As with all children, intervention approaches should focus on active participation of the child in all activities. Because children with visual impairments may not be able to learn by watching what is going on around them, they must learn "by doing" and interacting with their environment. Interventions should focus on the development of contingency awareness and the intrinsic motivation and drive of the very young infant and the development of the physical skills that are necessary for the child to move out and explore. Children with visual impairments should be given the opportunities to participate in all of the activities that they encounter. If a child cannot participate independently, explore ways that he can be assisted through the activity, allowing him to complete the steps that he can do independently
Active engagement can be:
- Playing social games ("so big", pat-a-cake, "gonna get you") and allowing the child to "tell" you that he wants to play again;
- Allowing a child to reach for a toy that is placed on his leg instead of putting it in his hand;
- Giving a child a choice of what toy he wants, what story he wants to hear or where to sit;
- Following predictable routines that allows a child to know what will happen next and allow him to initiate the next step;
- Showing and letting a child make his own sandwich; or,
- Providing stability at a child's shoulder so that he can scoop his food independently versus moving his hand for him.
Creating Ways that the Child Can Understand the "Big Picture"
Vision loss restricts a child's perception of an object or activity. For example, a child may have a limited concept of a "car" if not given the opportunity to explore, touch and manipulate different parts of a real car. Similarly, his concept of "apples" may be limited if he doesn't get the opportunity to pick apples from a tree or select them from the store, to handle and eat different apples, to make apple sauce, apple pie or fruit salad.
Examples of ways to create a "big picture" include:
- Field trips to explore all aspects of a concept;
- Use of routines and predictable schedule;
- Life-like child-size spaces and objects (playhouse, miniature car, wading pool, etc.).
- Reverse telescope for children with low vision; and,
- Use of variety of real objects to teach specific concepts (such as using a wading pool, hula hoop, wheels of a toy car to teach the concept of "circle")
Demonstrating Skills that are Usually Learned Visually
For a totally blind child or a child who cannot see to imitate you, you may need to move the child through an activity to demonstrate what you want him to do. When demonstrating a new skill, it is easier to be behind the child so that your body is in the same orientation as his. As quickly as possible, you need to let the child actively move through the activity on his own.
Social skills are one area that may need to be demonstrated. You may need to show a child how to invite another child to play, how to take turns in play and how to share toys.
Hands-on Interaction With Real Objects
In order to learn about the world, a child with visual impairments needs experience with real objects. Provide real objects if possible, especially when a child is learning a new concept. For example, use real fruit and vegetables instead of plastic ones.
Facilitating Functional And Meaningful Language
It is not meaningful to provide a non-stop verbal description of everything that is happening all of the time to most preschoolers. For the young child, it is most important to provide critical information that the child can understand and about what is happening at the moment.
To help facilitate meaningful language:
- Provide plenty of hands-on experiences using real objects, and all parts of the whole.
- Acknowledge and comment on child's expressive utterances.
- Imitate and expand on child's expressive utterances.
- Model and encourage appropriate responses.
- Describe the world and include demonstration and exploration with the description, fill in the gaps as necessary.
- Introduce change in the experiences and language you provide.
- Provide a variety of experiences.
- Use open-ended questions to keep conversation going.
- Make it fun!
Facilitating The Development Of Sensory Skills
Young children who are visually impaired need play and intervention to help develop and use all of their senses.
Encourage children who have low vision to use their vision by controlling environmental conditions such as lighting and glare, color, contrast, size, etc. Allow the child to hold materials at whatever angle or distance that is best for them and encourage them to move close to you at story time or circle time. Choose toys that have lights, bright colors with contrast. If using pictures or books, select pictures that have colorful and simple pictures rather than pictures that are visually cluttered. Also, if using photographs, use matted finishes instead of glossy finishes to reduce glare.
Provide opportunities for exploring tactual components of relevant objects and promote discrimination of objects by touch. Provide toys that have a variety of textures, shapes, sizes, and weight. Look for toys that have many different ways to activate them such as pushing, pulling, sliding, pinching, etc.
Provide experiences that focus on the auditory discrimination of people's voices and sounds related to activities. Encourage listening and the use of auditory clues to locate people or places. Proved toys that produce auditory feedback when manipulated, such as musical instruments and cause-and-effect toys.
Each child is individual n their needs for sensory input. Besides being aware of the sensory components of materials and activities, remember that you are also a source of sensory stimuli and may need to adjust your behavior according to the child's individual needs.
Facilitating The Development Movement
Movement can be encouraged early. Independent movement is crucial in having the child with visual impairments explore and learn about the world.
To help facilitate motor development and movement:
- The parent or caregiver can carry the young infant in an over-the-shoulder sling. This provides not only a safe and comfortable place for the child, but allows the child to experience different movements in different planes.
- Provide the infant with opportunities to experience different ACTIVE positions. Many infants with visual impairments demonstrate low postural and a paucity of movement due to lack of head movement. Infants with visual impairment are sometimes happy to stay on their back and need encouragement and experience with other positions actively. For older children, allow children to be in a variety of positions instead of seated in a chair at a table. Include side sitting, on their stomach on the floor, kneeling at different size tables, etc.
Present and position materials to encourage upright head posture. Make sure the tables and chairs are the right height, work on slanted surfaces or easels, or work with materials on the wall, pegboard, or chalkboard.
Provide movement activities that enhance the child's protective and equilibrium responses.
Don't always position yourself or materials at midline, but allow the child to orient and reach in different directions to encourage weight-shift and trunk rotation.
When a child is learning to walk, you can begin by having him push a heavy cart or push toy. Allow your child to be barefoot when appropriate so that he can get additional information about his surroundings.
Allow the child to move and explore the environment. Spaces can be defined to provide for safety and boundaries for exploration.
Children who are visually impaired and blind rely on their hands to learn about their world. It is important to enhance fine motor development, helping a child learn to use his hands. This includes playing with toys as well as getting information about objects, textures, people, sizes, letters, and eventually, learning to read and write print or braille.
To promote the development of hand-use:
Encourage the infant to hold his bottle to promote midline orientation of the hands. A bottle with handles may be helpful at first. A high-contrast patterned cover on he infant's bottle may help a child with low vision to visually attend to the bottle.
Play with the infant in positions that reinforce hand-to-hand, hand-to-knee, and hand-to-feet contact.
Provide toys and materials that have a variety of textures, shapes, sizes, and weight.
Provide toys and materials that have many different ways to be activated such as pinching, pulling, pushing, sliding, etc. and help the child to use a variety of hand and arm movements (rotating at forearm, poking with index finger, resistive play, etc.)
Play and provide materials that provide firm input into the hands (squeezing playdoh or putty, play in water or beans, pulling on elastic bands, etc.)
Provide opportunities for "messy" play. You may need to start with something like finding toys in a bowl of beans to playing with something "gooier".
Allow the child time to get familiar with new toys. Sometimes it is helpful for the child to "discover" the toy on its own.
Have toys and materials in a consistent location and accessible to the child.
Blind Children's Center (1993). First .steps: A handbook for teaching young children who are visually impaired. Los Angeles: Blind Children's Center.
Blind Children's Center (nd). Move with me: A parents' guide to movement development. for visually impaired babies. Los Angeles: Blind Children's Center.
Blind Children's Center (nd). Learning to play: Common concerns, for the visually impaired preschool child. Los Angeles: Blind Children's Center.
Chen, D., Friedman, C. T., & Calvello, G. (1990). learning together: A parent guide to socially based routines for visually impaired infants .Louisville, KY: American Printing House for the Blind.
Ferrell, K.A.. (1985). Reach out and teach.New York: American Foundation for the Blind.
Holbrook, M. C. (Ed.) (1995). Children with visual impairments. A parent's guide. Bethesda, MD: Woodbine House.
Pogrund, R., Fazzi, D., & Lampert, J. (Eds.) (1992) Early, focus: Working with young blind and visually impaired children and their families. New York: American Foundation for the Blind.
Warren, D. (1994). Blindness and children: An individual differences approach. New York: Cambridge University Press.
by Carla Brown