Evidence for Training of Visual & Auditory Skills

Effects of visual training on saccade control in dyslexia
Fischer B, Hartnegg K.  Perception 2000, 29(5):531-42
This study reports the effects of daily practice of three visual tasks on the saccadic performance of 85 dyslexic children in the age range of 8 to 15 years. The children were selected from among other dyslexics because they showed deficits in their eye-movement control, especially in fixation stability and/or voluntary saccade control. Their eye movements were measured in an overlap prosaccade and a gap antisaccade task before and after the training. The three tasks used for the training included a fixation, a saccade, and a distractor condition. In any of these tasks, the subject had to detect the last orientation of a small pattern which rapidly changed its orientation between up, down, right, and left, before it disappeared after some time. The task was to press one of four keys corresponding to the last orientation. The visual pattern was presented on an LCD display of a small hand-held instrument given to the children for daily use at home. The results indicate that daily practice improved not only the perceptual capacity, but also the voluntary saccade control, within 3 to 8 weeks. After the training, the group of dyslexics was no longer statistically different from the control group.

Saccade control in dyslexia: development, deficits, training and transfer to reading
Fischer B, Hartnegg K. Optom & Vis Devel 2008, 39(4):181-190
BACKGROUND: Saccade control is a complex function of our brain and relies on the co-ordination of several sub-cortical, cortical, and functional areas. In the past it has been difficult to use data from saccade analysis as an additional diagnostic tool for insight into any particular patient’s oculo-visual problem. With the development of technological advances and optomotor research there is now a better understanding of visually guided saccadic reactions. This article describes the development of saccade control, diagnostic data from dyslexic subjects, and the effect of daily practice and transfer to reading skills.
METHODS: All subjects were recruited from local schools. Several standard tests (reading, spelling, intelligence) were used for inclusion/exclusion of the subjects participating in the various studies. Eye movements were recorded by infrared light reflection methods. Prosaccades with overlap conditions and antisaccades with gap conditions were required in 200 trials for each task. Variables characterizing pro- and antisaccade performance were extracted for each subject. Means values and standard deviations comparing the experimental and control subjects were calculated in each of the 4 age groups in an age range of 7 to 17 years. ANOVAs or t-test were used for statistical evaluations.
RESULTS: The data from 114 normal control subjects show a developmental progression lasting until adult age. Among the 3230 subjects in the dyslexic group 20 to 70% (depending on age) failed the criterion of the age matched controls when looking at anti-saccade performance. Pro-saccade performance did not differentiate between the groups. Daily practice conducted by 182 dyslexic subjects improved their anti-saccade performance in approximately 80% of the cases. For training subjects, it was noted that the successful training transferred to the act of reading by reducing the percentage of reading errors in the experimental group (N=10) by 50% and by 20% for the control group (N=11).
CONCLUSION: This study suggest that deficits in antisaccade control but not prosaccade control contribute systematically to the problems of subjects with specific deficits in acquiring reading skills and that appropriate training can reduce the percentage of reading errors.

The effect of saccadic training on early reading fluency
Leong D, Master CL, Messner LV, Pang Y, Smith C, Starling AJ. Clinical Pediatrics 2014, 53(9):858-64.
BACKGROUND: Eye movements are necessary for the physical act of reading and have been shown to relate to underlying cognitive and visuoattentional processes during reading. The purpose of this study was to determine the effect of saccadic training using the King-Devick remediation software on reading fluency.
METHODS: In this prospective, single-blinded, randomized, crossover trial, a cohort of elementary students received standardized reading fluency testing pre- and posttreatment. Treatment consisted of in-school training 20 minutes per day, 3 days per week for 6 weeks.
RESULTS: The treatment group had significantly higher reading fluency scores after treatment (P < .001), and posttreatment scores were significantly higher than the control group (P < .005).
CONCLUSION: Saccadic training can significantly improve reading fluency. We hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.

The effect of in-school saccadic training on reading fluency and comprehension in first and second grade students
Dodick D, Starling AJ, Wethe J, Pang Y, Messner L, Smith C, MAster CL, Halker-Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D. J Child Neurol 2017, 32(1):104-111.
Efficient eye movements provide a physical foundation for proficient reading skills. We investigated the effect of in-school saccadic training on reading performance. In this cross-over design, study participants (n = 327, 165 males; mean age [SD]: 7 y 6 mo [1y 1 mo]) were randomized into treatment and control groups, who then underwent eighteen 20-minute training sessions over 5 weeks using King-Devick Reading Acceleration Program Software. Pre- and posttreatment reading assessments included fluency, comprehension, and rapid number naming performance. The treatment group had significantly greater improvement than the control group in fluency (6.2% vs 3.6%, P = .0277) and comprehension (7.5% vs 1.5%, P = .0002). The high-needs student group significantly improved in fluency (P < .001) and comprehension (P < .001). We hypothesize these improvements to be attributed to the repetitive practice of reading-related eye movements, shifting visuospatial attention, and visual processing. Consideration should be given to teaching the physical act of reading within the early education curriculum.

Oculomotor training improves reading eye movement
Carly Lam, Hong Kong Polytechnic University, 2017
BACKGROUND: Reading is one of the integral elements for learning and poor readers were reported to have less efficient reading eye movements. They were typically characterized by having higher number in fixation and regression, reduced reading speed and perceptual span. The purpose of this study was to investigate if vision therapy which limited to training of oculomotor skills can improve reading eye movement.
METHODS: This was a randomized, prospective study. 30 subjects aged from 8-9 years of age with reading difficulties and reading eye movement problems were recruited. They all have normal intelligence and ocular health, but failed to meet the Taylor reading eye movement norms when tested with the Visagraph III. The subjects were randomly assigned into either the treatment group (15) or the control group (15). The treatment group had to go through a course of oculomotor vision therapy and the control group was given placebo exercises. Vision therapy for the treatment group involved 8 weeks of training (office training – 3 times a week, 30 min per session; home training – 4 times a week, 30 min per session). Office training involved the use of Vis-Flex (Visual Flexibility Trainer – an electronic device with L.E.D. lights which can display various flashing patterns at variable speeds). Home training involved several saccadic eye movement exercises. Subjects and parents were also asked to grade the reading symptoms checklist before and after the training.
: Currently awaiting publication

Adaptation of voluntary saccades, but not of reactive saccades, transfers to hand pointing movements
Cotti J, Guillaume A, Alahyane N, Pelisson D, Vercher J. J Neurophysiol 2007, 98(2):602-12
Studying the transfer of visuomotor adaptation from a given effector (e.g., the eye) to another (e.g., the hand) allows us to question whether sensorimotor processes influenced by adaptation are common to both effector control systems and thus to address the level where adaptation takes place. Previous studies have shown only very weak transfer of the amplitude adaptation of reactive saccades–i.e., produced automatically in response to the sudden appearance of visual targets–to hand pointing movements. Here we compared the amplitude of hand pointing movements recorded before and after adaptation of either reactive or voluntary saccades, produced either in a saccade sequence task or in a single saccade task. No transfer to hand pointing movements was found after adaptation of reactive saccades. In contrast, a substantial transfer to the hand was obtained following adaptation of voluntary saccades produced in sequence. Large amounts of transfer between the two saccade types were also found. These results demonstrate that the visuomotor processes influenced by saccadic adaptation depend on the type of saccades and that, in the case of voluntary saccades, they are shared by hand pointing movements. Implications for the neurophysiological substrates of the adaptation of reactive and voluntary saccades are discussed.

Outcome of treatment of visual problems in children with reading difficulties.
Learning Difficulties Clinic, Royal Berks Hospital, Reading & University Laboratory of Physiology, Oxford
Clisby C, Fowler MS, Hebb GS, Wlaters J, Southcott P, Stein JF. Professional Association of Teachers in Special Situations (PATOSS) Bulletin Nov. 2000, 9-14
Results show that our treatments helped children with reading problems very considerably; their rate of increase in reading tripled compared with what would have happened had they not been treated at all. This compares favourably with much more time consuming and costly remediation programmes such as those described by Hornsby and Miles (1980) and Thompson (1993) after which reading improvements of 1.8-1.9 months per month were seen. Monocular occlusion, vergence fixation and pursuit tracking exercises are effective because they help children to improve slight defects in their control of the two eyes when they are trying to fixate text. Long wavelength (red, yellow and green) filters probably help because they enhance input to the parvocellular system which is normally in competition with the magno system. We speculate that blue filters cutting out long wavelengths may help some children because they have abnormally large numbers of blue cones that are depressed by long wavelength light. We are actively researching these ideas at present.

Just For Interest….

Quiet eye training improves surgical knot tying more than traditional technical training: a randomized controlled study
Causer J, Harvey A, Snelgrove R, Arsenault G, Vickers J.  The American Journal of Surgery 2008, 208(2):171-177
BACKGROUND: We examined the effectiveness of technical training (TT) and quiet eye training (QE) on the performance of one-handed square knot tying in surgical residents.
METHODS: Twenty surgical residents were randomly assigned to the 2 groups and completed pretest, training, retention, and transfer tests. Participants wore a mobile eye tracker that simultaneously recorded their gaze and hand movements. Dependent variables were knot tying performance (%), QE duration (%), number of fixations, total movement time (s), and hand movement phase time (s).
RESULTS: The QE training group had significantly higher performance scores, a longer QE duration, fewer fixations, faster total knot tying times, and faster movement phase times compared with the TT group. The QE group maintained performance in the transfer test, whereas the TT group significantly decreased performance from retention to transfer.
CONCLUSIONS: Quiet eye training [QE] significantly improved learning, retention, and transfer of surgical knot tying compared with a traditional technical [TT] approach. Both performance effectiveness (performance outcome) and movement efficiency (hand movement times) were improved using QE modeling, instruction, and feedback.


Instability of fixation in dyslexia: development-deficits-training
Fischer B, Hartnegg K. Optom & Vis Devel 2009, 40(4):221-228
BACKGROUND: While eye movements as a necessary prerequisite for natural viewing become more and more important as part of the neurological evaluation, the utilization of fixation is not well established. THis paper discusses two different and independent types of instability of fixation which can only be recognized by recording and analysing specific movements of the eyes that include: (i) binocular instability (slow movements of the two eyes with different velocities mostly of the opposite sign) and (ii) simple instability (small involuntary conjugate saccades (intrusions) during periods of fixating a stationary fixation point).
METHODS: A prosaccade task with overlap conditions is utilized which requires periods of stationary fixation as well as saccades to a new stimulus target. This allows the quantitative determination of the appropriate variables.
RESULTS: The diagnostic data from children diagnosed with dyslexia are compared with those of age-matched control subjects. An optomotor therapy procedure with one eye covered reduced the binocular instability by 50%, while the simple stability was reduced by 20%.
CONCLUSION: The results indicate that the two types of fixation instability are independent from each other. Both may contribute to problems of visual processing of those with dyslexia and possible other learning problems.

Monocular occlusion can improve binocular control and reading in dyslexics
Stein JF, Richardson AJ, Fowler MS. Brain 2000, 123:164-70
Developmental dyslexia is a neurodevelopmental condition which causes 5-10% of children to have unexpected difficulty learning to read. Many dyslexics have impaired development of the magnocellular component of the visual system, which is important for timing visual events and controlling eye movements. Poor control of eye movement may lead to unstable binocular fixation, and hence unsteady vision; this could explain why many dyslexics report that letters appear to move around, causing visual confusion. Previous research has suggested that such binocular confusion can be permanently alleviated by temporarily occluding one eye. The aim of the present study was therefore to assess the binocular control and reading progress of dyslexic children with initially unstable binocular control after the left eye was patched. One hundred and forty-three dyslexics were studied. They were selected from children aged 7-11 years referred to a learning disabilities clinic if they were dyslexic and had unstable binocular control. They were randomly assigned to wear yellow spectacles with or without the left lens occluded, and were followed for 9 months. Significantly more of the children who were given occlusion gained stable binocular fixation in the first 3 months (59%) compared with children given the unoccluded glasses (36%). This advantage was independent of IQ or initial reading ability. Furthermore, at all the 3-month follow-ups, children were more likely to have gained stable binocular control if they had been wearing the occluded glasses. Gaining stable binocular control significantly improved reading. The children who did so with the help of occlusion improved their reading by 9.4 months in the first 3 months, compared with 3.9 months in those who were not patched and did not gain stable fixation. Over the whole 9 months, children who received occlusion and gained stable fixation nearly doubled their rate of progress in reading compared with those who remained unstable. At all the follow-ups the reading of those given occlusion was significantly better than that of those not occluded. Thus monocular occlusion helped children with unstable binocular control to gain good binocular fixation. If they gained stability, they made significantly faster reading progress. The progress made by the children who gained stable fixation was much greater than that achieved with other remedial techniques.

A randomized prospective masked and matched study of orthoptic treatment versus conventional reading tutoring treatment for reading disabilities in 62 children
Atmon D, Nemet P, Ishay A, Karni E. Binocular Vis and Eye Muscle Surgery Qrtly 1993;8(2):91-106
120 reading disabled children were studied to determine if vision training can treat reading disabilities. This was a controlled study whereby 40 students were matched and randomly divided into three groups: orthoptic treatment, traditional reading tutoring and no-treatment control. The first two groups were given twenty minute training sessions per day. The results showed that increasing convergence amplitude to 60A was as effective as traditional in-school reading tutoring of the reading disabled. An added benefit of the OVT was that asthenopia disappeared. The author recommended OVT as additional treatment for reading disabled and primary treatment for students with asthenopia and convergence insufficiency symptoms.

The impact of vergence and accommodative therapy on reading eye movements and read speed
Gallaway M, Boas MB. Optometry & Visual Development 2007, 38(3):115-120
: Most studies investigating the impact of optometric vision therapy on reading speed and reading eye movements utilize ocular motility and visual processing procedures. Only one study has reported the impact of accommodative and vergence therapy alone on reading speed, but only with three subjects.
Methods: Six patients with symptomatic accommodative/vergence anomalies received vision therapy along with objective eye movement recordings before and after therapy. Therapy consisted of procedures to treat accommodative and vergence skills – no saccadic or ocular motor procedures were utilized.
Results: Each of the patients showed clinically significant improvements in reading speed and eye movement efficiency.
Conclusions: Accommodative and vergence therapy alone has the potential to improve reading speed and reading eye movements. Ocular motor therapy may not be necessary for some patients with accommodative/ vergence disorders who also demonstrate reduced reading speed and poor reading eye movements.

Convergence insufficiency treatment trial-attention and reading trial (CITT-ART)
CIIT-ART Investigator Group. Vis Dev Rehabil 2015, 1(3):214-228
BACKGROUND: To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic convergence insufficiency (CI).
METHODS: CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention.
CONCLUSION: The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.

Differences in dyslexic students before and after a remediation programe: A clinical neuropsychological and event related potential study
Zygouris N, Avramidis E, Karapetsas A, Stamoulis G. Applied Neuropsychology: child 2017, http://dx.doi.org/10.1080/21622965.2017.1297710
Developmental dyslexia is defined as an unexpected specific and persistent failure to acquire efficient reading skills despite conventional instruction, adequate intelligence and sociocultural opportunity. This article reports the outcomes of a study that evaluated the implementation of a 4-month intervention program. The intervention consisted of structured activities aiming at improving (a) the children’s phonological awareness, (b) their visual and auditory memory, (c) their visual discrimination ability, and (d) their text comprehension. Participants were 12 children diagnosed as dyslexic matched with 12 typically achieving peers of similar age and gender. Baseline assessment consisted of a clinical neuropsychological battery of tests and Event Related Potentials (ERPs) and resulted in confirming the discrepancy between the dyslexic and the control group. Following the remediation program, the dyslexic group did not differ significantly from their control group in six out of eight neuropsychological tests. The electrophysiological results revealed that the two groups had similar P300 latencies in 12 out of the 15 electroencephalographic sites assessed. These findings suggest that children with dyslexia can improve their abilities through a remediation program which aims to strengthen their audio-visual and phonological processes along with their working memory capability.

Effect of sports vision exercise on visual perception and reading performance in 7- to 10-year-old developmental dyslexic children
Badami R, Mahmoudi S, Baluch B. J Exerc Rehabili 2016, 12(6):604-609
The presented study was aimed at identifying for the first time the influence of sports vision exercises on fundamental motor skills and cognitive skills of 7- to 10-year-old developmental dyslexic Persian children. A pretest-posttest quasi-experimental study was conducted. The statistical population of this study was 7- to 10-year-old dyslexic children referring to two centres of learning disorder in the city of Isfahan. Twenty two of these children were selected using available and purposive sampling from the statistical population and were randomly assigned into two groups of experimental and control. The former (experimental group) participated in sports vision exercise courses for 12 weeks (3 one hr sessions per week) and the latter (control group) continued their routine daily activities during the exercise. Before the beginning and at the end of the exercise, Gardner’s test of visual perception test – revised and Dehkhoda’s reading skills test was administered to both groups. The results showed that the sports vision exercises increases motor skills, visual perceptual skills and reading skills in developmental dyslexic children. Based on the results of the presented study it was concluded that sports vision exercises can be used for fundamental and cognitive skills of developmental dyslexic children. 

Multiple causal links between magnocellular-dorsal pathway deficit and developmental dyslexia
Gori S, Seitz AR, Ronconi L, Franceschini S, Facoetti A. Cerebral Cortex 2015, Sep 22;1-14.
Although impaired auditory-phonological processing is the most popular explanation of developmental dyslexia (DD), the literature shows that the combination of several causes rather than a single factor contributes to DD. Functioning of the visual magnocellular-dorsal (MD) pathway, which plays a key role in motion perception, is a much debated, but heavily suspected factor contributing to DD. Here, we employ a comprehensive approach that incorporates all the accepted methods required to test the relationship between the MD pathway dysfunction and DD. The results of 4 experiments show that (1) Motion perception is impaired in children with dyslexia in comparison both with age-match and with reading-level controls; (2) pre-reading visual motion perception-independently from auditory-phonological skill-predicts future reading development, and (3) targeted MD trainings-not involving any auditory-phonological stimulation-leads to improved reading skill in children and adults with DD. Our findings demonstrate, for the first time, a causal relationship between MD deficits and DD, virtually closing a 30-year long debate. Since MD dysfunction can be diagnosed much earlier than reading and language disorders, our findings pave the way for low resource-intensive, early prevention programs that could drastically reduce the incidence of DD.

Effects of daily practice on subitizing, visual Counting, and basic arithmetic skills
Burkhart Fischer, Andrea Köngeter, Klaus Hartnegg. Optom Vis Dev 2008:39(1):30-34.
BACKGROUND:The ability of subitizing and counting undergoes a long lasting development until the age of 17 years. Large proportions of children with problems in acquiring basic arithmetic skills exhibit developmental deficits in the correctness and speed of this special visual capacity. The first study described in this paper tests the possibility that subitizing and visual counting can be improved by daily practice. The second study described in this paper shows that basic arithmetic skill were significantly improved in a trained as compared to an untrained control group.
METHODS: Altogether, 74 subjects (age 7 to 13 y) participated in the first study. They were given a special task for daily practice during a period of 21 days. Corresponding to the state of the subject under training the difficulty of the task was adapted. For the second study 21 children (aged 7.5 to 9 y), were recruited from a local school. All children had problems in basic mathematics and failed the test of subitizing. The training group (N=10) was given the required training, while the waiting group (N=11) had to wait. A standard test of basic mathematics (DEMAT) was used to measurebasic arithmetic skills before and after the training.
RESULTS: The analysis of the pre-post training data revealed that subitizing and counting were significantly improved in about 85% of the subjects: they reached the normal range of the control subjects (N=133) of the same age. The second study shows that basic arithmetic skills were significantly improved in a trained as compared to an untrained control group.
CONCLUSION: Since the result of the second study of this paper shows a transfer from improvements in subitizing to improvements of basic arithmetic skills one may conclude that the basic visual capacity of subitizing and visual number counting contributes to the problem encountered by children with dyscalculia.

Subitizing: vision therapy for math deficits
Groffman, Sydney Optom Vis Dev 2009;40(4):229-238
Subitizing is the immediate visual perceptual apprehension and enumeration of a small set of elements. Subitizing deficits are correlated with difficulty in math at all ages. The incidence of individuals with mathematics learning disability (MLD) is between 6-7% of the population. This is unfortunate because math skills are of prime importance in everyday life enabling us to understand number concepts and do calculations. Math ability is essential for many occupations and professions. Subitizing is a basic skill that young children and many animals exhibit. Subitizing has been shown to be a precursor of math skills. A subitizing computer program has been designed and based upon theories and experimental data appropriate for improving math skills. It consists of a diagnostic test and four therapy programs: Flash-Number, Comparison-Spatial, Visual Counting, and Temporal Visual Counting. Subitizing therapy appears to improve both subitizing and math abilities.

Training visual-spatial attention in developmental dyslexia
Lorusso ML, Facoetti A, Cattaneo C, Pesenti S, Galli R, Molteni M, Geiger G. In: Dyslexia in Children: New Research 2006, pp 143-160
Recent studies have shown the critical role of the ability to actively select visual information (attentional focusing) in developmental dyslexia. A program specifically devised byGeiger and Lettvin to train selection of visual information and small-scale focusing has been tried on a group of 16 dyslexic children. The results after three months training have been compared with those of another group of 11 dyslexic children after the same period of customary reading training in a speech-therapy context. All children were assessed on reading, spelling and phonemic awareness and their FRFs (Form-Resolving Fields), ie. the extent of their field of correct visual recognition , were measured. The children who followed the experimental training improved their reading and spelling performances as much as the children who were treated by speech therapists (no significant difference between the groups). However, separate analyses reveal improvements after treatment for the experimental group on reading accuracy, reading speed, spelling, phonemic awareness reached statistical significance. The group receiving customary speech therapy, on the other hand, shows significant improvements in spelling only.

Dyslexia in a French–Spanish bilingual girl: behavioural and neural modulations following a visual attention span intervention
Valdois S, Peyrin C, Lassus-Sangosse D, Lallier M, Demonet J, Kandel S. Cortex 2014, 53:120-145
We report the case study of a French–Spanish bilingual dyslexic girl, MP, who exhibited a severe visual attention (VA) span deficit but preserved phonological skills. Behavioural investigation showed a severe reduction of reading speed for both single items (words and pseudo-words) and texts in the two languages. However, performance was more affected in French than in Spanish. MP was administered an intensive VA span intervention programme. Pre–post intervention comparison revealed a positive effect of intervention on her VA span abilities. The intervention further transferred to reading. It primarily resulted in faster identification of the regular and irregular words in French. The effect of intervention was rather modest in Spanish that only showed a tendency for faster word reading. Text reading improved in the two languages with a stronger effect in French but pseudo-word reading did not improve in either French or Spanish. The overall results suggest that VA span intervention may primarily enhance the fast global reading procedure, with stronger effects in French than in Spanish. MP underwent two fMRI sessions to explore her brain activations before and after VA span training. Prior to the intervention, fMRI assessment showed that the striate and extrastriate visual cortices alone were activated but none of the regions typically involved in VA span. Post-training fMRI revealed increased activation of the superior and inferior parietal cortices. Comparison of pre- and post-training activations revealed significant activation increase of the superior parietal lobes (BA 7) bilaterally. Thus, we show that a specific VA span intervention not only modulates reading performance but further results in increased brain activity within the superior parietal lobes known to housing VA span abilities. Furthermore, positive effects of VA span intervention on reading suggest that the ability to process multiple visual elements simultaneously is one cause of successful reading acquisition.

Directional awareness training: remediation of receptive letter reversals
McKiernan J, Avakian M. Intervention in School and Clinic 1980, 16:193-197
BACKGROUND: Letter reversals, both expressive (written) and receptive (read), are common among children and adults with reading problems. Educators have long wrestled with the problem of eliminating letter reversals. This investigation examined whether a program which trains directional awareness can reduce the letter reversal discrimination errors of deficient readers. We chose to examine receptive letter reversal errors for two reasons: first, because they represent a significant reading problem; and second because a standardized measure of these errors exists in the form of the Jordan Left/Right Reversal Test.
METHODS: Ten deficient readers, ranging from 6 to 19 years of age, were selected to participate in the study. Although the older students exceeded the norms range of the Jordan Test, they were included in order to examine the viability of maturational and “critical period” hypotheses which might have some bearing upon skill gains among learners of different ages. Eight of the ten had achieved scores within the normal range on standardized measures of intelligence. All ten were diagnosed as having reading deficiencies or learning problems. Most were more than two years delayed in their reading skills, while four of the older students were functionally illiterate. School histories included reports of persistent letter reversal errors; these reports were substantiated by the results from the Jordan Test. In some cases, extensive efforts had been made to help the students through a variety of special education services but without success. Exercises were selected from a pool of over thirty component learning skill exercises. They involved awareness of left and right in relationship to the student’s own body, after which awareness of directional relationships among objects in space was cultivated. Directional training took place for less than one-half hour per session. Sessions were scheduled from three to five times a week over a period of 12 to 24 weeks. No use of words or letters was made.
RESULTS: Statistical analysis of the results showed that letter reversal discrimination can be improved through directional awareness training. The mean errors scores across all students was reduced by 56% from 26.3 to 11.7. Although one student only achieved a 2 point gain (from 1st to 3rd percentile, the actual error score was reduced by over 50% from 43 to 20), this student was also unable to complete the program. A Mest of means calculated for students whose ages exceed the norms of the Jordan Test was significantly improved at the p=0.001 level of confidence.
CONCLUSION: This study clearly indicates that remediation of a broad spectrum of lower level skills can enhance the ability of the learning disabled to perform academic tasks which incorporate that skill, even without specific remediation of the academic skills themselves. Ideally, this type of training would be carried out in the school on a daily basis, ensuring maximum intensity of the remedial effort and optimum integration with the rest of the child’s academic program. Prompt detection and treatment of the child who is having difficulty establishing such lower level competencies as directional awareness could aid in preventing academic failure.

Improving dorsal stream function in dyslexics by training figure/ground motion discrimination improves attention, reading fluency, and working memory
Terri Lawton, Front Hum Neurosci 2016; 10: 397. 
There is an ongoing debate about whether the cause of dyslexia is based on linguistic, auditory, or visual timing deficits. To investigate this issue three interventions were compared in 58 dyslexics in second grade (7 years on average), two targeting the temporal dynamics (timing) of either the auditory or visual pathways with a third reading intervention (control group) targeting linguistic word building. Visual pathway training in dyslexics to improve direction-discrimination of moving test patterns relative to a stationary background (figure/ground discrimination) significantly improved attention, reading fluency, both speed and comprehension, phonological processing, and both auditory and visual working memory relative to controls, whereas auditory training to improve phonological processing did not improve these academic skills significantly more than found for controls. This study supports the hypothesis that faulty timing in synchronizing the activity of magnocellular with parvocellular visual pathways is a fundamental cause of dyslexia, and argues against the assumption that reading deficiencies in dyslexia are caused by phonological deficits. This study demonstrates that visual movement direction-discrimination can be used to not only detect dyslexia early, but also for its successful treatment, so that reading problems do not prevent children from readily learning.

The impact of visual perceptual skills training on reading performance in students with dyslexia.
Same Siah Kalroudi L, Alizadeh Hamid, Kousheh MR.  Advances in Cognitive Science 2009, 11(2):63-72
BACKGROUND: The aim of this study is to determine the effectiveness of training visual perception skills on improving reading abilities, including comprehension and word recognition in texts among students with dyslexia.
METHODS: The present research is a semi-experimental study and the research plan is of unequal control group type. Diagnostic Tests of Reading and Andre Rey Test were administered to two groups of 30 third grade primary school students with dyslexia who were selected from primary schools using multi-step cluster sampling. Data analysis was carried out using independent t-test to assess the difference in the means of the two groups (experimental and control) in post-test.
RESULTS: The findings indicated a significant difference in the pretest and post-test scores of the experimental and control groups (p=0.05). The dyslexic students, who received visual perception training after pretest, achieved higher scores in post-test. In other words, these findings led an improvement in reading in dyslexic students.
CONCLUSION: Results indicate that training visual perception skills could enhance reading performance in students with dyslexia. Also, reinforcing visual perception skills could improve comprehension and word recognition in texts in students with dyslexia. Training visual skills can improve reading performance and therefore, lead to significant improvement in reading ability and comprehension in students with dyslexia. Therefore, it can be concluded that training visual skills is an appropriate educational method for all students with dyslexia who have problems in visual perception.

The effect of magnocellular-based visual-motor intervention on Chinese children with developmental dyslexia
Yi Qian, Hong-Yan Bi. Front Psychol 2015, 6:1529
Magnocellular (M) deficit theory points out that the core deficit of developmental dyslexia (DD) is the impairment in M pathway, which has been evidenced in many previous studies. Based on the M deficit, some researchers found that visual intervention focusing on M deficit improved dyslexics’ M function as well as reading abilities. However, the number and reliability of these training studies were limited. Therefore, the present study conducted an M-based visual-motor intervention on Chinese children with DD to investigate the relationship between M deficit and Chinese DD. Intervention programs included coherent motion detection, visual search, visual tracking, and juggling, which were related to M function. The results showed that M function and phonological awareness of training dyslexic group were improved to a normal level as age-matched normal children after intervention, while non-training dyslexics did not. It supported M deficit theory, and suggested M deficit might be the core deficit of Chinese DD.

Neural plasticity following auditory training in children with learning problems
Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Clinical Neurophysiol 2003, 114(4):673-684
METHODS: Children diagnosed with a learning disability and/or attention deficit disorder worked with commercial auditory processing training software for 8 weeks; control groups consisted of normal-learning and learning-impaired children who did not participate in any remedial programs. Auditory brainstem function was evaluated in response to click and speech stimuli in quiet; cortical responses to speech stimuli were obtained in quiet and noise. Academic achievement and cognitive abilities were assessed with standardized measures.
RESULTS: Compared to controls, the trained group improved on measures of auditory processing and exhibited changes in cortical responses in quiet and in noise. In quiet, cortical responses reflected an accelerated maturational pattern; in background noise, cortical responses became more resistant to degradation. Brainstem responses did not change with training.
CONCLUSIONS: Children with learning problems who practiced with auditory training software exhibited plasticity of neural encoding of speech sounds at the cortical, but not subcortical, level of the auditory pathway. This plasticity was accompanied by improvement in behavioral performance. This study demonstrates that in learning-impaired children working with commercial auditory processing training programs affects both the perception and the cortical representation of sound.

The effect of practice on low-level auditory discrimination, phonological skills, and spelling in dyslexia
Schäffler T, Sonntage J, Hartnegg K, Fischer B. Dyslexia 2004 May;10(2):119-30.
Phonological awareness is believed to play a major role in the auditory contribution to spelling skills. The previous paper reports low-level auditory deficits in five different subdomains in 33-70% of the dyslexics. The first study of this paper reports the results of an attempt to improve low-level auditory skills by systematic daily practice of those tasks that had not been passed in previous diagnostic sessions. The data of 140 dyslexics indicate that the average number of unsolved tasks can be reduced from 3 of 5 to 1 of 5. The success rates have values of 70-80% for intensity and frequency discrimination and for gap detection, but reach only 36% for time-order judgement and 6% for side-order judgement. The second study reports that successful low-level auditory training transfers completely to language-related phonological skills and also to spelling with the largest profit in spelling errors due to poor auditory analysis. Control groups (waiting and placebo) did not exhibit significant improvements. It is concluded that low-level auditory deficits should be considered and improved by practice in order to give the dyslexics more phonological help when trying to transfer what they hear to spelling.

Effect of non-linguistic auditory training on phonological and reading skills
Murphy CF, Schochat E. Folia Phoniatr Logop 2011, 63(3): 147-53
OBJECTIVE: To analyze the effect of nonverbal auditory training on reading and phonological awareness tasks in children with dyslexia and the effect of age in relation to post-training learning considering the ages from 7 to 14.
METHODS: In experiment 1, one group with dyslexia (total = 12) was trained and compared with a group of untrained dyslexic subjects (total = 28). In experiment 2, the performance of the trained dyslexic group (total = 18) was compared at three different moments: 2 months before, at the beginning, and at the end of training. Training was carried out for 2 months using a computer program responsible for training discrimination skills.
RESULTS: The group receiving nonverbal auditory training demonstrated significant improvements (mainly for the group from 7 to 10 years old), not only in the nonverbal auditory skills trained (p < 0.001), but also in phonological awareness syllable tasks (synthesis, segmentation, manipulation and syllable transposition) in experiment 1 (p < 0.003), and phonemic tasks (p < 0.001) and text reading (p < 0.001) in experiment 2.
CONCLUSION: The results suggest a link between verbal and nonverbal skills, in addition to corroborating studies regarding the existence of a critical learning period.

Vision therapy in a school setting
Brodney AC, Pozil R, Mallinson K, Kehoe P. J of Behav Optom 2001, 12(4):99-103
The purpose of the present study was to evaluate the effects of vision therapy in a school setting in which elementary school children enrolled in a reading mentoring program, Caring Adults Teaching Children (CATCH), were trained as a group. The experimental goals was to improve visual-motor and visual-perceptual skills, with the use of vision therapy in short sessions given weekly at school to children with reading difficulties. Sixty students were selected after the use of the Developmental Eye Movement test’s (DEM) exclusion criteria and were randomly assigned into one of two groups: vision therapy and non-vision therapy. Both groups received CATCH tutorial visits once a week for 50 minutes. IN addition, the therapy groups received a weekly 30 minute activity session in which three activities were completed from the following: oculomotor, accommodation, binocularity, visual motor and visual memory. The results revealed that vertical and horizontal eye movements and accommodative facility were improved after 22 sessions of group vision therapy. These improvements were related to attentional mechanisms leading to improved reading abilities. We believe this preliminary study gives evidence of the advantages of a program whereby vision therapy is provided in the elementary school setting to advance deficient visual skills that are related to learning and cognitive enhancement.

A comparison of auditory/language therapy with school visual support procedure in a public school setting
McKane PF, Maples WC, Sellars P, McNeil M. J Optom Vis Devel 2001, 32(Summer):83-92
BACKGROUND: There is little doubt that functional literacy is one of the major social challenges of the 21st century. Learning to read is difficult for some. Others have trouble reading efficiently. In neither case is the cause fully understood and is therefore the subject of debate. It is logical to think that sensory function, either auditory/language or visual, or the integration of these sensory functions, could be a cause. The literature concerning the influence of auditory skill facility and visual skill facility in th elearning process has yet to give a definitive answer. Some hold that poor reading eye movements are caused by poor language skills and if the auditory/language skills were improved that reading and eye movements during reading would also improve.
METHODS: Twenty-nine third grade children who had previously been identified as being below average in some academic area were the subject  of this study. The experimental group contained 18 subjects, equally distributed between genders. The control group contained 11 subjects, 4 females and 7 males. After screening evaluations, all children were enrolled in an auditory/language enrichment program and the experimental group also received school based vision techniques which were individually programmed by a board certified optometrist (FCOVD) and administered by school personnel, in the school setting for 30 minutes a day. The program was administered for 3.5 months during the spring semester of the school year.
RESULTS:Both groups improved significantly over pre-test scores on the reading aspect of the WRAT and reading rate with comprehension as measured by the Visagraph. The experimental group also demonstrated a significant improvement in reading eye movements as measured by the Visagraph, but the control group did not.
CONCLUSION: Both visual and auditory/language intervention have a positive effect on the reading WRAT scores as well as the reading rate with comprehension. Reading eye movements however were significantly improved only with visual intervention and not with auditory/language therapy.