(Out-of network services necessity)

This present evaluation is medically-based and “for now” unique to this office, though the protocol and methods have been presented in lecture twice over the past ten years1,2 and the term “neurodevelopmental optometry” was defined in a guest editorial in the Journal of Behavioral Optometry five years ago (as this is written).3 The Learning Clinic assessment is a unique sensorimotor evaluation in that it probes not just vision functioning and visual processing, but all avenues of a child’s neurophysiological processing: auditory-motor, tactual, integrative abilities, gross-motor and fine-motor skills, all as described below. It examines the adequacy and efficiency with which (s)he acquires sensory data, and asks the child to demonstrate how they are then able to neurally integrate the data with prior knowledge (a high order function largely founded in motor memory), how they perform motor planning, and how they are able to respond with age-appropriate, efficient motor movements.

This evaluation consists of four main areas of investigation:

Oculomotor and visual function evaluation (this is not associated with refraction or spectacle lens determination): This is a comprehensive sampling of the degree of neurophysiological sophistication in ocular pursuits, fixational skills, muscle fields, convergence and divergence patterns, and the adequacy of (freedom ranges of) compensatory binocular skills. Also determined are accommodative facility, and the level of stereopsis achievable at 6 m. and 40 cm. Other tests are performed as indicated.

Visual-motor processing: Determination of the adequacy of these neurodevelopmental skills by standardized neuropsychometric tests of copying skills, stereognosis, embedded figures, spatial organization, visual memory, puzzle conceptualization, and motor-free visual perceptual skills.

Auditory-motor processing: Determination of the adequacy of these neurophysiological skills by standardized tests of echolalia, auditory sequencing, phonological analysis and synthesis, and auditory memory.

Integrative processing: Determination of the neurophysiological integrity of these abilities by standardized psychometric tests of bilateral body motor integration, auditory-visual integration, auditory conceptualization, and to the extents that they are integrative, the Stroop effect (for neural processing/interference rates), and haptic-visual abilities.

The evaluation concludes with a parent conference and a diagnostic, prescriptive report (see enclosure). Validated neurodevelopmental therapies are generally needed in the rehabilitation of these problems. For all the above reasons, these services are not available within network.

1.Bowan, MD. Putting the “neuro” in neurodevelopmental optometry. Invited presentation. Transcript of the 49th Kraskin-Skeffington Invitational Symposium on Vision, OEP Foundation, Santa Ana, CA 2004.
2. Bowan, MD. Differential diagnostic questions to be answered to determine the roles of vision and perception in the efficacy of learning. Invited presentation. Transcript of the 40th Kraskin-Skeffington Invitational Symposium on Vision, OEP Foundation, SantaAna, CA, 1996.
3. Bowan, MD. What’s in a name?; Guest editorial. J. Behav Optom, Vol. 9, 1998, No. 1.

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