Beat the Reading Disease, Read Right Now!

Introduction

Normal eye function enables us to sense our surroundings. One of the special tasks of sight are to allow us to see the printed word. Our brain will then interpret these word symbols into ideas. The importance of this eye function cannot be disputed.

Unfortunately we are not able to understand how each person sees word symbols. We assume that if you have 20:20 vision, you can see to read! This my not always be true. Most reading disability involves dyslexic symptoms.

Dyslexia is a syndrome of strabismus, "lazy eye disease". Strabismus is a genetically dominant condition.

Clarity or vision focus known as acuity, is usually what we think of when we consider how well we see. Acuity (20:20) is only one part of seeing to read. If eyes do not move as a team, reading can be very difficult. Each eye sees a slightly different image because of its position on the face. There may be a little or lot of difference in what each eye sees, depending on the direction the eye is pointing at the split second it is looking. We rarely consider the importance of eye motion as it pertains to reading. Perhaps this is why a vision screening report that says our child has 20:20 vision causes us to assume that our child can physically see to read. We may be very wrong!

"Perception" is the process that selects, discriminates, organizes and compares what is seen in the environment with what was previously seen. A lot of problems with reading seem to be a consequence of poor perception since the learning disabled or dyslexic person almost always has 20:20 acuity. This means the eyeball is working right. Unfortunately the muscles that move the eyeball do not always work together.

During my experience as a school nurse responsible for eye screening, I noticed only about half of our Kindergartners had enough muscle strength to see symbols correctly all the time. This number rises to about two thirds by grade two. These children had weaker eye movements. They would have word reversals, a problem the other children with good eye muscle strength did not have.

My observations made over a four-year period were not part of a formal study, but were done in an effort to reduce student illiteracy problems at our school. Many of these children, and in some cases their parents, were able to under-go therapies that improved their reading.

3D / DEPTH PERCEPTION

Our eyes are separated by our nose. This separation causes each eye to see two slightly different images. When we put these pictures together as one picture we see in three dimensions. This process, called fusion, gives depth to what we see. Depth or 3D allows us to know where objects are in our environment. Depth perception only occurs when the two separate images are seen exactly together. We experience "depth" only to 150 feet (50 meters), objects look flat after that distance.

MUSCLE COORDINATION PRODUCES 3D

Most muscles are arranged in pairs. One muscle contracts while the opposing muscle relaxes, producing a smooth motion. This contraction/ relaxation activity takes place in the eye muscles. This muscle teamwork allows the picture seen by each eye to fuse together, making one 3 dimensional picture. This proper muscle action must take place 100% of the time for normal vision.

SCHOOL EYE SCREENS

The school eye screening was only meant to be a gross screening device and not a complete eye examination. Many parents do not realize this and think their child is getting a full eye examination. Vision screening is mandated in some states. The parts of this screen are visual acuity or focus, farsightedness (you can't see near objects), binocular coordination (how good our eyes work as a team)and color blindness.

The acuity test is given to check vision sharpness at twenty feet. "A child who is 3 years old can be expected to have an acuity in the range of 20/25 or 20/30 using the 'E game" or a recognition target test. With further maturation, a 5 to 7 year-old will have visual acuity of 20/20 to 20/25 as tested with a full line presentation of Snellen letters. All children over age 8 should be able to achieve 20/20 corrected visual acuity. Those who cannot should be referred for evaluation to explain the reason for the defective vision." p. 19.4 (6).

"Eye muscles are tested by moving the eyes right, left, up, down, up/ right, down / right, up /left, down /left. Vergence refers to the movement of both eyes together in conjugate gaze. Vergences are well established by 6 months of age.”p.19.7 (6).

Farsightedness (hyperopia) and color blindness are also tested. There is no completely accurate test for binocular coordination (phoria). Binocular coordination problems are not often included in routine school eye screens.

Many children with good acuity (20:20 vision) have very poor muscle action.

These children pass the school eye exam although their eye tracking may be so poor they may never read well. This is often a very large number of children!

TESTING FOR MUSCLE WEAKNESS

One problem with testing for binocular vision is the number of tests methods (stereoptic instruments, convergence tests, pen light and ocular pursuit and tracking tests). Eye fatigue will also change whether a muscle weakness problem is detected during the screen. This problem is much more obvious later in the day when eyes are tired. Testing should be done when eyes are tired to ensure that weakness is detected.

These binocular coordination or fusion problems may seem to be physically insignificant, but they are the cause of many errors in the precise tasks of reading and spelling. Eye doctors will often say, after doing an eye examination that a child has a "minor fusion or tracking problem". These MINOR PROBLEMS CAUSE READING AND SPELLING ERRORS!! They may say this because the child has good eye acuity. Eye doctors are interested in the health of the eyeball.

They concern themselves with conditions that cause blindness. Since the eye is mostly moving correctly, it may seem like a minor problem in a physical sense, but it will often cause very bad learning problems in the school. Eye doctors are not teachers and do not concern themselves with education.

At a conference for nurses presented by Wills Eye Hospital, according to Dr.Steinmetz, the ability to cross your eyes is considered to be a good indicator of external eye muscle strength. (3). This could be compared to flexing your biceps, which is considered a sign of arm strength. Parents must pay better attention to the fact that there may be an undetected muscle eye problem that will cause image fusion distortions. This type of deficit causes visual /perceptual difficulties especially with small print. Eye muscle defects detection is usually not part of school eye screening and often remains undetected even with a regular eye exam.

LETTER AND WORD REVERSALS

As children, people with normal vision never see letters backwards. I believe the frequently quoted statement, "seeing backwards is a normal part of development," is a misconception that arose because large numbers of people have this genetic fusion problem. Fortunately, about the same number of people never see anything backwards. I confirmed this fact when I interviewed grade school children over a four- year period. These children did not generally have reading difficulties.

We can conclude that children who have a history of seeing and recording symbols backwards, probably cannot cross their eyes and are very much at risk to have vision related school problems especially with reading and spelling.

About half of the school children in the United States have no trouble learning to read. Many of these children who can read may even have mediocre or low IQ scores. These children have no difficulty spelling and reading, though they may have difficulty with mathematics, depending on their intelligence. The symbols they have seen are stored correctly in their brain. They do not have the stored errors the learning disabled child has, when memory recall is required. Children of lower intelligence without reading problems will give more intelligent, learning disabled, children competition in the classroom. My observation was that this group of students correlated with the students with good eye fusion. Consider the physical process of reading then relate that to literacy.

READING DIRECTION

When reading in the vertical direction, the superior and inferior rectus eye muscles move the eye up and down the page. When reading horizontally, the medial and lateral muscles take over eye movement. Studies that I have read comparing reading styles of Asian students to American students do not discuss the differences in the anatomy and physiology used when people read in different directions. These studies concentrate on cultural and symbol system differences.

In Asian countries where reading is done vertically people have low illiteracy rates. Japan's rate is only 1.5% which represents the portion of their population with severe mental handicaps. All students learn to read through the same methods.

It is obvious that reading problems have little or nothing to do with intelligence or the way visualized symbols are processed. Reading errors relate only to the way images are seen when reading in a system where words are presented horizontally as in English, Hebrew or Vietnamese.

SYMPTOMS/PROBLEMS IN LEARNING DISABILITY

1. SQUINTING OR EXCESSIVE BLINKING
2. COVERS ONE EYE
3. HAS UNUSUALLY GOOD OR “SIDE“ OR PERIPHERAL VISION
4. UNABLE TO CROSS YOUR EYES ALL THE TIME, ESPECIALLY IF TIRED
5. THE PUPIL OF ONE EYE IS SLIGHTLY LARGER THAN THE OTHER
6. SEEMS CLUMSY, TRIPS, SPILLS THINGS, WALKS INTO OBJECTS THOUGH HE HAS GOOD PHYSICAL DEVELOPMENT
7. FEAR OF HEIGHTS
8. HAS MORE BRUISES THAN EXPECTED
9. RIGHT/LEFT CONFUSION
10. DIRECTIONALITY PROBLEMS
11. ONE EYE MAY DRIFT AWAY FROM THE NOSE WHEN TIRED
12. EYES HEAVE DIFFERENT ACUITY (ie. 20/20 LEFT EYE: 20/25 RIGHT EYE)
13. EYE DOCTOR REPORTS “A MINOR TRACKING OR MINOR FUSION PROBLEM” AS A FINDING IN AN EYE EXAMINATION (your physician may not emphasize this problem)
14. EYES “WATER” OR TIRE EASILY WHEN READING
15. “LIGHTS” IN YOUR EYES (CORNEAL LIGHT REFLEXES) ARE NOT IN THE SAME PLACE IN BOTH EYES (one light may be in the pupil of one eye, while the other is in the iris of the other. This may be checked with a disposable camera)

PROBABLY ONLY SOME OF THESE SIGNS WILL BE PRESENT, THE NUMBER DEPENDS ON THE SEVERITY OF THE CONDITION.

These difficulties may vary according to age and developmental level.

When a child sees a group of symbols, they have no idea what order is correct for that group of symbols. Their eyes may have scrambled some of them up in some way. They see them scrambled and they are stored in their brain wrong. They attempt to recall what they stored and it is recalled just as they stored it – scrambled!

A child may hesitate when asked to spell a word since there may be spelling errors as well as the correct spelling stored in his memory. They must address all the word pictures they have stored so that they can choose the correctly spelled word. This is confusing and time consuming. Normal storage consists of only correct spelling.

An example of how this could happen is a child's storage of a word like "geography" which may have erroneous forms such as "goegraphy", "gaegrophy", "georgaphy", "goegraphy", "gaeogrphy","geopraghy", "goeagrphy". All are so similar they are hard to distinguish from the correct spelling. We have not even considered the inverted letter storage possibilities, since they can't be typed!. Choosing the right spelling word would take much more concentration.

Guessing becomes feasible- an easy escape from the mess they have stored in their brain!

These children are under much more tension than those with only one spelling of the word stored. If they thinks they are right they are more likely to answer out of turn in their excitement to be correct. Then they are labeled "impulsive"! After a pattern of corrections in front of the class, they become quiet, then often depressed.

Spelling can also be difficult even if phonics is attempted, when children confuse the phonetic symbol letter with the correct letter spelling. (ie. can/ kan, caramel/karmel, see/cee). Another problem arises when there is visual letter confusion and a similar letter form is substituted for the correct letter as b for d.

Going through these stored spellings errors with their subtle differences is a confusing task for these children, especially under the pressure of a classroom situation. It takes more time to go through a list of words composed from the same word when letters are transposed. It is frustrating and embarrassing for them to make a mistake, but it is very probable one will be made. Storage in the normal reader's brain would only contain one spelling of the word "geography" that could easily be distinguished from other stored words.

The statement, "This child makes careless mistakes" could indicate this child has difficulty distinguishing from a list of very similar symbols. The lack of attention demonstrated by these children can relate to the longer amount of time it takes them to go through all the "trash" symbols in their memory. We know these symbols exist because they are frequently reproduced by the "learning disabled".

The more errors made, the more criticism these children experience, the more likely they will believe they are slow and ignorant. A spiral into apathy and failure may follow this constant criticism. Ironically they may be very intelligent!

Difficulty copying from the board, sustaining attention or problems following directions are symptoms that arise from poor accommodation (getting the eyes to jump from one point to the next and maintain focus). This child may prefer mathematics or science to language or reading. He may have difficulty reading charts, maps or music with horizontal grids. He may have the artistic component to be very musically talented. Many talented musicians do not read music (i.e. Shirley Jones).

These children trip, seem clumsy, spill drinks at the table and may fear heights. They are generally quite accident-prone. I suffered many bruises as a child from walking into objects whose placement I misjudged, not to mention the ballet classes I was forced to attend because I was so “clumsy”. I spoke to one parent who was questioned by school authorities about the bruises her child had. They were also reading disabled. Though we are physically well developed, poor perception of our surroundings causes us to have major problems with object location.

We are prone to bruises because we see false images of objects. We do not correctly judge the location of objects, so we seem clumsy, though if you look at our physical development we are usually normal.

Right/ left confusion, directionality problems and having difficulty with targets, such as hitting a ball with a bat commonly exist. Many of the grade school children I spoke to who had letter reversals, also had right/left confusion.

The reading disability causes them to be at greater risk of developing secondary psychological problems that may include stuttering, attention problems, anxiety, depression, addiction, Tourette's syndrome or even schizophrenia.

NORMAL READER vs. DISABLED READER

Simplistically, normal reading takes place when the reader is able to "see" or distinguish a group of symbols the same way. The symbols are then interpreted by the brain and stored for future reference. Ordinarily the eye is the usual instrument used for perception, however, the fingers may be used as in the "reading" of Braille.

As a reading disabled child reads, their weak eye looses fusion and for a split second wanders to another spot on the same page that may have the same word or phrase as the one they are reading. Instead of continuing to read along the line they were reading, they skip to the place with the same word or phrase and miss the material in the middle. This causes them not only to loose their place, but also to loose the meaning imparted in the writing.

This reader will have great difficulty with the flow and meaning of the material and will be forced to reread in an effort to understand content. They will understand what is read to them much better than what they have read themselves.

They may frequently skip over large quantities of printed material as their eyes jump from one word to the same word, sentences or even paragraphs, when his weak eye wanders to what “looks” like the next word. It is probably the same word in another part of the text.

This problem can be used as another indicator of reading disability.

If you have your child read to you, and they have difficulty understanding the content; but you continue to read the same material to them and they have a good understanding of the context, they are reading disabled.

The degree of difficulty understanding what is read will be determined by the number of times their eye wanders as they are reading and the material they skip over. Understanding will also relate to the child's efforts to reread material they realize they have missed. When the same material is read to the child, they will be able to understand the concepts because the arranged order of the information is correct. This gives us further proof that their eyes are not working together all the time, but their brain is functioning correctly.

EYE MUSCLE WEAKNESS

Heterophoria is the term that means the eyes are not working together as a team. There are different types of phorias named according to which way the eye is wandering. The most common type is exophoria, where the eye moves to the outside or diverges. Esophoria is when the eye moves inward too much or crosses.

Hyperphoria were movement is too vertical.

We are most concerned with exophoria. This phoria is very hard for parents, teachers and even physicians to see unless you know what the symptoms are and check for them when the eyes are tired.

All these symptoms arise from perceptual deficits caused by a weak medial eye muscle control. The muscle is weak because the nerve that sends out the impulse fails to fully work at times. When the nerve signal is incomplete, the muscle does not flex enough to allow complete visual fusion. The eye, held in place by the weak muscle, moves too slowly causing the image seen to split into two, creating a second, incorrect image. The false image may be the inserted letter or word, image of an object like a glass, stair-step or baseball. It is often possible to observe this poor muscle function when the child is unable to cross his eyes satisfactorily and the symptoms of reading disability are present.

The nerve that is not working probably is usually the third cranial nerve which controls many actions like medial eye muscle movement or pupil dilation often symptoms in this condition.

Fortunately this problem seems to be only a partial, intermittent loss of nerve impulse. The degree of loss of nervous stimulation dictates the amount of learning disability. This also explains why these children often have a mildly dilated pupil.

READING PROCESS

As we read, our eyes jump from one group of words to another. This quick movement is called saccadic motion. Saccadic motion occurs so fast that any images seen by the eyes during the jumping motion are blurred out. The rate of this motion is referred to as the" blurring speed". The blurring speed (fast motion) prevents the eyes from seeing and the brain from misinterpreting the information the eyes scan over as they jump from one group of words to the next.

When saccadic movement is too slow, some of the images that are not blurred appear to turn or move.

These images appear to move, but only the eye is moving during the saccadic jump. These moving letters or words are seen and stored in the wrong positions. The effect of weaving and moving is like that of an old fashioned video camera as the view is photographed. Remember, the objects where not moving, the camera was. In this case the print was not moving the eyes were!

We must distinguish between pre brain information errors and those that occur after the information is taken into the brain. I believe most learning problems happen before the images even enter the brain. I believe they go in scrambled because of subtle eye and ear problems.

If you read a notice that said “Santa Clause is the president of the United States” and you did not know who Santa Clause was, this information would be stored in your brain and you would believe Santa Clause was the president of the United States! The information going into your head was wrong. The recall was right, but the fact was not true. There was no brain-processing problem.

The wrong information was given to the brain in the first place!

This is the same problem the dyslexic faces. The information is seen wrong before it enters the brain. There is no reason to expect information seen or heard wrong will somehow go through processing and brain storage and come out correct. It comes out just as it went in- WRONG!!

Pre-brain errors occur when the image is seen wrong because there is a physical problem with the way our eyes move or perceive the images they “see”.

These problems are correctable. Compared to diseases that rob us of our sight, these are seen as minor to the medical community though they impact our self-image, income and literacy for our entire life. Recently I spoke to an eye doctor who stated “that minor muscle problem couldn’t possibly cause all those problems!” I was always able to see that “minor” muscle when I checked children with reading problems! Why?

BLAMING THE BRAIN

Unfortunately, usually brain function is blamed for problems of learning disability and not poor perception. The brain is a mysterious "catch-all" that we really do not fully understand. Therefore no one is held accountable to explain how or why their treatments are successful or unsuccessful. Medicine blame's the brain even though the medial muscle/ nerve deficit can often be seen with a simple physical exam.

It is very intimidating for a parent to be told that their child has a "brain malfunction", much more intimidating than being told their child has "a muscle that is not always contracting properly." Brain involvement usually means slowness or mental retardation that “normal” people do not have.

We are less demanding of treatments that effect brain function because of the mystique we hold about the brain and our knowledge lack about how the brain works. However, if people would realize that the learning disabled child did not have brain malfunction; just a perceptual problem the public would be more demanding and "the reading disease" would be better understood and corrected.

COMPLETE EYE EXAMS

Every person with learning problems deserves a complete eye examination from a competent eye doctor. Unfortunately fusion problems may be intermittent or seem so minor they are regarded as an insignificant problem that will resolve with development as the child matures. Your eye doctor may tell you there is " a minor tracking" or "minor fusion" problem that will disappear. It won’t!

Request a fuller explanation: What anatomical part must mature? What makes it a minor problem? Be aware of the fact that sometimes this minor fusion problem may be so insignificant to your eye doctor that he may not notice it on the exam. This is one reason the eye exam should be done when your child's eyes are tired, in the evening or after a day of reading at school. He should not have taken any stimulants or other medications that could "mask" the symptoms.

When someone is very close to achieving fusion he may have more visual/perceptual confusion because of the closeness of the false and true images. People with a complete "lazy" eye, read without any confusion because the images seen by each eye are so very far apart one is deleted by the brain so no confusion exists. There is no confusion in reading with a true “lazy" eye.

Unfortunately this perceptual problem does not disappear, but becomes hidden as the child's body of knowledge develops. The more he sees a word the more likely he will eventually get it right. This is why the dyslexic child eventually gets the alphabet right. Unfortunately by the time he gets the alphabet right the rest of his class has gone onto other concepts that he misses. He is always behind and easily looses interest in school!

Reading correctly demands "precision eye movement". It would not surprise you if a person with an injured leg fell. You would expect his legs not to work together as a pair because of the injury. The same thing happens when we can't move our eyes with precision, but in this instance we fail! This fusion problem continues to effect learning through the person's life as slow reading, poor spelling and much more. This minor physical defect can cause major reading, spelling and life disasters.

REVERSALS ARE NEVER NORMAL

You may be told that many people write backwards, writing backwards disappears with time, and therefore is not significant. No one considers that people who never write backwards never have learning problems. Children with reading problems, that I have observed, have always written backwards at some time. Children without learning problems have not written backwards.

Many times it is difficult to remember but the person usually can recall writing backwards in their early childhood. If you wrote backwards and overcame the problem, you still are working up to your full potential. You may be a hard worker with a mild dyslexia. Generally I found those who were always able to cross their eyes never had reading problems.

PHYSICAL SIGNS THAT CAUSE POOR READING

Physical signs often seen in these people are squinting, closing or covering one eye or unusually good peripheral (side) vision. When the medial eye muscle is weak the affected eye drifts to the outside and you have more “side” vision. These actions allow the body to eliminate one image that is confusing the brain. There is nothing to fuse with only one image.

Using one eye frequently is harmful because the eye that is not being used may become functionally blind. This extreme condition of medial eye muscle weakness is called strabismus or "lazy eye" disease.

I would suggest always making sure your child's eyes are tired when examined. Have him tested after school.

Always using both eyes as a team is normal. Acuity or sharpness should be 20:20 in both eyes. Acuity imbalances like 20:20 in one eye and 20:40 in the other, indicate a subtle eye problem, possibly a muscle balance problem that should be corrected before vision worsens. You may notice that one pupil is slightly larger than the other.

In rare cases one eyelid may droop a condition, which is called ptosis of the eyelid. This problem is related to poor function of the same nerve that controls horizontal eye motion and pupil size (third cranial nerve). A drooping eye lid may also indicate poorly working eye muscles. Unusually good peripheral or “side” vision is another indicator that the eyes are poorly aligned. A weak medial eye muscle causes this condition.

Your child should be able to cross his eyes. Eye crossing indicates that the medial eye muscles are working well according to a pediatric ophthalmologist from Wills Eye Hospital Dr. Steinmetz. Unfortunately, recent writings have "watered-down" these criteria. Almost crossing your eyes can cause many reading problems.

It has been my experience that eye crossing ability is essential, if you expect people to have enough muscle strength to read accurately. Students that were good readers, were able to cross their eyes and hold them crossed for 15 seconds. Many children can do this.

Eye crossing is accomplished by flexing the medial eye muscles. The ability to flex these muscles, especially if they are tired, indicates good muscle strength. If there is a weakness on one side, that eye will not cross as completely as the healthy eye muscle, indicating an imbalance.

My experience leads me to believe that eye muscles must be strong enough to do slow eye crossing 100% of the time, whenever reading is attempted, to have the capacity to read without making mistakes. Reading is always a precision task. The eye muscles must work together all the time for accurate reading to occur. Readers who have good eye muscle control do not make mistakes!

HOW TO TEST FOR GOOD FUSION

To determine if your child can cross his eyes you need a pencil with a distinguishable eraser or push pin on top. The child should be tested when his eyes are tired. After school is a good time. Use a well-lighted area. Stand about four feet away from the child. Hold the pencil at eye level. Move very slowly toward the child as you ask, "How many erasers do you see?" Continue to move toward the child and repeat the question. Watch his eyes carefully. They should cross when the pencil gets to the bridge of the child's nose. The child should always see one pencil with one eraser as he focuses on the pencil. If he can do this, his eye muscles should be strong enough to read correctly. This test should always be done when your child's eyes are tired. Many more mildly malfunctioning muscles will then be identified. A mild muscle deficit may actually cause more visual distortions than a greater muscle deficit.

If the child is unable to cross his eyes completely, measure the approximate distance from the place where “two erasers” are seen to the bridge of his nose. You may notice that the child was starting to cross his eyes but as the pencil got closer, his eyes no longer continue crossing. This point is to the point to begin measuring. The stronger the muscles are, the closer to complete eye crossing the subject will get.

This measured distance should continue to get shorter as muscle strength improves, regardless of the therapy you choose to correct this muscle/nerve deficit. You can use the distance from where two images are first seen to the bridge of the nose to determine if the therapy you have chosen is working. This measurement should be recorded and reassessed as the child progresses through the chosen therapy.

When the measurement gets very close to the bridge of the nose, your child may experience an increase in the amount of visual confusion. At this point similar images from each eye are very close together, but are not yet meshing into one picture.

Though these people may be experiencing a lot of perceptual problems, normal fusion is often very close. When fusion is accomplished, this visual confusion should disappear completely and stay away as long as complete muscle function is maintained.

Another way to check eye alignment is to look for the corneal light reflexes (the "lights") in your child's eyes. To do this check, shine a pen flashlight in the center of the child's face. If the child is looking straight ahead at the light, the "light" in each eye should fall on the central portion of each pupil. If the "lights" are not in the same spots in each eye strabismus is present. Remember this may miss be with intermittent strabismus.

A cheap method using a flash throwaway camera may also be used to show these.

THE ‘EYE LIGHTS’ OR CORNEAL LIGHT REFLEXES ARE EASILY SEEN HERE

(This picture was taken with a disposable camera after 10 days of electrical stimulation therapy) "lights". Remember to make sure the child is tired, then take a picture of the child's eyes as he looks straight ahead with you right in front of him. You could also take this picture to your eye doctor to help with the diagnosis or keep these photographs and do update photos to make sure to make sure improvements are made with whatever treatments are used .

Smoothness of coordination among the eye muscles may be assessed with the points of gaze test. Testing is easily accomplished by having the subject moves his eyes through the six points of gaze as described earlier.

These movements should always be smooth. Jerky eye movement indicates a tracking problem.

As eye exercise programs or other therapies are implemented there should be measurable improvement. The observer can usually assess how much eye muscle strength the child has by just noting where two images are seen. As the muscles are strengthened you will be able to measure muscle improvement because the distance from the double image to the bridge of the nose will keep getting shorter. Eventually the person will finally be able to cross their eyes. The closer the image from the right and left eye come before converging the more confusion the person may have until the images finally converge.

In the case of extreme weakness this could take a year. However, in most cases it should take only a few months. Keep good records.

CHECK FOR IMPROVEMENT

Estimate the distance from where two images are seen to the bridge of the nose. Record the result with the date the measurement was taken. Repeat the measurement about every week while you are undergoing eye muscle therapy. This number should get smaller as eye muscle strength improves, until the subject can cross his eyes and keep them crossed for at least fifteen seconds. The points of gaze test should be accomplished more smoothly and easily with any effective therapy. Improvement in school performance is also an indication that the treatment you chose is effective.

Remember as the images seen by each eye get closer together due to improved muscle action, more perceptual confusion will result from this closeness until the images finally mesh. Visual confusion should resolve when complete fusion is achieved. This can happen quickly with electrical enhancement or increased magnification.

TEST FOR READING RATE AND COMPREHENSION BEFORE THERAPY

A simple test to check reading rate and comprehension can be done by using your child's reader or other reading material on his reading level. Before any therapy is started; tape- record your child reading a selection from his reader.

Time his reading for 5 to 10 minutes. Count the words read in a few paragraphs or a page. Divide by the number of minutes it takes to do the reading. This will give you the number of words he reads per minute, that is his reading rate.

Listen to the tape carefully and count the mistakes he has make in a specific number of lines. Count mistakes as deletions, insertions, hesitations, skipping or failure to follow punctuation.

Words Per Minute

Math:

Divide # of Words Read by the # of Minutes it took= Words/Minute (reading rate)

# of Words Read

______________ = Words/Minute Rate Time in Minutes

Tools:

You need an age appropriate reading sample You need a stop-watch or clock with a second

hand

SAMPLE:

320 words

______________ = 80 words/minute 4 minutes

Record both the number of mistakes made in the sample. Choose a specific amount of reading material to test. Each time you do testing use about the same number of words as your sample. Continue to use the same story or book but start in a new place each time.

Comprehension can be checked by asking the child questions about the story. Have him read a part of the story or book, then you continue to read a part of the same story or book aloud. Question him on what he read, then on what you read aloud. Follow the “who, what, where, when and why” line of questions used by reporters to get a general idea of comprehension. You should compare what is understood when he reads, to what is understood when you read part of the material to him. If his understanding improves when you read to him, he is probably loosing his place while reading to himself. Losing his place causes him to miss some of the information and misunderstand what he has read.

If you use a 300 word sample to tape, then continue to count 300 words in each succeeding test sample. The reading sample size will depend on the child's ability to read. Ignore any extra reading on the tape. It is important to get a typical reading sample, no matter where it is in the material that is read.

You may want to allow your child to read a couple of lines to " warm up" before you start counting to get a more accurate reading sample. Using a taped sample with a written copy of the material being read, allows you to count out the number of words after the reading is taped. You can also listen to the tape again to count the number of reading mistakes.

Keep these tapes. Label the sample tapes with the date. As your child goes through the therapy/ therapies you have chosen, go back and listen to the old tape. Compare it with his most recent reading to get an idea of the progress attained. If improvement is not being made to your satisfaction, choose another therapy or combination of therapies for your child.

It is important to remember the faster this problem is corrected, the fewer the number of mistakes that will be stored in your child's brain and the fewer problems he will have with learning tasks. Schools should also be taping reading samples to keep a permanent record of your child's reading progress.

There should be definite improvement with any chosen treatment.

Reassess and record at least each month, weekly would be better. Keep a written record of reading rates, the average number of errors in a line and the taped reading. These records will help you know if good improvement is being made. Progress that is recorded in some way, can also be used to instill some confidence of ability back into your child. A reading rate of three hundred words per minute is considered to be normal for an adult.

In my opinion no test should be used to determine your child's future.

Your child's physical disabilities, hearing, and eyesight, both past and present, should very carefully be determined and reviewed as probable causes for learning deficits. Intelligence must also be considered. Corrections must be made for physical deficits and time must be given for these corrections to become effective before any life altering judgments should be considered. NO LABELS!!!

TREATMENTS FOR READING DISEASE

1. PASSIVE EXERCISE- Patching the good eye. Treatment often used by ophthalmology

2. ACTIVE EXERCISE- An exercise program that may involve Specific exercises and computer activities, that train the eyes to move increasing muscle size and improve tracking patterns. Usually done by optometry

3. FAST FOR WORD PROGRAM- improves eye movement and eliminates stored mistakes through repetition

4. MAGNIFICATION- allows fusion to take place more easily

A. Magnifying glasses, sheet magnifiers, or “stress reliever” lenses

B. Large print

5. CHEMICAL STIMULANTS- increase muscle tone

A. Drugs- Ritalin, Clonidine, Adderal, Clyert, Desonyx and Dexedrine are a few of the many drugs prescribed for Learning problems.

B. Beverages containing caffeine coffee or cola

6. EDUCATIONAL METHODS

A. PHONICS- uses the ears instead of the eyes, avoiding eye image fusion problems

B. AUDITORY PRESENTATION- much of teaching involves lecture type teaching where the student listens to the information

C. Tape recorders, movies

D. TACTILE / KINESTHETIC METHODS- use other nerve pathways to reach the brain. These include using sand or clay letters and touch

E. STUDY WHEN EYES ARE RESTED- Read when you first wake up

7. ELECTRICAL STIMULATION-adds electrons to the poorly innervated 3rd nerve, improving muscle tone and function. Not currently available.

ALL TREATMENTS WORK TO ALLOW IMAGE FUSION BY IMPROVING MUSCLE OR NERVE FUNCTION OR MAKING FUSION EASIER TO ACHIEVE

THE TREATMENTS CAN BE COMBINED FOR FASTER RESULTS REMEMBER THE OLD MISTAKES STILL HAVE TO BE ELIMINATED FROM BRAIN STORAGE

Parents must understand how treatments work and must question everything that affects their child's ability to learn to read. Learning is key to success and no one has the right to alter the outcome through authority or pressure. We have to question any authority that is trying to make decisions for our child's future. How accurate is their information. What tests they did use. Why do they think their judgment is appropriate. Don't let your child get boxed in to a place he does not belong based on testing that is in vogue today.

EXERCISE TREATMENTS

Obviously the way to eliminate these visual/perceptual problems is to strengthen the eye muscle/nerve complex so that fusion will always be accomplished. Active range of motion exercises is helpful. These are exercises that moves the eye through its normal daily activity. These are just the same kind of exercises as any simple exercise program you do in your living room to tone your thighs. Exercises can be done at home or with the help of an eye exercise program conducted by an eye doctor. Usually this kind of therapy is done by an optometrist.

Eye tracking exercises, like ball pursuit exercises, are effective if done conscientiously. p.440 (3). All the muscles that move the eye can be strengthened easily. These exercises have the child follow a ball with there eyes. Video games like PAC MAN, that cause the eyes to track from side to side are helpful. You should remember that active range of motion eye exercises put the eye muscles through the same activity they should normally be experiencing during usual daily activities.

Passive eye activity is accomplished when the ophthalmologist patches the strong eye muscles; this allows the weak eye muscles to exercise passively. The weak eye exercises as it moves to see. The patched good eye is not exercised during the period of patching. This strengthens the weaker eye, while the patched eye looses muscle strength. The hope is to balance the eye muscle function, allowing fusion to be accomplished.

EYE EXEERCISE INSTRUCTIONS

Items Needed:

A ball, such as a tennis ball - a fishing bobber would also work

Strong string, about 9 feet

2 eyehooks to hook the ball to the string and suspend the string from the door jam or ceiling (any other method that will allow you to suspend the ball from the door jam or ceiling and allows it to rotate is fine)

Something comfortable to lie on

Assembly:

Insert the screw eye into the tennis or handball.

Tie the string into the screw eye.

Insert the other screw eye into the ceiling or door jam. (There must be enough space to let the ball swing freely so that it can swing in at least a 1 foot circle)

Tie the string through the second eye to a length about 1 1/2 to 2 feet off the floor (The ball must be high enough to allow the person exercising to lie underneath and be able to rotate the ball with one hand while he covers one eye with his other hand). A parent may rotate the ball for a younger child.

Exercise:

Exercise by lying directly under the suspended ball.

Move the ball with one hand in a circle so that you can always see the ball as it turns in the circle. Cover the left eye. Follow the ball with the uncovered right eye, as you make the ball move clockwise for 2 minutes.

Then follow the ball counter clockwise for 2 minutes with the same eye.

Cover the right eye and repeat the process 2 minutes in each direction.

Record:

Keep a record of the dates the exercises were done and the time spent.

Record the distance your eyes were from complete fusion on the Fusion Test Chart.

As you exercise, test your reading improvement. Record this information on the Reading Progress Exercise Table.

Record your original reading rate and error rate, then exercise 1 month before you begin to check for improvement.

Try to be consistent about when you do reading testing. Use the same level of material and test about the same time of day to ensure that the person is tested under the same circumstances. This will make the comparisons more accurate and will give you a truer picture of muscle and possibly even nerve function improvement.

This exercise strengthens all the external eye muscles that move the eyeball.

ALWAYS REMEMBER AS THE IMAGES SEEN FROM EACH EYE GET CLOSER TOGETHER, MORE CONFUSION WILL RESULT UNTIL THEY MESH TOGETHER INTO ONE IMAGE AND FUSION IS COMPLETE!

NEVER OCCLUDE ONE EYE TO ACHIEVE READING SUCCESS

THAT WILL CAUSE THE READER TO BECOME LAZY- EYED

However, if one eye is covered as a test and you notice improved reading, then you know your child is seeing two images at times. You must seek help from an eye doctor. Never let this condition continue without some therapy. Make sure the therapy is affective by noting improvement in reading. Use the suggested testing methods.

Neither passive or active exercise programs addresses the neurological cause of this muscle dysfunction. The muscles are affected as long as exercise is done. Muscle function may revert back to its former state unless the problem of nerve dysfunction is somehow addressed. At this time there is no permanent cure for the weak nerve signal in this condition.

MAGNIFICATION OF PRINT OR LENSES

Magnification accomplishes fusion more easily by reducing the amount of contraction that medial eye muscles must do to accomplish image fusion.

Magnification can be done with simple magnifying lenses or also enlarging the print being read. We do not see two houses or two people; we see ghost images when the print is small and close together. The number of these false images that confuse us can be reduced or eliminated with magnification. The use of magnifying lens or using enlarged print as we are reading allows fusion to take place more easily.

I preformed a test using the same story in two different print sizes, the adult subject read 60 words per minute faster just by enlarging the print.

Magnifying lenses can be prescription glasses, sometimes called "stress reliever lenses", hand held magnifying lenses, over the counter reading glasses or other magnifiers.

The effect of print size on reading becomes evident when children who may not have been considered learning disabled, suddenly have a great deal of reading difficulty. This usually occurs in the second or third grade when the print in their reader gets smaller and closer together.

Take note of the print size when " reading " problems develop. Parents should be made aware of this problem and protest for larger print books in school. Always remember "trash symbols" are still being stored in the brain and may cause reading and spelling errors!

These are valid observations. It is interesting to note that the print in school text books gets smaller at this time. Your child has already been traumatized by the school environment each time he has innocently gotten a letter reversal or accidentally tripped or spilled something. These incidents are very traumatic to a child even when they are not accompanied by adult criticism. The sensitive child is aware of his failure and associates it with school.

The large amounts of criticism experienced by the learning disabled population will contribute to their dislike of learning. Scaring occurs with the erroneous label " learning disabled" when it should be "perceptually impaired". If a child came to school with a cast on his hand no one would expect him to write; yet learning-disabled children go to school daily with poor visual perception and a head full of "trash" symbols and are still expected to read while competing with children who are not perceptually impaired.

EMOTIONAL PRESSURE FROM MISSED DIAGNOSIS

A child has every reason to try to please his parents and teachers.

Emotional and tangible rewards such as love, praise, acceptance and toys come from success, not to mention the reward of achievement which increases self esteem. Children are normally highly motivated to please their parents and teachers. This is usually very evident in the three through six-year age group.

We must ask ourselves why would they not still be trying to please us? The answer is very obvious in most cases. They have a physical problem that does not allow them to perform to our expectations.

Unfortunately this problem is so deeply hidden from parents, teachers, and health professionals that it has been misinterpreted as laziness, indifference, distractibility, or lack of focus. The more often the child experiences negative criticism from the mistakes he makes, the lower his self esteem and the less his desire to succeed. After all, the grown-ups must be right! Going to school to him is more like going to war- a matter of survival!

Your child knows what he sees. He reports what he sees by the way he reads, writes, or spells. Then he is criticized for the mistakes he makes. He "realizes" he can not rely on "himself" so he tries to please us by guessing or faking. This practice is very bad for his emotional well-being because it is close to telling a lie, but it gets him "off the hook" especially if he does get the right answer. The pressure is always on this child whether it originates from teachers, parents, peers or the child, himself.

COLUMNS/ VERTICAL READING

Selecting reading material that is arranged in narrow columns instead of long lines of horizontal print will help. In this case the eyes are mostly tracking in a vertical path using other neuro/muscular pathways. Examples of this vertical arrangement are used in most newspapers and magazines. I'm sure publishers inadvertently publish this way because it sells better than horizontal print without columns.

STIMULANT DRUGS

Another popularized reading help is the use of drug stimulant therapy.

This is not advertised as a reading aid. It is considered to be a way to calm and focus the attention deficit, hyperactive population is frequently learning disabled. When drug stimulant therapy is used the entire body is medicated. Eye muscles are an incidental part of the therapy. Stimulants create an increased tension on the eye muscles allowing them to work as they should.

This muscle tone improvement can be tested with the simple fusion tests mentioned in this book. Unfortunately you have to drug the whole body to get this effect on the tiny medial eye muscles. Is it really necessary to drug the learning disabled child who has a problem sitting still in class due to the confusion from his learning disability?

The drugs of choice are stimulants. They are being used to "calm" the child. We are told no one knows how they work. All the other stimulant drugs I dispense as a nurse, work as stimulants. Logically, so should these. They are stimulating all skeletal muscle tissue including very tiny muscles that move the eyes.

The effects of using Ritalin, a drug related to the amphetamines, or other controlled substances have not been well examined in young children. The length of time drugs must be taken, the expense and long term physical effects should be considered before beginning drug therapy. Are these drugs possibly gate way drugs that may cause later addiction problems? Unfortunately morbidity has even been linked to the proper administration of stimulants in a few cases.

EXTERNAL ELECTRICAL STIMULATION

Another method of treatment that is still experimental, employs external electrical stimulation that immediately causes image fusion to take place, eliminating the need for drug use etc. This method works by supplying the missing electrical signal to the affected muscle. The only side effect seems to be muscle fatigue that is due to the exercise of muscles that are finally being effectively exercised. The eye muscles can be strengthened through regularly induced exercise retraining by enhancing the nerve /muscle complex. It is hoped that the nerve function will also improve.

The advantage of electrical stimulation is first that only the necessary amount of stimulation is employed. Second that the stimulation is delivered only to the area where it is needed, unlike drug therapy that affects the whole body. Third that electric stimulation uses electrons that already are an important part of human physiology.

EDUCATIONAL METHODS

Educational methods may also be promoted as a cure for literacy problems.

Normally you would expect educators to correct literacy problems but these problems have a medical root. The effectiveness of your child's education does not depend on the teacher as much as it depends on the degree of disability your child has. Teachers may recognize the existence of this condition but are at a great disadvantage to remediate the problem. Teachers are educators and not medical experts. They should not be blamed for medicines failures. This disease is caused by a palsy. If your child had a large muscle palsy of his legs, would you take him to school and ask his teacher to teach him how to walk? If not, then how can you ask his teacher to teach him to move his eye, so that he can read? The therapies that work all improve muscle function in some way, even the educational approaches. This is not an educational but a physical problem.

When you consider lack of knowledge about learning disability, poor rate of diagnosis and treatment, basic IQ differences, genetic dominance and then compound the problem with ideas like mainstreaming, and pretending learning disabled doesn't exist unless the child is at least they are two years behind in his reading- you have a disaster.

PHONICS AND EAR FLUID PROBLEMS

Educational methods are addressing some of the symptoms. Phonics is a very commonly used technique. Phonics uses our auditory sense to improve learning.

The phonetic approach assumes that the child's hearing is normal. In truth the child's hearing is often less than normal. Unfortunately the most common cause of sick visits to the pediatrician for the young child is middle ear infection.

When the child develops a middle ear infection they are usually treated with an antibiotic that cures the infection but does not restore hearing loss due to fluid accumulation behind the eardrum. The antibiotic kills the infecting bacteria, if it has been taken as prescribed. Unfortunately fluid often still remains behind the eardrum.

My experience has been that this fluid accumulation may take as long as three months to reabsorb. I noticed this when I did repeat hearing tests on children who had been treated for ear infections. While absorption is taking place, there may be some degree of hearing loss in the affected ear/ears. The affect is similar to having water in your ears. It becomes easy to understand why a child with frequent ear infections will have some hearing deficit that effects his learning and speech. Soft phonetic sounds are usually the first to be distorted.

Parents must be taught about the extended period of time fluid re- absorption can take. Even a conscientious parent may not be aware of how this fluid impairs hearing temporarily and may assume that the child is hearing normally because he was treated with an antibiotic. The hearing loss can be severe, affecting one or both ears for lasting several months.

Parents should insist on a school hearing screening after a middle ear infection. They should be aware that there is a relationship between this type of temporary hearing loss and delayed or impaired speech.

If you don't hear a sound correctly, you will store it and reproduce it wrong. The task of correcting the miss-learned sound can begin only after the sound is heard correctly and the wrong sound is deleted from memory.

The teaching staff is often unaware of this temporary loss and assumes that the child can hear as well as before the infection. Schools make no special provisions for learning during this long period. Some children may miss a lot of instruction depending on the number of episodes of middle ear effusion the child has.

Until fluid absorption takes place the child is not hearing normally and may be inattentive or disruptive. Class seating changes and individual attention at school and at home may be helpful until complete hearing returns.

Middle ear effusion may also be related to blocked eustachian tubes that can occur without infection. This fluid collection called serous otitis is usually related to allergies. Painless serous otitis is difficult to detect.

Unfortunately the problem of middle ear fluid will impact on a child's ability to master phonics.

Many children who are not hampered by middle ear fluid problems succeed very well with phonics. Remember that middle ear infection is the most common reason for early visits to the pediatrician that are most prevalent when speech is developing.

Treatment should be sought as soon as ear infection or hearing problems are suspected. There are many treatments. Antibiotics are used for the initial infection. Tubes and even laser therapy may be used to quickly remove the fluid.

New vaccines to avoid the initial infection are being perfected.

SYMBOL/SOUND STORAGE CONFUSION

Another less obvious problem exists when the phonetic approach is employed causing symbol and sound storage confusion. This problem occurs when there is difficulty determining which symbol goes with which sound. Symbol confusion occurs from the similarity of symbol forms in the alphabet. If the phonetic sound is stored with the wrong visual symbol it may be very difficult to correct since both visual and auditory learning are involved. If you are not visually sure "b" is "b" or "d" is "d" you may have stored the wrong sound with the wrong symbol. Correct recall will be confusing.

Consider the visual confusion a child may already have when so many symbols look similar: a,c,e,o; b,d,p,9,q,f; E,W,M,3. The alphabet as well as numbers should always be presented in very large print to help avoid storing errors in the child's memory. How many shapes of the alphabet could a child with a fusion problem store? The number is endless! Symbol/sound storage confusion will also invalidate intelligence testing based only on hearing.

OTHER TREATMENT METHODS

Other educational methods such as tactile (touch) and kinesthic (motion) that involve other nerve pathways and other areas of the brain may also be helpful. A combination of several of the previously mentioned techniques should be tried to improve reading and learning in general.

Neurofeedback is considered a possible option to drug therapy or possibly to be used in combination with drug therapy. The goal is to "stabilize” the over arousal or under arousal through regulation of electrical charges and blood flow in the brain. This therapy costs between $ 1,200 and $10,000.

Surgery may be considered in some cases of oculomotor nerve palsy, if the muscle imbalance is obvious. When surgery is done, it is considered to be cosmetic, and you can not expect improvement in academic performance. Surgery costs about $8,000 for each attempt.

HOW IMPROVED LEARNING TAKES PLACE

Strengthening the weak eye muscle through exercise improves the ability of the eyes to work as a team allowing the image seen by each eye to fuse into a normal three-dimensional picture.

Magnification increases the size of each image thus reducing the amount of eye muscle strength needed to accomplish fusion.

Stimulant drugs like Ritalin assist with fusion by increasing the tone of the defective muscle, increasing tone will increase image fusion.

Reading in columns allows the reader to use the unaffected rectus muscles, rather than the defective eye muscles. Since the rectus eye muscle is not diseased there is no reading deficit. This explains why reading is not a problem in countries like Japan where reading is done vertically.

Phonics uses the sense of hearing that effects the auditory area of the brain- reinforcing memory in another way. Phonics can be helpful if hearing is at least 15 decibels or less in each ear. A loss of 15 to 25 decibels is considered a slight hearing loss. (When hearing is measured the larger numbers mean the loss is greater).

Kinesthetic or tactile (motion and touch) methods also reinforce memory by stimulating other areas of the brain, which sense touch and motion. Other nerve tracks serve these types of stimuli.

Electrical stimulation therapy improves reading by boosting nerve function that in turn improves medial muscle function (2). Very little stimulus is needed because the muscle you are improving is very small. Its job is to move the eyeball with the help of other muscles.

MILD STRABISMUS- A DOMINANT GENE

Genetic dominance means only one gene is needed to produce the disease condition. If two people have only one gene for learning disability between them, one of them will be learning disabled. The learning disabled parent may not be aware of the problem because of the way he has compensated. He may be using one eye to read. He may have very mild disability. He may be a mathematical whiz. He may do most of his learning by listening.

When these people have children each of their children will have a fifty per cent chance of having the learning disability if only one parent has one gene.

If each parent has one defective gene each of their children will have a seventy-five percent chance of having a learning disability. When you consider if one parent has two genes for this disease all their children will have the disease to some degree. Their children will pass the gene to at least to half of their children if no more defective genes are introduced.

Considering the way learning disability effects chances for success, it is very likely that these people will be found in areas where poverty prevails such as the inner city.

Carrying this thought one step further, since people in poverty are likely to be confined to their own neighborhoods. They are more apt to inner marry making them more likely to have more genes for learning disorder. Unfortunately their learning disabled children are much less likely to break out of poverty since the presence of the gene for strabismus is linked to learning disability.

Families usually can identify members with "lazy-eye".

A sad note when looking at test scores in Philadelphia I noticed that 80% of the 5th grade did better on the math section of the PSSA tests than reading. I then tried to make a correlation to 11th grade only to notice that the enrollment in 5th grade was 216,228 while the enrollment in 11th grade had dropped to 57,181.(4).

Again I think that we should be questioning why math scores are higher than reading scores in such significant number of children. Why is reading harder when it should be easier, or are we all math wizards?

Learning disability is probably the most costly disease the population has because of the way it robs the individual of his future successes. Every effort must be made to eliminate this hidden condition.

REASONS WE ARE BETTER IN MATH AND SCIENCE

Learning disabled people usually do better in science and math. This phenomena is very evident in the standardized tests that are taken by our school age children. Tests like the California Achievement Test and the Stanford-Bennett reflect a large group of students who seem to do better in mathematics and science than in reading and language arts. Obviously there are some very talented mathematicians who also excel in language.

On the contrary, someone who is intelligent enough to do math should be doing better in reading. Why aren't they? Unfortunately we should look at these scores realizing that they really show students who could do much better in reading, language and spelling, all are easier subjects than mathematics and science.

The principles of reading and language are learned in elementary school, while many of the difficult concepts of mathematics and science are not understood until high school and beyond.

When symbol systems are first introduced to children, mathematics has the advantage of only having ten symbols that are distinctive. The alphabet has twenty -six letters many with very similar forms. When you are five years old letters are confusing.

The second point is that mathematics is a system that is first taught in an up and down direction, not across the line as spelling and reading are taught. Another muscle/ nerve complex is involved that obviously does not have a neurological deficit.

The last thing that must be considered is related to the concept of success and reward. The child is more likely to have early success with math because it has fewer symbols to learn and it is presented in a vertical format when first introduced. Therefore he is more apt to be rewarded for his performance in math. This success will probably spur him on to do more math. Science is another area where the intelligent, learning disabled person will find rewards as he progresses in school. Scientific material is usually condensed, so a small amount of printed material gives the reader a lot of information. If you have a reading disorder you are less likely to read a novel, but more likely to read scientific writing, poems or short stories. These are condensed forms of reading material that may use a columns format.

Column reading uses mostly vertical eye movements. The muscles controlling these movements have no neurological defect.

People with this problem often have eyestrain that may cause discomfort or eye watering when even small amounts of material are read. These physical symptoms discourage reading for reasons that may not even be obvious to the reader. The reader may relate this discomfort to a dislike of reading and stop the way one might stop singing if he had a sore throat.

At the least reading scores should be equal to math scores, they should really be a lot better than the math score, if you consider the difficulty of the subjects involved.

DEVELOPING FAILURE LOW SELF ESTEEM AND DEPRESSION

Since learning failure is the largest problem related to learning disability, it is very obvious that this side effect causes lifelong disaster, unless remediated.

The first type of problems you may notice are clumsiness, tripping and falling caused by the false images seen by the child. The tripping and falling creates insecurity about the placement of objects in your environment.

Falling when we begin to attempt walking puts us at risk for injury. With 20:20 vision, we still haphazardly dance through our environment like Mr. Magoo.

Labels like "clumsy "and "careless" arise from tripping up the steps or walking into things. We are always "tripping over our own feet" or some other distorted image. We learn to accept bloody knees and broken bones as a matter of course.

One way we protect ourselves from criticism is to play roles like the "clown " to cover our clumsiness.

Difficulty hitting targets, like a ball in front of your father or friends may cause embarrassment. Self esteem drops when you are always chosen last at the ball game because it is difficult to "see" where the ball really is.

The children that I observed often compensated for this deficit by choosing gross motor activities like swimming, running or soccer that uses a large ball.

These children spill their milk at mealtime as they go to grab the image they think is the glass, only to find it is the " aberration" of the glass. As they go to grab it; they hit the real glass spilling the contents. Even if you have an understanding family; this still creates a scene that is uncomfortable for any child.

A very big problem arises because the child really believes that he is seeing the correct image. There is no way to separate correct from incorrect images. He is told by adults that what he saw was wrong while his brain is telling him what he saw was right! A real emotional crisis arises when you can't believe your own eyes! You want to get it right for the adults you are trying to please.

When formal learning begins, the child who may seem very bright to his parents, will begin to make many, many mistakes. Each mistake will carry with it a " failure", "stupid" or "lazy" label, that is internalized by the child. The more failure labels these children accumulate, the more they believe they are failures both in and out of school. They fail the family because they cannot succeed academically.

The harder they try, the more they probably will fail because the emotional stress causes the medial muscle/ nerve complex to fire even less efficiently. When they take a test, try out for the team, read for the school play or try to read music, failure is almost certain especially since they already have a history of failing. The stress of the situation causes even greater eye muscle malfunction. Our literacy statistics should be as good as the Japanese.

The loss of self-esteem and dignity from this problem is to blame for much of the childhood and teenage depression. Depression is closely related to failure. We must remember how frequently each day this child faces potential failure. He not only fails his parents and teachers but also fails himself each time. The worse part of the whole problem is that he thought he was right because that is what he saw!

Obviously, if the child no longer has the symptoms of learning disability, he will be able to work up to his full potential. If he has a low IQ, he will still have a sense of fulfillment because he is working up to his capacity. When a child is working up to his potential, he is satisfied with himself and is no longer likely to be distracted or disruptive in class.

Disruption is more apt to occur when a child with a higher IQ is unable to satisfy his intellectual curiosity. His performance is stuck at a low level due to poor visual perception. The higher his IQ, the higher his level of frustration because he expects more of himself, while others expect more of him.

DETECTING IMPROVEMENT

We are accustom to physical symptoms being more overt as they are in most other disease conditions. A physical problem usually does not coexist with an intellectual deficit. Correction is more difficult to understand because of the relationship between the seemingly minor eye movement problem and the major intellectual problems created by the resulting perceptual distortions.

Improvement in physical symptoms such as better fusion, improved eye movement, less clumsiness and improved depth perception are also very hard to discern by the infrequent observer.

The muscle that is being corrected is very small and not visible due its location in the head. This makes it more difficult to relate improved learning to improved muscle status. You will never be able to see an increase in muscle size or palpate the muscle for improved muscle tone because of its location in the head. You can only observe an increase in muscle strength by checking to see if the muscle is strong enough to cross the eyes and move the eyes smoothly as a team.

Improvement in school performance may still be the best indication of successful treatment even to a professional engaged in helping your child. It must be noted that stored mistakes will not go away as soon as physical symptoms disappear. These "garbage" images take a lot of repetitive correct images until the brain finally "forgets" the bad storage.

A REVIEW OF TREATMENT

All treatments improve literacy by improving fusion or reducing "trash" symbols. Each treatment effects the medial nerve /muscle complex in some way or helps mistakes fade from memory. A combination of therapy would be the fastest remedy.

Muscle exercises increase eye muscle strength that improves image fusion.

Better muscle strength allows the images seen by each eye to fuse into one picture. These exercises must be completed to the point where fusion is always 100% correct. We must always see only one picture!

Magnification helps because it enlarges each image making fusion easier.

The learning disabled child only has problems with small images and accommodation. One example where accommodation is critical is copying work from the blackboard. Blackboard work goes from large images carried through a distance and written in smaller form. This is like an acrobatic exercise for the weak medial eye muscle. At the same time the lenses of the eyes must go through the process of accommodation .

Large images are stored correctly. We never see scrambled houses or cars only scrambled letters or small objects such as those presented in a non verbal reasoning test. Magnification improves reading by reducing the amount of muscle strength needed for fusion to occur. Enlarging the print allows the weak muscle to accomplish image fusion more easily. Always use large print to avoid mistakes.

Just as your electric lights may dim during a partial power failure, so does the medial eye muscle contract intermittently with partial electrical flow.

Electrical stimulation therapy prevents this "brown out" effect by adding electrons to the intermittently working nerve. The nerve can then stimulate the medial muscle correctly. The medial muscle works properly causing fusion to be accomplished, that allows normal eye muscle function and correct perception.

Drug stimulant therapy such as Ritalin works by improving the muscle tone of the medial muscle. Unfortunately, it stimulates the rest of the muscles in the body as well. While increasing tone is not listed as a drug effect, the symptoms of overdose listed include "hyper reflexia, tremors, muscle twitching,... other sympathomimetic effects." P. 881(50). These are symptoms of too much muscle stimulation.

Using stimulant drug therapy introduces children to regular drug use at an early age and may cause future patterns of drug dependence. Ritalin has a short-term effect and must be taken frequently. Ritalin can be expensive depending on the dosage and the length of treatment.

Educational efforts improve literacy by several means. Repetition can be used to improve incorrect storage. This method is used in any visual or auditory approach. Education may employ other senses to reinforce or correct stored information by using more nerve pathways.

When educational methods employ other senses such as hearing, the way that sense functions must be considered. If the child is also having a problem with hearing and is relying on his ears for information because he has made many visual mistakes, his success will be dependent on how well he can hear when information is presented.

Hearing will be sporadic if he gets ear infections or has silent serous otitis from allergies. Unfortunately, by the time these problems are uncovered and corrected, the child may already have a large intellectual deficit. The problems from serous otitis may never be noticed because the child is often pain free. Fortunately a new vaccine is being developed that will eliminate the causative bacteria in a large number of ear infections.

Temporary hearing loss often leads to language delay and speech problems. Ear effusion (fluid) reduce hearing similarly to having water in your ears or like having your head under water. First time parents may not realize their child is having a language delay since they usually do not have an understanding of where their child's language development should be. Working parents have less time to observe their child. It is difficult for other caretakers to make significant observations because of time limits, lack of knowledge about symptoms and a lack of familiarity with your child.

Parents should be aware of the relationship between middle ear fluid problems and speech and language problems. Remember there can be as much as a three month hearing loss with each ear infection. No one can determine the quality of what your child is actually hearing during this time.

The best treatment for this condition would be a cure for third nerve deficit that causes strabismus. This treatment has not been developed to my knowledge. Muscle training programs are helpful. They work by improving muscle tone and strength. Remember the muscles you are trying to impact are very small.

They are only responsible for lateral movement while two other muscle groups control vertical and oblique movements. Six muscles control this lightweight eyeball; compare this to the large muscles that move the bones in our legs.

This will give you an idea of the differences in the magnitude of the exercises needed. You can understand a great deal of the problem is the lack of good nerve impulse.

Muscle exercises done at home can be very effective and cost less than optometric programs. What must be considered is that you are doing range of motion exercises. This means you are putting the eyes through the tracking they would normally go through in daily activity. When you try this with the learning disabled child you will find certain parts of the exercise will be difficult for him to complete at first.

Repetition will improve this tracking. When muscle strength improves to the degree that fusion is accomplished; the person will have improved reading and no visual confusion. The time required for this to be achieved varies with the degree of muscle/nerve deficit.

Exercise cannot completely relieve the symptoms of learning disability.

Third nerve malfunction is not cured by exercise. However, it may be improved.

For this reason, the child may have to continue with the exercise program or do it again at a later date.

If you use a formal eye exercise or retraining program, remember that you are only paying for range of motion exercise. These exercises may seem miraculous but unless more than eye movement is being done they are still only exercises, no different from exercises you could do in your living room.

Computers may be used as a part of the exercise program. Remember you are only following an object with your eyes, you are still just buying exercise. Some video games, like Pac Man, that promote horizontal tracking may be helpful.

The Fast For Word program uses computer sound as well as graphics.

Schools should have these fine muscle exercise programs as part of there regular physical education curriculum. Fine muscle exercises have been ignored too long. Many learning disabled children would be helped, test scores would be raised and many schools problems would be eliminated if fine motor exercises were done regularly. Not only would literacy improve, but sports, music and other activities demanding eye fusion would also improve.

Drug therapy acts on the muscle to improve function. Parents should be questioning the way the drug works to help. If behavior is truly the problem, isn't behavior a problem on weekends or holidays or is this not the real reason your child is being drugged? If learning is enhanced then is it really being improved by a change in brain function? Why isn't this change necessary on weekends and holidays or is the real problem, only a flabby eye muscle that affects your child's school performance! I have observed many of these children only to notice that they "focus" very well on the TV, often for hours. This activity takes attention, focus and quiet behavior.

Increased motor activity is probably the only drug affect needed to improve literacy. As long as it is taken stimulant drug therapy like Ritalin will improve school performance. Side effects of Ritalin including nervousness, nausea, dizziness, palpitations, headache, skin rash, cardiac arrhythmias, and weight loss have been reported. Death from overdose can occur from abuse, deliberate attempt at suicide from depression caused by the disease symptoms and drug withdrawal should also be considered before this therapy is chosen. Even the correct use of Ritalin has proved fatal at times. The cost of the drug therapy should be considered as well as the length of treatment required. Caffeine another stimulant drug has some of the same effects as Ritalin. Many times college students can be seen drinking a cola or coffee before they file into a classroom for an exam. Why?

How do stimulants work to reduce hyperactivity when they cause a more tense, alert state? The most logical answer still seems to be they add tone to the flabby eye muscle tissue. Better eye fusion lets the child sees the lesson better, now he can understand the work and get interested in the class. He is rewarded for his interest and improved behavior. Better vision increases his interest and effort in the class. Class gets very boring if you cannot see the information correctly.

Focus becomes difficult. Imagine yourself in a social studies class presented in Chinese where you are the only one who doesn’t understand the lesson. How long could you stay focused? Students who are not intellectually challenged are much more likely to create classroom problems.

When children with a high IQ have sever learning problems, the teacher may have a very difficult discipline situation.

Electrical stimulation therapy is still being developed for this application. Electrical stimulation treatment enhances the nerve/muscle complex without causing the side effects seen in drug therapy. Other third nerve functions such as acuity and ptosis problems are alleviated.

The cost of this therapy after development is expected to be low since it is not complex.

Ridding your brain of "trash images" can be accomplished through repetition, like play practice, the more you reinforce a correct image, the more often you will recall it correctly. This is why it is very important to make sure images are seen correctly the first time and each time thereafter.

Large images are always easier to see and will be more likely to be stored correctly. If you have incorrect images in your brain storage, try to erase them by deliberately looking at the correct, enlarged picture of the word or letter. Remember to do this when you are well rested.

Introduce new words verbally or by using auditory means such as tapes to prevent visual storage mistakes. This is especially helpful for spelling words.

The words can be spelled on a tape or repeated out loud. If you use this technique; make sure the child knows his alphabet images with no symbol confusion. Present new words when the child is rested. The morning is ideal. After the child hears the correct spelling, he should repeat the spelling out loud. The word can be further reinforced by having the child write the word as it is spelled. Repetition of correct visual images will also help to obliterate incorrectly stored words.

Magnification or large print should be used to make sure images are seen right. The alphabet should first be presented in large print to insure correct storage the first time. Always introduce the alphabet, numbers and new words in large print.

MYTHS

Writing backwards is normal is a myth. If writing backward were normal most of us should write backwards. Large numbers of children never write letters backwards. These people are not learning impaired. Writing backwards seems to disappear as we develop an understanding of how letters should be pictured. Unfortunately writing letters backwards is often missed as a diagnostic sign that should alert us of a child who will have school difficulty or never reach full potential. Misprinted letters are stored in the brain too and they occasionally are recalled backwards as they were stored. The dominant nature of this trait causes a large number of people to write backwards.

People with this deficit, have been told that writing backwards is normal because this myth has been taught to many of our teachers. I interviewed several of the teachers in the school where I practiced school nursing. No one was able to tell me where they learned this fact. All accepted and promoted this belief as a truth. It was probably accepted as a normal behavior because of the dominant character of the trait. Large numbers of people displayed the defect therefore it was accepted as normal. Disease traits are usually not dominant.

You must be two years behind in your reading “level” to be learning disabled. This criterion determined by federal guidelines, does not address large numbers of children who have some degree of learning deficit. If all the people who have this disease were addressed, there would be a great educational disruption. How many measles do you need to have the measles?

Each time we do not recognize this condition, though the student may be partially succeeding, we are not allowing the person to develop to his full potential. Society will always pay a high price for a lack of literacy. We must recognize the large numbers of learning disabled who are not fully reaching their goals because they never knew they had a “minor” learning disorder.

Dyslexia goes away. It never goes away and must be addressed every day.

Treatments can help but there is no cure. We are fooled when we can finally get the alphabet right. The next crisis arises when we realize reading is difficult. Our eyes are skipping all around the page causing us to miss the concepts presented. We begin to adapt by listening very carefully to what is being presented. Our reading rate is slow because we frequently have to reread.

We learn to rely on other senses to learn. In cases of mild learning problems the student may be a slow reader who doesn't realize he has the potential to do so much more. His potential will never be met because his disability goes unrecognized. Even when treatments correct most of the problem, the only cure is correction of third cranial nerve dysfunction.

Dyslexia is caused by a brain malfunction. If this were true many of the therapies used to improve reading would not bring any relief since they do not affect the brain. The only therapy that claims to affect the brain is drug therapy. When stimulant drugs are taken muscle tone improves affected muscle.

Pharmacology does not have an explanation of how drug therapy works to affect the brain. It is difficult to deny that stimulants affect skeletal muscle tissue generally. Improved muscle tone that makes all muscles including the eye muscles function better, improves image fusion. Ritalin or stimulant therapy is known to cause hypertonic muscle action. Tics and Tourette's syndrome are examples. Some medications that affect the muscles such as steroids or stimulants may also temporarily mask muscle dysfunction and appear to relieve this disease.

Magnification, colored lenses, and exercise do not affect the brain.

Even though the latest MRI study conclusion infers that there is a functional difference in the way dyslexics read in relation to the way normal readers read.

MRI scans never address how images are perceived before they enter the brain.

Researchers only discuss what happens after these stimuli affect the brain discounting whether the stimulus was seen by one or two eyes. The amount of stimulation received by the brain will affect the blood flow to the various parts of the brain including the occipital lobe.

Understanding that the brain is not impaired should relieve some parental fears. However, you must always consider the child's true IQ when you consider there learning potential.

CONCLUSIONS

Obviously people without this weak muscle problem will see everything correctly and will not have perceptual problems with spelling, reading or other related learning. They will continue to create competition for the learning disabled but they will eventually disappear as our dominant gene takes over and we become a learning disabled society! Will there be any "normal children" left or will we all be learning disabled! Frightening thought! Isn't it!

ABRIDGED BIBLIOGRAPHY

1.Assessment of Eyes and Ears (1984,May 19). Pennsylvania State University, College of Human Development, Ogontz Center Campus, Wills Eye Hospital (presenter). H. Boyde-Monk,Program Director.

2.Fisher, M. (1994) Method and device for improving cranial nerve function to improve muscle function and thereby overcome visual/perceptual dysfunction patent No. 5,360,438. Published by the United States Patent Office, November 1, 1994.

3.Heath,E., Coo,P.& O’Dell,N.(1976 summer). Exercise and reading efficiency. Academic Therapy. 435-445.

4.Langland,C., Borowski,N., Rohr,M., Jones,R., (1998) Report card on the schools. The Philadelphia Inquirer, September 20, 1998 SectionP,p.1-30.

5.Physicians Desk Reference (1999). Anky, R. & Davidson,C.(p.2078). Montvals, NJ: Medical Economics Company.

6.Zitelli,B., Davis,H., Oski,F.,(1994) Atlas of Physical Diagnosis,2nd ed. (1994) Singapore: Grower Medical Publishing Co. Mosby-Wolfanimprint of Time Mirror International Publishers Limited.

FOR MORE DETAILED INFORMATION AND COMPLETE FOOTNOTES PLEASE READ THE UNABRIDGED VERSION. THIS WAS ABBREVIATED FOR PARENTS AND LAY PERSONS WHO NEED THIS MATERIAL TO IDENTIFY THIS PROBLEM.