Seeing the Whole Picture

Seeing the Whole Picture: Oculomotor Development, Occupational Therapy, and Primitive Reflex Integration

By Irene Hannam, MS OTR/L

Why Oculomotor Development Matters in Occupational Therapy:

Oculomotor control—including pursuits (smooth tracking), saccades (quick eye shifts), convergence (eye teaming), and accommodation (focus changes)—is foundational for functional school tasks like reading, writing, classroom copying, and visual scanning. Deficits manifest as line skipping, loss of place while reading, poor handwriting, slow task completion, and visual fatigue.

Research underscores this connection: visual health significantly correlates with academic performance in school-aged children learn.carrickinstitute.com+1ResearchGate+7PMC+7Boulder Valley Vision Therapy, P.C.+7. 

Occupational therapy that supports oculomotor development can enhance participation and learning in school settings.

The Connection Between Oculomotor Skills and Primitive Reflexes:

Primitive reflexes—such as ATNR (asymmetrical tonic neck reflex), STNR (symmetrical tonic neck reflex), and TLR (tonic labyrinthine reflex)—normally integrate in infancy. When retained beyond developmental expectations, these reflexes can impair midline crossing, postural adaptation, and, critically, oculomotor control.

Research highlights these links:

• Persistent reflexes have been shown to disrupt oculomotor and cognitive function in children, emphasizing the need for integrative intervention PMC+1.

· The vestibular-ocular motor connection is essential for classroom learning. Research shows that disruptions in eye movement control—such as pursuits, saccades, convergence, and accommodation—are linked to difficulties with reading, copying, and sustained attention. While much of this work originates in concussion and rehabilitation research, the same principles apply to school-aged children, where oculomotor inefficiencies can present as academic and behavioral challenges (Ertzgaard, 2024; Chen et al., 2025).

OT’s Role in Supporting Oculomotor Development:

Occupational therapists embed eye movement control into functional, classroom-relevant activities. Practical interventions include:

• Tracking games (e.g., following a moving object).
• Shifting gaze tasks (e.g., looking between targets on desk and board).
• Vergence and accommodation practice (e.g., near–far gaze shifts as part of tasks).

Combining these with reflex integration strategies—like cross-crawl for ATNR or neck mobility exercises for STNR—supports sustained gains in visual-motor control and academic participation.

How OTs Screen for Oculomotor Deficits in the School Setting:

Occupational therapists combine functional observation with targeted screening in naturalistic environments.

Classroom-Based Observation:

OTs look for signs such as:

• Losing place or skipping lines while reading.
• Excessive head or finger movement during visual tracking.
• Difficulty shifting focus between near (desk) and far (board).

Core Screening Components

Why This Screening Matters:

• Clarifies whether visual behaviors stem from oculomotor control issues versus attention or academic difficulty.
• Provides tangible data to justify classroom modifications or referrals for vision evaluation.
• Supports targeted intervention planning to enhance school engagement and academic function.

Classroom Accommodations That Support Oculomotor Challenges:

• Preferential seating to improve visual access and reduce environmental distractions.
• Use of reading guides or highlighted lines to support visual tracking.
• Segmenting visual tasks into smaller, manageable chunks.
• Allowing finger-guided reading or copying.
• Frequent movement breaks to reset visual focus and support attention flexibility.

Research Evidence Supporting Integrated OT Intervention:

• Oculomotor dysfunction is linked to broader neurocognitive and vestibular-motor issues, especially in pediatric populations—highlighting the importance of screening and intervention SpringerLinklearn.carrickinstitute.comijspt.scholasticahq.com+2learn.carrickinstitute.com+2PMC.
• A pediatric manual focusing on oculomotor control development in school-aged children underscores the feasibility of supporting these skills within OT practice Boulder Valley Vision Therapy, P.C.+15ResearchGate+15SpringerLink+15.
• App-based, game-like interventions targeting saccades, pursuits, and fixation are emerging as promising, engaging tools for improving eye movement control, especially for children with special needs PMC+5SpringerLink+5Wikipedia+5.

MTSS Tier 1: Universal Visual Strategies for All Students:

At the universal level, OTs can support all learners by:

• Incorporating visual tracking into class “brain breaks” (e.g., pointing games, following objects).
• Embedding midline-crossing movement activities (e.g., cross-crawl) into routines.
• Designing classroom-wide scanning activities (e.g., “Find the letter/shape” hunts).
• Working with teachers to optimize lighting, reduce glare, and create visually clear learning materials.

These strategies support oculomotor readiness and visual attention, benefiting all students—not only those on OT caseloads.

Research-Based Takeaways:

• Oculomotor development is closely tied to academic performance—especially reading, visual tracking, and copying tasks SAGE Journals.
• Retained primitive reflexes disrupt oculomotor and cognitive functioning, reinforcing the need for integrated OT intervention PMC+1.
• Functional, classroom-based OT screening captures meaningful visual behaviors and guides intervention planning.
• Emerging tools—such as tablet-based oculomotor training and pediatric manuals—offer promising advances for school-based practice medcoeckapwstorprd01.blob.core.usgovcloudapi.net+15ResearchGate+15ScholarWorks+15.

Recommended Resources for Further OT Professional Research:

• Ertzgaard et al. (2024) on screening convergence, accommodation, pursuit, and saccadic function in neuro-visual rehabilitation PMC+1.
• Hodgson et al. (2025) on the role of oculomotor screening in OT practice and its impact on functional therapy PMC.
• Scoping review on ocular motor disorders and their relevance to broader rehabilitation contexts,      including children ScholarWorks+3PMC+3ijspt.scholasticahq.com+3.
• Development of school-based OT iPad manual supporting pediatric oculomotor function ResearchGate.
• App‑based interventions for improving oculomotor control in children with special educational needs SpringerLink. 

References:

• Ertzgaard, P. (2024). Oculomotor screening and neuro‑visual rehabilitation: Convergence, accommodation, visual motion sensitivity, saccades, pursuit eye movements. Neurological Research, 40(9), 752–757. PMC
• Hodgson, T. L. (2025). Oculomotor deficits in children with sensory processing disorders: OT perspectives on oculomotor examination. PubMed Central. PMC
• Chen, A. M., et al. (2025). Intervention for ocular motor disorders: A scoping review. Optometry & Vision Science. medcoeckapwstorprd01.blob.core.usgovcloudapi.net+6PMC+6PMC+6
• Kingrey Francisco, M. O. T. (2021). Addressing ocular motor dysfunction in children through occupational therapy education (Master’s thesis). Shawnee State University. digitalcommons.shawnee.edu
• Clark, R., et al. (2021). Oculomotor control in children with special educational needs: Development of an evidence-based game for therapy. Springer. SpringerLink

Disclaimer
I am an occupational therapist providing information intended to support academic success in students. This resource is designed for teachers, parents, and occupational therapy professionals as a general guide. It is not medical advice, diagnosis, or treatment, and should not be used as a substitute for individualized medical care. Please consult appropriate professionals for individual medical or therapeutic concerns.