The shoulder was tough for me. All of those muscle origins and insertions, innervations and actions that had to be memorized. Then learning the names of those movements; external rotation, scaption, abduction and the rest. Next it was assessing the shoulder, taking range of motion measurements, manual muscle testing, and watching for substitutions. We learned a lot about shoulders in OT school.
I then took 3 CEU courses about shoulders after I graduated because we see so much shoulder pathology as OTs.
I am still pretty good with shoulder pain. I remember many of the provocative tests I was taught in those CEU courses. I could get a referral from a general practitioner for “shoulder pain”, assess the patient and have a pretty good idea of the problem this patient was having. I would frequently still refer the patient to orthopedic docs for assessment and imaging before becoming too aggressive.
I briefly remember talking about the eyes and vision as well in school. A quick look at the anatomy, a more in depth exploration of the visual pathway in a behavioral neuroscience class, a bit about macular degeneration and glaucoma, visual field cuts, then visual motor integration assessment and visual perception assessment concluded our training concerning vision.
Presbyopia? Near vision focusing ? Strabismus ? These were not really discussed and the visual consequences of TBI and concussion were not yet being studied.
It has been my pleasure work learn from and work side-by-side with some of the top optometrists in the world over the last 8 or so years. I quietly listened as Dr. Don Tieg and Dr. Fred Edmunds talked about the finer points of performance vision training, as Dr. Alex Andrich and Dr. Scott Krauchunas discussed their techniques for treating concussion and TBI complaints. I had valuable conversations with Dr. Charles Shidlofsky and Dr. Charles Boulet about how our professions can best work together for the benefit of our patients. There have been too many ODs to list, but I have appreciated all of their willingness to share there experience and knowledge with me.
…as the Teacher
It has also been wonderful teaching so many therapists, teachers and parents about vision and helping them become “vision aware”.
I have always chosen carefully the words I use and the information I share. While I share some techniques that may be used in vision therapy, my courses do not claim to make OTs into vision therapists. Instead, I share basic assessment and treatment techniques for ocular motor and near vision focusing. When pressed on techniques for treating strabismus or suppression, I always explain to leave these things to the VT docs and their teams. Even when I explain how tools like prism and lenses are used in the clinic, I caution therapists to make sure they understand their states regulations involved with the use of these tools.
I also talk about eye doctors. Opthalmology, optometry, vision therapy docs and neuro-optometrists are all explained. We talk about the need for a comprehensive eye exam for every child, every year and the components of that exam. We talk about the need for an eye exam for every patient with a vision complaint and who may be the best doctor to provide that exam.
Best Correct Visual Acuity
Unlike a shoulder complaint, visual complaints can have very complex causes or very simple causes. The wrong eye glasses maybe to the cause. Or there could be problems of the retina, optic nerve or visual pathway. All of these could be at the root of the our patient’s visual complaint and even the therapist’s observation of their ocular motor skills. An observed ocular motor problem can even be the result of some common vision diagnosis, making understanding a patients vision history and the functional affects of that diagnosis important.
While many of my patients are referred from local optometrists near me, some are not. Some have been referred because they are having visual complaints that a neurologist was unable to explain. These patient always go to the eye doctor first, just as we would send the shoulder pain patient to the orthopedic doc.
The Interdisciplinary Team
As therapists, working as part of an interdisciplinary team is not new. We have all spent hours around a table discussing patients with our team of OT, PT, Speech, Psychology, recreational therapy, social work and doctors. It is important for therapists that Optometrists have a seat at that table as we become more vision aware and attempt to help our patients with their vision complaints.
In my classes, I encourage therapists interested in vision to reach out to optometrists and begin to form these teams that are so beneficial to our patients.
The Doctor Therapist team is not new
We are at an exciting time for our patients. The recognition of vision skills beyond just acuity, as a performance component that affects function , has lead to the creation of the vision rehabilitation. This team of doctor and therapist should function just as past teams of doctors and therapists in orthopedics, assessing and diagnosing doctors, referring to trained therapists to manage what can be managed by therapeutic intervention in the rehab context.
We need more trained therapists and more trained docs. We need more events like the Vision Rehab Roadshow and sites like VisionMechanic.net, where doctors and therapists collaborate and present the information needed to fill the current gaps in knowledge.