• Empathic + motivated + creative

• Dave has worked at Kessler Rehabilitation’s outpatient neurological rehabilitation program for the past eight years, beginning as a per diem occupational therapist before transitioning to a full-time role. As a new graduate, he gained experience treating a wide variety of neurological diagnoses.

• Working alongside an experienced neuro-optometrist sparked his interest in vision rehabilitation and inspired him to pursue specialized training through continuing education. Since then, he has helped strengthen Kessler’s outpatient vision rehabilitation program and created the Kessler Vision Special Interest Group (SIG), which brings together clinicians interested in learning more about vision rehabilitation through education, quarterly meetings, and discussions about processes and practice changes within the company.

• Dave has also provided education nationally to speech-language pathologists and physical therapists on vision rehabilitation, including how to complete vision screens, what to look for, and when to refer patients for additional evaluation.

How did you specifically become involved in working with vision remediation

• Dave’s interest in vision rehabilitation began while working alongside a neuro-optometrist at Kessler, who sparked his curiosity about the specialty. He pursued additional training through continuing education courses, independent research, and mentorship from leaders in the field, including Vincent R. Vicci Jr., O.D., and Karen Wauters, OT.

• Through his involvement with the Neuro-Optometric Rehabilitation Association (NORA), Dave connected with professionals who further supported his growth in vision rehabilitation. He became a board member of the organization and has gone on to teach courses at conferences, including internationally in London.

• Dave is currently completing the second part of a fellowship focused on becoming an expert in neuro-visual rehabilitation and developing the skills needed to both provide specialized services and educate other professionals in the field.

• Through NORA, Dave also teaches clinical skills courses focused on neuro-visual rehabilitation, covering foundational, application, and advanced topics. He teaches nationally and internationally, including in London, and has taught Clinical Skills 2 for the past two years.

• Clients may seek occupational therapy services for vision remediation following conditions such as concussion, traumatic brain injury (TBI), stroke, neurodegenerative diseases, and low vision. Dave works with clients experiencing oculomotor deficits, visual-perceptual challenges, binocular vision dysfunction, and visual-vestibular integration difficulties.

• He also works with individuals experiencing dysautonomia, including complications related to conditions such as Postural Orthostatic Tachycardia Syndrome (POTS), and some individuals with Ehlers-Danlos syndrome (EDS) who may experience secondary visual symptoms. These challenges can impact how individuals process visual information, tolerate stimulation, and maintain attention.

• Through vision remediation, Dave helps clients develop strategies to improve participation in meaningful activities such as reading, driving, working, and completing daily tasks.

What does your evaluation process typically look like for clients receiving vision remediation?

• When evaluating clients for vision remediation, Dave typically begins with a comprehensive vision screen and visual-perceptual assessment. He also evaluates specific areas of visual function, including oculomotor skills and binocular vision, to better understand how visual challenges may impact daily activities.

• Because occupational therapy focuses on function, he also incorporates additional assessments based on each client’s goals and needs. These may include cervical range of motion, upper extremity range of motion, fine motor skills, grip strength, postural alignment, and functional observation. For clients working toward returning to driving, he may also assess skills such as reaction time, Trail Making Tests, and maze assessments to evaluate cognitive and visual-motor performance.

Can you describe some of the interventions you use with clients?

• Dave’s interventions are individualized based on each client’s visual challenges and functional goals. He commonly addresses visual-perceptual skills, visual-motor integration, binocular vision, oculomotor skills, and visual-vestibular integration.

• Interventions may include proprioceptive anchoring strategies for individuals experiencing spatial neglect, as well as for clients with dysautonomia or post-concussion syndrome (PCS). These strategies can help improve sensory processing and support activation of the parasympathetic response. For example, Dave may use tools such as a wrist cuff or weighted vest to provide proprioceptive input and improve awareness of body position in space.

• For clients with binocular vision challenges or double vision, he may incorporate tools such as the Brock String to support visual coordination. Dave emphasizes that proper instruction and technique are essential when using tools like the Brock String, as understanding what the client should be seeing during the activity is critical for effective intervention.

• He also incorporates functional, task-based activities to challenge visual and cognitive skills together. For example, clients may complete visuo-spatial activities while balancing on a foam surface or performing strengthening tasks to add a cognitive component. Technology-based interventions, including the Bioness Integrated Therapy System (BITS), Dynavision, and Vision Coach, are also used to provide interactive visual training and support functional outcomes.

What does a typical day look like as an OT practitioner for Dave?

• A typical day for Dave involves treating approximately 14–16 patients, with about two patients scheduled per hour. Working in vision remediation requires strong time management, preparation, and flexibility.

• Because each patient presents with different diagnoses and goals, Dave plans treatments in advance while also preparing alternative approaches when adjustments are needed. His goal is to ensure that each session is appropriately tailored to the individual so that patients receive the most effective and meaningful care possible.

How would you describe occupational therapy’s distinct value when working with vision remediation?

• Occupational therapy’s unique contribution to vision remediation is its focus on function and participation. Dave helps patients use their improved visual skills to return to meaningful activities such as reading, driving, working, shopping, completing household tasks, and caring for themselves and their loved ones.

• Vision plays a critical role in how we interact with and understand the world around us. When the visual system is affected, a person’s independence and quality of life can be significantly impacted. Occupational therapists help bridge the connection between visual skills and the ability to successfully participate in everyday activities.

What do you think is the biggest challenge (current or future) for occupational therapy practitioners in this specialty?

• One of the biggest challenges in vision remediation is increasing awareness of the role occupational therapy can play in this area of practice. Many occupational therapy practitioners are still learning that vision rehabilitation is within the scope of OT practice and how these skills can be applied to improve functional outcomes.

• Continued research and evidence supporting vision rehabilitation, along with greater support from professional organizations, will be important in advancing this specialty. Increased recognition, education, and advocacy can help strengthen occupational therapy’s role within vision rehabilitation and encourage more practitioners to develop skills in this area.

What advice would you have for an OT practitioner or student who is interested in vision remediation?

• For occupational therapy practitioners and students interested in vision remediation, Dave encourages them to stay curious and continue learning. There is a lot to explore within this specialty, and developing these skills can make a meaningful difference in patients’ lives.

• He recommends connecting with others who are already practicing in the field and joining the Vision Rehabilitation Community of Practice (CoP). Although it is a smaller community, it is a passionate group with resources and support available for those who are just getting started. Practitioners interested in this area do not have to navigate the journey alone.

Can you share a project or case study from your experience that offers valuable insights for other occupational therapy practitioners?

• Dave shared a case example of a client recovering from a second concussion. The client was a 30-year-old laboratory technician whose job required significant computer use, attention to detail, and sustained visual demands. Following the concussion, she experienced dizziness, double vision, light sensitivity, and difficulty managing everyday activities. She was unable to work and had reduced participation in activities such as shopping, going to restaurants, and spending time with friends.

• Treatment focused on regulating the autonomic nervous system, improving binocular vision skills, and addressing challenges related to the dorsal processing stream-the visual pathway responsible for processing spatial information, movement, and understanding where objects are in relation to the body and environment. Dave incorporated visual-perceptual activities, binocular vision training, and progressively challenging functional tasks by adding cognitive and environmental demands.

• Interventions also included proprioceptive anchoring, interoceptive awareness training, and symptom monitoring to help the client better understand her body’s responses and recognize when she needed to adjust her activity level. The client learned strategies for pacing, planning, and pairing activities, such as walking, laundry, and shopping, to better manage her symptoms and allow her nervous system time to recover.

• Over time, the client was able to return to work full-time and resume social activities. While she was not completely symptom-free, she reached approximately 90% recovery and developed effective strategies to manage remaining symptoms. This case highlights the role occupational therapy can play in helping individuals with concussion recovery regain function, confidence, and participation in meaningful daily activities.

Anything else you would like to share with our community?

• Dave has seen firsthand the meaningful impact vision remediation can have on patients’ lives. Watching patients improve and regain participation in the activities that matter most to them has reinforced the value of this specialty.

• He hopes more occupational therapy practitioners will become interested in learning about vision rehabilitation and developing these skills. There is a tremendous opportunity for occupational therapists to make a difference by helping individuals improve function, independence, and quality of life through vision-focused care.