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(Originally published in Spring 2006 SEE/HEAR Newsletter. Web Resources have been updated 4/2017)

By Holly L. Cooper, Ph.D., Outreach Assistive Technology Consultant, TSBVI

Abstract: This article describes and illustrates a variety of tactile writing systems used with individuals with blindness. Tactile codes included are New York Point, Boston Line Type, American Modified Braille, Moon type, Fishburne and standard Braille. Alternative media including Tack-tiles and tactile symbols are also discussed.

Key words: Programming, Braille, tactile symbols, tactile writing, reading.

This year, 2006, is the Sesquicentennial anniversary of the founding of Texas School for the Blind and Visually Impaired. In 1856, when TSBVI was founded, not only was Texas on the frontier of the American west, but education for people with blindness and visual impairments was also at the frontier of education. At the time there was no standard tactile reading code for people with blindness. In recognition of the advances and changes in blindness education in the last 150 years, we present an overview of tactile reading and writing codes for people with blindness.


Braille, the reading and writing code currently used in the U.S. and other English speaking countries by readers with blindness and visual impairments, was invented by Louis Braille. Braille was a Frenchman who lost his sight from an eye infection caused by an accident with his father’s leather working tools in childhood. Louis Braille developed his ideas for a tactile code system adapted from French soldiers who wanted to be able to read notes in the dark. Louis Braille modified this 12-dot system into 6 dots and had written in Braille and taught others by 1832. Braille was introduced in the U.S. about 1860 and was taught at the St. Louis School for the Blind and other schools.

The Braille Alphabet A through J

There have been many other tactile reading media for people with blindness in the past 200 years. Originally, most reading instruction was done with books made with raised or embossed letters created by wetting paper and printing with an ink printing letterpress. People also learned letters and reading by using carved wooden letters arranged into words, and letters made with bent and twisted wire. It was long thought by educators of blind people that having a tactile code different from letters that sighted people read would separate blind people from the mainstream of society and limit the amount of reading material to which they had access. Special reading codes would also mean teacher training was more demanding, and finding teachers able to work with students with blindness more difficult. Around the same time Louis Braille was developing his code, other codes were also being developed. Many blind students secretly learned Braille and other dot-based tactile writing codes when their schools officially taught embossed letters. Ultimately the dot-based letters of Braille became the most widely accepted tactile reading code in English speaking countries, and most of the world.

Boston Line Type

Boston line type was developed by Samuel Gridley Howe, the founder of the New England School for the Blind (later Perkins School for the Blind) in Massachusetts. Since at the time there was no reading medium for people with blindness, Howe developed an embossed simplified angular roman alphabet without capitals which he called Boston line type. He published the first book in Boston line type in 1834, and this type continued to be the primary tactile reading code used in the United States for the next 50 years. The American Printing House for the Blind first published books in Boston line type, and it was the official code used by students at Perkins until 1908.

A finger gliding across embossed type, probably Boston Line Type

New York Point

William Bell Wait, working in New York in the middle 1800’s, developed a point code for readers who were blind that used characters which were two dots high and one, two, three and four dots wide. Working at New York Institute for the Blind, Wait began teaching this system to students and invented a point writing machine called the Kleidograph which allowed for easy production of text without the use of slate and stylus. New York Point was widely used by schools for the blind in the United States in the late 1800’s. Mary Ingalls, the sister of Laura Ingalls Wilder author of the Little House books, learned New York Point and embossed letters at Iowa Braille and Sight Saving School in the late 1870’s and 80’s.

new york point alphabet

American Modified Braille

Joel Smith, a piano-tuning teacher at Perkins School for the Blind in Massachusetts, developed the American Modified Braille Code in the 1870’s. When developing his system, Smith designed characters he believed would be fast to read and an efficient use of paper. This code was used in 19 schools for the blind in the United States, including Perkins. American Modified Braille assigned the fewest dots to the characters that occur most often in the English language. If you look at American Modified Braille, you will see the familiar three dot high and two dot wide characters, but dot configurations correspond to different print letters and letter combinations than standard Braille today.

American Modified Braille alphabet letters A through J


Before the development of Braille writing machines, people writing Braille used a slate and stylus. The slate held the Braille paper and provided a template for the dot locations, and the stylus was used to punch holes into the paper. Since the dots are raised, the person had to learn to write in reverse from the back of the paper. Frank Hall, superintendent of the Illinois School for the Blind, developed a personal Braille writing machine in the late 1880’s. In the next decades, other inventors developed writers for Braille and New York Point. Since most machines were not mass produced, their reliability and consistency of writing varied widely. In the 1930’s, the American Foundation for the Blind commissioned a Braille writer from a typewriter manufacturer. It was heavy and not durable enough for practical use. Later, David Abraham of the industrial arts department of the Perkins School For the Blind worked to develop a Braille writer at the urging of Gabriel Farrell, director of Perkins. He had a model working by the early 1940’s but the war years limited manufacturing. After World War II, Abraham’s Braille writer went into production and was on the market in 1951 as the Perkins Brailler.

Since the Perkins Brailler is available to students who read Braille in the United States at no cost through a quota funds system with American Printing House for the Blind, it is the most widely used method of writing Braille in the U.S. However, many other Braille writers are available, particularly in Europe. Now the Tatrapoint is available in the U.S. from Maxiaids. It is lightweight and easily portable with some components made of high-impact plastic. The adaptive model allows adjustment to accommodate different hand and finger sizes. Quantum Technology in Australia recently released a small manual brailler called the Jot-A-Dot. It uses letter weight paper of a small size and is intended for taking short notes. The same company also makes the Mountbatten Brailler, an electronic Braille writing device which talks. Some models interface with computers and ink printers. The Mountbatten provides good support for people helping students who read Braille, but who don’t read Braille themselves.

Braille Writing Devices

slate stylusperkins braillewriterjot a dotmountbatten brailler

Braille Writing Devices Pictured from Left to Right: Slate and Stylus, Perkins Braillewriter, Jot-a-dot, Mountbatten Brailler


William Moon of Great Britain lost much of his sight in childhood from scarlet fever. After finishing school in the mid 1800’s Dr. William Moon experimented with a variety of raised alphabets for teaching reading and writing to blind students. He eventually settled on Moon type, a raised line code based on print letters. Still used in Britain for people with learning or fine motor difficulties, and those who have lost their sight later in life, Moon type is believed by its supporters to be easier to learn and more tactually simple to discriminate than Braille. Although almost unknown in the U.S., books in Moon are available from the Royal National Institute for the Blind and are available in Canada and Australia as well as Great Britain.

Moon can be generated with computer software today. Duxbury, readily available in the U.S. has an English Moon translator available in their “translation tables” menu. Files can be embossed in a “dotty Moon” style with an Enabling Technologies embosser with a Moon setting. Some Moon fonts can be found on the Internet for use with a computer.

Moon books are still produced through a modified typesetting process. Reading materials are now also generated with Moon Writers, thermoform machines, computer Moon fonts printed on swell paper, and Moon translation software and embossers. Moon can also be handwritten with a stylus on plastic sheets with a frame guide in a manner similar to using a slate and stylus to produce Braille. A Moon teaching curriculum is available from Royal National Institute for the Blind in Great Britain.

Moon letters A through J

Moon Type embossed on paper


The Fishburne system of tactile writing was developed in 1972 by S. B. Fishburne. Mr. Fishburne became acquainted with some blind adults and found that many of them were not able to read Braille. He developed a tactile alphabet, which is larger than Braille, to be used primarily for labeling items used by people in daily activities. Fishburne is typically used for labeling objects, containers and appliance controls, not for literary purposes.

The complete Fishburne alphabet

A Fishburne labeler and magnetic labels


Since standard Braille is always the same size, each character 1/8 inch wide by 1/4 inch high, it can be difficult for people with motor impairments or problems with tactile sensitivity to read. Even Jumbo Braille is very small. To address the issue of literacy for individuals with significant disabilities, Kevin Murphy developed Tack-tiles. Tack-tiles are small Lego-sized blocks with Braille dots on each. They are used primarily in educational settings to teach Braille to very young children and those with additional disabilities. Tack-tiles can be used to create a computer keyboard labeled with Braille using the Intellikeys keyboard. Tack-tiles are available with all Braille symbols, including punctuation marks and contractions. Specials sets are available for math and Braille music. For many students with visual impairments and additional disabilities, Tack-tiles and a computer are the best or only means to literacy.

Tack-tiles displaying, "Braille is fun!" in uncontracted Braille.

Tactile Symbols

While not traditionally considered a literacy medium, the use of tactile or tangible symbols has become widely used with students with deafblindness or visual impairments with additional disabilities. Educators seeking to expand the opportunities for such students to communicate and participate in supported literacy experiences in the classroom are using tactile symbols in a variety of learning activities. These symbols are used in communication boards, labels in the classroom, and children’s literature books and language experience stories. While there is no standard vocabulary of tactile symbols as there is the widely used Meyer-Johnson picture symbol system, some recommended standards do exist. The Texas School for the Blind and Visually Impaired maintains an illustrated dictionary of picture symbols on our website. American Printing House for the Blind now has a kit called Tactile Connections with instructions for making and using tactile symbols.

A teacher-made page from a book using a combination of tactile symbols and Braille states, "'A' does the can crushing job. She collects the cans and crushes them in the can."

Access to Literacy

Early in the twentieth century the widespread use of many different tactile reading codes and systems made learning to read a challenge for learners with blindness. Disagreement about which code was easiest to read and the most efficient use of paper led to the “War of the Dots” between educators in English speaking countries. A uniform English Braille system was agreed upon in 1932 which included the alphabet and grade 2 contractions. Since that time discussion about other tactile modes of literacy has been limited. In the last five years, concern about access to literacy for individuals with visual impairments and additional disabilities has given rise to discussions about the use of uncontracted Braille, Tack-tiles and other large format Braille, Moon type or other embossed letters, and tactile symbols. While the adoption of standard Braille has given tactile readers access to a large amount of material and more consistent quality of educational experiences, consideration of access to literacy for all learners should prompt educators and parents to broaden their definitions of tactile reading and consider the use of alternative tactile media.

Note: Embossed materials including Boston line type, Moon, New York Point, Fishburne and Tack-tiles photographed courtesy of Texas School for the Blind and Visually Impaired Learning Resources Center teaching materials and archives.

Web Resources

  1. Joel Smith and American Modified Braille
  2. American Printing House for the Blind (APH)
  3. David Abraham, Developer of the Perkins Braillewriter
  4. Moon and Duxbury
  5. The Getting in Touch with Literacy Conference
  6. Paths to Literacy
  7. History of Tactile Reading Codes
  8. Mary Ingalls and the Iowa Braille and Sight Saving School
  9. MaxiAIDS: Products for Independent Living
  10. All About Moon
  11. Deirdre Walsh's article Story Boxes and Story Boards for Students with Multiple Disabilities
  12. Quantum: Maker of the Mountbatten Brailler and the Jot-a-Dot
  13. Samuel Gridley Howe and Boston Line Type
  14. Tack-Tiles Braille Systems
  15. TSBVI's Tactile Symbol Directory (with DIY directions and photos)
  16. Visual Impairment Centre for Teaching And Research (VICTAR)
  17. Robert Irwin's article As I Saw It (War of the Dots)
  18. William Bell Wait and the New York Point System of Reading for the Blind

Terese Pawletko, Ph.D. & Lorraine Rocissano, Ph.D.
Psychology Department
Maryland School for the Blind

AER/DENVER, July 18, 2000

Explanations for "Autistic-like" Behaviors in Blind Children

Their behaviors (e.g., stereotypes, rituals; restrictions in play) seen as:

  • indicative of emotional disturbance
  • associated with sensory deprivation (e.g., turn inward for stimulation)
  • related to mother-child attachment (e.g., in incubators longer; lack of eye contact so hard to read cues; maternal depression further limiting her involvement with child)

Non-Autistic and Autistic Rubella - 
Distinctions noted by Chess et al.

Non-autistic rubella children with sensory defects:

  1. Are very alert to their surroundings through their other senses
  2. Exhibit appropriate responsiveness - "Some are shy, some slow to warm up, some perhaps wary; but one is impressed by their readiness to respond to appropriately selected and carefully timed overtures."

Rubella children with autism and sensory defects

  1. Do not explore with alternative senses
  2. Maintain distance from people that is not explained by the sensory deficits nor by degree of retardation
  3. Their affective behaviors do not resemble those of the same mental age.

Caveats in Diagnosing

  1. Autism is a developmental disability, not parent induced, not induced by blindness
  2. It is a syndrome; no one symptom yields a diagnosis.
  3. Autism is a spectrum disorder, with a wide range of functional levels, and behavioral presentations.
  4. While symptoms show improvement over time, the individual remains autistic. Autism is a lifelong disorder and for most individuals some level of support may be required.

Note: the following sections were depicted as "icebergs." They detail the key diagnostic features of autism using an iceberg approach - the behaviors one might observe on the surface, and the processing difficulties that might account for them.

Problems with Socialization


  • Fails to or has difficulty engaging in reciprocal interactions
  • Treats others as though they were objects
  • Seems uninterested in peers

What you do not see: 

  • Problems shifting attention
  • Unable to process social information effectively
  • Difficulty processing complex stimuli due to difficulties telling figure from ground, and problems making very rapid shifts of attention
  • Cannot process multiple sensory stimuli simultaneously

Implications for Parents and Educators

  1. Recognize that the social world is more complex and less predictable for an individual with autism, and therefore more stress producing.
  2. Do not assume that simple exposure to peers will result in the acquisition of social skills.
  3. A child cannot be pushed to acquire social skills. Begin with something short, structured, teacher directed, and success oriented.

Problems in Language


  • Seems very verbal but can't follow instructions
  • Poor receptive language
  • Echolalia (Echolalia is a positive sign in that it shows that the child is at least discriminating among phonemes, sequencing sounds, using working memory)
  • Pronoun reversal
  • Non-verbal

What you do not see: 

  • May use words expressively which they don't really understand (receptive language lower than expressive)
  • Difficulties discriminating language sounds - poor central auditory processing
  • Difficulties with sequencing phonemes and words
  • Can't break the linguistic code


  1. Check out whether child understands what he/she is saying (e.g., "what does that mean?")
  2. Use controlled language (e.g., short, concrete phrases with time between statements to allow for processing)
  3. If student has vision, try to provide some information visually; if not, provide information tactually.

Problems in Communication


  • Perseverates on one topic
  • Shows no interest in other people's topics
  • Too close or too far when talking
  • Says something unrelated to the conversation
  • May become angry when he hears certain words

What you do not see: 

  • Can't apply rules in context
  • Problems with impulse control
  • Inability to take the perspective of another, as well as problems shifting attention


  1. Direct instruction in the actual setting is key.
  2. Identify clear, concrete rules that the child needs to follow in specific situations.
  3. Social stories can be helpful in providing a child with a script to follow.

Perseverative or Narrowly Focused Interests


  • Need for sameness, predictability
  • Motor stereotypies
  • Focuses on parts of objects in play (e.g., wheels, spins everything, flips handle of basket repeatedly)
  • Age appropriate pretend play not observed
  • Restricted and perseverative interest (e.g., elevators, Xerox machines, CD titles)

What you do not see: 

  • Difficulty getting meaning from environment due to all cognitive processing deficits
  • Repetitive events are easier to understand and make sense of than multifaceted input
  • Repetitive behavior may be experienced as soothing


  1. Recognize that the routines and self-stimulatory behavior are the things that the child understands best and may serve as a "life-preserver" for the child. It is the child's retreat to his comfort zone.
  2. The child's reliance on such behaviors will tend to increase in times of stress and anxiety (e.g., transition, lack of clear expectation, challenges). Ask yourself "why is the child engaging in this now?"
  3. Identify a time when the child can engage in his self- stimulatory behavior; tighten up the structure, schedule, routine to decrease anxiety and increase non-verbal information.

Hypo- and Hyper-Sensory Systems


  • Over-reacts to certain noises (e.g., fire-alarms, vacuum cleaner, fan motor)
  • Finds certain tactile experiences aversive (e.g., certain foods, texture of clothing, soft furry objects, being touched)
  • Often finds warm temperatures aversive
  • May not react to bumping head, falling down, etc.
  • Stops listening to instructions when asked to open book

What you do not see: 

  • Has poor regulation of auditory system (e.g., at times may find raindrops sounding like gunshots, other times not a problem; visceral panic regulation to sudden loud sounds like fire alarm - heart and respiration rate do not return to normal for several hours)
  • Can only process one sensory input at a time
  • Brains process temperature, texture, multi-sensory things differently


  1. Be alert to how the sensory environment may be impacting on your student.
  2. Try to keep the environment as low key as possible (e.g., visually clear, sound absorbing materials, no extraneous noise or conversation; balance lighting needs for children's visual impairment with those of arousal).
  3. Be aware of possible multi-sensory input issues and adjust instruction accordingly.


By Kate Moss (Hurst), Education Specialist, Texas Deafblind Outreach

Originally published in the See/Hear Newsletter, Spring 2004 Edition by TSBVI Outreach Programs

Abstract: This article shares information from Dr. Lilli Nielsen’s book, Are You Blind? It focuses on five phases of educational approaches that teachers are to use in working with children if they are using an Active Learning theory approach.

Dr. Lilli Nielsen is the author of many books that look at the way children with visual impairments learn, especially those with other disabilities. Over a period of more than twenty years, she has developed her approach to working with these children that is called Active Learning. This approach is based on the notion that all children learn exclusively by doing until the developmental age of about three. The actions of examining and experimenting with objects using their bodies, is the foundation for the development in cognitive, motor, problem-solving and social skills. She believes that our role in helping children to learn is to create environments that build on skills the child already has, to encourage him to use his body and mind for higher-level tasks. In her book, Are You Blind? She discusses five phases of educational treatment that teachers are to use in working with children. This article will examine these five phases and share some of the highlights of this book.

It is important to note that before beginning to work with any child, a thorough assessment of his/her skills and emotional development is needed, so that you know where to begin. If you start too high you will likely frustrate the child and if you start too low, you run the risk of losing the child’s interest and motivation. Dr. Nielsen has developed a comprehensive assessment tool, the “Functional Scheme” (Nielsen, 2000), and a curriculum to help teachers called the FIELA Curriculum – 730 Environments (Nielsen, 1999).

Phase I: Technique of Offering

Children at this Level

Children at this level of development may seem reluctant to do much. They are often passive or engaged in self-stimulatory behaviors. Their world exists for the most part within the confines of their own bodies. They seldom seek out others for social interactions and may have limited experiences interacting with objects and their environment. This generally occurs because of motor disabilities or health issues that make movement difficult, and/or sensory disabilities that prevent the child from being enticed by the sights and sounds that motivate a typically developing child.

The Role of the Adult

At this stage, Lilli recommends using the technique of offering with the child. First of all the adult will need to set up an environment, such as a Resonance Board with many motivating objects, so that the child can come in contact with them incidentally if he or she makes any movement. The adult will also be with the child, either sitting alongside the child or supporting the child in a sitting position from behind if the child trusts the adult enough for this close contact. If not, the adult needs to respect the child's need for distance and only move in as close as the child seems comfortable with at any time. One of her goals at this level is just to have the child stay in the same room with her.

The adult’s first job is to simply offer the child toys and objects by placing the objects under the child’s hand. The child may touch or grasp the objects when and how he or she pleases. The adult does not talk to the child while the child explores the object in his or her own way. If the child drops or pitches the object, the adult simply offers another object. While offering the objects, the adult also must observe and take note of the objects the child seems to enjoy and those he seems to dislike. What is it about the object that seems to interest the child? What are the actions the child takes on the object? How does the child explore the object and with what physical actions (banging, mouthing, throwing, rolling, etc.)? What distresses the child and how does he show that distress? Does the child show interest in contacting the adult? How does he do that?

Purpose of the Offering Technique:

  • To convince the child that he can trust the adult has no intention of demanding that he does anything at all. Lilli’s only demand is that she wants to play in the same room as the child.
  • To observe the reactions of the child.
  • To learn about the child’s likes and dislikes.
  • To find out what may frighten the child most.
  • To learn about the child’s way of contacting, using this to assess the emotional level of the child.
  • To introduce sound self-activity.
  • To provide the child with the basis for successful introduction to phase II.

Points that Lilli Emphasizes at this Level:

  • Do not move too close to the child too fast — move in a little and watch his reaction.
  • Display an active and positive interest in whatever the child is doing.
  • Some children will not initiate play until they feel certain the adult has left the room. Periodically stop playing for a minute to a minute-and-a-half and just sit silently to see how the child responds. Does his behavior appear to be an invitation for you to continue your activity?
  • Everything the adult does should be done as an “offer.” If the child attempts to initiate an activity, don’t make a big deal about it; act as if he did that every day.

Phase II: Technique of Imitation

Children at this Level

Children at this level are generally somewhat more interested in things outside their own bodies, although they still may exhibit withdrawal, especially with unfamiliar people or people they do not trust. Their interests may also be very limited in scope. They may continue to show a lot of self-stimulatory behaviors, but are more aware of others and can be enticed into interactions with trusted people. They typically don’t initiate many interactions or have limited ways to make contact with others. They are able to play more with objects, but their play with others is more at a level of parallel play rather than interactive play. They also may have only a few actions they perform on objects and have only limited participation in activities. At this point the child may seem unsure of himself in many of his actions.

The Role of the Adult

At this level the adult continues to set up the environment with objects and activities that are highly motivating to the child. For example, if the child likes an object that vibrates, the adult will try to find many different objects that vibrate in differing ways. If the child is particularly fond of a certain color or texture, the adult finds things that seem to expand the child’s experience with other objects that share that quality. One child we know liked banging on and playing with disposable aluminum pie pans. The quality about these objects that seemed to be of most interest to him was the sound they made and that they could be bent to change shapes. He might also have enjoyed that they were lightweight, shiny and cool to the touch. Other things that could be offered to him would include: many sizes and types of metal containers such as individual pot pie pans, turkey roaster, tin cookie canister, metal coffee can; sheets of shiny aluminum foil; wire whisks; metal springs; metal spoons; metal ball bearings or Chinese Mediation balls; and other shiny and/or pliable materials.

In this phase the adult begins by imitating the actions of the child on the objects. For this reason, it is a good idea to have multiple numbers of an object. If the child bangs on the object, so does the adult; simply playing alongside the child at the same level. After a time, the adult can introduce a new action with the object and see if the child will imitate him. If the child does, great! If not, the adult should go back to imitating the action of the child again. This is a conversation of a sort, a turn-taking game. ’“You show me something, and I pay attention and copy you. Now I show you something. Maybe you will pay attention to and copy me. Now it’s your turn again.”

The Purpose of Imitating

  • To increase the child’s interest in activities happening nearby.
  • To increase the child’s ability to take initiatives.
  • To increase the child’s belief in himself.
  • To introduce activities and movements not as yet performed by the child.

Points Lilli Emphasizes at this Level are:

  • Imitation is primarily through auditory and tactile sensory modalities.
  • If the child throws an object, don’t correct him/her! Pick up the object, repeat your play and then place it before the child. It is best to have two of each object — one for child and one for adult.
  • The adult should begin by imitating child, then add some more constructive games (e.g., putting materials together or into one another) briefly before returning to the action the child began.
  • An increase in crying or screaming in a child who was doing that behavior before should be read as a positive “call for attention” from the adult.
  • Your goal is to give the child the opportunity to discover that being with the adult is “pleasant and exciting, and may include new auditory and tactile experiences.”
  • You also want the child to have the opportunity to “discover that he can take initiatives and that doing so leads to the ability to master something in his surroundings.”
  • He learns he has more actions to contribute to the interaction. This provides him with growing self-identity and ability to initiate interactions with other people.

Phase III: Technique of Interaction

Children at this Level

Children at this level are beginning to be interested in more interactive types of games (Lilli calls these “you to me and me to you” games). For example, you might have a bowl with marbles that you both hold on to and take turns pushing and pulling it back and forth between you. You want to see the child attempting to take a turn. The child may not necessarily initiate these games in the beginning at this level, but can be more easily engaged with others. He may, at times, want to take time out for his own exploration of an object, but will come back to the adult to share his interest after a time. This is the child that is interested in his environment and the actions of others and so is ready to begin learning that he can help others. This is a child who may also need support to transition from an enjoyable, interactive activity to a new activity without the adult. Some children at this level may fuss when an interaction comes to an end. It is as if the child were saying, “I want you to stay” and signals an emerging self-identity. The child begins more and more to attempt to make contact with others as he progress at this level.

The Role of the Adult

The adult sets up situations and environments that will foster interactive games. It is important for the adult to be patient and wait for the child to take his turn without trying to persuade him to act. Simply be quiet and still. If the child is trying to complete a motor skill that he has not yet mastered but matches his motor development, the adult can say, “You can help me.” If the child will use his hands, the adult needs to provide every opportunity for the child to familiarize himself with the activity and participate, and to complete the moment when he wants to do it. If the child will not use his hands, the adult can model the activity as close to the child’s hands as the child will allow. This allows the child to have control of his hands, and he can withdraw them when he needs a break. Lilli also cautions us to stop playing the game with the child while the play is still enjoyable. If it goes on longer than the child enjoys, the child may be unwilling to continue to interact with us. Another point Lilli makes is about the adult giving the child “presents.” Say “I put milk in your cup,” instead of “There is milk in your cup.” The whole notion of “yours versus mine” helps promote the child’s self-identity. Use a phrase like, “Your toys are on your shelf and my toys are on my shelf.” The adult also prepares the child when it is almost time for the interaction to come to an end so that the child does not see the adult as rejecting him.


  • To help the child to learn sound dependency on one or several people.
  • To help the child to initiate interactions.
  • To enhance the child’s development of self-identity.
  • To give the child the basis for social development.

Points Lilli Emphasizes at this Level:

  • Focus in on “you to me and me to you” games.
  • If the child becomes interested in something he wants to explore on his own, this should be respected. Wait patiently for a blind child to use his fingers to “look” at the object.
  • It is important always to wait for the child to initiate his part of the game.
  • Complete an action that may be too complex for the child to do, but at the same time tell the child he can “help” with the action.
  • Move at a slow pace. Know when the child “has enough to consider for a while.”
  • Tell the child before you come to the end of the activity that you will be leaving and that you are going on to a new activity. He may continue to play on his own if he chooses to.
  • If the child begins to say “more” or “again,” names the adults, or seeks out adult attention, he is ready for Phase IV while continuing with Phases I-III.

Phase IV: Technique of Sharing the Work

Children at this Level

The purpose of using the techniques of phase I, II, and III focuses on the child’s emotional development. It is done by establishing “an exchange and balance between periods of interaction and sound self-activity, between dependence and independence.” In the next phase, the child is at a place where he is ready to learn that taking action and interacting with others does not mean that he has to do everything or do it perfectly. The child exhibits confidence in performing some actions or activities. He has some beginning understanding of time and a sequence of events. He may appear threatened when familiar activities are changed slightly.

The Role of the Adult

Set up environments and activities that give the child tasks to do that are based on the things the child has experienced success in doing. In the beginning the tasks can be completed in a few seconds up to a few minutes without any consideration for how perfectly the child can complete them. The adult needs to let the child know which part of the tasks he will complete and which part the adult will complete. If the child is reluctant to do the task after being asked several times, the adult can suggest they do it together. The adult must make sure to give the child plenty of time to complete the task, but if he still won't do it, consider if the task is too hard. In complex tasks the adult may need to use various techniques (e.g. offering, imitation, etc.) for different parts. Let the child know how long the task will last and what will follow. This is when you can begin to teach time concepts like yesterday, today, tomorrow, now and next. It is important to have an established schedule.


  • To increase the child's experience of success.
  • To involve the child in new social relationships.
  • To increase the child's interest in acquiring new abilities.

Points Lilli emphasizes at this level:

  • Help the child learn that to be the one who does something does not necessarily mean that one has to do everything or do it perfectly.
  • The abilities the child has been successful with in previous phases form the basis for deciding which activities can be used for the technique of sharing work.
  • Keep tasks short (few seconds or minutes) initially, accept whatever the child does as correct.
  • Explain each time which parts of the activity the adult will perform and what the child will do.
  • Give plenty of time for the child to initiate the task and wait silently and calmly — be neutral.
  • Let the child know how long the activity is supposed to last.
  • Try to keep the environment the same or only make gradual changes.
  • Before going to more complicated and longer lasting activities the choice of technique for every part of the activity should be given careful consideration.

Phase V: Technique of Consequence

Children at this Level

Before using techniques at this level the child needs to have an emotional age of two years. This is when the child is ready to learn that his own actions have consequences. The child must show some confidence in what he can do and feel secure interacting with others generally. He may still have some difficulty initially in handling changes, but begins to show more coping skills at this level.

The Role of the Adult

The adult needs to model how consequences work for the child through a discussion of the adult’s actions. By this I mean things like saying, “I have to stop playing and cook dinner, or you will not have anything to eat.” Or, “I need to ask you to wait; I need to find a clean shirt for you.” Then after a time the adult begins to set up situations where the child can experience the consequences of his actions. For example, “If you want me to pour more milk, you must put your glass on the table.” The adult may accept a less than perfect response from the child, and may need to offer encouragement either through prompting or modeling. For example, “See you can put your glass here.” The child begins to understand choice-making.


  • To help the child to endure meeting demands.
  • To help the child to endure changes in life.
  • To help the child to feel self-confident, which is fundamental to the ability to make decisions about his own life.
  • To establish the basis for the sense of responsibility.

Points Lilli Emphasizes at this Level:

  • When the child feels secure and confident in performing different activities and has received information about the consequences involved in activities, it should be possible to let the child experience consequences. BUT only through activities the child is able to perform.
  • As the child is able to fulfill more and more requests he may demand more attention — don’t overly praise but rather act as if it is the most natural thing in the world that he can do something.
  • As independence increases the child may be able to tolerate that he sometimes is unable to succeed in what he intends to do. He will become better able emotionally to accept significant changes in his life. As he moves higher, he will be able to make friends with other people, decide when faced with situations that he has a choice.


Are You Blind? is a book that offers a great deal of guidance in working with a child who is at an emotional developmental age under age three for a typical child. By using the five phases of educational treatment Dr. Nielsen outlines in this book, we can help the child grow emotionally. When the child reaches the emotional age of three, then new approaches to learning may be available to him. We can begin to consider incorporating other more traditional ways of teaching into our plans with these children beyond simply learning by doing.

By Kate Moss and Stacy Shafer, Education Specialists, TSBVI Outreach

Abstract: This article focuses on Phase IV and V of Lilli Nielsen's five educational phases of educational treatment outlined in her book, Are You Blind?, and how the Active Learning principles can be incorporated into activity routines.

Key Words: programming, blind, deafblind, visually impaired, Active Learning, Lilli Nielsen, activity routines

In Dr. Lilli Nielsen's book Are You Blind? she outlines the five phases of educational treatment we can use to help the child with blindness or deafblindness grow emotionally and develop cognitively. The purpose of using the techniques of the first three phases is to establish "an exchange and balance between periods of interaction and sound self-activity, between dependence and independence." In Phase IV, which Dr. Nielsen calls "sharing the work", she describes a child who is at a place where he is ready to learn that taking action and interacting with others is within his capabilities.

If we think about the child at each of these educational phases we can see the progression:

Phase I - The child is very inwardly focused, engaging in self-stimulation, with very limited experiences with objects in the environment, and who is very reluctant to engage with others except the most trusted adult (usually a caregiver).

Phase II - The child is somewhat more interested in his environment and others and can be engaged in brief interactions around high-interest objects or actions or "start-stop-start" games such as patting, swinging, bouncing, rocking, etc. He is still somewhat withdrawn, has limited interests, has limited ways to make contact with others, and has limited things he can do with objects. He can "play" along side the adult and show some interest in what the adult is doing, but does not try to imitate the adult.

Phase III - The child is interested in more interactive types of games (sometimes referred to as "you to me and me to you" ) where he can take a turn, although he may not be able to initiate these games. Many of these games have imitative elements. The child may take time out from the game to process the experience or explore independently, but will come back to the adult to continue the game. He is interested in his environment and other adults and may fuss when the activity comes to an end.

Phase IV - The child is ready to learn that taking action and interacting with others does not mean he has to do everything or do it perfectly. He has confidence in some of his actions or activities. He is beginning to understand time and a sequence of events and will often become upset or act threatened when familiar activities are changed.

Phase V - The child is ready to learn that his own actions have consequences. He generally feels secure interacting with others and though he still may have difficulty initially handling change, he is showing more coping skills. He should have an emotional age of two years before attempting to work with him at this phase. (Nielsen, 1990)

Dr. Jan van Dijk, in his approach to working with deafblind multiply disabled children, also emphasizes the importance of establishing a relationship and learning to read the child's subtle communication as a first step. Similarly he uses co-active movement following the child's lead to engage the child in interaction. He develops anticipation through building structured activities and routines; then slightly changes something in the routine to introduce novelty and learning. All along his goal is to build the child's self-esteem and confidence in his abilities to do for himself and to interact with others. Specific communication skills are tied to these experiences as concepts are developed through experiential learning. (van Dijk, 2001)

Best practices teach us that throughout the child's development in these early stages, routines and turn-taking interactions play a critical role. For example, all children participate in basic care-giving activities such as bathing, diapering, and feeding. Through these care-giving activities that occur daily, the child begins to establish a memory and can anticipate events. Later on, through participation in simple turn-taking games that are done in a routine way, the child is able to cause the adult do something pleasurable by taking an action of his own. Still later in his development, the child is able to take part in a simple series of actions that result in some desired outcome through more structured routines. Finally the child develops independence in completing the steps of the routine he has spent time "helping" the adult to complete.

Phase IV - Sharing the Work or Level I Routines

In her book, Communication: A guide for teaching students with visual and multiple disabilities, Linda Hagood describes three levels of routines, and the child at Phase IV is just at Level I. In the Level I routine she describes an activity that:

Uses short, easy, predictable steps.Has a consistent beginning and end.Occurs at a consistent place and time with consistent objects and person.Is based upon the interests of the child.Is done with the adult in close proximity.Focuses on relationship building.Does not have the expectation of the child completing the activity on his or her own.Uses non-language forms such as objects, vocalizations, touch cues, etc.Views non-communicative behaviors as having communicative intent.

When a child is engaged in an Active Learning approach, it is at Phase IV when we begin using activity routines to supplement his independent exploration activities and simple interaction times with an adult.

At this phase the child should exhibit confidence in performing some actions or activities and have some beginning understanding of time and a sequence of events. When the child is demonstrating these traits, you can begin to include some routines where you expect the child to play an active part into a portion of each day. For example, he might show some anticipation of a familiar set of steps used in making his breakfast by trying to help pour the milk in his cup when the milk carton is opened. He may also become upset when he discovers that the carton contains orange juice and not milk.

Select a Motivating Activity

So how do you begin? As a first step, try to select activities that are motivating to the child. Think about the things (the objects) the child most enjoys playing with in independent exploration or in times when you are interacting with him. Are there activities you can design that will incorporate these materials? For example, if the child is interested in wire whisks, could you use a whisk to make instant pudding? Also consider the kinds of actions the child finds interesting. Can some of these actions be included in the routine you design? If the child likes to bang the whisk on another object can you have him bang the whisk from the finished pudding on the side of the bowl?

Pick an activity that is simple, one without a lot of complicated steps. Some of the payoff for participating in the routine needs to be apparent to the child from the beginning — "I get to play with the object I like." Additional perks for hanging in there until the end of the activity should also be included along the way — "I really like chocolate. I like banging the whisk on the side of a bowl with my teacher. I like to tear open cartons."

Organize the Materials

Participating in a routine with a child requires your undivided attention so you can respond to him emotionally and not miss any of his comments or reactions. Make sure you have all the materials you will need collected before you begin the activity. Think about the space where you will do the routine. Is this a space where the child feels comfortable and is not distracted by events or people? Is the area set up so that you can be at the child's level, even if that means sitting on the floor? If the child can't or won't sit, can he physically access all the materials and complete an action? This might mean covering the floor with a protective cloth if the activity is likely to get messy. Will the child help you collect some of the materials or is that too much to ask of him at this point? Get everything ready before you ask the child to come "play".

Provide Time to Explore

Give the child time to explore the space and the materials you will be using during the routine. Be sure to let him explore it in his own way and not the way you think he should explore it. If possible, let the child experience his own exploration of the objects outside the routine before introducing it into a structured routine.

Share in his exploration by having a duplicate set of materials for you to use or by giving joint attention to the object. For the visually impaired child this is often demonstrated through a shared tactile experience using a hand-under-hand approach (Barbara Miles, 1999). For example, if he bangs the wire whisk on the table, have one you can bang along side him. If he puts his hand in the water, put your hand in there with his so that he knows you are aware of what he is doing. Don't hurry him in his exploration — this means you need to allow plenty of time for the routine.

Set up the Sequence

It is necessary to the child to provide a clear sequence of steps in the activity. Using a slotted box like the ones typically used for a daily object calendar works well. Place an object you will use in each step in sequential slots of the box. Organize them from left to right so the child can find his way to the next step easily as each step is completed. Provide a finish basket or box to discard the object after you have completed the step. After he becomes more familiar with the routine the child may be able to help you load the objects into the slots after he has thoroughly explored each one. If not you may quickly review each one that you have pre-loaded into the slotted box so he knows where each object and action occurs in the sequence.

Complete the Steps

As you introduce each step, give the child a little time to re-explore the object before asking him to "help" complete the step. Then you can give him the word or sign for the object and model what you are going to do such as pour, stir, throw, tear open, etc. In the beginning the tasks you are asking him to complete can be completed in a few seconds up to a few minutes without any consideration for how perfectly the child can complete them. Be sure he understands which parts you are asking him to complete and which parts you will do. Most importantly, give him plenty of time to attempt to do the step before helping him complete it.

Modeling using a hand-under-hand approach during the routine, allows him to access what you are doing without making demands upon his hands to do all the work. If the child wants to explore the object a bit more after you use it, let him, but finish each step by helping to place the object in the finished box. Going back to the left-most slot and feeling for the next object can be beneficial in encouraging the child to look for the next "step" in the routine. (This is the perfect time to begin to introduce the concept and language of "next".) Eventually (after many times helping you do the action) the object should prompt the child to take the action independently. Wait silently and patiently!

Be Mindful of Pacing

Though you don't want to rush the child through the activity, you also don't want to lose him by dragging things out too long. This is where your teaching becomes an art; you have to be a keen observer of the child's emotional state. You know the child and can read his signs of boredom, anxiety, or pleasure. Allow more time for his "fun" parts and move more quickly through steps that are less pleasurable.

Clean Up and Put Away

To whatever degree the child is capable have him help you collect materials and clean up the space. At first this might simply mean helping you get a key item from its place or put the object representing the activity in the finished basket. If he can carry dirty materials to a sink or throw a water toy into the bucket, get him to do that much. Over time, he should be able to take on greater responsibility for collecting and putting away the materials.

After the Activity is Completed

Take a few moments after the activity is done to "talk" about how the child helped. Don't overly praise him, just comment on his successes and what you did together. If the child is using a calendar system at an anticipation level (at least), you may be able to reflect on the activity before you place the representing symbol in the finished box or basket.

Throw a Curve Once the Routine is Well-Established

When the routine has been completed a number of times and the child is definitely familiar with both the materials and the steps, it may be time to throw him a curve. For example, change the container that holds the milk, put bubble bath into the water, get a very large wire whisk or a very small one. Don't change too much too quickly. You will likely see some surprise or even anxiety when he encounters the change. This surprise will provide a great topic for conversation. It also will expand the child's knowledge of objects and /or actions based on a very familiar, understood event. This is the way we all learn the best, not too much new to take in at one time.


Using routines is an invaluable tool when working with children who are developmentally delayed. A well-designed routine provides a great structure for learning. Incorporating Active Learning principles into the routine is also helpful. Just remember some of the points Dr. Nielsen mentions:

Help the child learn that to be the one who does something does not necessarily mean that one has to do everything or do it perfectly.The abilities the child has been successful with in previous educational phases form the basis for deciding which activities can be used for the technique of sharing work.Keep tasks short (few seconds or minutes) initially, accept whatever the child does as correct.Explain each time which parts of the activity the adult will perform and what the child will do.Give plenty of time for the child to initiate the task and wait silently and calmly — be neutral.Let the child know how long the activity is supposed to last.Try to keep the environment the same or only make gradual changes.Before going to more complicated and longer lasting activities the choice of technique for every part of the activity should be given careful consideration.


  • Hagood, Linda. Communication: A Guide for Teaching Students with Visual and Multiple Disabilities. Texas School for the Blind and Visually Impaired, 1997.
  • Miles, Barbara and McLetchie, Barbara. Developing Concepts with Children who are Deaf-Blind. DB-Link, 2004.
  • Miles, Barbara. Talking the Language of Hands to Hands. DB-Link, 2003.
  • Moss, Kate. "Five Phases of Educational Treatment Used in Active Learning Based on Excerpts from Are You Blind? by Dr. Lilli Nielsen." Texas School for the Blind & Visually Impaired, See/Hear, Volume 9, No. 2, Spring, 2004.
  • Nielsen, Lilli. Are You Blind?, SIKON, 1990.
  • Van Dijk, Jan. Development Through Relationships. DB-Link, 2001.
  • Van Dijk, Jan. An Educational Curriculum for Deaf-Blind Multi-Handicapped Persons, DB-Link, 2001.

By Stacy Shafer, Early Childhood Specialist, and Ann Adkins, Education Specialist- TSBVI Outreach Programs

Abstract: This article describes some of the techniques of Dr. Lilli Nielsen's Active Learning Theory.

Key Words: blind, deafblind, Active Learning, Lilli Nielsen, real objects, Little Room, resonance board, position board, play

Editors Note: In a previous edition of See/Hear, we printed "An Introduction to Dr. Lilli Nielsen's Active Learning" and promised to provide additional information on active learning in each issue this year. In this issue, we'd like to examine some of Dr. Nielsen's learning strategies and the importance of using real objects. We would also like to hear from others who have used active learning, and encourage you to contact Ann Adkins at , Sara Kitchen at , Scott Baltisberger at , or Chris Montgomery at to share your experiences.



Visually impaired children learn by exploring and manipulating the objects in their environment and by comparing new objects to familiar ones. They need as many experiences as possible with real objects and textures. Hands-on experiences with a variety of objects, made out of as many different materials as possible, allow students to work on a variety of skills and learn about their environment. Concrete experiences with real objects also facilitate concept development. It is important to give students ways to actively impact their environment and teach them to be active participants in their world instead of passive recipients of stimulation from adults. The active learning techniques developed by Dr. Lilli Nielsen provide excellent opportunities for visually impaired students to gather information through the exploration and manipulation of real objects. Dr. Nielsen's approach encourages children to be active learners, and helps them discover that they can control events in their lives.


Some of the active learning equipment and materials that we have observed include:

The Little Room

The Little Room is described in detail in Dr. Nielsen's book, Space and Self, and in the article in the last edition of See/Hear. It is a piece of equipment that provides students with a safe environment for independent play and exploration. Many children are more willing to tactually explore objects when they are in control of an activity and can anticipate what might happen. The objects in the Little Room are attached with elastic and go back to their original positions when the child lets go of them, enabling him to find them again and repeat an action as quickly and as often as he wants. It gives students the opportunity to work on object exploration and manipulation, object comparison, object permanence, cause and effect, spatial concept development, problem solving, independent play, recognition, anticipation, sensory integration, and spatial memory. The Little Room also provides the opportunity to learn about the different materials from which objects are made (paper, leather, wood, metal, etc.) and the different attributes of objects (size, weight, temperature, etc.). As students experience these different objects and learn about their specific characteristics, they will discover that some objects are better for some activities than others. They will learn that some objects make better sounds when batted at than others, some are better for mouthing, some are more interesting to touch, etc. Although the Little Room is an independent activity, it MUST be supervised at all times.

The Position Board

This is a piece of pegboard to which objects are attached with pieces of elastic and is also described in Space and Self. It may be used as an independent activity if the position board is placed so it will remain stationary, or it may be used with an adult. It can be attached to a student's wheelchair tray, attached to a wall, or placed on the floor or table. Like the Little Room, objects should remain in the same position to encourage the development of object permanence, and the elastic attached to the objects needs to be long enough for students to be able to bring the objects to their mouths. Be sure to include objects with different weights and textures.

The Scratching Board

This is a piece of wood with different textures attached to it. These textured squares are approximately 3" X 3". Examples of textures to include are: leather, carpet, cork, shiny wrapping paper, packing "bubble" sheets (if there is not a danger of the student tearing off a piece and getting it in his mouth), corrugated paper from a box of chocolate candy, shiny ribbon, suede, etc. Fine screening, like tea strainers or cooking strainers, can also be used if the edges are covered to prevent injury. The scratching board can be attached to a student's tray or positioned so that it can be used while the student is lying on the floor, with either his hands or feet. The Scratching Board can be stabilized so it is an independent activity.

The Tipping Board

This is a board that is fixed in an upright position. Hang objects from the top of the board so that students can receive sensory feedback by batting at them. Again, it can be positioned so that a student can use both his hands and feet. Some objects to consider using include: shiny bead necklaces, strings of interestingly shaped beads, chains (such as those used in the 70's as belts and necklaces), bells, a plastic or metal slinky, wooden spools strung on cord, etc. Inexpensive necklaces can be restrung with nylon fishing cord or dental floss to prevent breakage. The Tipping Board is an activity that students can do independently, with supervision, if the board is stabilized.

Vest with Objects

The Vest is like a cummerbund with Velcro. Objects and interesting textures are attached to it for students to explore independently. Headliner fabric may be used instead of Velcro to reduce the possibility of abrasions.

The Resonance Board

Playing on a resonance board can be a very rewarding activity for students, providing them with sensory input from the vibrations created by their play. Position the student on the resonance board with several interesting objects around him to encourage him to explore his immediate environment. Playing on the resonance board can be an independent activity, or it is an activity that could be shared with an adult or another student. The child should be on the Resonance Board when using a Little Room.

All of the activities described above encourage students to use their hands to explore their environments. Visually impaired students need repeated opportunities to tactually explore and examine real objects every day. They need a variety of experiences that require active responses. Additional information on active learning can be found in Dr. Nielsen's books, Space and Self and Are You Blind? These books also include information on suggested objects to use with the activities. The student's educational team should work together to choose appropriate objects. Objects should be pleasurable, graspable, and have tactile, auditory, and visual qualities. Real objects from everyday experiences and daily activities are recommended because they can provide more meaningful and rewarding experiences than toys. Toys and commercially available objects are often made of plastic, and plastic provides little information that is tactually meaningful for visually impaired students. Objects should also be presented in such quantities that the child will have the opportunity to choose, compare, and play counting and sequencing games. They should also vary in weight and texture. Caution is advised because some objects are not appropriate for use with all students. Teams should ensure that all materials and boards used in active learning activities are splinter free, that rough edges are covered with heavy layers of masking or packing tape (especially pegboard), and that any paint, acrylic, or finishing agents used are nontoxic. Even though these are independent activities, they MUST be supervised at ALL times.


  • Nielsen, Lilli. Space and Self, SIKON, 1992.
  • Nielsen, Lilli. Are You Blind?, SIKON, 1990.
  • SEE/HEAR Winter 2004

Last Update: 4/12/2017 AKL

(Originally published in in the June 1995 edition of VISIONS)

Summer 99 Table of Contents
Versión Español de este artículo (Spanish Version)

By Stacy Shafer, Early Childhood Specialist, TSBVI, VI Outreach

Dr. Lilli Nielsen has worked as special education adviser at Refsnaesskolen, National Institute to Blind and Partially Sighted Children and Youth in Denmark since 1967. She was trained as a preschool teacher and psychologist. She has performed research in the area of spatial relations with infants who are congenitally blind and has written several books and articles about educating children with visual impairments and multiple disabilities. Dr. Nielsen's approach is called Active Learning. She has presented week-long training sessions on developing the full potential of young children with visual impairments and multiple disabilities in countries around the world. We were very fortunate that she presented in Dallas, Texas, May 1994. I was asked to write about some of the information she has shared with us.

All young children learn through play. They need to be encouraged to explore their environment and objects in their environment. Dr. Nielsen believes that all very young children learn by being active, rather than passive recipients of stimulation. We need to observe typical children to see how they learn to move their own bodies (raising their heads, reaching for objects, sitting up, etc.); use their bodies to explore their surroundings (including any and all objects within their surroundings); and actively participate in interactions with other people. A visual impairment prohibits a child from having enough opportunities to develop these abilities and have these experiences without intervention. She encourages adults to set up the child's environment so that s/he can do this.

Here are a few of Dr. Nielsen's recommendations when developing the child's environment:

  • Observe the child. It is imperative that we know what the child can do, what activities s/he enjoys, what type of objects s/he likes, etc. Assessing the child's existing skills and preferences is the first step in programming. Observation will help you note the child's current developmental skills. A child's preferences are indicators of the underlying strengths of his system. These preferences can guide you in the selection of objects and activities. You need to know a child's repertoíre so you can notice change and improvement.
  • Provide the child with more activities and objects that are similar to those he enjoys. This will encourage the child to explore and experience new things and broaden his knowledge base. Young children with visual impairments need to be encouraged to explore, not only toys from the toy store, but also everyday objects around the house.
  • Give the child opportunities to practice and/or to compare. As adults, we are often tempted to remove materials as soon as the child shows that s/he can use them. We all relate new information to things we already know. For example: The first time you successfully drove a car around the block, you still needed lots more experiences driving in different environments. For example, you needed to drive on different types of roads and highways, different vehicles, different times of the day and night, in different types of traffic, with the radio on and off, with friends in the car, and so forth, before you really mastered all the skills and concepts about driving. When a child begins to bang one object on another one, he needs to be given the opportunity to bang lots of different objects on lots of different surfaces. (The sound produced when banging a metal spoon on the couch is much different than banging it on the coffee table or a metal mixing bowl.) Children need to be able to repeat an action many, many times in order to learn.
  • Provide a few materials and activities that are at a slightly higher developmental level. This will provide a challenge for the child, so he doesn't become bored. You only model these activities for the child. You do not expect him to imitate.
  • Do not interrupt a child by talking when s/he is actively engaged in play. Most of us have had the experience of talking to an infant who is busily kicking her legs and having the child stop kicking to listen to our voice. We need to refrain from talking to a child who is exploring or playing with an object or practicing a new movement. We should wait until the child turns to us to share her/his experience or at least until s/he takes a little break in the activity before commenting. This does not mean that we need to stop talking to our young children with visual impairments, just that we need to pick our moments.
  • Slow down when interacting with a child. We must be willing to wait and give the child time to take a turn in the interaction. When playing with a child, Dr. Nielsen tells us to give the child time to explore an object alone, rather than jumping in and showing her/him how to use it. At a conference during a child demonstration, Dr. Nielsen offered a battery operated facial brush to a child. She let him explore the brush in his own way. He held the brush against various body parts, moved it from hand to hand, turned it over, put it on a tray, moved it against other objects on the tray, picked it back up, put it to his lips, and did many other things with it. Then he turned to Dr. Nielsen to share the experience. That was the moment she talked with him about the facial brush and the things he had done while playing with it.
  • Let the child have control of her/his own hands. Dr. Nielsen feels that when we are interacting with a child who has a visual impairment, it is important not to take her/his hand and bring it to the materials. Instead, we need to develop alternate strategies for presenting objects to the child (e.g. gently touching the toy to the child's arm or leg to alert her/him of the object's presence, making noise with the object to arouse her/his curiosity and encourage her/him to reach out, placing several objects near or touching the child's body, so any movements s/he might make will bring her/his body in contact with an object, etc.).
  • Provide opportunities for the children to actively participate with their environment. One of these "special environments" is the "Little Room". The "Little Room" consists of a metal frame supporting three side panels and a Plexiglas ceiling from which a variety of objects are suspended. These objects should be ones that the child finds interesting and enjoyable. This gives the child the opportunity to experience the properties of objects, to compare different objects, and to try out different things with the objects on her/his own without adults interpreting that experience for her/him. Since the objects are stable (secured to ceiling and walls), the child is able to repeat her/his actions with an object as many times as s/he needs to, at one to two second intervals, without dropping and losing them. The immediate repetition enables the child to store the information gained from the experiences in her/his memory.

Dr. Nielsen has given us lots of information about ways to encourage a child with a visual impairment to learn and develop. For more information about Dr. Nielsen's Active Learning, contact the Consultant for the Visually Impaired at your Education Service Center (You can find a map of Texas Education Service Centers at or call Outreach Services at Texas School for the Blind and Visually Impaired at 512.206.9268).


Here are some of the books and articles written by Lilli Nielsen.

  • Environmental intervention for visually impaired preschool children with additional disabilities, VIP Newsletter, Vol. 8, No. 3.
  • The blind child's ability to listen, VIP Newsletter, Vol. 10, No. 3.
  • Active learning, VIP Newsletter, Vol. 10, No. 1.
  • Space and Self, SIKON, 1992.
  • Early Learning Step by Step, SIKON, 1993.
  • Are You Blind?, SIKON, 1990.
  • Notes taken from lectures given by Dr. Lilli Nielsen at conferences in Albuquerque, New Mexico, in September 1992, in Milwaukee, Wisconsin in October 1993, and Dallas, Texas, in May 1994.

Video of student in the HOPSA dress

When a student is visually impaired or deafblind with significant cognitive and physical disabilities (especially if the condition is congenital) unique instructional strategies must be used to systematically teach what other children learn incidentally. One of these strategies is known as Active Learning, an approach developed by Dr. Lilli Nielsen. This approach uses specific equipment and techniques to help students from birth thru high school age functioning developmentally at ages younger than 4 years or 48 months. This approach focuses on creating environments for the learner to develop foundational concepts and skills in all areas. It can be used to provide instruction at an appropriate learning level in both the standard curriculum and the expanded core curriculum for these students with the most profound disabilities.

Some teachers and administrators have questioned the use of Active Learning because it looks very different from typical instructional approaches used in most educational settings. It looks like “play” to many people. However, very specific learning goals and prerequisite skills are the focus of a true Active Learning approach.

In a guidance letter from Office of Special Education and Rehabilitation Services, Department of Education (November, 2015) the appropriateness of a focus on prerequisite skills aligned to the standard (or general) curriculum was discussed. Below are pertinent excerpts from this document related to these students:

Based on the interpretation of “general education curriculum” set forth in this letter, we expect annual IEP goals to be aligned with State academic content standards for the grade in which a child is enrolled. This alignment, however, must guide but not replace the individualized decision-making required in the IEP process.5 In fact, the IDEA’s focus on the individual needs of each child with a disability is an essential consideration when IEP Teams are writing annual goals that are aligned with State academic content standards for the grade in which a child is enrolled so that the child can advance appropriately toward attaining those goals during the annual period covered by the IEP.

The Department recognizes that there is a very small number of children with the most significant cognitive disabilities whose performance must be measured against alternate academic achievement standards, as permitted in 34 CFR §200.1(d) and §300.160(c). ….The standards must be clearly related to grade-level content, although they may be restricted in scope or complexity or take the form of introductory or pre-requisite skills.

Excerpt from Pages 4-5 of a guidance document from OSERS on alignment to the standard curriculum, November 2015

Texas School for the Blind & Visually Impaired Outreach Programs has developed a process for aligning instruction for these special learners that utilizes Texas Early Learning Pathways, Pre-K Guidelines, Essence Statements, and Texas Essential Knowledge and Skills. This is done by utilizing the Functional Scheme assessment and other assessment tools to determine the learner’s current developmental levels prior to developing the PLAAFP and setting priority areas goals and objectives. For learners at this level, many if not all of these goals are focused on pre-requisite skills.

We invite you to learn more about Active Learning and utilizing this approach at Active Learning Space (, a special website developed by Penrickton Center for Blind Children, Perkins School for the Blind and Texas School for the Blind and Visually Impaired. You may also want to view a webinar about Active Learning, alignment and instruction which can be found at

Object Calendars can be used to help facilitate communication. Calendars also help children transition from one activity to another. The team chooses a few activities that the child does on a daily basis. They then choose an object from each activity to represent that activity. The chosen activities should include several that the child enjoys. The object that is used to represent an activity needs to be meaningful to the child. The team slowly keeps adding to the number of activities in the child's day that are represented in her calendar. You can work on joint attention, social interactions, anticipation, sequencing, object exploration, choice-making, turn-taking, etc. There are many different types of calendar systems you can use with a student. The first level of calendar system is described below:

  • The team chooses a few fun activities (4-6) that the child does on a daily basis (playing with the tent, sit-and-spin, water play, jumping on a rebounder, going for a walk outside, eating a snack, etc.). Then choose an object from each activity to represent that activity. (You will have 4-6 different objects.) The object that is used to represent an activity needs to be meaningful to the child and needs to be used during the activity.
  • Cue the child that an activity is about to occur by presenting the object associated with that activity to her. Allow her to handle the object and explore it as she wishes, then IMMEDIATELY take her to the area the activity is going to occur, preferably while she's still holding the object, and engage in the activity.
  • Cue the child that the activity is finished by presenting a distinctive basket that is unlike any other basket in her daily life. This will be her "finished basket". For example: When it is time to end the activity, present the finished basket to her, let her tactually explore the basket, then help her take the object that represents that activity and place it in the finished basket. Then IMMEDIATELY pick up the materials or move her out of the area.
  • At least once a day, present a different basket containing all 4-6 object symbols to the child and let her explore with it. When she picks up one object symbol and begins to play with it, go do that activity with her.
  • When the child begins to search for the object symbol for her favorite activity, this is the beginning of pre-symbolic object-based communication and she will be ready for the next level. (Or when she places the object symbol for an activity that she doesn't like into the finished basket as soon as it is given to her.)
  • The team slowly keeps adding to the number of activities in the child's day that are represented in her calendar.

The next step will be to set-up a permanent location in the classroom for the calendar system. Instead of taking the object to the child, you bring the child over to the calendar. Then while the child explores the next object in her calendar, you have a short discussion with the child about the up-coming activity, then the child takes the object with her, goes and does the activity, brings the object back to the calendar and puts it in the finished basket.

Developed by Stacy Shafer

For additional information please contact Sara Kitchen

A wonderful resource book about Calendars is now available!!

Robbie Blaha's, Calendars for Students with Multiple Impairments Including Deafblindness is available from the Curriculum Department at the Texas School for the Blind and Visually Impaired.

Photo of hands reading braille.

The current English Braille American Edition (EBAE) code will be changing beginning January 2016. Students across the United States will start learning Unified English Braille (UEB), a new code to facilitate braille compatibility with new and emerging literacy needs and current technology.

Spring 2017

  • Provide STAAR tests as per plan developed in 2016-2017 school year.
  • Continue data collection for research studies regarding the use of Nemeth Code.
  • Explore the addition of an innovative course in UEB Technical Code to TEA’s list of approved state elective course.

Fall 2016

  • Start teaching UEB at Texas Tech University.
  • Start teaching UEB to elementary students and older students who are new to braille.
  • Begin to collect data for research studies regarding the use of Nemeth Code vs. UEB Technical Code, focusing on Math and Science.
  • Make Braille TExES in UEB available and continue to offer Braille TExES in EBAE for two more years.
  • Facilitate the Braille Challenge in UEB format.

Summer 2016

  • Start teaching UEB at Stephen F. Austin State University.
  • Continue preparation for 2016-2017 UEB implementation for teaching students with visual impairments.
  • Continue the implementation of Nemeth Code training for transcribers and teachers of students with visual impairments.
  • Release plan for STAAR testing.

Spring 2016

  • Statewide celebration of National UEB implementation on Louis Braille’s birthday (January 4 th).
  • Continue preparation for 2016-2017 UEB implementation for students with visual impairments.
  • Continue the implementation of Nemeth Code training for transcribers and teachers of students with visual impairments.

Fall 2015

  • Continue to develop training plans for braille transcribers and teachers of students with visual impairments.
  • Implement Nemeth Code training for transcribers and teachers of students with visual impairments.
  • Develop a plan to transition STAAR to UEB code with TEA and test developer.
  • Send survey to braille transcribers to determine UEB knowledge and skills and level of certification.
  • Continue public relations regarding UEB with districts and ESCs.
  • Continue braille curriculum transition to UEB code.

Summer 2015

  • Plan training for braille transcribers and current teachers of students with visual impairments for 2015-2016 school year with ESCs and TSBVI.
  • Continue to develop Nemeth Code training plans for transcribers and teachers of students with visual impairments.
  • Continue to develop university UEB braille courses.
  • Add UEB code information to the 2015 Guidelines and Standards for Educating Students with Visual Impairments in Texas.
  • Begin transition of current braille curriculum (Braille FUNdamentals, APH programs) to UEB.

Spring 2015

  • Begin State of Texas Assessments of Academic Readiness (STAAR) transition development with TEA and the STAAR test developer.
  • Advertise National Braille Association training in April, 2015 in Austin, Texas.
  • Present UEB overview to conferences: Texas Council of Administrators of Special Education (TCASE), Deafblind Symposium, Low Incidence Disability (LID) network, and Texas Association of Education and Rehabilitation of the Blind and Visually Impaired (TAER).
  • Post Unified English Braille overview items on state and regional websites.
  • Continue to develop training plans for braille transcribers and teachers of students with visual impairments via ESCs and TSBVI.
  • Begin face-to-face and online trainings for braille transcribers and teachers of students with visual impairments.
  • Begin exposing teachers and students to UEB recreational readings.
  • Develop university UEB braille courses.
  • The decision to retain the Nemeth Braille Code for mathematics and science was made by the Braille Authority of North America (BANA) in November, 2012; BANA will provide provisional guidance on how to transcribe the Nemeth Code within UEB contexts.
  • Work with teacher certification test developer and TEA to plan UEB Braille TExES development timeline.
  • Plan the transition for state-adopted instructional materials to the UEB code with TEA Instructional Materials Division.
  • Provide public relations UEB awareness campaign with school district administrators.
  • Evaluate access to UEB via technology for students with visual impairments.
  • Facilitate the continued use of the Nemeth Code by creating a Nemeth Code Handbook.
  • Facilitate the continued use of the Nemeth Code by developing training plans for transcribers and teachers of students with visual impairments.

Fall 2014

  • Explore available options for training for braille transcribers and current teachers of students with visual impairments.
  • Develop resource document of available references on rules, resources, and training.
  • Advertise National Braille Association (NBA) training on April 16-18, 2015 in Austin Texas.
  • Develop UEB training plans for braille transcribers and teachers of students with visual impairments throughout the state in conjunction with Education Service Centers (ESC) and Texas School for the Blind and Visually Impaired (TSBVI).
  • The Texas Education Agency (TEA) will collaborate with the teacher certification test developer for transition to UEB on the Braille Texas Examinations of Educator Standards (TExES).
  • Explore opportunities for funding for teacher and transcriber attendance at the National Braille Association UEB training in April 2015 in Austin, Texas.

Compiled by Texas UEB Stakeholder Group - November 5, 2014; Revised August 20, 2015

Here is a collection of resources for gaming. There are 2 sections. First, is magazines dedicated to the gamer with visual impairments. Second, is a list of sites where you can download and/or purchase games.


  • How To Play a Text Adventure, Part 1
  • QuestML - What is QML? QML, the Quest Markup Language, is a free XML-based Choose-Your-Own-Adventure game system by. Adventures can have images, sound, states to check, random events and much more. You can have them be played on any browser, even make them accessible by text-to-speech clients.

Accessible Games