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Behavioral Optometry BOAF
Volume1 Number1 2012
behavioral model, and how they may enhance this practice.
If we look at the formal definition of the word behavioral, which is an adjective, it reads as fol- lows: “involving, relating to, or emphasizing behav- ior: closely related species have similar behavioral patterns.”
I would like you to pay attention to the last part of this statement. We work with the species that are human beings. As a species, humans should really have a “closely related similar behavioral pat- terns”. By understanding the fact that humans should have certain reactions to certain tasks, we should then be able to realize if we observe some- thing that is outside what we would consider a ‘normal’ or ‘ideal’ behavior pattern.
Thus when we, as behaviorally minded Op- tometrists, are performing a series of tests, or probes with our patients we should expect some ‘typical’ responses. When we do not see these ‘typical’, or desired responses, and get some ‘other’ response, we should be on alert. This should bring about a level of attention with us. The goal then to try and figure out ‘why’ our patients have reacted in this manner, and what this reaction means.
To further understand the concept of ‘reac- tions’ by our patients. It is very important to realize that every ‘test’ we do with our patient is a form of stimulus. It is not the result of the test we are com- pletely worried about. (The test result can be very important!). It is the response to the stimulus that will provide the Behavioral Optometrist with the greatest amount of meaning. This can be further broken down into an Input/ Output concept. Within the visual system this is usually identified as the Afferent and Efferent pathways. (It is not the scope of this article to delve deep into the concepts of Afferent/ Efferent pathways!)
In my opinion, one of the fundamental keys for practicing Optometry from a behavioral perspec- tive is using the art of observation. The ability to observe is an art, that is not always innate. It tends to be harder to do when you are in a thinking mode. If you need to think about ‘how’ to perform an exam, refraction, or particular test, you probably
will not be in an ideal ‘frame of mind’ to utilize your power of observation to its fullest. Thus, my first recommendation to you would be to try and do the same tests, in the same sequence, with the same instruction set. Following this recommendation should allow you to become somewhat ‘automatic’ with your testing. Once on ‘auto-pilot’ you will be more ‘available’ for making observations of the patient’s responses to the test/ stimulus.
What I would like to do is provide you with a small list of examples that you may start to use during your examination. This will provide you with an idea of some different things you may be able to watch for. This list of examples is by no means meant to be exhaustive, or all inclusive. It is meant to get you started, or get you thinking about being an observer, and the concept that usually for an input, there is going to be some sort of output. It is the type of output you observe that will provide the most information about your patient. These obser- vations will start to give you an indication as to what level your patient is operating on, and where you may need to start in helping this patient.
Let’s start!
The Waiting Room: Simply watching the child in the waiting room before calling them back pro- vides you with your first opportunity. Does the child play with other children? Do they play by them- selves? Sit close to their parent? Does their play indicate that they are using vision to lead?
History: Does the child try to answer the ques- tions on their own, or do they look to their parents to answer for them? Are they mute? Do the par- ents answer without giving the child a chance to reply themselves? Do the patient’s lips move while you are asking them questions?
Visual Acuity: When you give the child the oc- cluder. Do they pick it up with the hand you asked them to? Does the child need some sort of ‘crutch’ to figure out which hand is their left or right? When covering an eye. Do they try and close either eye? Do they squint? Do they approach the task confi- dently? Are they afraid to ‘guess’? Do they lean forward, or to one side?
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