APPENDIX A Bibliography 1. APELL, R. J. and R. W. Lowry, Jr.: Preschool Vision. American Optometric Association, 1959. 2. AUSTIN, Caroline: Mass Preschool Vision Screening. Children, March-April, 1959. 3. BETTS, Emmett A.: An Evaluation of the Baltimore Myopia Control Project. Journal of the American Optometric Association. Vol. 18, No. 9, April 1947. 4. BETTS, Emmett A.: Visual Readiness for Reading. Foundations of Reading Instructions. American Book Co., 1946. 5. BETTS, Emmett A. and Agnes Sutton Austin: Visual Problems of School Children. The Professional Press, 1941. 6. BING, Lois B.: The AOA Policy on School Vision Screening. The Journal of the American Optometric Association. Vol. XXVIII, No. 8, March, 1957. 7. BING, Lois B.: Visual Problems in Reading and Optometric Limits. Monograph No. 239. American Academy of Optometry, 1958. 8. : Blueprint for Visual Screening. Euclid Public Schools, Euclid, Ohio. Rev. 1959. 9. BLUM, Henrik L., Henry B. Peters and Jerome W. Bettman: Vision Screening for Elementary Schools. The Orinda Study, University of California Press, 1959. 10. BORISH, Irvin: Clinical Refraction. The Professional Press. 1954. 11. BROCK, Frederick W.: Two Eyes Can Be Worse Than One. Education, Vol. 77, No. 8, April 1957. 12. : Check Your Child's Vision. American Optometric Association. 1958. 13. CIOCCO, Antonio: Changes in the Types of Visual Refractive Errors in Children. Public Health Reports, Vol. 53, No. 35. U. S. Gov't Printing Office. 1938. 14. : Conducting Interprofessional Forums on Children's Vision. American Optometric Association. 1957. 15. CRANE, M. D., Franklin M. Foote, Richard G. Scobee, and Earl L. Green: Screening School Children for Visual Defects. Children's Bureau, U. S. Dept. Health, Education and Welfare, No. 345, 1954. 16. DEBOER, John J. (Edited by): Unsolved Problems in Reading. El. Engl., Reprinted from Oct. and Nov., (Champaign, Ill., Nat'l Council of Teachers of Eng., 1954.) 17. : Do You Know These Facts About Vision and School Achievement. American Optometric Association. 18. EBERL, Marguerite T.: Manual on Visual Care of the Non-Achieving Child. American Optometric Association, St. Louis, Mo. 1959. 19. EBERL, Marguerite T.: Report to the Midcentury White House Conference on Children and Youth. American Optometric Association, 1950. 20. EWALT, H. Ward, Jr.: The Baltimore Myopia Control Project. Journal of the American Optometric Association, Vol. 17, No. 6, Jan. 1946. 21. GESELL, Arnold, Francis L. Ilg and Glenna Bullis: Vision - Its Development in Infant and Child. Harper and Brothers, 1949. 22. GETMAN, G. N.: What About Your Child's Vision? American Optometric Association. 22A GETMAN, G. N.: Streff, J. W.: Mommy and Daddy. American Optometric Association. 23. GORDON, Dan M.: Squint in Children, Jnl. of Pediatrics (St. Louis) 29: 640-646, Nov., 1946. 24. GRAY, William S. and Nancy Larrick (Edited by): Better Readers for Our Times. International Reading Association Conference Proceedings, Vol. 1, Scholastic Magazines, 1956. 25. GREGG, James R.: Variable Acuity. Journal of the American Optometric Association, Vol. 18, No. 8, March 1947. 26. HACKMAN, Roy B.: An Evaluation of the Baltimore Myopia Project. Journal of the American Optometric Association, March 1947. 27. HARMON, Darell Boyd: Notes on A Dynamic Theory of Vision, Optometric Extension Program, Revision, 1958. 28. HIRSCH, Monroe J.: Effect of School Experience on Refraction of Children. Vol. 28, No. 9, American Academy of Optometry, 1951. 29. HIRSCH, Monroe J.: The Relationship of School Achievement and Visual Anomalies. American Journal of Optometry, Monograph 183. American Academy of Optometry. 30. ILG, Francis L. and Louise Bates Ames: Child Behavior. Dell Publishing Company, Ed. Rev., 1959. 31. KELLEY, Charles R.: Visual Screening and Child Development. The North Carolina Study, Department of Psychology, North Carolina State College, 1957. 32. KEPHART, Newell C.: Help for Brain-Injured. Wisconsin Optometrist, 1957. 33. KEPHART, Newell C.: Visual Changes in Children. American Journal of Optometry, Monograph 93. American Academy of Optometry, 1950. 34. LUCKEISH, Matthew: Increase in Eye-Defectiveness in School Children from Grade to Grade, Journal of the Florida Optometric Association, Florida Optometric Association. 1953. 35. MILES, Paul: Children with Increasing Myopia. Missouri Medical Journal. Vol. 54, Dec. 36. 1957. : Monograph on Optometry. American Optometric Association. 37. MURROUGHS, Thaddeus, R.: A Clinical Guide to Amblyopia Therapy. American Optometric Association. 1958. 38. POTTER, J. A.: Bent, Leo G.; Zebell, Chester R.: A Vision Testing Program for University Students. Journal of the American Optometric Association, June, 1954. 39. .: Reading Takes Seeing. American Optometric Association. 1958. 40. ROBINSON, Helen M. (Edited by): Clinical Studies in Reading II. University of Chicago Press, No. 77, 1953. 41. ROBINSON, Helen M. The Findings of Research on Visual Difficulties and Reading. Reading for Effective Living. International Reading Association Conference Proceedings, Vol. 3, 1958. 42. ROMAN, Melvin: Reaching Delinquents Through Reading. Charles C. Thomas, 1957. 43. RYAN, Vernon: Referrals from Visual Screening of School Children. American Journal of Optometry. Vol. 36, No. 8. 44. SATO, T.: The Causes and Prevention of Acquired Myopia. Kanehara Suppan Co, Ltd., Tokyo, Japan. 1957. 45. SCOBEE, R. G.: Esotropia. American Journal of Ophthalmology. Vol. 34, No. 6, 1951. 46. .: Services for Children With Vision and Eye Problems, American Public Health Association, 1956. 47. SPACHE, George: Optometrists and Reading Specialists. Journal of the American Optometric Association, Vol. 28, No. 5, 1956. 48. SPACHE, George: Vision and Its Relationship to School Achievement. Journal of the American Optometric Association. December, 1957. 49. STEWART, Charles R.: TV and Prevalence of Ocular Discomfort in School Children. Optometric Weekly, Vol. 42, 1951. 50. SWEETING, Orville J.: An Improved Vision Screening Program for the New Haven Schools. Journal of the American Optometric Association, Vol. 30, 1959. 51. TAIT, Edwin F.: Textbook of Refraction. W. S. Saunders. 52. TAYLOR, Earl A.: Eyes, Visual Anomalies and the Fundamental Reading Skill. Reading and Study Skills Center, N. Y., N. Y., 1959. 53. : Teacher's Guide to Vision Problems with Check List. American Optometric Association. 54. WICK, Ralph E.: Tragedy of the Commonplace in School Visual Problems. The Journal of the American Optometric Association. Vol. XXIII, No. 2, 1956. 55. WILSON, Charles C.: School Health Services. National Education Association, 1953. 56. WINEBRENNER, Mary Ruth: Finding the Visually Inadequate Child. Visual Digest, 1952. : Your Baby's Eyes. American Optometric Association. 1958. 57. 58. : Your Eyes and Optometry. American Optometric Association. 1958. : What Everyone Asks About Contact Lenses. American Optometric 59. Association, 1959. APPENDIX B OPTOMETRIC VISUAL CARE FOR THE BRAIN-INJURED CHILD By G. N. Getman, O. D., D. O. S. The visual and perceptual problems of the brain-injured child have come to the professional attention of optometrists through a very normal course of events. A large segment of the optometric profession has been deeply interested in the functional aspects of the ocular and visual mechanism for the past thirty years. [1] This interest has increased in the past twelve years when clinical practice demonstrated that a child's total motor organization was primary and essential to adequate visual performance in the classroom. [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] Hundreds of cases were being reported where the proper teaming of the two eyes and more efficient motility of ocular movements brought an enhancement of visual perceptual skills in spite of extreme ametropías. The age old physiological adage that function affects structure more than structure affects function apparently could also be applied to vision. Optometrists providing visual training for their patients found that visual skills could be enhanced to such a degree that visual perceptions were not entirely determined by the anatomy of the eye ball. There were cases, however, which did not respond to the usual optometric clinical methods of training. Further study of visual processes, visual behavior, the neurology and psychology of vision suggested that attention to the total gross motor patterns was necessary. This led to interest in the pre-school child, his visual development, and his unique visual problems. [13] These problems were especially unique because methods and philosophies suited to the visual behavior of every person above the age of 7, 8 or 9 did not apply, nor were they clinically successful in caring for the very young child. Therefore, research and clinical investigation into the development of visual abilities by the child from infancy through childhood has become an important part of the profession's activity since 1945. This research provided a catalog of the experiential sequences and developmental processes that a child should achieve in the first six or seven years of his life. It is now evident that these processes and sequences are of primary significance if the visual mechanism is to make its proper contribution to the total gestalten essential for adequate perceptual performance within the cultural demands of 1960. [14] [15] [16] [17] These will be summarized later in this paper, and their application to the brain-injured child will be discussed. It became significantly apparent out of these studies that a normal, non-pathologic pair of eyes were not enough for the visual performances demanded by culture. [18] [19] [20] [21] [22] Many children with no refractive error, who could achieve 20/20 sight (or its equivalent) on standard Snellen test conditions could not demonstrate normal visual behaviors and visual judgments of size, form, depth, direction, or distance. Complete and thorough neurological examinations made by qualified neurological specialists upon many of these children showed them to be normal in every respect. At least all neurological test results were negative. Developmental procedures of optometric visual training were provided for these children. [23] [24] These procedures were based upon the studies of visual developmen: from infancy mentioned above. These procedures were administered to provide children with the opportunity to re-experience each level of visual development. This program of clinical guidance was carefully designed to insure that each child made every possible integration of visual, tactual, skeletal, proprioceptive, verbal, and auditory stimuli as mechanisms facilitating a total perceptual organization. Out of all of this research and clinical activity optometry has evolved a philosophy which can be applied to every child and more especially applied to the child diagnosed as brain-injured. 1. The visual mechanism is anatomically, physiologically, neurologically and psychologically designed to operate as the most adequate sensory receptor for information regarding the external world. [25] [26] [27] [28] [29] [30] 2. The visual mechanism is not solely dependent upon the structural or functional adequacy of the receptor end organs (the ocular globes) for its perceptual ability although these adequacies are most desirable. When inadequacies do exist, the optometric application of proper lenses to enhance function and consistency of ocular performance may significantly contribute to the perceptual results. Nevertheless, these oculi, in and of themselves, are not capable of obtaining all the visual information essential to the fullest interpretation of the external world. [31] [32] [33] [34] 3. Children do not achieve the ultimate visual development through visual experience alone. They must have every opportunity to integrate tactual, auditory, verbal and all proprioceptive experiences with the visual experiences to assure ultimate visual development. [35] [36] [37] 4. Visual development can only be achieved through active movement within actual visual space so the relationship between the physical self and physical space can be learned. Thus, an accurate grasp of the body scheme and an extensive knowledge of body movements are necessary before the visual mechanism can be expected to comprehend space and its contents. [38] [39] [40] [41] [42] 5. Therefore: the visual mechanism reaches its ultimate levels of contribution to the perception of size, form, depth, direction, and distance, as a result of total organismic motor patterns related to these visual experiences. The verification and abstraction of motor patterns by the visual mechanism through the feedback and integrative systems of the central nervous system provide a total organization wherein vision can substitute for overt, trial and error exploration of the external world. [43] [44] 6. As a result, visual training based upon a total organismic development concept will contribute to a greater self-sufficiency in every child. This concept of visual training is of even greater importance to the brain-injured child because the very nature of his hanicap has its greatest impact upon his visual perceptions of his external world, and prevents his acquisition of many visual perceptual skills when left to his own devices. As a result, his general and cultural intelligence may remain at a level below his potential and his lack of visual development can prevent the fullest possible utilization of his biologic endowment. [45] [46] [47] [48] In the usual course of events children who had been diagnosed as brain-injured by qualified neurologists become available for optometric examination and care in many offices scattered across the nation. These children showed the same absence of refractive errors, the same nonpathologic oculi, and the same visual problems as seen in the so called normal children. Carefully designed and controlled optometric procedures were used with these children. These children also demonstrated significant gains in visual behavior and visual judgments following the training. Their social and academic achievements clearly indicated gains that were greater than time or other guidance methods had produced. Finally, their scores on standard intelligences tests, administered by qualified psychologists showed significant gains in I. Q.'s. The fact that these I. Q. gains are possible has been further substantiated by independent and unrelated studies of I. Q. changes as reported by Dr. Robert Felix, director of the National Institute for Mental Health, and by Professor Arthur W. Combs of the University of Florida. These latter reports do not specifically state that these investigators have been such gains in known brain-injured children, but their data which shows that I. Q.'s can change substantiates the psychological tests on damaged children. An extensive search of recent literature in several allied fields dealing with the functional behavior of the human being has proven very interesting. There are many verifications of the 15 year old optometric philosophy that considers the visual-motor processes as primarily essential to the development of perceptual abilities. In many instances this literature repeats and restates the concepts which have been clinically applied by optometry in dealing with children diagnosed as braininjured and with those who operated "as if" they were brain-injured in spite of negative neurological findings. Many data have been published reporting that most children with brain injury are below normal in many areas of visual-motor behavior. The most characteristic lack demonstrated by these children is in figure-ground interpretations. [48] [49] [50] Optometry holds that this lack of skill does not mean this type of child can never acquire some visual perceptual skill. It merely means that left to his own devices he did not achieve some of the visual-motor abilities expected in all children. Neither does optometry hold that if these children are given proper visual training and guidance, they will become normal children. It does hold, just as reported by other clinicians dealing with |