Thursday, October 21, 2010

Our Visit to Snider Therapy Center - the expanded version

(This is the LONG version. I mean LONG and DETAILED. If you are new to this blog, you may perhaps want to read the short version of the story first...)

We had an adventure yesterday that I want to tell you about. Our family drove up to Birmingham to take Trevor to a doctor. We left home at 6:13 a.m. and pulled up in front of the doctor's office at 9:55 for our 10:15 appt. So far, so good.

On the front door, there is this picture next to the name of the facility:



Samuel brightly said, "This is the bwain doctor. This is wheh they check yoe bwain."

Oh, dear.

In we go to see this new place. It was bright and cheerful...pretty pleasant for a doctor's office. At one's first visit to a new doctor's office, there are, of course, always papers to fill out. I was pleased that the only paper they gave me to fill out was one with some questions for me to go over with Trevor. It had questions like:

~When you are reading, do the words ever blur or move on the page?

~Do you ever reread a line, or skip a line?

~Do your eyes ever water or hurt?

~Do you get tired easily when you read?

Can you tell this is not your typical doctor's office? As I tell the story, you may get more of a feel for it, but basically they use various therapies to "retrain" the brain. Well, at least that's my take on it. They say they "specialize in the field of Neuro-Visual Rehabilitation".

ANYway...I have asked Trevor those kinds of questions in the past, as prompted by the Snider Therapy website, and he has said no. So, I was a little shocked when he answered yes to many of the questions on that sheet! (You can see the questions HERE, by clicking on the School Age Child Symptom Sheet link.

Snider Therapy Center is run by a couple, Mr. Randy and Dr. Sharon Snider. They are very friendly and pleasant to be around. Mr. Snider took us back first, and did a basic vision test on Trevor, just to make sure he could see.

Then, another lady did 3 or 4 exams with Trevor. I got to sit outside the room, and observe through a window. I watched him do a letter and number reversal exam (he did poorly); a timed reading test (using numbers, not letters or words) to see how fluently he reads (which he did poorly); and a visual-perceptual test, which was very interesting.

That test was mostly shape recognition. The tech would show Trevor a page with a shape on it,

a circle


...and when he indicated he was ready, she would show him a new page with 4 shapes on it.

a circle 2


He would then have to choose the shape that matched the first page.


The shapes would get harder...

a spiral

a spiral 2


...and harder. Sometimes the shapes were on the same page, and he had to find the right shape hidden in a mess of other shapes...

a mess

There were shapes overlapping shapes, shapes of different sizes, and increasing complexities. If there were 2 pages, Trevor would look at the first page for, oh, about 2 seconds, indicate he was ready, and then look at the second page. Sometimes he would puzzle over the second page for as long as maybe a minute...sometimes between 2 and 10 seconds. He often made his choice before I could find it on the page, looking over his shoulder. There were so many pages... I would guess about 60 sets of puzzles. I was exhausted just from watching, and trying to match them myself. I had no idea how he did, but when the tech came out, she said he was very smart.

Phew! We took a 2 or 3 minute break...then we were on to the next exam.

We went back into the same room, this time with Mr. Snider (this time I was allowed to come in and watch). He tested Trevor's visual field. Or, rather, he tested to find how much of Trevor's visual field he was actually using. This was very interesting.

Now, if I hold my hand behind Trevor's head, and slowly bring it around the side to the front, it comes into his peripheral vision like you would expect...somewhere near his shoulders. HOWEVER, that doesn't mean his brain is using that information. Mr. Snider was able to plot on a paper, and show where Trevor's functional vision was.

Okay...here is a rough shot of what the paper looked like for one eye. He tested each eye separately.

a plot

The red line is sort of where the boundaries of Trevor's active vision lie. They ought to have been off the page. I believe it would be like if you held up your hands and made a big circle of them, and held it in front of your face, and looked through the circle.

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I believe that is all that Trevor really sees. That doesn't mean that all around it is black, but just that it is not information his brain is processing. THAT might be why he trips off of curbs, crashes into doorways, and bumps into corners. HE IS NOT SEEING THEM!

Sigh.

Here's another little example. If you put your fist up, like so...

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and stand on one foot...notice what happens. Really, for the love of Trevor, you should try it.

Okay. Now, using that same hand, open it up to an "O" shape, and hold it like a telescope over one eye, and shut the other eye. Now, try to stand on one foot again.

Surely you could stand on one foot both times, but did you notice if it was harder either time? For me, it was noticeably more difficult with the open O hand. That is because our peripheral vision is so important for balance. NO WONDER Trevor is so wobbly!

Back to the exam. Next, Mr. Snider did a hearing test on Trevor. Trevor has had hearing tests before, but I think this one was a little different. This test measured his hearing sensitivity. Trevor sat with tight-fitting headphones, and I sat behind him, watching. Mr. Snider sat across from Trevor, behind a little "booth", where we could easily see him. Whenever Trevor heard a "beep beep beep" he was supposed to raise his hand. That poor boy got quite a workout. I wonder if his arm is still tired? Mr. Snider plotted some results on a graph, and afterwards told us a little about it. Here is what we learned.

I made you this little sample graph. Ha! I'm just working from my memory, so it's not perfectly complete or accurate.

a hearing

I totally don't know what frequency all those things are...but you get the idea.

What we learn from this is that Trevor has VERY SENSITIVE hearing. Most standard hearing tests, the basic ones that just check if you CAN hear, do their check at 30 decibels. I think Mr. Snider said that often children can hear at 15 dBs. The places where Trevor's line goes up to the top of the chart peaked out at -10 dBs. Sometimes people say something is "off the chart"...like it is really good, or something. Well, Trevor's hearing was "off the chart" in 4 frequencies. That means, the quietest level that there was on the chart was not necessarily where Trevor could hear. Quite possibly, his hearing would have been even more sensitive than the chart showed. Mr. Snider said he has had children come in that were "off the chart" in 1 or 2 columns, but never 4, like Trevor. He has never seen a child so sensitive of hearing.

Sigh.

What that means is, Trevor is being bombarded with sound all the time. Mr. Snider said that the chart is a little hard to comprehend because the gap in volume between, say, 10 and 20 dBs is very great. Some sounds we hear could sound 100 times louder to Trevor. I can't even understand that. SO, Mr. Snider believes that Trevor's mind sort of shuts down his auditory center, in order to cope with all the terrible noise he hears. USUALLY children with super- sensitive hearing have frequent "melt-downs" and tantrums, because their senses are under such constant assault.

Sigh.

Praise God, praise God. I am in amazement that we have not had melt-downs. God is so kind to us.

And no wonder Trevor seems like he can't hear well. His mind has turned it off.

Can you believe that was not the end of the testing????

The next test was a "Brain Timing" test. Weird name. This test was basically done by clapping to a beat. Trevor wore headphones, and a round device on the palm of his hand which recorded his claps into a computer. Mr. Snider sat at a computer and Trevor stood nearby. Then a chime, or tone, sounded a slow, but steady beat in the headphones. I could hear it...if I had to guess, I would say it was one tone per second. It was rather like a metronome. All Trevor had to do was clap on the tones. Sounds easy...but...It was almost painful to watch how difficult this was for Trevor. At first, he would just clap AFTER each tone. Bum, clap...bum, clap. Mr. Snider stopped him, and tried to re-explain what Trevor was supposed to do. After working at it for maybe 30 seconds to a minute (that sounds like a short time, but at a tone-per-second, that would be 30 claps! 30 tries!), Trevor would finally make a clap ON the tone...and would keep the right rhythm for maybe 5 claps. Then he would laps off again. It was awful. Then Mr. Snider stopped him, and added a new element. Along with the tones, Trevor was going to hear other sounds. All he had to do was ignore the other sounds, and continue to clap on the tones. The tones sounded designed to throw a person off...which I'm sure they were. How can I express how difficult it was for Trevor? The look of utter concentration on his face, and the totally random, uncoordinated clapping was almost too much to bear. Honestly, I wanted to laugh! but it was also so sad, I just almost couldn't watch.

A person perfectly clapping on the tones would be zero milliseconds off the beat. Mr. Snider said that was impossible, and that at best, a person could clap maybe 6-7 milliseconds off the beat. Trevor was over 300 milliseconds off.

What did I learn? This brain-timing test reveals how a person's brain is doing at planning, organizing, staying on task, and processing. This is what the Snider Therapy Centers website says about it:

Interactive Metronome (IM) is a brain-based rehabilitation assessment and training program developed to directly improve the processing abilities that affect attention, motor planning, and sequencing. This, in turn, strengthens motor skills, including mobility and gross motor function, and many fundamental cognitive capacities such as planning, organizing, and language.


Any of that sound like it's hard for Trev? Attention; motor planning; motor skills; gross motor function; planning; organizing...uuhhhh. Yes, those are problems. These were things I already knew...but this demonstration added to my awareness of how difficult things are for Trevor.

LUNCH BREAK! All of that was 1.5 hours of our morning. No wonder we were tired.

Tim and the other two boys had been out playing, and came back and picked us up. After eating at DQ, which was Trevor's special choice, we headed back near the Therapy Center, and enjoyed feeding some geese and koi at a nearby pond.

DSC04559

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It was so refreshing to get out in the air.

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And feeding those funny animals was delightful.

DSC04557

The koi were really about as big as the geese, and loved the golden grahms just as much.

DSC04550

It was nice to tell Tim all about our long morning.

DSC04554

And the boys were precious.

DSC04544

After our refreshing break, we went back for more testing. Really, the afternoon testing felt like it went rather quickly. It was mostly a series of eye exams done by Dr. Snider. Trevor has been in glasses so long, that this was nothing very novel for us. His eye doctor in town, our good friend Joe, has done such a thorough and excellent job, that I didn't feel surprised by much. Dr. Snider was very pleased that Trevor is in bifocals already, and said his eyes both had great vision (that is, with his glasses on). She did do a couple of tests to see how well his brain is USING his vision, and how well his eyes are working together. As it turns out, it seems that Trevor's brain uses both of his eyes alternately, instead of together, which I can't remember if we have ever checked that before. But, that is something that Therapy can work to make better.

That's about all I'm going to say about that. There just wasn't much new or note-worthy. The short of it was, that Trevor IS very far-sighted, and DOES use both eyes; but that he also needs work to make his muscles stronger, and and to make his eyes work as a team.

After this, Tim came back and got Trevor, and I stayed for the "feedback" appt. Mr. Snider went over all the tests with me, and helped me understand what they all meant. Most of that I have thrown in with the blog already. I didn't explain yet about the visual-perceptual test...the one with the shapes. Mr. Snider said the average child would score in the 50th percentile, and that Trevor scored at the 99th percentile. He has VERY good visual-perceptual skills. Nice news, after all the other hard stuff.

At this Therapy Center, they have a special treatment called Sensory Learning, which they would like to see Trevor do. It is an intense, 12 day program that we would go stay in Bham for. During the program, Trevor would have 2 sessions of therapy a day for 12 consecutive days, consisting of a multi-sensory treatment. After that, Trevor may do a year or so of vision therapy, which I know little about, and will be researching!

They let Trevor come in and check out the Sensory Learning Room before we left. They have a room, which really reminded me of a spa room--perhaps not so fancy, however. There was a station in a corner with a computer and such, and a large table in the middle that almost looked like a bed. There was a pillow on it. They had Trevor lay down on the table, and they put headphones on him. The headphones play "grandma-ish" music that I'm sure has some scientific-ness to it that I don't understand. Also, there is a light box that they lowered to about 18 inches above his head. It had a violet light that gently turned on and off, that was really rather soothing. Also, they turned off the overhead light, and the room was so completely dark that I couldn't see a single thing, except the violet light. Then, while the light was going, and the music, the bed moved gently, though I have no idea how much or how fast, since is was utterly dark. They let Trevor try it for about 5 minutes. He loved it. I think it was very relaxing for him. He said he loved the violet color of the light, and it reminded him of rides at the fair. Cute.

So, that is what the treatment is! Apparently they add more colors to the light sequence as the days go on, and over time this multi-sensory stimulation helps integrate the senses. At least, that's my limited understanding.

You can click HERE if you want to link to more information:

So, how did Trevor respond to all this?

He was so excited!! Well, actually, at first he was just plain tuckered out. But, after we got home (at 9:30 p.m.) and had a snack, he really brightened up, and wanted to talk and talk about it. I told him some things that the therapy might be able to help, like not stumbling into things, and being able to concentrate better, and he liked that. I told him they might be able to help his hearing not be so sensitive, and he said, with a little chuckle, "Oh-ho...that would be SUCH a blessing." How cute is that? Poor, poor little guy. He is so excited to go get started, and wishes we could go today. I guess I'll be praying that his expectations don't get out of control, and that he won't be disappointed if things aren't ALL BETTER.

Mr. Snider said that Trevor should be off all his ADHD/OCD medicines before we get started, so I predict that we will have a few rough weeks with a highly distractable and wild child. But, I pray that it will be worth it. Dear, sweet Trevor...he has had so much forbearance with us...it should be our joy to forbear with him.


Here are some links for those who are interested:

Snider Therapy Centers

Sensory Learning

Online form you can fill out to have evaluated by a professional to see if you might be a good candidate for Sensory Learning Therapy

Vision Therapy

5 comments :

  1. Jill, I have read your lengthy narrative of your encounter with the Snider. Clinic nearing two years ago . Did Trevor go on to receive treatment ? What was recommended? What changes did he or you notice, or teachers for that matter, which you feel were attributable to his treatment? Negative comments or concerns ? I'm interested to know as I have kiddos who also need some vision help and I know little about this group or their efffectiveness. Your opinion and comments would be very appreciated.

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    1. Hi! So glad you asked.
      Yes, Trevor did go through the Sensory Learning Program. I think if you click the therapy label on the left side of the page, some posts about how that went will come up. I do have more perspective a year and half later, though. We did see improvement in Trevor. He was more self motivated, more focused, less clumsy, and has been off his medications ever since. We home school, so I missed out on having a "teacher's" perspective. As the mom and the teacher, I think you sometimes miss things that an "outsider" would see.

      We did not go on to do the home based therapy. We got pregnant, and put all that on the back burner. Interestingly, after the baby was born Trevor started some major regressions. When we were at our wits end, we took him back to the Sniders. They said that a "big event" (like having a baby) may have caused regression since we never actually corrected the problems that Trevor had with his vision and hearing. So, we are currently in our 2nd week of home-based therapy, and are headed up to Bham tomorrow to check in and see if there has been any improvement.

      I think very highly of the Sniders. I never felt like they were trying to take advantage of me. I think they are very good at what they do, and that their program is very helpful. I hope that I will have much more of a success story in the near future!

      I may have said in my post, but the cost of the initial evaluation was worth every penny. It was so helpful to know Trevor better, and I highly recommend it. Also the link to the Sensory Learning website where you can take that test is very helpful.

      I would be happy to share more about it, if you are interested. You can email me at tolleson47(at)aol(dot)com :)

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  2. Hi Jill!
    My husband and I are looking into Snider Therapy as well for our little boy and we wanted to know how things are going now. Did you finish the therapy? Are the results holding? Has there been any more regression and if so, what do you think caused it? Would you recommend them? Thank you for any insights, comments, opinions you can offer!
    Janna P

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  3. Hi Janna!
    Thanks for asking!
    Q:Did you finish the therapy?
    A: Sadly, no. We went to vision therapy for a year--but we didn't hold up our end of the deal very well. There were 2 times that we had to miss one or even two of our monthly visits. Also, while we did do our homework some, I never felt satisfied that we did it as often or as rigorously as we should have. Notice I say "should" not "could". Even now, I think we were giving it all we had...we just didn't have enough time or energy to make progress at the pace we wanted. After a year of therapy (one trip to Bham a month) we had made some progress, but not near enough. We decided that we either needed to begin going weekly, or quit indefinitely. There were many times that I tried in my mind to scheme up some way that we could move to Bham temporarily, just to do therapy.

    Q: Are the results holding?
    A: Oh man...so hard to answer that. Mostly, I think Yes. We have also learned that diet plays a huge role in Trevor's life. It is often hard to divide the two issues and evaluate them on their own. If I try to evaluate just the vision, I'd say yes, the results are holding.

    Q: Has there been any more regression and why?
    A: To a degree...we definitely have ups and downs. I really believe that is all due to diet, and hormones, and life. Trevor is still Trevor: quirky, a little clumsy, absent minded, and highly distractible. However, when I look back on where we were with him before we started with Snider Therapy Center, there's been huge progress. He can get up in the morning and get ready for the day. He can monitor his activities and get things done on his own initiative. He runs into things WAY less often! He sleeps better. When we walk to the car he doesn't just follow me to my door :) But then, I flip again in my head and say: but he still never remembers to shut his car door when he gets out. He almost never remembers to take his plate from the table. It can take him 2 hours to get his math done that he should be able to do in 10 minutes. And on, and on.

    Q: Would you recommend them?
    A: Wholeheartedly. I think that the services they offer are very effective. I also think that you get out of it what you put into it. I'm SO glad we did the sensory learning program. I'm also glad we did VT, and wish we could have done more. I wish we could have been one of those super-amazing success stories...but we got out of it what we put into it.

    I know God has a plan for the way he made Trevor. He's an amazing boy with some really cool talents and abilities. He sees the world in such a different way that I do, and I think that God will use him for something special. At the same time, it breaks my heart to see him struggling and learning such hard lessons.

    I'm both sorry to hear that you had to look into therapy--what parent hopes for that??--and excited for you to have the opportunity to learn more about your little boy. Taking that initial evaluation was one of the best things we ever did for Trevor. I hope you take the plunge.

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  4. Thank you so much for your response. Yes it's not the best that we have to look into this, but we are happy to find something that offers a solution, not just symptom management. Our little one is struggling so much already and we are just finished our first year of schooling, so this gives me hope. And thanks for the words of wisdom about you get out of it what you put into it. That will ring in my mind if we have to do the year long therapy. If we want him to get better, we have to tough it out.So thank you so much. You have helped us a lot. I truly appreciate it!

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