Dr Bryce Appelbaum with patient

Maryland based therapists "marry" optometric vision therapy and OT for significant results. Husband and wife team Stan Appelbaum, OD, FCOVD, and Barbara Bassin, OTR/L, BCP, are truly one of a kind. The board-certified vision therapist and board-certified pediatric occupational therapist work together in the same practice, offering patients both optometric vision therapy and sensory-integration-oriented occupational therapy. Read this article in its entirety.

"I’m writing this as my daughter, A., has completed her last eye therapy session. Our experience began about two years and two months ago. While that may seem like a long time ago, time really did go by quickly.Her success today is determined by her motivation, not her impaired vision skills."

Read this Vision Therapy Success Story in it's entirety.

"When N. first started vision therapy she was uncomfortable in large groups of people. She cringed and flinched when other children would run past her. Playground situations caused her anxiety. Since beginning vision therapy, I have noticed that she is much more comfortable with people approaching her."

Read this Vision Therapy Success Story in it's entirety.

Hours of Operation

  • M - W - F : 10:00 am - 7:00 pm
  • T - Th : 10:30 am - 7:30 pm
  • Sa : 9:00 am - 5:00 pm

Occupational Therapy at Appelbaum Vision

And Most Frequently Asked Questions about Occupational Therapy

Occupational Therapy addresses the functional skills of infants, children, and adults to enhance performance in their daily life through therapeutic activity, we work to improve an individual’s performance and enable participation in play, school, movement, work, and overall daily living. Occupational Therapists enhance development and function, promote success, further performance, maximize independence, and prevent dysfunction in people with developmental, physical, behavioral, social, or emotional issues.

But what does it all mean?

What is sensory integration?

Sensory integration is the ability of the brain to receive, organize and integrate information from the senses and produce an appropriate response to the demands of the environment. The 5 known senses include vision, hearing, smell, taste, and touch. There are actually 5 more senses that are important to our functioning well in life.

They include vestibular (the balance and movement sense), proprioception (the sense that tells us where are body parts are in space through our muscles and joints), pain, temperature, and interoception (the sense of the internal organs to regulate blood pressure, digestion, breathing, hunger, and other functions of the autonomic nervous system). Issues in sensory integration can interfere with an individual’s coordination, behavior, attention, and comfort.

What are some symptoms of SPD?

There is a wide range of symptoms involved in SPD. You or your child will not have all symptoms, but may be over-responsive in some sensory areas and under-responsive in others. Some common symptoms include: hyperactivity or distractibility, behavior problems, muscle tone and coordination problems, difficulty in school and/or with schoolwork, speech and language delays, and sensory overload. If we take a closer look you may recognize some of these symptoms:

Sensory Oversensitivity:

  • Tactile Sensitivity – uncomfortable or negative experience to touch; avoidance of certain touch experiences that can be wet, messy, or perceived as unpleasing but are generally accepted by others; dislikes having hair or face washed; sensitivity to clothes, tags in the shirt, seams on socks, food textures and picky eating; isolation from others
  • Gravitational Insecurity - a sudden fearfulness when off the ground or on something unstable; avoids jumping, climbing, or activities that are unpredictable in movement; cautious or fearfulness in movement
  • Movement Sensitivity - carsickness, or dizziness when moving head
  • Noise Sensitivity - over reaction to loud or unexpected noises that most others could tolerate
  • Oversensitivity to smell or pain
  • Difficulty calming self; feeling stressed with sensory overload

Sensory Undersensitivity:

  • Seeking movement constantly; fidgety; overly active; unable to remain still
  • Clumsy or uncoordinated movements, may frequently bump into others or things
  • Overly high tolerance to pain; does not seem to notice sensations others would feel as painful
  • Constantly touches others or things; craves being touched
  • May be too rough with other others, does not realize how hard to touch, squeeze, or hug
  • Does not seem to notice strong odors; unaware of temperature, never cold

Movement and Sensory-based Motor issues:

  • Issues in postural control, balance and equilibrium
  • Poor muscle tone and/or posture
  • Trips and falls easily
  • Bumps into things
  • Clumsy, awkward movement
  • Poor motor planning of new movement
  • Delayed gross motor skills
  • Delayed fine motor skills
  • Poor handwriting
  • Avoids sports

How do issues with self regulation impact behavior?

When someone is having difficulty with self regulation, they may have difficulty modulating and regulating their nervous system and emotions. This can lead to issues in alertness, attention and focus. In children and adults, it may also lead to frustration, anxiety, anger, fatigue from cognitive demands, tantrums, withdrawal, and difficulty in social situations, schoolwork, and avoidance of life activities.

  • Visual Issues – many vision issues go undiagnosed or can be misdiagnosed as a learning dysfunction. This goes beyond visual acuity. May have trouble eye tracking, maintaining eye contact, an eye turns in or out, difficulty copying from the board, makes reversals with letters, or becomes overly excited with a lot of visual stimuli. Rubs eyes, get headaches or eyes water after close work or reading. Avoids reading, must read aloud, or loses place when reading.
  • Behavior – poor self confidence, distractible, difficulty with transitions.
  • Difficulty chewing or handling utensils.
  • Muscle Tone – poor posture (standing or sitting), tires easily, stronger or weaker than others.

How do issues with self regulation impact behavior?

If someone is having difficulty modulating their self regulation they may get angry easily, become frustrated quickly, get fatigued from cognitive demand, not be able to transition to a new activity or setting very well, may have frequent tantrums, gets “in trouble” often at school or at work, and could dislike and often avoid activities they are aware they can’t handle. Children and adults with self regulation issues may isolate themselves from others, have difficulty in social situations, and avoid life activities.

How does Occupational Therapy treat children and adults with SPD and Sensory Integration Dysfunction?

Occupational Therapists are trained and skilled at identifying the underlying causes for any sensory based or motor difficulty an individual might be having. OT's perform an evaluation and design specific therapeutic activities that will assist the child or adult to either help overcome these issues and/or create strategies to better deal with them.

We provide an array of sensory-based, motor, and developmental or graded tasks that are specifically designed therapeutic activities to help improve sensory processing, self regulation, and motor control. We use sensory and movement based equipment, motor skills and neurodevelopmental activities, the Alert Program for Self Regulation, Handwriting Without Tears, Therapeutic Listening, Wilbarger Deep Pressure Brushing Protocol, and the Interactive Metronome programs.

How does Occupational Therapy work with sensory based self regulation issues?

Self regulation is the ability to modify our own behavior, emotions, and thoughts depending on the situation we are in. We use the Alert Program for Self Regulation to first increase awareness of your own alert levels, then build sensory strategies to change your alert levels and achieve a "just right" level of alertness throughout the day or for a specific situation. Children have many demands placed on them at an increasingly earlier age than recent years. We can help make them aware of their own self regulation and choose the right strategies to achieve optimal performance on all daily tasks. Adults may need to learn strategies to help them calm or rev up their nervous system to alert, focus, and attend to life’s demands.

How does Occupational Therapy improve coordination?

Issues in one's vestibular, proprioceptive, and tactile systems often lead to poor motor coordination. By providing movement and sensory-based exercises on a consistent basis, we can improve coordination by increasing muscle tone and strength, improving equilibrium reactions, decreasing fearfulness in movement, promoting confidence in movement, improving motor planning, and allowing a child or adult to explore their environment at their individual level and build their coordination skills. We find the 'just right challenge' for each person's needs.

How do Occupational Therapists work with infants?

We conduct a full evaluation of an infant’s sensory processing, self regulation, postural control, motor coordination, and feeding as indicated. We know an issue in any of these areas can affect their sleep, feeding, behavior, attachment/bonding with the parents, and can prevent the infant from reaching their developmental milestones and their ability to handle life's demands. We work closely with the infant and parents to provide therapeutic intervention at an early age.

How does Occupational Therapy work on handwriting?

There are various aspects involved in the ability to write and complete homework. We evaluate the upper extremity function and skill level, grasp of a pencil, motor coordination with the pencil, visual motor integration, visual perception, posture at the desk, focus, and screen for possible visual issues. We look carefully at letter formation, directionality, line placement, size consistency, spacing, and organization for writing.

We determine the underlying areas impacting the writing problem and provide therapeutic activities to address the issues and improve handwriting.

What are common possible symptoms of sensory issues in adults post concussion (no s) (as well as) adults who have had sensory issues since childhood?

  • Cognitive Fatigue
  • Coordination issues
  • Light or noise sensitivity
  • Visually overloaded easily
  • Poor quality of sleep
  • Anxiety
  • Isolation
  • Irritability
  • Inability to handle daily life activities

How do we treat adults who have a Traumatic Brain Injury or Concussion?

It is common for those affected with any type of brain injury to have their neural timing and coordination affected. By implementing a computer-based program called, Interactive Metronome, we can combine specifically designed motor exercises to be performed in sync with a metronome beat. Treatment with this program can improve attention, motor skills, cognition, behavior, quality of sleep, and can overall better synchronize timing in the brain. We also provide movement based activities when needed to enhance performance, coordination and daily life activities. Activities of daily living including planning, organization, scheduling are helpful in daily living and quality of life. Sensory counseling, self regulation strategies, and sensory-based therapeutic activities are useful for adults with these issues.

What is sensory counseling?

We provide sensory-based counseling to our patients that teaches new strategies to overcome or best deal with sensory issues in their daily lives.

How do OT and Optometry work together in our office?

Appelbaum Vision was the first practice in the country to offer both Vision Therapy and Occupational Therapy and is proud to continue to be considered the gold standard of integrating these fields. We provide the highest quality of Optometric Eye Care, Vision Therapy and Occupational Therapy in the same practice. Our history of working together as a team allows us to provide a comprehensive and holistic approach to vision, movement, and development for both children and adults.

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