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Within the human body, many systems overlap. For example, our sense of taste is closely tied to and affected by our sense of smell.
Similarly, the visual sense is closely tied to the auditory sense, which may be surprising. Vision encompasses much more than most people realize, and the more we understand all the aspects of vision, the easier it is to see how closely it is tied to the auditory sense. Knowing this opens doors to improving various aspects of the visual system in many natural ways. One of those ways is through The Listening Program, which vision therapists actively use as a powerful tool to help clients of all ages improve the vision sense via the auditory system.
“Addressing the ear is fundamental in developing visual skills.” – Patti Andrich.
It is helpful to look inside the brain to understand why addressing both the auditory and visual systems is essential when providing or receiving vision therapy. Several places in the brain connect visual information with auditory information. One such area is located in the brainstem, where two small but essential nodules exist: the superior colliculus and the inferior colliculus. The inferior colliculus has to do with auditory processing. And the superior colliculus has to do with visual processing. The inferior and superior colliculus are stacked, one on top of the other, which means the nerves run straight through them both, which also means they have to communicate.
In daily life, we see the results of these two areas working in synchronization any time we turn our heads and look for the location of a sound while making sense of the sound. It’s an instinct that is also a way the brain keeps us safe, alerts us to potential danger, or invites us to explore something of particular interest. Imagine sitting in a room and hearing a startling sound. Likely, your eyes would be the first to dart in that direction to localize the sound, determine what it is, and if danger is involved.
A person’s depth perception is also a great example of the interconnectedness of the eyes and ears. While it is possible to look at an object to determine how far away it is using just the visual sense, more often, we unknowingly utilize sound to determine distance. A noise heard 3 feet away on the right side of a person would sound very different from a sound 30 feet away behind a person, helping them to determine the location of those objects solely through their ears. The two systems often work together, which means after deciding the location through the ears, our eyes can then look toward the sound to learn more about it and determine if there is any danger. This demonstrates how the auditory and visual senses are connected and help us make sense of the everyday world. Knowing that the two systems work together, it’s only natural that they would be treated together when one isn’t functioning correctly.
The vision sense emerges throughout a person’s developmental process and encompasses more than most of us realize, meaning any delay can cause many daily problems, making addressing it imperative. To fully understand the extent of the developmental process of our visual system, the work by Dr. AM Skeffington, a pioneer in behavioral optometry, can be helpful. In the 1930’s Dr. AM Skeffington first proposed that vision emerges as a result of four subprocesses occurring simultaneously. He created a Venn Diagram to describe his theory of vision emerging throughout life.
The first circle is the ANTIGRAVITY subsystem, where an infant learns to defy gravity by crawling, sitting, and walking. The antigravity system begins with primitive movement patterns that eventually mature so that we can control and refine movements and balance our bodies.
The second circle is CENTERING. A child then learns to look at something by centering their eyes. This happens by learning to coordinate the six muscles surrounding each eye, allowing the eyes to rotate or move up, down, left, and right.
The third circle is the subsystem of IDENTIFICATION. An individual can identify something by focusing their eyes to see clearly. Most people call this 20/20 eyesight, facilitated by the eyes’ focusing muscles.
Dr. Skeffington labeled the last system as SPEECH & AUDITORY. This subsystem allows a person to communicate what they see. This again shows how important it is to address the ears when addressing vision. There’s a belief that people can’t produce sounds they’ve never heard. So for speech and language to develop, the auditory system must also be involved.
The process is complex, but there are many ways in which the eyes and ears develop over time and work together to help create the fully functioning visual sense many people take for granted. Only when all four sub-processes are addressed simultaneously will vision emerge to its full potential. Skeffington’s work demonstrates the need to simultaneously address both the visual and auditory senses to improve the many facets of the visual sense.
Many vision therapists utilize this auditory, visual connection to improve vision skills. One such therapist is Patti Andrich, COVT, OTR/L, an internationally honored occupational therapist, researcher, and author known worldwide for her success as a certified optometric vision therapist. She is the founder of the Sensory Foundations Program and co-owner of The Vision Development Team, where she has been using The Listening Program to improve visual skills since 2007. Her approach involves maturing primitive reflexes while stimulating the eyes and ears to enhance communication within the brain.
In her work, she has seen that if signals from the eyes and ears are delayed or mismatched in any way, people can easily become confused, anxious, and frustrated, impeding the quality of their daily life. This can make getting through a school or work day stressful and exhausting. The therapy Patti and other vision therapists offer can provide relief by setting the stage for the visual and auditory systems to communicate so that better coordination, listening, and visual skills are optimized.
Patti’s work is based on research done in 1949 by Donald Hebb, a neuropsychologist who discovered a law of the brain that is simplified as “neurons that fire together, wire together.” In terms of the auditory and visual sense, this means that when the auditory nerve is fired along with visual pathways, the brain makes connections between the two. People can feel the difference in daily life when their eyes and ears work well together. Two of the most common examples are the sense of depth perception, and the ability to organize space becomes more accurate.
Firing and wiring together the auditory system and visual system, as Patti does, produces meaningful results for people with vision problems such as:
Patti states: “In vision therapy, I set the stage for visual skills to emerge and become more refined. I know that by stimulating the auditory system while training visual skills, I can fire and wire the neurons together. Doing this allows a person to perceive the world auditorially and visually simultaneously and feel more at peace.”
The Listening Program is one way Patti and other vision therapists stimulate the auditory sense to improve the visual sense. TLP utilizes spatial surround to help the ears localize to sounds in a 360 plane, assisting a listener in hearing music not just on the right and left but in front, back, and all around them, just as in the natural world.
Because a person’s reflexive system naturally triggers the eyes to localize to a sound’s direction, listening to TLP encourages the eyes to move towards those sounds naturally. If a client has a left eye that isn’t working well, the music can be localized solely to the left ear, stimulating the left eye gently and effectively. This is just one more example of the neurological connections between the eyes and ears and how stimulating one can improve the other.
This process was used with one of Patti’s clients who had strabismus, which occurs when one or both eyes are not aligned. This can result in an eye turn and potentially visual suppression. When visual suppression occurs, the brain does not perceive visual information from the turned eye(s). This client’s right eye was consistently turned in towards her nose. Patti used auditory stimulation to elicit a reflexive eye movement toward the sound. With the support of optometric tools and exercises prescribed by the eye doctor, her client learned how to appropriately align her eyes to team and see the depth of space. This client and many others have realized the importance of using the auditory sense to help improve visual skills.
By using the natural connection between the eyes and ears, many people whose vision skills need improvement are finding the psychoacoustic modifications of TLP to be an enjoyable part of vision therapy. By stimulating both the auditory and visual systems together, Patti’s clients, as well as many others, achieve more significant results by incorporating whole-brain and body techniques, allowing them to live more productive, relaxed, and enjoyable daily lives.
Andrich, Patti. Indicators of Primitive and Postural Reflexes Assessment (IPPRA), Optometric Extension Program Foundation, United States of America. 2022
Andrich, Patti. “Neurosensory Motor Maturity: Understanding the Link between Primitive Reflexes and Optometry.” Applied Concepts in Vision Therapy, edited by Leonard Press, Optometric Extension Program Foundation, United States of America, 2022, pp. 371–412.
Andrich, Patti, et al. “Statistical Relationships Between Visual Skill Deficits and Retained Primitive Reflexes in Children.” Optometry & Visual Performance, vol. 6, no. 3, July 2018, pp. 106–111.
Tags auditory processing, The Listening Program, Vision, Vision Therapy
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