Interprofessional WesternU team researches impact of sensory processing disorder on vision, gait and balance

An interprofessional Western University of Health Sciences team is collaborating on a study examining how sensory processing disorder affects a child’s vision, gait and balance.

The study has produced multiple posters, conference presentations and, most recently, the publication “Differences in Oculomotor Function between Children with Sensory Processing Disorder and Typical Development” in Optometry and Vision Science, the Journal of the American Academy of Optometry. The authors are Assistant Professor Kimberly Walker, OD, FCOVD, and Director of Community Outreach Kristy Remick-Waltman, OD, FCOVD, from WesternU’s College of Optometry and Professor Emerita of Physical Therapy Education Donna Redman-Bentley, PT, PhD, and Associate Professor Dayle C. Armstrong, PT, MS, DPT, from WesternU’s College of Health Sciences. Click here to view the article online: https://journals.lww.com/optvissci/Fulltext/2019/03000/Differences_in_Oculomotor_Function_between.5.aspx.

This article uses data collected from one part of their larger research project – administering an eye movement test developed by the Northeastern State University College of Optometry (NSUCO) that WesternU College of Optometry students learn in their second year. The patient follows targets with their eyes and the optometrist evaluates whether their eye movements are within a normal range.

“We looked at typically developing (TD) children compared to children with sensory processing disorder (SPD) to look at if eye movements are different,” Walker said. “Children with sensory processing disorders had more difficulty with the test and scored lower on the test.”

The TD group scores from this study validate the NSUCO test norms established in 1992.

Optometrists should evaluate whether their young patients’ eye movements are below the norm, Walker said.

“Most optometrists probably don’t ask sensory-based questions other than those that are vision related,” she said. “I think more importantly for the general optometrist is if they see these eye movements that are really out of the norm for that child’s age group then they should ask the parents about sensory issues to find out if this kind of testing and vision therapy is needed.”

The WesternU Eye Care Institute has optometrists who specialize in vision therapy, often seeing children on the autism spectrum or with neurodevelopmental delays.

“We are examining vision but it’s the whole child. We need to address all those other things too,” Walker said. “I thought it was an interesting project because this is my population. These are the people that I work with and for the most part I rarely see a neurotypical child, especially in the vision therapy area. So it’s just really nice to dig in and do some figuring out if the tests we are doing is effective in this population and if they are valid tests. What are differences and what should I look for?”

As part of this study, the WesternU team also tested patients’ eye teaming, ocular focus, visual processing and visual motor integration. Two other tests that showed significant differences between the two groups – typically developing and those with sensory processing disorder – were visual motor integration tests and stereopsis, or depth perception.

“This makes sense. It is a really sensitive measure of someone’s binocularity, or how well their eyes are working together as a team,” Walker said. “If you have difficulty with tracking then often times the eyes are not going to work well together as a team. The kids with sensory processing disorder weren’t coordinating their eyes as well as the typically developing group.”

Vision, balance and gait, or the way a person walks, require the ability to take in sensory stimuli, process it in the brain, and then give some kind of motor output, Redman-Bentley said.

“When one or all three of those are defective, then it creates problems for children to be able to see appropriately, or be able to balance or have good postural control, or even to be able to walk without falling all the time,” she said.

Walker and Redman-Bentley have each given platform presentations based on this study at various conferences and meetings.

“Our future studies are going to involve more collaboration with writing articles of the correlation between vision and balance and vision and gait,” Redman-Bentley said. “What we will eventually be trying to do is show some of these tests can be a predictor of children who are demonstrating sensory processing disorder. If you see a very low score that could indicate that this child is having sensory processing disorders.”

They are also working on an article looking at falls and fall risk. This interprofessional project has helped the collaborators understand different perspectives.

“I know a lot more about vision than I ever knew before,” Redman-Bentley said. “I also learned a lot from podiatry. They sometimes have a different way of looking at gait than what PTs do. So that was interesting to get input from the podiatrists about what they tend to focus on with gait.”

Walker said she learned a lot about how podiatrists and physical therapists evaluate patients differently than she does as an optometrist.

“I think it helps me with patient care too because I’m in the clinic identifying patients that need these other kinds of evaluations and services,” Walker said. “In the past, I worked a lot with OT (occupational therapy) because of vision therapy but not really as much with PT and podiatry. These kids with neurodevelopmental disorders, autism, ADHD, sensory processing disorders, they need all these things. It’s not just about eyes. It’s really that collaboration between all of us is how the patient improves.”