Author Archives: Robert Nurisio COVT
Perhaps more than any other activity we walk our patients through, vectograms are the quintessential interpretive process. Quite naturally, patients look for what they perceive as the correct, or the “how it’s supposed to look ” answer, as we strive to keep them in the process of visual exploration. Embracing this as therapists is, in and of itself, a process of learning and calibration. When put into practice, the line of questioning quickly becomes clear as the patients truly define the beginning and the end of the process, as well as all points in between. With that idea in mind, my hope is the first question of the activity is clear:
What do you see?
A circle. A clown. A spiral. Bozo. A rope. This makes my head hurt. Or the 19 minute exclamation of every aspect, every curve, every wrong of rope, every block, every 90° angle, and every little detail involved in the creation, manufacturing, and usage, add the two plastic cards sitting in front of them. No matter what the answer is, your patient will give you with that first answer the foundation for the appropriate line of questioning. A vague answer might be met with the request to elaborate, a detailed answer might be met with the request for a more global awareness and or appreciation of the picture. Whichever situation your patient presents, the main thing to keep in mind is we are working to expand their awareness, so asking questions which take them into a process of exploration is preferred.
A big aspect of this exploration process is to have a full understanding of the targets we are using and the benefits each target carries. As an example, the Quoit (aka Rope Circle) offers some detail, but by comparison to other options, is fairly simple. When working with a patient who tends to be highly detail oriented and perhaps struggles with global awareness, both in the visual and perceptual sense, this target is a good place to start as there is not much to “hold” their attention. For the patient who is excessively global, and perhaps struggles with holding their attention in highly detailed settings, the Clown target might be considered as there’s lots to look at! Again, this should all be discussed and executed under the supervision of a Developmental Optometrist; but when working with a patient, it always helps to have a full understanding of the target we’re using, and why.
In Part One, we covered the setup of each target and it bears repeating. Along with the background consideration, there’s always the window with a Base In target, there’s the more traditional plastic stand which offers a solid white background. Some offices even use an overhead projector with a silver screen to project the targets. If you’re going to project (something I try to do with every patient at least once), there’s a few factors to consider. First, vectograms are designed to be viewed at 16 inches and obviously projecting them requires more space and changes the scale and demand of the target. With this, a patient’s perception of depth when viewing the target may be different from when it’s in the holder, in either direction. Depending on their visual makeup, they may have an easier time seeing the depth, or not. Enlarging the vectogram by projecting it asks the patient to engage their peripheral fusion on a much broader scale, which depending in their individual diagnosis, should be accounted for. The last aspect of the setup to be thought through is the possibility of incorporating movement. Some offices incorporate a “walk away” procedure into their vectogram activities (to explained in a later post) and some even set the Quoit in a low Base In setting and swing a Marsden Ball behind it to help their patients appreciate the space as the ball swings in and out of the ring.
Most important – remember our goal is clear and single.