Tanni L. Anthony, Ed.S.
Colorado Department of Education,
201 E. Colfax, Denver, CO, 80203, USA
Over the past several decades, the profession of Orientation and Mobility (O&M) has revised its teaching strategies to focus upon the needs of young children. Within the past five to ten years, a particular emphasis has been placed on the early O&M skills specific to infants, toddlers, and preschoolers who are visually impaired.
With the inclusion of the birth through age five population, the field continues to refine both instructional philosophy and actual teaching techniques. Both have required careful steps; the process of merely "watering down" methodologies which are appropriate for older children has not always proven effective with very young children.
Research on the developmental route of the child with a sight loss has been helpful, but further research is still needed. Areas of specific challenge in each developmental domain have been documented. Based on this information, specific intervention methodologies have been devised, only to be revised with the contributions of new findings. It is fair to note that early intervention for children who are visually impaired is still within it's own toddlerhood of development.
A Proposed "Formula of Purposeful Movement"
Based on current research findings, it may be supposed that three primary areas emerge as important program domains within an early intervention O&M program. A "formula of purposeful movement" is offered for consideration which includes the following three components of program attention: physical readiness, cognitive connection, and motivation invitation.
Past research by Selma Fraiberg indicated that visual impairment did not have an effect on the order of gross motor milestone development. This may be changing, however, from the current longitudinal study in progress by Dr. Kay Ferrell and colleagues. Project PRISM (1994) is currently collecting information on the sequence of developmental milestones. Gross motor development maybe an area of noted unique skill acquisition order.
The rate of gross motor milestone development may be influenced by a visual impairment. There is evidence of delayed movement postures. This may be due in part to the possible presence of low postural tone, and the interdependent relationship of movement and the acquisition of true object permanence and/or auditory localization skills.
Physical readiness, however, far exceeds the mere acquisition of typical gross motor milestones of sitting, crawling, walking, and so on. It encompasses both quantity of skillacquisition and quality of movement. It is critical that motor milestones have qualitative excellence.
Quality of movement depicts the "underlying scaffolding" of both the static and dynamic postures of the child. It refers to the level of refinement of a particular gross motor skills. Without vision to confirm the infant's early body movements, the sense of proprioception may not develop to full maturity and low postural tone may be evident.
Brown and Bour (1986)report on one theory that the reason many babies who are visually impaired have low postural tone is because of a lack of experience in the prone position. Limited opportunities in this position ultimately deny the child the needed proprioceptive stimulation for neuro -motor development.
Low postural tone often will compromise the refinement integrity of motor skills involving balance and strength. Balance reactions, hunk rotations, and actual motor milestones may be influenced. For example, a child may be able to sit independently, but the actual sitting posture may be compromised. A rounded back with the legs situated far apart may be the only way the child can achieve independent sitting. Due to low trunk tone, the child may need to establish a wide base of support to maintain an upright sitting posture.
Compensatory patterns such as these may become habitual. If repeatedly used over time, the child is at risk for physiological change in her muscles; some may lengthen and some may shorten to accommodate for the compensatory posture. If left untreated, it is possible that an orthopedic deformity such as scoliosis may develop (Campbell, 1983).
It may be wise to consult with a physical and/or an occupational therapist to ensure that the child's motor skills are developing in a manner that reflects good quality of movement. Attention to positioning and special activities to strengthen the trunk muscles are two ways to address the influences of hypotonia. With consultation from a motor therapist, these activities can be easily incorporated into the child's daily care activities.
Three stages in particular have great influence on the child's acquisition of early travel skills: (a) attainment of object permanence, (b) development of means-end, and (c) the early constructs of spatial relations. As each area is reviewed, it will become evident how one skill area is developmentally intertwined to other skill areas. It is impossible to fully isolate one from the other. For simplicity, however, they will be discussed as separate behaviors.
Object permanence in lay person's terms is simply "out of sight, “out of mind." During the first nine months of life, the infant does not have the memory capacity to search for an item completely removed from view, or in the case of a child with visual impairment, out of touch.
During this time period, however, the sighted infant demonstrates steady progress in the area of memory and search skills. At approximately four to six months of age, she will find an object that is touching her body (Johnson-Martin, Jens, and Attermeier, 1986). These authors further report that the sighted infant will briefly search for a newly dropped object and deliberately uncover a partially hidden object at six months of age.
By nine months, the infant learns that an object continues to exist even if it is covered from view. A favorite interaction game at this age is the classic Peek-a-boo.
Selma Fraiberg (1968) noted that sound is not a substitute for sight; between six and seven months of age, hearing and holding are two separate events for the child who is blind. Her research noted that the beginning of search behavior occurred between seven to nine months of age.
The child who is visually impaired may have a unique timetable as she acquires skills leading to object permanence and more sophisticated memory. Her individual level of functional vision will play an ongoing role in her ability to discern a world outside of immediate touch.
The ability to problem solve with an end result goal mind is called means-end. This indicates that a child is able to understand what means (actions) will result in a certain end (result). Over the course of the first two years, the child learns to construct a simple goal, then use the motor skills within her repertoire to achieve that end result.
The young infant, however, does not initially realize that her body movements knowing produce a certain sensory result. Body movements are not associated with reactions such as the visual movement of a swatted mobile or the chime bells of the kicked chime ball toy. During these early days, the infant is practicing newly acquired volitional movement as motor reflexes are fully integrated. Movement occurs for the sake of movement alone.
With repetition, however, the infant begins to discover that her body movements can make something happen. One of the first indications of intention occurs with deliberate hand watching behavior. With the discovery of her hands as a "working part" of her body, the four month old infant learns to reach for nearby objects.
Tactile cueing may be necessary to help initiate a reach of a desired object. As the child becomes more proficient with her understanding of a world beyond touch (expansion of object permanence), these touch cues will become less necessary.
Other means-end behaviors include early tool use. The child teams to pull a string to obtain the attached toy or use a stick to acquire a toy just out of reach. Clarke (1988) reports that tool use has great implications for a child's ability to successfully use a mobility device or long cane during the toddler and preschool years of development.
As the child expands her understanding of the space beyond her body and has the physical readiness to move out into space, the reach is extended from an isolated arm to a full body movement. This is the hallmark passage of purposeful movement; the child can begin to use self propelled ambulation for an end result. Her worldly travels have begun from a mobility perspective whether in the form of a roll from back to front or a long stretched reach while in a prone position that results in forward movement toward the object of interest.
Spatial relations development involves the concept formation of position, location, direction, and distance from one's own body (Morgan, 1992). Spatial constructs have three primary categories: (a) spatial awareness of one's body, (b) awareness both near and distance space as it relates to one's body, (c) awareness of the space dimensions between objects. All three of these areas have developmental beginnings in infancy.
Each area will be briefly discussed as to the associated developmental skills during the first two years of life.
The infant learns about her body as people touch and move her. Baby massage is an excellent means of proprioceptive input to the infant concerning the spatial dimensions of her body. Touching interaction games such as "I'm going to get you!" and a variety of body positions are also natural teaching methods of body image.
Dressing and undressing activities also play an important role in the internal mapping of the child's body. Dressing and bathing routines will further shape a child's labels of her body parts.
With maturation, the infant will master voluntary movements such as hand watching, midline hand play, and bringing her feet to her mouth. These movements give her even more information about the dimension and parts of her body as they are self regulated. As the infant reaches for her foot, she is participating in the discovery and confirmation of where her feet are located on her body.
Coinciding with spatial mapping of her body, the infant will begin to explore the immediate parameters of the world around her. Toys located on her body and next to her body will be the first ones explored. As she has repeated reinforcement for her random movements out into space, she will begin to actively search for "what is out there." Organized play areas with defined spatial boundaries and content will soon invite her visual and tactile search for people and toys.
The human spirit needs both encouragement and reinforcement to work and to play. For the young child, it is important that the efforts associated with movement be met with inner delight of intrinsic reward.
A child who is engaged in the activity at hand, will be more willing to take a risk such as moving out into new space to continue an activity. In the beginning, it may be as simple as a slight weight shift from one side of the body to the next as a toy is offered in a slightly different location. Later, the child may independently navigate across an open space just to get a hug from her parent.
The goal is to determine what is motivating for the child. Two factors usually create a successful motivator; the child's cognitive development level and sensory preferences. It may be the thrill of reaching toward a colorful music toy for the infant with low vision or the satisfaction of walking across the room to the high chair for an afternoon snack for the toddler who is blind.
It is important for all children to be explorers of their world. The gift of self initiated quality movement in the early years is a priceless and lasting one. Early attention to the child's development from an OEM perspective can offer intervention at a critical time in the child's life.
Meeting the child at her developmental level will greatly assist 0&M practitioners when working with families and other team members. All three of the suggested components can be readily infused into the daily routine of the child. The result will hopefully be a supportive and involved family, a cohesive early intervention OEM program, and a child who moves out confidently and successfully into a world of new leamings.
Brown, C. and Bour, B. (1986) Movement Analysis Curriculum. Florida State Department of Education, Tallahassee, FL.
Campbell, P. H. (1983). Basic considerations in programming for students with movement difficulties. in M. Snell (Ed.) Systematic Instruction of the Moderately and Severely Handicapped (2nd ed.), Charles E. Merrill Publishing, New York, NY. .
Clarke, K. (1988) Barriers or enablers? mobility devices for visually impaired and multihandicapped infants and preschoolers. Education of the Visually Handicapped 2 0 (3), 115 -130.
Fraiberg, S. (1968). Parallel and divergent patterns in blind and sighted infants. Psychoanalytic Study of the Child, 23, pp. 264 - 300.
Johnson-Martin, N., Jens, K., and Attermeier, S. (1986). The Carolina Curriculum for Handicapped Infants and Infants at Risk. Paul Brookes Publishing, Baltimore, MD.
Morgan, B. (Ed.) (1992) Resource Manual for Early Intervention with Infants, Toddlers, and Preschoolers Who Are Visually Impaired and Their Families. SKI'HI Institute, Logan, UT.
Project PRISM (1994), an ongoing longitudinal study by Dr. Kay Ferrell and colleagues, University of Northern Colorado, Greeley, CO.