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Looking at Balance:

October 31, 2014


By Roxanne Chess MS, OTR/L                                        

Director of Occupational Therapy

The McCarton Center for Developmental Pediatrics



The link between balance, play, and functional vision

A Three Part Series


Guided Reading Questions:

  • What is functional vision?
  • How can functional vision help my child balance?


Guided Reading Questions in the Next Installment:

  • What does it take to balance?
  • What are some great balance activities to do at home?


What is Functional Vision? :

Functional vision is primarily defined as the way in which an individual uses whatever vision he or she has. The term “vision” refers to the end product of sight, and “sight” refers to the process of light stimulating the receptors in the eyes. The information from these stimuli travels up the nerves to the higher brain, or cerebrum, where meaning is ascribed to the visual input. In order to see and see clearly, two things are required: a visual input of light, and well functioning eyes that do not distort the input (e.g. blurry or double vision). But what, exactly, is functional vision?

The following are all examples of functional vision:

Ballerinas maintaining focus on a spot each time the spin around to avoid becoming dizzy.

Tennis players moving quickly around the court while keeping their eyes focused on the ball.

Now think of your child on a scooter. Think of whether

your child keeps their head still while watching people walk by, or if their

whole head moves to track passersby. Does your child scan the environment for obstacles while maintaining balance and fluid movement? There are many examples of functional vision in children’s daily lives.


Think of copying from the blackboard. It takes some children more

time to refocus their vision on the paper in front of them after looking far away at the blackboard. Consider the smooth visual pursuits required to track a ball as it’s tossed around during basketball. The child has to be ready to catch that ball. Only by tracking the ball while moving with the group can your child participate fully. Think of balancing during yoga or on a wobbly subway train. Visual fixation on a single point would help your child balance during yoga poses or when on a subway train.


When your child’s occupational therapist (OT) uses the term functional

vision they may simply be referring to visual perceptual skills used functionally. One example of these skills is accommodation. Accommodation is when the eyes refocus from near to far and vice versa. One such example already noted above was looking at the blackboard and back to the paper on the desk. Another example is looking ahead while driving, then refocusing on the speedometer up

close.  However, when your OT says, “functional vision” they may also be referring to a wide variety of daily skills such as:

–             scanning a worksheet

–             visually tracking the teacher as he or she moves around the room

–             keeping track while reading lines in a book

–             focusing on a target when throwing

–             tracking the curser on a computer screen

–             maintaining eye contact while swinging


Depending upon your child, functional vision goals may range from visual fixation to other more complex uses of vision to support balance. Your child’s OT may be working on integrating the vestibular system and the visual system. The vestibular system is a complex neurological network that gives us the ability to

balance. Visual input, while not directly part of the vestibular system, can be

used to support balance. The two systems are closely linked in the brain. This is why your child’s OT maybe be working on improving the coordinated symbiotic functioning of these two systems.

When your child is working on balance in occupational therapy or with their Energetic Juniors Trainer how is functional vision incorporated? Maybe your child is learning to spot for static balance. Maybe your child’s therapist or trainer is teaching them to track a moving object while keeping their head still. Maybe your child is learning to keep their eyes fixated on a target, while moving their body around the room. Your child could even be learning to re-establish visual focus between movement cycles, just like the ballerinas. While every child’s individualized goals can be different, some basic principles do apply to almost everyone:


Principle 1: The visual and vestibular (balance) systems are closely linked in all of us.

Principle 2: Improving that neural link supports more fluid and natural balance.

Principle 3: Focusing on 1 spot helps us maintain balance poses.

Principle 4: Learning to move our eyes without moving the head and neck allows for visual tracking without disrupting the postural alignment needed for balance.

Principle 5: Improved functional vision will help your child participate in games and sports faster and with better accuracy.


The next installment of this three part series will cover more of what goes into balance, and activities to do at home. Until then, thank your neurology for keeping you upright and visually engaged!