The Relationship Between Vision and Toe Walking
Following our webinar, “Eye Movement and VOR Therapy”, I received a very interesting question about vision and its relationship to toe walking. As many of you know, toe walking is not unusual as an infant is learning to walk. Developmentally, many experts suggest that toe walking should end by the age of two. Toe walking beyond that age may suggest numerous neurological and physiological concerns, such as, autism, cerebral palsy, vestibular dysfunctions, developmental delays, and is also seen occasionally in traumatic brain injury.
The most dramatic way to correct this problem is the use of yoked prism lenses. A prism lens (usually 2 diopters) is placed, base down in front of each eye. When prisms are placed with the base in the same direction, they are referred to as “yoked” prisms, and the image seen by the subject is moved or displaced in a direction opposite to the bases.
In the case of toe walking, placing the prisms base down will move the world up, their head will often move up as well, and the heels will usually come down. The amount of prism is then reduced in .5 pd steps with time, in an effort to reduce the need for the prism in the long run. In addition, visual spatial and perceptual therapies may be employed to assist in the process. These therapies are primarily done in the vertical plane. This is an excellent opportunity to work with your developmental or neuro-optometrist for the best outcomes for the patient.
We also received requests and questions about the Hart or letter chart that I mentioned. I am attaching a pdf of one I designed for your use. This one also has three different size nearpoint charts at the bottom as well. They are also commercially available from several suppliers as well.
To watch the webinar, please click the link below, and subscribe to @BertecHQ on YouTube:
About the Author:
Charlie Shearer, OD has been a nationally recognized leader in the areas of vision therapy, visually related learning problems and sports vision enhancement. He has worked with US Olympic athletes and teams, professional and amateur athletes, and coordinated national screening of both Special Olympics and Junior Olympics. Charlie is a leader in the field of instrumentation development as related to his role of Vision Science Consultant for Bertec Corporation, as well as his work with other companies. Charlie was born in Mishawaka, Indiana. He received his undergraduate and optometry degrees from Indiana University, upon graduation he returned to Mishawaka, Indiana, where he is in private practice. He has been a leader and innovator in of areas of pediatric vision, neuro-optometry, vision training and visual perceptual problems. He also has an interest in sports vision and continues to consult with the Colorado Rockies Major League Baseball team.
