Vision Therapy Activities

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Home Vision Therapy Activity Descriptions

Below you will find videos and instructions on how to do common vision therapy techniques at home.  They are designed to facilitate optometrists, vision therapists, and their patients in prescribed vision therapy activities.

These activities should only be used under the guidance of a licensed optometrist.  These are not designed to be self-directed or self prescribed.  Emergent is not liable for the use of these guides outside of their intended design.

 
 

Oculomotor Activities

 

Eye Stretches

To improve fixation and basic pursuits

Equipment Needed:

Mainframe, Occluder

Instructions:
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1. Patch an eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing this activity set or when your eye starts to feel tired. 2. Clasp the hands with the pointer fingers extended and touching. Wiggle the fingers so that they rub together. 3. Move your clasped hands in an upward direction following the fingers with your eyes and then return your hands to center. Repeat moving your hands and following your pointer fingers as they move in different directions such as to the right, left, or downward. 4. Helper: Watch that their eye remains on the fingers the entire activity. Instead of telling them to focus harder on the fingers, remind them to look at their fingers in relationship to their surroundings.

Hart Chart Level 1

This activity helps to improve saccades, fixation, and internal rhythm

Equipment Needed:

Mainframe, Occluder, Hart Chart

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Stand 6 feet away from the Hart Chart with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. 2. Turn on a metronome at a tempo set by your vision therapist. 3. Without head or body movement, read the top line of the hart chart and continue through to the end of the chart 4. Helper: First help the patient work on accuracy. If they make a mistake wait until they have completed a line and see if they can pick up on their own mistake. Try to point out what they did right instead of just what they did wrong. Once accuracy improves, move to increasing or decreasing the tempo depending on which is more difficult.

Hart Chart Columns

This activity helps to improve saccades, fixation, and internal rhythm

Equipment Needed:

Mainframe, Occluder, Hart Chart

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Stand 6 feet away from the Hart Chart with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. 2. Turn on a metronome at a tempo set by your vision therapist. 3. Without head or body movement, read the letter from the top row, 1st column and then the letter from the top row, last column. Continue to call out the letters from the 1st and last columns all the way down the activity.working from the outside in. Repeat the activity with the 2nd and 9th columns, 3rd and 8th columns, and so on working your way into the center two columns. 4. Helper: First help the patient work on accuracy. If they make a mistake wait until they have completed a line and see if they can pick up on their own mistake. Try to point out what they did right instead of just what they did wrong. To help with accuracy, instead of telling them to focus harder on the letters, tell them to look at the letter while noticing where that letter fits in relationship to the other letters. Once accuracy improves, move to increasing or decreasing the tempo depending on which is more difficult.

Hart Chart - Outside In

This activity helps to improve saccades, fixation, and internal rhythm

Equipment Needed:

Mainframe, Occluder, Hart Chart

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Stand 6 feet away from the Hart Chart with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. 2. Turn on a metronome at a tempo set by your vision therapist. 3. Without head or body movement, read the top row working from the outside in. For instance for the top row you would read, "O, E, F, H, N, C, P, T, V, D." Continue on through to the bottom of the chart. 4. Helper: First help the patient work on accuracy. If they make a mistake wait until they have completed a line and see if they can pick up on their own mistake. Try to point out what they did right instead of just what they did wrong. Once accuracy improves, move to increasing or decreasing the tempo depending on which is more difficult.

Four Charts

This activity helps to load the Hart Chart activity to now having to make larger saccades

Equipment Needed:

Mainframe, Occluder, 4 smaller hart charts

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Arrange the 4 smaller hart charts in a square separated by 1-2 ft or as directed by your vision therapist. Stand 6 feet away from the Hart Chart with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. 2. Turn on a metronome at a tempo set by your vision therapist. 3. Without moving your head or body, read the upper right letter of the upper left chart. Then in order read the upper right letter of each of the upper right, lower left, then lower right. 4. Continue with the 2nd letter in each of the 4 charts and so on. 4. Helper: First help the patient work on accuracy. If they make a mistake wait until they have completed a line and see if they can pick up on their own mistake. Try to point out what they did right instead of just what they did wrong. To help with accuracy, instead of telling them to focus harder on the letters, tell them to look at the letter while noticing where that letter fits in relationship to the other letters. Once accuracy improves, move to increasing or decreasing the tempo depending on which is more difficult.
 
 
 
 
 
 

Accommodation Activities

Instructors

Look Hard/Look Soft

This exercise is to help you to see and feel the difference between focusing your eye and relaxing the focus of your eye

Equipment Needed:

Mainframe, Occluder, Hart Chart

Instructions:
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1.Patch one eye with the magnetic Emergent Translucent Occluder. Stand 1-3 feet away from the Hart Chart (closer will typically give a stronger response) with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. 2. Look at the letter in the very center of the chart. Keep looking only at that letter but try to relax your body, take slow deep breaths, ‘look softly’ at the letter so you are conscious of what else you see both in the chart, around the chart, and around the room. Make a mental note of what you see and how well you can see it. Do this for 10 seconds. 3. Now, look as hard as you can at the central letter. Block out your peripheral vision. Concentrate very hard as you tense up your body, clench your fists, and concentrate only on that letter while ‘looking hard’. Make a mental note of how your eyes feel and what you see. Do this for 10 seconds. 4. Next, try to totally relax your body, take slow deep breaths, and close your eyes for 5 seconds. Open your eyes and repeat the ‘look soft’ process as in step 2 followed by ‘look hard’ 5. Make a note of the differences you notice in your body, in how your eyes feel, in what and how you see between looking soft and looking hard. Does anything look sharper or darker, how much of your surroundings can you see, how did your body and your eyes feel?

Bulls Eye

This activity helps the patient to see and feel how to accommodate and relax accommodation

Equipment Needed:

Mainframe, Occluder, Bulls Eye, Plexiglass Lid

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Find the Emergent Fusion Card with the Bulls Eye. To help plastic from being too flimsy Hold the Bulls Eye about 6 in to 12 in from the eye. 2. Look through the Bulls Eye at an object on the other side of the room. The object should be clear and the Bulls Eye should be blurry. 3. Look at or focus on the Bulls Eye while the Bulls Eye is still covering the same object on the other side of the room. The object should be blurry and the Bulls Eye should be clear. 4. Make a note of the differences you notice in how your eyes feel when focusing at near or in the distance. How clear can you make object across the room and how blurred out can you make the Bulls Eye? How clear can you make the Bulls Eye and how blurry can you make the object across the room?

Near/Far Hart Chart - Monocular

This activity helps the patient to see and feel how to accommodate and relax accommodation

Equipment Needed:

Mainframe, Occluder, Large Hart Chart, small transparent Hart chart, Plexiglass lid

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Stand 6 feet away from the Hart Chart with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. Hold the small clear hart chart about 6 in to 12 in from the eye. In your vision, position the small hart chart so that it covers the large hart chart. 2. Focus on the near Hart Chart until it is clear. Read the top line of the near hart when it becomes clear. The distance chart should be blurry. 3. Now focus on the large Hart chart at 6 ft. The near Hart chart should be blurry. Read the second line of the distance chart when it becomes clear. You can read the letters straight across or use another variant of the Hart chart activity such as Outside/In or Columns. Make sure you don’t continue with the activity until the chart you are looking at is perfectly clear.

Monocular Flipper Reading

This activity helps the patient better understand their accommodative system and improve accommodative stamina and magnitude

Equipment Needed:

Mainframe, Occluder, Accommodative Flipper, Reading Material, Tilt Board

Instructions:
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1. Patch one eye with the magnetic Emergent Translucent Occluder. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Open your book (or take out the reading material your therapist gave you) and place it on the Emergent Tilt Board. 2. Hold the flipper on either the plus (+) or minus (-) side over your eyes and magnetically attach it to the Emergent Mainframe and read a sentence from your reading material. Make sure that you are able to get the text completely clear before you read the sentence. 3. Flip the accommodative flipper over to the other side so that you are looking through the other lens. Read another sentence. Again, make sure that you get the image all the way clear. 4. Continue flipping back and forth with each sentence. NOTE: You should either be doing patched flipper reading or red/green flipper reading. Under no circumstance should any patient be doing flipper reading with neither implement. If you are uncertain of which method you were given, double check the home instructions from your doctor or therapist.

Biocular Flipper Reading

This activity helps the patient better understand their accommodative system and improve accommodative stamina and magnitude

Equipment Needed:

Mainframe, Occluder, Accommodative Flipper, Reading Material, Tilt Board

Instructions:
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1. Put on the Emergent Main Frame and attach the Red/Green clip. Place the red lens over the eye that is stronger or as directed by your vision therapist. Open your reading material (or take out the reading material given you by your therapist). Position the red and green bar reader over your reading material so that the stripes are going vertically up and down the page. 2. Hold your flipper in front of your eyes and magnetically attach them to the Emergent Mainframe on either the plus (+) or minus (-) side. Read a sentence of your reading material. Notice if any of the bars on the bar reader look like they are getting dark, or if they all look like they are equally dark. Remember: If every other bar starts going dark that means that one of your eyes is turning off. Try tapping beside that eye, snapping your fingers in your ear on that side of your head, tapping your feet, opening your periphery and focusing on all the space around you, or using any of the other methods that help you get both eyes turned back on. 3. Turn your flipper over to the other side and read the next line of your material. Always be aware of whether the words are clear or not and whether you have both eyes on. 4. Continue flipping back and forth with each sentence as you reading your material. Evaluate whether you are able to keep both eyes on and, if not, pause and try to get them turned back on. 5. If you find that the words or the bars appear to be doubling or moving around (this is often accompanied by dark bars), notice which side of the flipper this tends to happen more on. Most likely, if this occurs on the minus side of the flipper, you are converging (pointing your eyes in front of the paper). Try to remedy this by either tapping a finger on the paper to remind your eyes where they need to be pointing, or if you have practiced fusion cards, you can deliberately try to diverge your eyes to make the paper become single again. Always make the words single before attempting to clear them. If the doubling appears on the plus side of the flipper, you are most likely diverging (pointing your eyes past the paper). Try tapping again to remind your eyes where to point, and you can attempt to converge slightly to bring the paper back into focus. NOTE: You should either be doing patched flipper reading or red/green flipper reading. Under no circumstance should any patient be doing flipper reading with neither implement. If you are uncertain of which method you were given, double check the home instructions from your doctor or therapist.

Near/Far Bi-ocular Hart Chart

This activity helps to develop fast and accurate accommodation (eye focusing) without an eye being patched or covered.

Equipment Needed:

Hart Chart, Lens blank (-6.00 or other power)

Instructions:
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1. Place the lens blank over 1 eye such that you are seeing a small Hart chart with 1 eye through the lens and the other eye is seeing the Hart chart normally. Switch eyes after completing the activity with one eye or when one eye begins to feel tired. Stand 6 feet away from the Hart Chart with back straight, feet shoulder width apart, knees slightly bent, and weight evenly distributed. 2. Focus on the smaller Hart chart in the lens until it is clear. Read the top line of the chart when it becomes clear. The Hart chart seen with the other eye should be blurry. 3. Now focus on the large Hart chart at 6 ft. The smaller Hart chart in the lens should now be blurry and read the second line. You can read the letters straight across or use another variant of the Hart chart activity such as Outside/In or Columns. Make sure you don’t continue with the activity until the chart you are looking at is perfectly clear.
 
 
 
 
 
 
 

Binocular Activities

Monocular Pointer and Straw

This improves eye hand coordination and localization.

Equipment Needed:

Mainframe, Occluder, Pointer and Straw

Instructions:
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Bi-ocular Pointer and Straw

This improves eye hand coordination and localization.

Equipment Needed:

Mainframe, Red/Green Clip, Pointer and Straw

Instructions:
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Marsden Ball Hits

This activity helps the patient gain basic localization through better binocularity

Equipment Needed:

Marsden Ball

Instructions:
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Marsden Ball Touches

This activity helps the patient gain basic localization through better binocularity

Equipment Needed:

Marsden Ball

Instructions:
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Marsden Ball Bunting

This activity helps the patient gain basic localization through better binocularity

Equipment Needed:

Marsden Ball

Instructions:
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Brock String Set Up

This video provides several ways that the Brock String activity can be set up.

Equipment Needed:

Brock String, Emergent Magnetic Attachment (optional), Emergent Beads and Brock Discs (optional)

Instructions:
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Brock String Bead Jumps

This activity helps the patient improve the alignment of their eyes.

Equipment Needed:

Brock String, Emergent Magnetic Attachment (optional), Emergent Beads and Brock Discs (optional)

Instructions:
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Brock String Bead Localization

This activity helps the patient improve the alignment of their eyes.

Equipment Needed:

Brock String, Emergent Magnetic Attachment (optional), Emergent Beads and Brock Discs (optional)

Instructions:
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Brock String Bug Walk

This activity helps the patient improve the alignment of their eyes

Equipment Needed:

Brock String, Emergent Magnetic Attachment (optional), Emergent Beads and Brock Discs (optional)

Instructions:
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Lifesaver Card Convergence

This activity helps the patient improve the control of the alignment of their eyes.

Equipment Needed:

Lifesaver transparency, Emergent White Tilt Board (optional) or white paper

Instructions:
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Lifesaver Card Divergence

This activity helps the patient improve the control of the alignment of their eyes and gain better depth perception.

Equipment Needed:

Lifesaver transparency, Emergent Plexiglass Lid

Instructions:
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Eccentric Circle Convergence

This activity helps the patient improve the control of the alignment of their eyes and gain better depth perception.

Equipment Needed:

Eccentric Circle Transparaency, Emergent White Tilt Board (optional) or white paper

Instructions:
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Visual Perceptual Activities

Instructors

Parquetry Blocks General Instructions

 

This activity helps the patient to better process what they are seeing visually to make it easier to interpret things like letters and words.

Equipment Needed:

Parquetry Blocks, Emergent plexiglass lid and spray bottle (optional)

Instructions:

1. This activity requires a helper.  The helper should sit opposite from the patient.  2. The helper then makes a pattern and asks the patient to match that pattern in any of the following ways that will be described in the other instructional sets: Direct Matching, Matching with reversals and rotations, matching by memory, matching from verbal instructions, matching from tactile feedback. 3. Once the patient has replicated the pattern using the desired method, the helper then checks to see if this is done correctly. With the Emergent parquetry blocks, this can be done by putting water on the Emergent plexiglass lid by either spraying it with water or taking a wet towel and wiping the surface of the lid. Then the helper presses the wet side of the plexiglass lid over the helper’s parquetry block pattern.  The blocks should stick to the lid and the helper can now move the lid over the patient’s block pattern to see if it was done correctly. It is important for the patient to discover what they did incorrectly rather than the helper giving that to them. 4. The order of difficulty of parquetry block patterns is as follows: Easier patterns have a square in the middle. To make it more difficult, use other shapes as center or have no center at all to the pattern. Start with 2 shape patterns.  The more the shapes in the pattern, the more difficult it is to replicate it.  Patterns where the blocks fit up against each other are easier.  To make it more difficult, create pockets of space or complete separation between the blocks. Patterns where the corners of the blocks touch and line up are easier.  To make it more difficult, align the blocks such that they are off centered from each other. An example would be if a triangle was placed on the center of the side of a square. Patterns where the shapes are parallel to each other are easier.  Tilting shapes will make it more difficult for the patient.

Parquetry Blocks - Direct Matching

This activity helps the patient to better process what they are seeing visually to make it easier to interpret things like letters and words.

Equipment Needed:

Parquetry Blocks, Emergent plexiglass lid and spray bottle (optional)

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Instructions:
1. Follow the “Parquetry Block General Instructions” to set up the activity 2. Direct Matching is done when the helper creates a pattern and the patient replicates that pattern exactly as they see it. The pattern should NOT be flipped so that the pattern mirrors what is seen. 3. The helper should check the accuracy of the patient’s pattern they build according to the “Parquetry Block General Instructions” 4. Follow the “Parquetry Block General Instructions” to vary the difficulty of the activity.

Parquetry Blocks - Reversal and Rotation Matching

This activity helps the patient to better process what they are seeing visually to improve letter and word reversals.

Equipment Needed:

Parquetry Blocks, Emergent plexiglass lid and spray bottle (optional)

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Instructions:
1. Follow the “Parquetry Block General Instructions” to set up the activity 2. Reversal and Rotation Matching is done when the helper creates a pattern and the patient replicates that pattern in a certain orientation. The helper may ask the patient to build the pattern as if it was rotated 180 degrees like a mirror pattern or some other rotation such as 90 or 270 degrees. 3. The helper should check the accuracy of the patient’s pattern they build according to the “Parquetry Block General Instructions” 4. Follow the “Parquetry Block General Instructions” to vary the difficulty of the activity.

Parquetry Blocks - Matching by Memory

This activity helps improve a patient’s visual memory to improve letter and word recognition and general memory.

Equipment Needed:

Parquetry Blocks, Emergent plexiglass lid and spray bottle (optional), the Emergent Case or other object to block the patient’s view

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Instructions:
1. Follow the “Parquetry Block General Instructions” to set up the activity 2. Matching by memory is done when the helper creates a pattern and then gives the patient a certain amount of time to study and commit the pattern to memory. Then the helper blocks the pattern from the patient’s view. The patient then replicates that pattern from memory. 3. The helper should check the accuracy of the patient’s pattern they build according to the “Parquetry Block General Instructions” 4. Follow the “Parquetry Block General Instructions” to vary the difficulty of the activity. The helper can also ask the patient to rotate the pattern when building from memory to also increase the difficulty.

Parquetry Blocks - Matching by Verbal Instructions

This activity helps the patient to better verbalize what they are seeing to improve verbalizing in activities such as retelling..

Equipment Needed:

Parquetry Blocks, Emergent plexiglass lid and spray bottle (optional), the Emergent Case or other object to block the patient’s view

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Instructions:
1. Follow the “Parquetry Block General Instructions” to set up the activity 2. Matching from verbal instructions is done when the PATIENT creates a pattern and then blocks the pattern from the HELPER’s view. The patient then describes the pattern in a specific enough way so that the helper can build the pattern based on the patient’s description. If the description is not specific enough, the helper should try to build the pattern inaccurately while still following the patient’s instructions. 3. The helper should check the accuracy of the patient’s pattern they build according to the “Parquetry Block General Instructions” 4. Follow the “Parquetry Block General Instructions” to vary the difficulty of the activity.

Parquetry Blocks - Matching from Tactile Feedback

This activity helps the patient to better visualize or see things from their mind’s eye.

Equipment Needed:

Parquetry Blocks, Emergent Tilt Feet, a piece of paper, Emergent plexiglass lid

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Instructions:
1. To set up the activity, the blocks or pattern should be blocked from the patient’s view but the patient should still have the ability to feel the blocks or pattern of the blocks. 2. Matching by tactile feedback is first done with the individual blocks. Each block should be put in the patient’s hands without them being able to see it. The patient then from touch tries to determine which block they are holding. After this is done successfully, patterns should be built by the helper out of the patient’s view. The patient then feels the pattern and tries to replicate it based on what they felt. 3. The helper should check the accuracy of the patient’s pattern they build according to the “Parquetry Block General Instructions” 4. Follow the “Parquetry Block General Instructions” to vary the difficulty of the activity.

Parquetry Blocks - Using a Paper Pattern

This activity helps the patient to better process what they are seeing visually to make it easier to interpret things like letters and words.

Equipment Needed:

Parquetry Blocks, Paper Patterns

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Instructions:
1. Place a parquetry block paper pattern in front of the patient. The patient should then try to use the blocks to fill the pattern accordingly. 2. The patient should try and put the correct block into the correct place on the pattern simply by looking at the blocks and deciding which one fits. They should not use trial and error to move the block around to see if a block fits in the pattern. 3. The patient may also alternate hands to do this to work on bilateral integration (getting both sides of the body to work together). To increase difficulty the patient could say the alphabet so that they are not using verbal cues to help them (you may notice a patient subvocalizing and saying something like, “That looks like a red square. I’m going to try that one.”). The helper may also have the patient look at the pattern and then take the pattern away to see if the patient can build the pattern from memory.