By: Loren Shlaes, OT
Most, if not all, of the children who come for occupational therapy have an undiagnosed visual problem. This is because the low muscle tone in the neck and trunk of children with sensory processing issues does not give the eyes a stable base of support from which to operate. As a result, the fine motor coordination in the eye muscles is compromised, which in turn affects the brain’s ability to process and interpret visual information correctly. This makes tasks like reading and writing, copying from the blackboard, navigating the playground, and participating in team sports an extra challenge. Because the child has to work extra hard to coordinate the muscular activity of his eyes, his mental and physical energy for the actual task he is using them for is less. His endurance and performance are going to suffer as a result.
Since the strength and coordination in the eyes is so dependent on the strength and stability of the spine and neck, the child should be given ample opportunity to play outside, and provided with gross motor activities regularly. This can be a team sport or martial arts class, swimming, tennis, volleyball, bike riding, dance, or anything that the child enjoys and will participate in willingly and happily. 
If a child is continually resistant to close work, has a poor attention span for reading or tabletop activities, rubs his eyes, loses his place while he’s reading, doesn’t copy well from the board, misses part of the page when using a workbook, or complains of headaches or double vision, he is undoubtedly struggling with weak eye muscles. If his vision doesn’t improve after a year of working in a sensory gym on suspended equipment, it’s time to see a neurobehavioral optometrist, who can prescribe vision therapy if it is warranted.
Here are some activities that can improve the fine motor coordination in the eyes:
To improve convergence and the ability to do close work:

1. Give the child a drinking straw in one hand and a strand of uncooked spaghetti in the other. Tell the child to look straight ahead as he brings his hands up in front of his face and slowly slides the spaghetti into the straw. Repeat ten times. Do this once or twice a day.
2. Provide the child with whistles and bubble toys that have moving parts when blown. They encourage the child to pull the eyes in together to watch.
3. Give the child a lollypop to suck on while doing close work. The vacuum created while sucking will pull the eyes in together. Have parents give the child all of his drinks through a straw and provide frequent opportunities for resistive sucking, such as giving the child smoothies, juice boxes or drinkable yogurt.
4. Provide craft projects that challenge and motivate the child. The S and S Worldwide catalog has lots of great craft projects that are not too expensive.
5. Play marbles, jacks, and other eye hand skill games.

To improve pursuit fixation, or the ability of the eyes to track and maintain attention on stable and moving objects:

1. Have the child race a car on a lazy eight {sideways} speedway track on a chalk board or on the floor.
2. Play balloon tennis, either with rackets or hands.
3. Have the child jump on a bosu or mini trampoline while catching small beanbags and tossing them at targets around the room.
4. Play “I spy.”
5. Blow some bubbles. Have the child chase and pop them. I give them a little claw toy or a pair of zoosticks to pop them with so that they are also working on fine motor skills.
6. Dim the lights and have the child chase the beam from a laser or a flashlight.

To improve visual memory:

1. Play concentration, where the child has to turn over cards and find matches. This teaches the child to develop good strategies for visual memory.
2. Play “What’s different?”. Put three things on the table, have the child close his eyes, and then change one. Have the child tell you which one is different. Use more objects as skills increase.
3. Place a covered tray with a dozen or so objects on a table, let the child look at it for 30 seconds, cover the tray, and have the child write down or tell you everything that he remembers. This is a fun group activity.

To improve saccadic vision {the ability of the eyes to jump and fix, the skill required for reading}

1. Lacing, beading, coloring, and cutting activities.
2. Mazes, dot to dot, and tracing activities.
3. Have the child draw and paint while standing at an easel.
4. Weaving and sewing activities.

To improve visual discrimination:

1. Play the “what’s different in the picture? game.
2. Put together jigsaw puzzles, play Search a Word, and “Where’s Waldo?”
3. Play Connect Four, tic tac toe, and make a square.

For figure ground:

1. Hide little toys for the child to find in a large container of beans or in a ball pit.
2. When reading a picture book together, play “I Spy” with the drawings. Describe something to the child and have him try to find it in the picture based on your description. Then have him find something and describe it to you for you to find.

Have the child sit on a therapy ball while reading, watching television, or doing homework. The slight postural adjustments he makes while he’s sitting will help stabilize and strengthen his back and his eyes. Or have the child lie on the floor on his belly propped up on his elbows while working for brief periods. This will strengthen the neck, which will help stabilize his eyes.
Our Featured Author: Loren Shlaes, OT
Thanks to Loren Shlaes for providing us with these Visual Perception Improving ideas.
Loren Shlaes is a pediatric occupational therapist specializing in sensory integration and school related issues, particularly handwriting. She lives and practices in Manhattan. She blogs at http://www.pediatricOT.blogspot.com/.