Pointer In Straw
By Guest Blogger: Jessica Zwilling COVT
Last time, I shared the creativity and innovation of a mother of one of my current patients, a 2 ½ year old with an intermittent left eye esotropia. She had a creative spin on another activity that is routinely prescribed at our office – “Pointer-in-Straw.” (I will talk about her variation at the end.) Readers who are Vision Therapy professionals will be familiar with this particular activity and the many ways it can be executed. For our non-optometric readers, I will explain further.
Using a wooden or plastic pointer stick (“pick-up stick”) and a straw, the patient must simply put the pointer in the straw – hence the elaborate name and high tech equipment. There are many ways to do this and that will be determined by the doctor’s diagnosis and stage of therapy in which the patient is working. This activity can be done monocular or binocular and by holding the straw on the x, y, or z axis. The parent or helper is instructed to hold the straw opening centered with the patient’s eyes and on the prescribed axis. Upon success of the patient accurately getting the pointer in the straw, this technique is repeated in all points of the patient’s gaze and at different distances from the patient’s eyes, as prescribed by the doctor. I like to tell my patients to think of a compass in order to remember all the points of gaze.
As an interesting side note, I learned a different way to do this activity with each new doctor with whom I worked. With Dr. Goldstein, we only used this activity binocularly on the y axis for convergence training. Everywhere, I have seen this technique done monocularly on the z axis, although not with a stick and straw, but in the form of a pegboard rotator or a stick with a pipecleaner. At my current office, the doctors primarily prescribe this procedure to be executed binocularly on the x axis. So, somewhere in the last 10 years, I decided that all three dimensions, monocular and binocular, are effective, and continue to use them during the different stages of therapy.
With toddlers and pre-schoolers, I incorporated some variations of the pointer-in-straw technique. Melissa and Doug makes a great set with dowels and chunky beads perfect for little hands.
When training fixation or convergence, I don’t even use the pattern cards. We just make “towers” while I move the stick close, far, and into all points of gaze. To train basic left to right saccades, I hold two sticks and have the child alternate stacking one bead on the left and then one bead on the right until both sticks are filled. If you want to add a cognitive element, you can have the child sequence patterns by color or shape.
For home practice, an easy and inexpensive variation of this toddler friendly pointer-in-straw technique can be accomplished by stacking uncooked pasta on either a skewer stick, chopstick, or straw. Any good Italian will know that Rigatoni is the perfect size and shape for this task. As suggested by a VT parent, if you are feeling extra crafty, you can also color dye your pasta to enable the child to sequence patterns while stacking. Here is a link for a simple recipe on how to color dye your macaroni.
Back to the 2 ½ year old esotrope – Although he liked my chunky wooden beads in the office, he wasn’t too interested in stacking pasta with mom and dad at home. So, mom gave him Rainbow Loom rubber bands to stack on a straw. The result was a fun, spiraling sensation! Just think what it will look like with a really long straw (compliments of 7-11, Starbucks, or Dunkin’ Doughnuts).
In our gadget-driven world, let us not forget the effectiveness of our time tested, low tech VT tools. Combine them with some creative people, and you will be able to provide access to new and different patient populations.