which provide comprehensive eye and vision care. Developmental behavioral or neuro optometrists that specialize in the development aspects of vision. We've got vision therapists that provide therapeutic intervention to train the entire visual system.
the eyes, the brain, and the body. Ophthalmologist, which is a medical doctor that can perform surgery on the eyes. And occupational therapist works on visual perception and visual motor integration. So ocular motor screenings to check to see if there might be something that you would want to refer out to a vision therapist or neurodevelopmental optometrist.
But what is within your scope of practice as an S2C practitioner? practitioner. What can you do and what can't you do?
We're going to take a look at a presentation by Dr. Amber Smith, who is a neurodevelopmental optometrist, and she is going to show you different ways that you can go about doing a visual screening that's within your scope of practice. You are in no way allowed to diagnose a problem, but you may see some patterns that might lead you to suggest getting some sort of screening or seeing the vision therapist or optometrist to be able to get, for them to get help that way. All right, so we're going to talk about some ocular motor testing today, and I just called this one track scan in case, just because.
All right, so the, this is almost to be used as a screening, okay, don't use Thanks. don't try to diagnose. You guys are not qualified to do it.
Just let us know what you're seeing, and that helps me go forward with helping your patients out, okay? But don't tell them what you're finding. Just tell them that you think it's a good idea to see a specialist, okay? All right, so just a recap for you all. The oculomotor functions, we have three major ones that we're going to talk about today of fixation, pursuits, and cicades, okay?
A fixation is where we just hold our gaze stable on one object. So if I have my thumb up here, I'm just going to hold my eyes on it and just keep looking at it. Okay.
It's a stable object, nothing moving. Cicades are when we move our gaze from one object to another. So if I've got my two thumbs up here, I'm looking back and forth between the two.
That's a saccadic eye movement. It's when we're looking through between any stable object. So it's when you're looking around your room or when you're looking in between people in a crowd, that's what you're using.
pursuits are the next one that's where we follow a moving object so if i have my thumb here i'm going to follow it around in a little circle i can follow it side to side it's moving and my eyes are just tracking it as we go now fixations are the easiest one to test i'm going to show you guys how to test everything with just using a couple of pencils because they're really useful with little erasers on top it's best to have two different color ones though okay fixations are the easiest to test all you got to do is hold your target 16 inches away from the patient so my the cameras not great position. There we go. About that far from the patient. Okay. I'm just going to hold it straight in front of them.
You're going to tell them to look at that target, which I'm trying to move a little closer. You guys can actually see my eyes. And what I'm doing is I'm looking at that target and just holding my gaze on it.
My eyes should be turned a little bit towards each other to where that object is in space. And I recommend doing this with each other so that way you can see what normal looks like before you start doing it with patients for any of these tests. Okay. A stable normal gaze is seven seconds without looking away or without the eyes moving or twitching.
All right, let me go to the next slide. And so we saw normal already where I'm looking at that target. Abnormal alignment would be like if I'm looking away from it.
One eye may look like it's looking at your target, but the other eye will look like it's looking way off into the distance somewhere. Get a little closer and I'm going to see if I can show that to you. So it kind of look a little bit like that. Okay. Now, a normal movement is whenever you are having the patient look at the target, then they start moving their eyes, okay?
So, a little look, and then they might look at you. They might look away. They might turn their head.
They might just disengage in any way, shape, or form from that target. And I've got a little animation here that we can look at. eyes just bounce a little bit. They may just totally turn away and not come back as well.
Cicades are a little bit harder to test, but not too bad. You're going to need two objects this time because you want them looking in between the two objects. So I'm going to, my eraser's a little bit bigger here. All right, so I've got two objects like this, and I'm going to have the patient look between the two to my directions, okay?
I'm going to have them look at red and then green and then red and then green and have them go as fast as they can back and forth. So you can tell them quicker and quicker and quicker is usually what I do. OK, we want to do this both horizontal so we can see the eyes move horizontally and also vertically.
OK, I'm a little constrained by my screen here. You should be about a foot apart from each other and right about eye level. OK, so I have to look up and then down and up and then down and then side to side, side to side. You should be, again, that's 16 inches away from your patient. There you go, that's 16 inches away, a foot apart from each other.
Okay. And then you can have them do them several times so you kind of get an idea of how fast and how accurate the cicades are. The normal is super fast and super accurate.
These are the fastest muscles in the entire body, the fastest movements of the entire body, and the most accurate movements of the entire body. When in doubt, refer. Okay, because if it looks even a little bit off to you, it's probably a lot off.
Let's see. The other thing is you should look for head movements. My little kiddos tend to do this with their cicades, moving heads between one and the other, and then up and then down.
Okay, that's really abnormal. It means they're not making any movements at all. All right, let's see.
Let's go over some abnormals. Normal should look fast and accurate between the two targets like that. an abnormal This is an undershoot, means we're going to go part of the way to the target. We go there and then we would go back maybe or it might be small movements in between the two targets.
Let me show you what that looks like. So if I'm doing movements, this is going to be tough with my targets. It's okay.
There we go. So I'm just going to look on the screen. Pretend that we're all here.
Okay. So fast, accurate movements would be like this. Undershoots, I'm going to go kind of halfway and I might look like in the middle. My kiddos tend to look like at me instead of going all the way.
And then if you go really big movements, we're going to go one, two, one, two, and then off to the side, way off to the side. Okay. Again, try this with each other. So that way you can see what abnormal looks like. And it might be subtle.
Okay. Again, if you're noticing a problem, there's probably a problem. Okay. If I'm noticing a problem, it's, you might not even notice it because my eyes are trained a little bit more to see this.
And they're really tiny movements, okay? So watch for undershoots and overshoots. And then poor initiation with developmental apraxia. This is something I see all the time, okay, is the poor initiation. So I'll tell the patient, look to the green, and they just stare at me.
And they won't do it. Or they might, like, turn. And then I tell them, now look at the red.
And there's just, like, nothing. They either won't move or they're just going to stand there. Or it's a really slow movement like this, okay?
That's a poor initiation. Again, these should be fast. fast, fast, fast, okay? So abnormal undershoots look like that. Abnormal overshoots, they look way out there, okay?
And again, watch for that no movement as well. Now, pursuits are the hardest ones to test, but I find that they're easiest ones to see when it's wrong, okay? Because it's either going to be smooth or it's not.
So we test a pursuit in what's called this double H pattern here at the bottom on the left, an X pattern. in the middle and then I like to do a circle going in both directions as well. Okay and that really gives you an idea of if it's smooth enough to handle normal everyday life. All right sometimes you may hear this referred to as the EOM test that stands for extraocular motor test and that's how we label it on our charts.
If you're ever looking at one of our charts that's what that means. So you need one fixation target again pencil a little toy top or something like that works. You're going to hold 16 inches away from the patient. And I'm going to scoot back so you can see this one.
And you're going to have them track in a big double H. I like to go, you're going to go about 45 degree angle out from their eyes. So if you go further away from them, it needs to be a bigger H. Okay, if you're getting closer to them, it can be a smaller H.
Okay, so you're going to look at, have them look at it. And you go up and down like that. Come back to center.
Go out to one of the sides. Up and down. Come back to center. Out to the other side.
Up. And down like that. And then come back to center. Make sure that their eyes contract the whole thing.
Okay. What I like to do is go straight from my double H pattern into the X's. So when you're doing your, when you're down.
points, then you go straight into an X like this, then come down again and go straight in the X. Then you can go straight into that circular motion like this and come back up for the other side like that, okay? And this should be really, really, really slow.
That was going awfully fast. You really want to track nice and steady and slow like this, okay? Super, super slow. Because if you don't go really slow, what happens is that some people lose track.
And then you'll see the jumps when they're not supposed to be there. Okay. Nice and slow like that. Okay. Let me come in and I'll show you what some abnormals look like.
Now for a normal person, showing you what an abnormal looks like, this is really tough. Okay. So it's not going to look exact. I want you to try this on patients and you'll see it pretty quickly.
Okay. But smooth and accurate. I'm going to try to do my eyes here. You can see my eyes. Nice and smooth.
Up and down. like that again try it on each other so you can see it and let me show you the animation again nice and slow super slow all right and then our double x is going to look like that Nice and smooth. And our circles, nice and smooth, okay?
The X's, dot dot dot, and then the circles. Whenever you're looking for abnormal on these, you want to look for these motions to not be smooth. They may look jittery, so as they're moving across, they may jerk like that. That one I cannot show you. It's really hard.
stimulate in my own eyes. They may jump from target. Okay, so if I am moving my marker like this, I might look away and look back.
Okay, that's like a lag. And a leading motion is where they'll actually go ahead of your target and come back to the target like that. Try this out with each other.
You'll need to see it in order to really get a handle on it. Other things you should be looking out for is any twitching. Um, looking away from the target, looking away from you, head turns as well, just like we were talking about with the saccades.
So if I'm following my target with my nose instead of just my eyes, that's big no-no. All right. If my eyes or my eyelids are twitching, look, really pay attention to that because sometimes you'll get like the fluttering of the eyelids. Um, and that's more of a subtle sign that there's just a lot going on and they're having a hard time.
Okay. Face movements, head movements, any of that stuff. Sometimes I get my little kiddos who do something like this.
Those eyes go real wide or the eyelids, they blink a lot, stuff like that. Okay, you might see that tongue come out and try to follow the target. It means they're using all those facial muscles to help move the eyes, which they shouldn't be doing.
Okay, we call it a motor overflow is the technical term. So you may see that on one of our reports. Okay, vergences.
Now, these ones you guys got to be careful with. Okay, once you test it once or twice, that's it. If you're not sure, put a question mark. because you can do some damage by doing this over and over and over again.
We've got two eye movements that we make for when we converge and we diverge. Convergence is coming in like this and divergence is going out like that. Divergence is hard to test. Don't worry about it.
Let us do it. Convergence is pretty easy though. So for convergence, one little target just again.
You're going to hold it out. I like to start like two feet. So you're way, way, way out from that patient. They're going to bring it closer and closer and closer to their face, and they're going to try to keep their eyes on it. I was looking at my camera, so I'm going to try that again.
Closer and closer and closer, and you should see my eyes come all the way in, like I'm turning my eyes towards each other. In this case, that's normal, okay? Normal should be smooth and accurate, just like the pursuits, and the eyes should swing together like this, okay?
At some point, you're going to see what we call the near point of convergence, okay, which is why this test is also... called the near point of convergence test or npc test that's what you'll see on our charts the near point of convergence is the point where the eyes can no longer hold that strain and they split they'll just stop doing it they kind of give up on that object okay what it's going to look like is if i'm bringing this closer and my eyes all of a sudden turn out from each other it may also look like one eye slides out to the side um and it may also look like i lose track of it just turn away i may also startle and try to move backwards from it okay if you see any of that stuff that's the point that you need to take note of all right um normal is just when the eyes split and the eyes just to give up or one slides off to the side that's okay in this case if they startle or they move back that's something abnormal that i need to know about okay um normal is about four inches away from the nose so it's good to have like either like a tape measure or like a really small um a ruler on hand when you're doing these so that way when you make that measurement when you make that measurement you can actually tell me how much it was from the nose to your to your target all right um and again try this on on each other you'll see where that break point is some people can get closer than others You'll notice people who have reading glasses or need reading glasses at near that their point is a little bit further out than like a young 20 year old. For instance, ours, not ours, not 20. But the younger you are, the closer you can get to your nose.
All right. So normal should look like this. If that target comes in, the eyes come in. An abnormal alignment might look like this where one eye slides off to the side and it can be either eye. And then a lack of movement, you'll bring that target close and they'll just keep looking at you or look at something behind you.
All right. We already talked about those movements. If they start to jerk back from that, that's a problem. All right.
For recording, for fixations, what we want to record is how long were they able to do it? I want you to count to 10, 10 seconds. Okay. If they can make seven, they're good, but you want to see if they can do the full 10. If they can't do the full 10, that's the normal average for an adult.
Okay. If they weren't able to look at that target, so you say, look at my pen, look at my pen, look at my pen, and they just can't look, that means their fixations are normal. They have a zero second attention.
Cicades, you're going to tell me how fast, or sorry, how accurate they are, if you see any overshoots or any undershoots. They have a hard time initiating that movement too, so they're looking and they're looking and they're looking and they can't move the eyes to the other one. That's abnormal. Just write it down.
Any face movement or body movement we need to know about as well. And remember to record both the horizontals and the verticals. So they're going up and down and they're also going side to side.
Pursuits, this is still, again, the tricky one because it's got a lot of stuff that we need to know about. So record the quality, smooth, irregular or jumpy or anything else that you notice that makes you think that they're not correct. Any loss. Okay, so basically if they're...
coming from one side of the other and they start looking at you that's one loss okay they come on the other they're looking at you again that's another if you count more than like four then i like to put it as frequent okay if it's anything less than that then i just write occasional this is not something that's scientific or anything like that but it tells me how often it's happening if it's constant like they you go a little bit and they look at you and a little bit and they look at you and they're constantly not able to attend to that object that's a bigger deal than if they can do it sometimes. So it's good just to note it. Report for me if one or both of the eyes cannot reach the ends of your double H or your X pattern. So if you're way over here on your double H, let me bring my pen into the few, and one eye is looking at that target and the other eye is not, then I need to know which eye was not looking and where it wasn't looking. Okay.
So this would be if it was my left eye that's not looking, I'd say left eyes and right gaze or right side. Okay. And that'll...
that's called a restriction. If you can't note this, it's not the end of the world, but if you see it, just tell me. For convergence, we're going to note down that near point of convergence, that point where they break down, okay, where they're coming close, close, close, and then all of a sudden they look at you. Tell me how far you were from the nose when you saw that, okay? Tell me if they can't converge, okay?
That's just as bad. And if you see, if you can tell which eye slides out to the side, that's useful information, but it's not the end of the world if you can't get it, all right? um instability what that means is if you're coming close and one eye is jittering as it's coming in let me know that okay that's an instability and you can tell me which eye to that that's helpful and then you're also going to report it again the client's not able to bring that in at all we'll just kind of stare at you all right i know there's a lot in a little bit of time but that's it so look this over again and you know review it if you have any questions you can let me know or any of my colleagues if you're looking for somebody to refer This is a great website.
It's covd.org. It stands for College of Vision Development. Just look up there. There's a provider list there as well. So you can find somebody in your area if you're not in ours.
Okay. Again, let me know if you have any questions. Something I want to definitely point out there is for convergence and divergence. Amber mentioned that it shouldn't be, you know, just kind of a quick thing.
Don't do it more than once or twice. This is something that if done incorrectly can actually cause some harm to the eyes. The other things, the saccades and pursuits and things like that, totally fine.
But if you're uncomfortable or not sure, avoid working on or screening for the convergence and divergence issues. You'll have enough information, I think, from the other two to kind of know if it's something that you should recommend. And I will tell you that, honestly, most of our spellers could probably benefit from some form of vision therapy.
Because, again, we've talked about that muscle control. There's a lot of difficulty with 12 small muscles moving in the eyes. But I want you to tell me, what was your main takeaway from Dr. Amber Smith's presentation?
What stood out to you the most? Go ahead and pop it in the chat. She gave a presentation at Motor Morphosis two years ago, and it blew my freaking mind. It was incredible. What was your biggest takeaway?
What stood out to you the most? Yeah, Ocular Motor is huge. I have to beg people.
I kept wondering how she was going to respond to the... Honestly, Colleen, that's a good question. There are a lot of...
I think the short story is... That's what I'm looking for. like ocular vision therapy, something like that.
But I do have a sheet that she gave me a few years ago that has activities that you can do at home that help strengthen the eye muscles that have to do with saccades, tracking, so on and so forth. So once you're done, or once we're done here, I'll email you guys that list of activities. You can, I give it to parents and I say, do this at home, like once a week.
If they go to OT, hand them this list, have them do it. Um, so there are some activities that you can do to help, but yeah, like Megan said, when in doubt, just refer. Um, yeah.
How important it might be to recognize if there's an issue, all of your spellers have these problems. Yep. Same here. So much going on working together to get the eyes moving purposely. When I was a main who talked about how much prism glasses helped her son.
Interesting. Yeah. I always tell parents, I'm like, try out.
whatever you want and whatever works for your child, go for it. And something that I tell people in my like first session when I meet them is I preface the whole ocular motor thing. As neurotypicals, we show people that we're listening by making eye contact with them. We connect with people by making eye contact.
And it can certainly be the case that spellers, some spellers might not like making eye contact. Sometimes I don't. Sometimes times. They'll say, you know, I can feel people's emotions too much when I look at them in the eyes. But looking at someone when they speak or looking at something purposefully is motor.
So if you have somebody whose eyes are going all over the place, chances are they just have a lack of motor in those super teeny tiny muscles. Susan Daniel. Interesting. I'll have to look that up.
Thank you for sharing. Yeah, it's. all in the eyes. And that research, I meant to say this earlier, but the study where you can see where their eyes are going before they're poking is so fascinating. And that study was led by Vikram Jaswal.
And he actually does our research seminar, which a lot of people say the research seminar is their favorite. He's really cool. She has a 27 year old.
Cool. So she's got some experience. Thank you for answering and let's move on. But how can you support the eyes during spelling?
So as practitioners, what can you do to support eyes, ocular motor, all that jazz during a session? Yep. Visual prompts. What else? Yep.
Lots of prompting. What else can we do? Coach the eyes.
Yeah, eyes first, then poke. Yeah, you got a lot of people poking without looking. Give them breaks if needed. Yes, I've seen some practitioners that have like an eye mask.
And while they're reading, like some spellers like putting on a little eye mask, like keep it nice and dark. You can also use high contrast backing on your boards to make it a little bit easier for them to see the letters that they're poking. One thing that I do, which it seems really small, but I find it really helpful.
And granted, I get lots of daylight in my office is I actually keep the lights off in my office 24-7. Called them the big bad lights. I hate them. They strain my eyes.
I don't even like that they're on in this room right now. So when spellers come to work with me, it's dim. And I find that it helps a ton to not have like harsh overhead lighting on. So maybe invest in a lamp. Or if you have lots of daylight, just rely on that.
So yeah, you can do a lot more than just prompts. Prompts for sure. But you can also integrate some other things that could help them out. go ahead and pop it in the chat. Great, I'm sure you had some great answers.
We are going to look and talk about a couple of them in a little more detail. So one of the things that we can do is use high contrast boards and that can be either if they're on the sensory board, you've got the high contrast sensory, right, dark background, very light letters. If you're on the stencil, you can still make it high contrast and stay there.
So this has a backing. There's the ring light. A backing. It's just a laminated piece of paper taped to the back of the board. I like the bright yellow.
White can work as well. So you're helping the eyes out with this. So if your speller has a lot of difficulty keeping their eyes on the board and has low accuracy because of it, you can go ahead and try out the high contrast boards.
But you will want to make sure that that is what's happening and that they are not just in need of stronger prompt prompting, including directional prompting and gesture prompting from you. So as you're learning the skill of being a CRP and practitioner, it will be difficult to see their eyes and do everything else at first because you're learning. That's OK.
But if you're unsure of making this accommodation for your speller, ask your mentor. So one of the reasons we sit at a 90 degree angle. to our spellers when we're their CRP is so that as we get more comfortable with doing and tracking with our outer letters we're also able to see their eyes out of the corner of our eyes and able to glance up at them very quickly to see are they even looking at the board are their eyes stuck do I need to give some more eye prompts again it's a lot to manage when you first start doing this so it's totally understandable if that's a difficult skill for you right now. It will get easier with time and practice.
and as all the other things become more automatic for you. But again, when you're learning, you're learning how to prompt effectively. So it's just one of those things. We don't wanna jump to an accommodation of high contrast boards very quickly because it may not actually be something that is required, but just maybe you're still figuring out the best way to support your spellers.
So again, use your mentors wisely for that. The other thing you can do is use flaps. This can usually be in conjunction with other motor challenges and the need for this. But if you have a speller that has difficulty changing rows or is stuck on just poking a lot on, let's say, the bottom row, then flapping the board and lowering the demand on one row would be helpful.
So what that would look like, this also has a high contrast backing on it. You may not need this, especially if it's for another motor issue versus the eyes. You can reuse a laminated piece of paper because it just holds up better.
You can use a plastic folder that you cut or something like that if you don't have a laminator. But just some scotch tape from the front and back or the top and the bottom just allows for an easy flap for you. All right. Again, check your prompting. Make sure you're supporting your speller and if it's still very difficult or you're seeing that habit where they're just stuck only on the bottom row, let's go ahead and just cover one row.
and then as that accuracy starts to develop just like with any other board progression, you're going to take off that flap and then you'll move to the 26th when the time is appropriate. Another thing, there's some other little things that you can try. This one would be a very rare instance but you have those little finger lights. You can get a whole box of them for very very cheap.
Like I have a speller who has difficulty with his eyes and actually Amber Smith came in and observed his session, but he's got this little finger wiggle that he does before he pokes. So she suggested a finger light. So it just has a little rubber band goes on and you just turn it on. It's really small and easy. So for him, having that wiggle, it's moving that light and bring his eyes back down towards that light.
It's kind of that reflex is helping them. Another thing you might try is a metronome behind the board. to trigger the orienting reflex. Just kind of like you might do a little light tap with the board for the same purpose.
But it's making the eyes seek out the source of the sound, right? But you want to make sure when you place it, it's on a table right behind the board. So that's where their eyes are coming to, right?
The board. There's free apps that you can use. I use Metronome Pro. It's got more of like a wood block sound and not such a piercing kind of higher sound. So you can play around with a couple of those, but like I said, free.
Start at 30 beats per minute and you can make adjustments if you notice a different kind of rhythm with your speller. Some other things that I do, because I have a lot of people with some complex visual motor right now, is I have longer nails and so I'll tap on the board like this and that'll usually get. their eyes back to the board.
I also sometimes like say this is their like, this is their knee. Sometimes I'll like lightly tap the board on their knee to draw their head and their eyes back to the board. You can tap it on a table. What else was I going to say?
Metronome also works. I think, I think that's all I was going to say. Okay.
Yeah. You can try any of those as well. Oh, the one thing that I really like doing, I don't have a board shaped thing. to show you and I may have mentioned this before but if someone's eyes are all around I'll put the board in front of where their eyes are and I'll have them slowly track it down and if it breaks I'll put it back up and have them slowly bring it all the way down tracking I think is the most helpful at least for my spellers try it out see if it works um and then of course eye prompts right that's the big one that we're going to be using so what eye prompts can you think of go ahead and pop some in the chat Alrighty, give me your best eye prompts. Look for it, scan the board, use your eyes.
Yep, look, look. What else? Shift your eyes.
Yeah, you shift your eyes a ton. Look, eyes on the board. Sometimes I'll say, find the letter with your eyes.
Look for it. move your eyes to the corner, move your eyes up, anything like that. Yeah, these are all great.
It's nice to vary them as well because sometimes if it's too repetitive, it stops working. So I try and throw in some different ones all the time. Awesome.
Yeah. Things like put your eyes on it, look, look, look, move your eyes, scan the board, shift your eyes, find it, look for it, move your guys. So, and during the acquisition phase, you can combine these with directions. So, for example, shift your eyes up or down, move your eyes all the way over, look up, look down, things like that. So, you can combine those in those phases.
And then once you're ready to phase out those directional prompts, you can continue to use those eye prompts. And they can be used forever, as long as there's not a direction associated with them for any of your spellers that need it without any form of influencing. So let's look at some vision therapy activities for ocular apoplexia.
And really, these are more for how your parents can help. Give them these activities to work on at home. You know, with your sessions, you're there for spelling.
You're going to support your speller's eyes and the way that we talked about with prompting, with potentially high contrast and things like that. That's how you're going to be working on the eyes. You're doing, you're basically doing eye exercises while spelling.
So these are really something that can be worked on at home simply with with the parents working with their spellers and to help the eyes additionally. And these can be done even if they're not working on the boards with their child yet. Right.
If they're not quite there yet to get trained, you can still work on these things to help that skill. Definitely take the time to educate some parents on on how they can help. So activities for fixation.
So one of the things you can do really simply is make a ring with your thumb and forefinger and or use a pipe cleaner to make a ring and have the client pierce the ring with either their own forefinger or with a writing utensil, a pencil. The patient can be sitting or standing to increase difficulty for this as that becomes easy. You decrease the size of the ring so it can even get as small as using a straw and a toothpick.
You've got to really hold your gaze to make sure you're getting in there. It's like poking at the board, right? You're holding and fixating your eyes on that letter and following with that pencil or finger. You could also have them put Froot Loops on a pipe cleaner or spring jewelry, same concept. Paint by stickers could be something to try as they need to practice keeping their eyes on the sticker and lining it up with the lines.
But do some of these activities for five to ten minutes a day. What are some activities for saccades? So simple saccades, you can attach letter or number cards to the wall in a random pattern. So not like I have in the picture, but just in a random pattern. And have the client sit or stand facing the wall.
Call out a letter or number and have the patient find and point to the given number. They should be searching very quickly between what's on the wall, the different things that are up there. And then to increase the difficulty when it's time. You can widen the spaces between the cards or use smaller letters or numbers.
Again, do this for five to ten minutes each day or have the parents do it for five to ten minutes each day. This next video is going to show a fun activity using blaze pods. This is great for cicadas as their eyes find the lit up pod, but it's also useful for initiation, continuation, and inhibition. And it's just fun.
Not something that you have to go purchase, but if you have the means. Like this can be a fun activity to do if you're working on some motor. Okay so there's these cool tools that you can use, let me grab one, called Blaze pods. They look just like this, you can get them in sets of four or six, but they are really great because you can connect them to an app on an iPad. So these can be really good for quite a few things including an activity for working on cicades.
So let me show you an example. In this one, this is the color catch. So you're going to have them laid out on the floor.
There's going to be four of them. And when you start, you're going to do a countdown and then it starts. So ideally you could have them go as fast as possible. This gives you an idea of what that would look like. So they're having to quickly bounce their eyes between those lights to find it.
It's really great for initiation, continuation, and inhibition. Like you can change the colors of the lights. So I might assign one light to right hand and one light to left hand.
And so if they're coming down to the color, if they realize it's the wrong color, working on pausing and switching as they go. There's different activities. You can get things to put them on the wall and do different hand ones, standing up.
You can use your feet with these. But either way, it's great for the eyes to bounce back and forth between the lights. You can also find something like this with athletic trainers or certain chiropractors. I know that a lot of you here are parents of non-speakers. When I was working at Invictus, we had a guy...
So cool. His name is Jake. He was a chiropractor and an athletic trainer.
And he would come into our school once a week and he had these lights, but they were sensors. And he would set them up on tripods in like a semicircle. And we'd have all of our students sit in front of the semicircle. And we started off with this where it was like touch or you had to swipe your hand over the one with the light. So it worked on reaction time.
And then it would be like you only swipe the red dot, not the green dots. and then you had to swipe them in patterns and it's really it was actually extremely helpful it helped a lot with reaction time and initiation with all of our students and we're able to integrate it in a more sports way and less in a therapy way so if you have the means to get these they're really awesome there are cheaper um versions of this on amazon but you can also find like chiropractors sports trainers personal trainers maybe that also integrate this that's equally as helpful. How about some activities for pursuits?
So they can roll or toss a ball back and forth with their kid to increase the difficulty, use smaller balls or balls that are more likely to bounce like a ping pong ball. You can also hang a ball by a rope from the ceiling or from a stick, such as a broom handle, and have them throw and have it come back to them. or hit it. You could do balloon toss or toy cars also work for this activity, tracking those, right?
Word searches can be a great tabletop activity, but anything where they need to scan or follow something with their eyes. So what other activities can you think of? Go ahead and pop them in the chat. Other activities that support the eyes.
Any ideas? Tossing a ball, for sure. Ooh, that could be fun, Tracy.
I really like that idea. I'd be interested to see how that works since it's auditory and they would have to obviously look and see what they need to do. That would be really cool.
You could also do the paint by stickers are really nice, but they are that. I don't know if you guys have ever seen them. They have stickers that are really tiny. So when I've done this before, I've had some people who could do it completely on their own.
For other people, I might do the really tiny ones or I might peel the stickers off and then they might place it on the sheet of paper. Puzzles are really good. Building blocks are actually really good, especially if you put like stipulations, like we're only going to stack the yellow blocks and we're going to only stack the red ones.
Yes, cicades, because they're going back and forth. And in my experience, things like that also really help with initiation, which is a common problem that I see with a lot of my spellers as well. You can do anything with sports, anything that involves looking up at a screen and then back down to adjust.
I say screen because I've done videos before on how to make something where they have to look back and forth to see. Yeah, you could do that one. You could do that, Samantha.
I think, yes, you can do that. What just makes it easier with the lights is it stands out more. So it would be more visually appealing if you were to have something light up when all the other ones are dim.
But I think for sure you could do that. Honestly, Twister would be pretty cool now that you say that. But anything that involves the eyes looking back and forth, especially anything that promotes hand-eye coordination, go for it. Awesome. So I hope you learned a little bit about the ocular motor skills that are needed for spelling or that could be impaired and need a referral out to a optometrist, especially a neurodevelopmental one.
You can have parents look or you can look so you can make a connection with one that's local to you at covd.org. So covd.org. But, you know, one thing also to note when we talked about doing a screening is if you do it in the beginning of a session, you're going to fatigue their eyes before you get to spelling.
And of course, at the end of a session. you are going to already have some fatigue guys before you do it. So find that balance. Maybe start off with a little spelling and then do a screening.
Or if you start with a screening, keep that in mind, and you may have to give them some extra support than what you've been needing to give them through that session. So just always pay attention to that. If you have any questions, of course, go ahead and ask them. But I hope...
this help understand a little bit more about how we can support our spellers that have some difficulty with their eyes or ocular apraxia. All righty. Does anyone have any questions about anything in the seminar?
Okay. Let's do some housekeeping real quick, and then I will get you guys out of here. So you had... your ninth clinical competency due. Crazy town, you only have three more left after this.
If you haven't let your mentor know that it's going to be late, please, please, please do. And then you'll be on your way. So your mentor only grades your CCVs and then they'll also grade your, what's the word I'm looking for?
Client case review, which we'll talk about once it gets a little bit closer to that. Sorry, it's loading. Okay, so your next lesson that's due is your issue lesson. This one's really fun.
My biggest piece of advice would be to just take a little bit to reflect on the spellers that you currently have, whether it be your own child, whether it be another client that you have. Think about something that... maybe they struggle with, or a conversation that they could benefit from.
Issue lessons are meant to talk about things that might be uncomfortable, but we can talk about it in a more organic way, if that makes sense. So I mentioned before I wrote an issue lesson on like the value and the value and the nature of hair across different cultures. Then I talked about like what people do to their hair to express themselves. themselves, whether it be dyeing or styling or cutting or whatever, because I had a student whose mom would just chop her hair off any chance she got.
So it's a really fun way to be like, you know, if you were to go to a salon today, what would you do to your hair? Would you keep it the same? Would you change something about it?
There's some, there are lessons on clothes. There are quite a few, but I think everyone has a really fresh take on it. Like one lesson is like closed through the decades and like common trends.
And one really great question is like, what trend or what decade do you identify most with? Like what resonates the most with you? I've seen some about anxiety and traveling.
You can do a lot with this. So think about what your spellers might be struggling with, and then think of a fun, more natural way to bring it up in conversation. Because obviously, I don't want to be like, hey, you keep ripping your shirts open. Why are you doing that? Maybe it's a sensory issue with clothing.
The issue lessons are just a better way to bring it up. Does anyone have any questions on issue lessons? Okay. If you have a topic that you're kind of rolling over in your mind and you're not quite sure about it, feel free to send it to me. I'd be happy to help you out.
You have lots of freedom with this one. just because you can make it specific to one person. If you're like, oh, I know little Timmy really struggles with XYZ, go ahead and try it.
And then before I see you again, you'll have your 10th clinical competency due. It's the day that we meet next. Just a reminder, I'm going through grades just to make sure that everyone's on top of everything.
And some people do have the revision assignments missing. Please, please, please do your revisions because if you don't do them now, you'll be stuck doing them at the end. And it is a real pain in the butt to do all of those at the same time.
They are required. And then I think we might be good. Let me just double check before I send you off into the world. Yeah.
Make sure your stuff is turned in. Next is issue lesson, your revision, and then your 10th clinical competency is due. Yeah.
Alrighty. So next time I see you guys, our seminar will be on regulation and just some regulation tools. If you have any questions, feel free to stay because I'm getting you guys out a little early. So feel free to stay and ask questions if you have any, or you can shoot me an email and I'm happy to help.
But I appreciate you all being here and I hope you have a fantastic week. Bye, guys. Have a good night. You're welcome.
Have a good night. You're welcome. See you later.
Do you all have any questions? I'm going to end the meeting because it seems like you don't. So if you have any questions, oh, oh, okay.
Yeah, that's so weird. Feel free to type it in the chat. A food related issue lesson. Do you have a specific like subject with food? Like, do you think it might be a sensory thing?
Are they not eating enough? Are they eating too much? Food sensitivities, and that's the only issue. Interesting.
Like, it makes sense. You could honestly approach it both ways, I think. So you could write a, how would I do it? You could do one on like the food pyramid or the MyPlate and like talk about diet and be like, and maybe talk about like foods that might make you feel great versus foods that might not make you feel great.
You could talk about foods from around the world. Um, you kind of have to make it broad. And then the issue lesson, I think a lot of times is where you like come in with the types of questions.
So if I was talking about, I mean, you honestly could just make it about like food sensitivities. Maybe you talk about the rise of food sensitivities and be like, you know, there's been a huge uptick in people with gluten and dairy intolerances, or they can't eat whatever, like, what are your thoughts on this? Do you, I figured out my mic, but that's really, really helpful.
Thank you so much. I think that's a great route to go. Like the rise of food sensitivities. Do I touch, is it too much to touch on like, oh, they banned certain ingredients in the U S but not, I mean, they've banned certain ingredients around the world, but not the U S maybe. I think you could absolutely do that.
I actually have a friend who is very wealthy because she can do this and I can't. She no longer eats food from America. She only imports her food from Italy. She lost like 50 pounds. She didn't exercise anything.
And I know when I go to Europe, so I don't eat gluten because I have PCOS. So I don't eat gluten. It makes me feel like garbage here. But when I go to Italy, I eat all the freaking bread. I feel fantastic.
Oh my gosh. Okay. Wow. That's really interesting. I feel the same way when I eat abroad versus here too.
and I'm like what's going on with our food? Okay. So maybe that's like a bit of my issue and kind of tied into their issue, but thank you.
That's really helpful. I mean, I think it's, it's easier to write a lesson and if you actually have an interest in it, but I think that would be really great. Thank you so much. You're welcome. Have a good evening.
You as well. See you later, Colleen. Bye-bye. Bye.
Hey, Erica, did you have any questions?