squinchel (Robert Kraskin diplopia)

Squinchel is a word credited to the late Robert A. Kraskin, OD (Bob), which he used to describe a series of activities which he published in his 3 volume, 36 chapter work, Visual Training in Action; 1965-68. In that series he took nearly 6000 words to go through multiple configurations of opportunities to develop, enhance, and elaborate various visual abilities. He looked at this developmentally and called the stages or levels: Introduction, Visual-Tactual Matching, Visual-Auditory Matching, Spatial Consistency, Hand to Peg, Blocks on Peg, Four Hands; Four Blocks, and Unfused Dowels.

Much has been written about specific ways and sequencing of how to guide a patient through their play/exploration of the Squinchel technique. Here we wish to spend the majority of our time on the global aspects of the technique and the variations in it. Once the fundamental understanding of the benefits of this technique are present, then you will recognize that the entire technique is a theme and variations, which we hope will free you to explore many alternate variations with your patients.

The THEME: The patient wears a set of 15 diopter base in prisms in front of each eye. For most people this will afford them the ability to see two volumes of space next to each other simultaneously. NOTE: A better way to think of this might be as having two perspectives on the same volume of space laid out next to each other in a way that they can be compared and contrasted. There are a few instances where you may need higher power prisms to achieve this.

A paraphrase of a statement attributed to Bruce Wolff, OD, is, “The visual process allows us to see likes and differences simultaneously.” He meant that this ability is unique to the visual process. This ability to appreciate the likes (similarities) reinforcing each other and helping to build a stable ground out of which an ability to appreciate the differences most often emerges as figure. The wearing of the prisms and the interaction with real objects in space allows for a concentrated (used in a chemical sense, not a tension type of sense) and different type of comparison of likes and differences, than in the unified view we have all the time without the prisms on. It is a bit like wearing a stereoscope, but having the freedom to move and interact with objects in an open, rather than closed environment.

Bob used the word “squinchel”, and in particular “squincheling”, to be the act of touching, feeling, or probing the objects in front of the person. He had them rub the table, or tap a block on the table, or touch a golf tee with their finger tip. Squincheling was a way of helping to channel attention to the specific area and volume of space at one moment. It served to increase the signal from a particular vantage point within the dual views of the environment.

We all have played with how a prism acts as a chief-ray shifter and appears to move the object of regard towards the apex (thin part) of the prism. The first movements immediately after a person puts the prisms on often are to some other place in space than the physical object but over time, adaptation occurs and the exploratory movements become more accurate.

Rather than a total unified shift, in squinchel, there are two simultaneous but opposite shifts that are present at the same time. Though we have the sense of putting attention to one channel at a time, what we want to emerge is the observation, the reality, that what is happening in one view is also happening in the other. Can the person shift their “center of attention” but continue to monitor what is happening in both views, with the potential emergence of a unified view? Achievement of this simultaneous but unified view is facilitated by moving slowly. At first the patient may focus so hard that they are not aware of what is happening in the other view and in fact, we have seen instances where the view through one channel seems to dominate guiding movement that the context appears to shift back to that side even when all intention was to be within the other side’s view of the space. Though “unfused” and apparently “disassociated”, we like to think of this as a unique form of binocularity, setting the stage for a degree of connectedness to the world never before achieved once the prisms have been taken off. Stated another way: This side-by-side comparison of views of the same space should set the stage so that when reunited, their now is a breakthrough to having finer just noticeable differences (JND’s) in spatial perception. Potential positive ramifications include seeing more precisely what is present and allowing better prediction of where things that are moving will be at a future point in time. This increases safety in the aged, and better sports performance in the athlete, and higher productivity in the workplace.

OK, enough philosophy or theory, let’s show some of technique. Keep in mind however, that the goal is a more efficient deriving of meaning so that the directions of action are done with grace and with minimal effort.