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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

By Robbie Blaha, Education Specialist, TSBVI Deafblind Outreach with help from Stacy Shafer, Millie Smith and Kate Moss, TSBVI Outreach

Since it’s inception of laws providing for the free and appropriate education for all students in this country our schools have seen a steady increase in the population of students who are considered to have the most profound disabilities. Although our willingness to serve these children is evident, our understanding of these students’ educational needs, assessment and programming is still very much in its infancy. It is easy to feel we do not know what to do with these students. Developmental checklists and assessment tools used with other populations are not often sensitive enough to provide usable information to those charged with the instruction of this type of student.

The purpose of this article is to: (1) present basic user friendly assessment questions and background information which relates to this particular population, (2) acknowledge the individuality of each of these children by building a personal picture of how they learn, and (3) provide useful information with which to develop programming. This is not intended to be a comprehensive assessment process but rather some questions and background information to consider when planning for this particular population.

What Can Be Done To Gain And Hold This Child’s Attention?

Attending And Biobehavioral States

A typical nervous system exhibits a range of levels of arousal. In all of us there is a structure in the brain stem that controls levels of arousal (biobehavioral states). Some examples of these levels of arousal states are deep sleep, drowsiness, alertness, anxiousness, and agitation. (Guess, 1988). If our nervous systems are n the normal range, we spend our day shifting across the states in a typical manner. We sleep at night, are alert and absorbed in a good book and drowsy after a big noon meal We may become very agitated when paying our bills or it a stray dog digs up the garden.

We are able to consciously control some of these arousal states. For example, if we find we are getting sleepy behind the wheel of a car, we stop to get a cup of coffee. We are calmer in a stressful situation if we bring along a friend or wear a favorite outfit. If something agitates or makes us anxious, we may engage in “self talk” as a form of state management. For example, to calm down we might think to ourselves, “I’m not going to worry about it. It’s not that big of a deal. If worse comes to worse I’ll just…”

For all of us, the only time we can learn new information is when we are able to achieve and maintain an alert state. This is why, after something traumatic throws you into an extremely agitated state, it is sometimes impossible to remember things that were said or to reconstruct a particular sequence of events. You may also find that, after a big lunch in a warm room, you become incredibly sleepy and have trouble reading a long memo from your boss. The ability to attain and maintain an alert state is essential for understanding and learning.

Children with profound disabilities may not exhibit the typical range of states. This is a characteristic of a number of students with profound disabilities. One student may always seem to be sleeping or drowsy. Another is chronically irritable or anxious, leaving adults fearful of interacting with her lest they “set the child off.” Many of these children may have brief cyclical periods of alertness, but seem unable to maintain this state long enough for typical instructional activities. Slightly over-stimulating this child can cause him / her to “shut down” to a sleep state.

Often these children have difficulty achieving and / or maintaining alert states. They may experience health setbacks that bring incredible drains on their energies and effectively prevent them from being able to respond to any environmental demands outside their bodies. In some students with deafblindness the lack of normal stimulation due to an extensive sensory loss causes them to spend much of their time in other than alert states. The key to instructing these children is to understand the internal influences on the child’s ability to attend to instruction.

There is a growing interest in the possibility that external factors can have impact on biobehavioral states in these children. During the assessments, we want to learn things about children that might help them develop better control of their states and maintain alert states for longer periods of time. The more adept they become to attending, the more opportunity they have for learning. Therefore assessment should help determine the child’s current profile of states and what adaptations to the environment may assist the child in achieving and maintaining an alert state.

The questions related to biobehavioral states that should be answered during assessments are:

  • What are the range of states the child exhibits across the day or week?
  • What are the child’s most common states?
  • Is this child able to reach the quiet alert or active alert state?
  • Can he maintain it?
  • What problems does the child have in shifting and maintaining states?
  • What variables appear to effect state in the child (especially attending)?

There are a number of tools that can help in obtaining this information. These include:

  • Assessment of Biobehavioral States and Analysis of Related Influences
  • Appetite / Aversion Form or Likes and Dislikes from the APH Sensory Learning Kit 
  • Assessment of Voluntary Movement Component
  • Carolina Record of Individual Behavior (CRIB)
  • Analyzing Behavior State and Learning Environments Profile (ABLE).
  • The Key to Attending: The Orienting Reflex

People have a subconscious monitoring system that is working at all times. If this system detects something that needs our immediate attention, it pulls us to attention with the powerful orienting reflex. The orienting reflex is just that: a reflexive alerting to: significant things. It tells us when to pay strict attention so that we may make a decision whether or not to defend ourselves or to get more information. It alerts the senses to the fact that they need to pay attention, so that survival matters and novel things can be handled. (Silverrain, 1991)

All of us have orienting reflexes throughout the day. As an example, say that you are driving along listening to the afternoon news. The words roll by you until suddenly you hear your street address being said over the air. You snap to attention, lean forward, and turn up the dial to take in every word. You reflexively oriented to something that is important to you. The orienting reflex is powerful because it is the prerequisite to the alert state in the array of biobehavioral states. (Rainforth, 1982) It pulls you to an alert state from another state. Parents use this reflex all the time. If you have a fussy (agitated state) child in the grocery store, you try to distract her so she will calm down. (“Do you see that man with the funny hat? What do you think his name is?”). What you are actually doing is trying to trigger the orienting reflex in the child so she will shift from an agitated state to a calm state.

In the area of attending, a critical component in both assessment and instruction is the orienting reflex. (van Dijk, 1985) It is important to consider because the orienting reflex can potentially be used to help the child who is usually in “other than alert states” shift into attending. The hope is that you can capture their attention on a reflexive level; then provide instruction. (See “associative learning” discussion.)

If the child shows an orienting reflex in response to a change in position, a particular scent, or colored lights, these materials or strategies can be embedded in the lessons to try to gain the child’s attention and help him shift to an alert state. Once he makes that shift, you have a brief window of opportunity to provide further information and to attempt to extend the amount of time that he attends.

An important thing to note: There is a difference between the orienting reflex and a defensive startle. Overhearing your name in a conversation produces an orienting reflex. “The orienting reflex readies the nervous system for further learning.” (Silverrain, 1991) The blare of a fire alarm typically produces a defensive startle. A startle indicates an overload of the nervous system, which is aversive rather than appealing. The result is not “attending,” but rather physical agitation and / or disorientation and / or withdrawal. The child who experiences a defensive startle during an interaction with his instructors or his environment feels under assault rather than invited to participate.

If the stimulus is perceived as aversive, you are less likely to attend and more likely to spend your energies trying to get away from the stimulus. Children who cannot physically get away from an aversive stimulus may literally shut down into sleep to escape. That is why it is critical to determine what the child tolerates or is attracted to (appetite) versus what repels the child (aversion). (van Dijk, 1985)

Families as well as other members of the child’s team often have valuable pieces of information related to the things that seem to catch his attention or deeply bothers him. In the assessment process you need to identify things that elicit an orienting reflex so that you can embed those in your lesson to help the child maintain attending. You also need to assess what things are aversive to the child so you do NOT inadvertently include these things in lessons or social interactions with him and take away his ability to attend.

The questions related to orienting reflex that must be answered during assessment are:

  • What does the orienting reflex look like in this child?
  • What elicits an orienting reflex in this child?
  • What does the defensive startle look like in this child?
  • What elicits a defensive startle in this child?

There are a number of tools that can help in obtaining this information. These include:

  • Assessment of Biobehavioral States and Analysis of Related Influences,
  • Appetite / Aversion Form,
  • Assessment of Voluntary Movement Component

How Does The Child Take In Information?

Preferred Sensory Modalities

We all use our senses to gather information from our environment. These senses include: visual, auditory, vestibular (related to movement and spatial orientation sensed through muscles, tendons, joints, and the inner ear) kinesthetic (related to bodily position, weight, or movement sensed through the muscles, tendons, and joints, olfactory (smell), and gustatory (taste).

We also have preferred senses for taking in information which impacts how we best learn. Some of us learn new material best by listening, others prefer to read the information, and others may need to write new information down. It is important to determine which sensory channel (s) the child with profound disabilities prefers to use and then provide instructional activities and information through those preferred channels. For example, a child may alert to a change in lighting. She may attend longer if there is some music involved in the lesson. She will accept certain types of tactual input in the palm of the hands but never on her mouth. Looking at the self-stimulatory behaviors (i.e. rocking, flicking, etc.) can also give you some information about which sensory systems have value to the child. (Moss & Blaha, 1993)

It is helpful to systematically test across all sensory channels with tools like Every Move Counts and to compile and analyze anecdotal information from families and staff who have daily interactions with the child. These observations contain clues about sensory things involving water. You observe that the one sound that seems to “tune him up” (bring him to attending) is the sound of water running from a faucet. That piece of information tells you that the child recognizes a consistent and a distinct auditory cue and associates it with something that he really enjoys.

The strategy of “multi-sensory approach” is sometimes recommended for this population. There seem to be different working definitions for this term. This approach is sometimes perceived as stimulating all the child’s senses at the same time with the same level of intensity. This version of multi-sensory approach assumes a couple of things:

  1. All senses are triggered in pleasant ways. This may not be true for these children. A child may orient to music through the auditory channel but find tactile information through his hands frightening. Combining these with equal intensity in a lesson may throw the child for a loop.
  2. The child can combine completely different sensory input into a meaningful whole. This may not be possible for all children. For example, some students may need to focus on one channel at a time to understand what is happening. It may be better to pace the lesson so the child can have a longer time to look at or touch something before you start talking about it. You can relate to this need if you think of the times you have turned off your radio when you were looking for a freeway exit in a large unfamiliar city.

The questions that should be considered in assessment related to sensory channelsare:

  • What sensory channels are most effective for gaining the child’s attention?
  • What sensory channels are important for conveying reliable information to the child?
  • What degree of sensory information or pacing of presentation of information helps the child shift his state to attending?
  • What channels are associated with orienting reflexes?

Assessment tools that help to provide this information include:

  • Learning Media Assessment (LMA),
  • Every Move Counts,
  • Appetite / Aversion Form,
  • Inventory of Self-Stimulatory Behaviors.

Does The Child Remember And Learn?

Any type of learning has to do with memory. The following are indicators that a child is remembering specific sensory information.

Habituation As An Indicator Of Memory

When I first moved to Austin I rented a home near the airport. It was a great house but unfortunately stood under the flight path. Incoming flights woke me up at night and interrupted phone conversations for the first few days. After a time, however, I tuned it out and stopped noticing the noise. When my sister came for a visit she asked me, “How can you stand it?” I honestly had no idea what she was talking about. I had gotten used to the sounds and had stopped hearing them. This is an example of habituation. Our minds unconsciously sort through incoming information. Habituation is an indication of memory because you only get used to things that your system is able to remember. Habituation decides what we should ignore or notice and is characterized by a lack of response. This is very important as it allows the nervous system to focus on relevant events and not be overwhelmed by all the trivial types of stimulation occurring around us all the time.

Watching for signs of habituation in a child is important because it tells you he is remembering. Many times you hear comments like, “He used to really jump when the intercom came on, but now he doesn’t seem to notice it. I don’t know if he can still hear it.” Or “This used to be her favorite tape, but now she doesn’t seem to respond to it.” These could be indicators of habituation which signifies that the child views the information as “old news.”

Building Associations As An Indicator Of Memory

Building associations between two events is a type of learning and remembering. Linking a new fact with a familiar one (associative learning) is one way we grow to understand the things around us. Before we talk about ourselves, however, let’s talk about less complex life forms and what they have shown us about associative learning.

“Snails, believe it or not, demonstrate simple associative learning. Recent studies show the effects of learning on the nervous systems of snails. Large groups of sea snails are given a fast spin (simulating the roll of a wave) which makes them contract. Each spin is preceded by a burst of bright light. Bursts of bright light alone have no effect on snails. After a while, the snails will contract when the light is shone on them, as if a spin were imminent. Researchers have shown that during this learning, new nerve connections have grown that did not exist before. The snails began to react or anticipate the spin simply by association with the burst of light.”

“You might find it interesting to know that new born human infants have also shown the ability to associate a preceding event with one that follows. A hungry, crying baby will become quiet when she hears her parent’s footsteps approaching in the night because she anticipates the bottle. We know that the human nervous system is capable of making associations between two events when the final event in the chain relates to basic survival or pleasure needs.” (Silverrain, 1991)

A child who dearly loves the taste of pudding initially shows no recognition of a spoon. However, over time, you may see him develop the same level of enthusiasm for a spoon as the pudding because you the repeatedly paired the spoon with the pleasure of eating pudding. The ability to make an association between the spoon and the pudding is an example of associative learning. (Note: We have learned from early studies that present the spoon immediately before he tastes the pudding is the way to help the child make the connection.) By building these meaningful pairs in a child’s life you are expanding his understanding of the world. Noting any associations that child may have already is important assessment information.

Anticipation As An Indicator Of Memory

Anticipation should be considered an indication of learning and memory. When a child feels his bib go about his neck and begins to open and close his mouth, he is anticipating the next step. He is showing us that he remembers. Unlike habituation that is characterized by a lack of response, anticipation is characterized by a “tuning up” of the system and some action on the part of the child that says “Oh yeah, I remember this!” Anticipation tells you that you have been successful in developing associative learning. You have built an association between bib and eating.

Anticipation of an upcoming event can “rev you up” to maintain an attending state. For example, a person is on a road trip and knows that the exit he must take will be a few miles past a factory on the left. This guy may drive along lost in his own thoughts for thirty minutes or so until suddenly, the factory appears on the left and triggers an orienting reflex. He shifs into the alert state and begins to anticipated the exit. Because he anticipates the exit, he stays alert for a short period of time and looks closely for the sign. Using cues with children helps them anticipate and pull to attending so they can learn.

Surprise As An Indicator Of Memory

Building in a surprise or what has been called a mismatch of expectations (van Dijk, 1985) is a test for memory and learning. A mismatch occurs for the child when he anticipates his mother picking him up and playing a particular swinging game, but is treated to this same game by this father. The child registers his surprise by fluttering his eye lids and breathing more rapidly. The surprise elicits an intense alert state in which associations previously learned are reviewed and compared with the new experience important learning has taken place for him. A child responds to a mismatch of expectations only because he remembers what should have happened.

Questions to ask related to assessing cognition (habituation, anticipation) include:

  • Are there things the child used to orient and respond to that he now seems to notice?
  • Does he stop responding after 2-3 times?
  • Does he seem to pair things, events, and/or people together?
  • Does the child show anticipation of what is about to happen?
  • Does the child register surprise when there is a change in a familiar routine?
  • Does the child seem to know familiar versus unfamiliar people?

As assessment tool that helps to provide this information is Every Move Counts.

What Can This Child Do To Impact His Environment?

Since learning is something the child does with you and not something you do to him, it is critical to determine the easiest way for the child to respond so that he is able to successfully participate. Possible responses that these children might make are changes in affect, vocalizations, gaze shift, and body movements. (Korsten, 1993) Even if these responses are not intentional, you should identify a particular response he gives and try to shape it into a purposeful response. Systematically testing for these responses is an important part of assessment.

Systematic Inventory Of Voluntary Movements

It is important to systematically observe the child in all the positions typically used with him and inventory the voluntary movements he can make. Some of these children are said to have no voluntary movements to use for instructional purposes. Typically this is not the case. When a child is observed in a variety of positions he may show a surprising number of movements. From this inventory of voluntary movements, the team can target a particular response(s) which will allow the child to participate in an activity.

Many children can make a particular movement easily in one position but not in another. Some positions are more stimulating or relaxing for a child and this effects their ability to attend. (“As soon as we put him in side-lying, he stops fussing.”).

Additionally, some children, when moved from one position to another, experience a significant change in their biobehavioral state. They may find the experience frightening and need a period of time to recover before they can attend. These children could benefit from strategies to make the transition less aversive (e.g., touch cues which signal that they are about to be taken from their travel chair or slowing down the pace of the transition). Other children may be at their most alert following a change in position. It is an individual things.

Questions related to voluntary movement that can be addressed in assessment include

  • What specific voluntary movements does the child exhibit across positions?
  • How do different positions affect the child’s level of arousal or biohehavorial states?
  • Does transition from on position to another cause a significant change in the child’s biobehavioral state?.

Assessment tools that help to provide this information include:

  • Every Move Counts
  • Assessment of Voluntary Movement Component
  • Physical Therapy Assessment
  • Occupational Therapy Assessment

Using The Assessment Information In Developing Programming

Programming Strategies

Once this assessment information has been compiled the educational team should be able to draw on it in developing their program. Ann Silerrain suggested some strategies to follow in her 1991 article. These include:

  1. Use assessment data to determine learning media that provides the appropriate level of stimulation---enough to be alert and not enough to cause withdrawal. We must forget about stimulation for the sake of stimulation. “Tolerating stimulation: is not an appropriate goal. Damaged nervous systems need the appropriate type and amount of stimulation; they do not need to be bombarded.
  2. Develop activity routines which have a predictable sequence of steps, objects, or actions that evoke the orienting reflex to reengage the child throughout the activity and provide opportunities for the child to respond or take a turn. Remember pacing is critical in getting child response.
  3. Use familiar objects and people in daily routines as a basis for instruction. Evaluate anticipatory responses to sensory cues to determine the appropriateness of the materials or actions used for cuing. As you cue the child, look for orienting reflexes to occur. Remember that you want to get an orienting reflex, follow with an activity of high interest or one that comforts or meets a basic need as a way of rewarding the child’s response. Over time we should begin to see the child show signs of anticipation. All things we want the child to respond to should be real things or actions that are used by or with the child in everyday routines.
  4. Design a daily schedule of predictable and pleasurable events or routines. With any activity, if we want to see an anticipatory response (evidence that the child remembers) the activity must have a strong emotional appeal for the child.
  5. When we see the child anticipate events and show some awareness of the functional use of objects, then primitive communication choice systems can be used. When a child does such things as gaze at a preferred item then at you; tactually explores two objects and picks the relevant one in context; pushes an object toward you; pulls or pushes your body in a way that says “I want you to do this with me,: then you are beginning to move into the realm of intentional conversation.
  6. When the child is consistently anticipating a particular object or action in a routine, toss in a mismatch to test awareness and communication. This check can only occur within the context of a stable routine. For example, the child is routinely expecting to have you present her red bib before meal time, but instead you put a hairbrush in front of her and her bib off to one side. Will she realize there is a problem and try to communicate that to you? Will she try to get your assistance in resolving the problem? These are indicators of a readiness for more complex learning.


As the family and the other members of the educational team work together they become more able to recognize and respect the skills and strong personal preferences that children with the most profound disabilities show us. All the children have ways of showing us what they want more of and what they would like to avoid. It is our responsibility to develop the assessment expertise needed to be aware of those messages and to use them to build better learning environments for the child.

References And Resources

Guess, D., Mulligan-Ault, M., Roberts, S., Struth, J., Siegal-Causey, E., Thompson, B., Bronicki, G.J., & Guy, G. (1988). Implications of biobehavioral states for the education and treatment of students with the most handicapping conditions. JASH, 13 (3), 163 - 174.

Korsten, J.E., Dunn, D.K., Foss, T.V., and Francke, M.K., (1993), Every move counts. Tucson, AZ: Therapy Skill Builders

Moss, K. and Blaha, R. (1993), Looking at self-stimulation in pursuit of leisure or I’m okay, you have a mannerism. P.S. NEWS!!!, July 1993, pp 10-14.

Rainforth, B. (1982). Biobehavioral State and Orienting: Implications for Educating Profoundly Retarded Students. TASH Journal, Vol. 6, Winter, 1982 (33-37).

Silverrain, A. (1991). An informal paper: teaching the profoundly handicapped child. San Antonio: ESC Region 20.

Simeonsson, R. J., Huntington, G.S., Short, R.J., & Ware, W. B. (1988). The Carolina record of individual behavior (CRIB): Characteristics of handicapped infants and children. Chapel Hill: Frank Porter Graham Child Development Center, University of North Carolina at Chapel Hill.

Smith, M., Levack, N., & MaGee, B. (1996). Teaching Students with visual and multiple impairments: a resource guide. Austin: Texas School for the Blind and Visually Impaired.

Van Dijk, J. (1985). Personal notes from a seminar.

SEE/HEAR Editor’s Note: This article first appeared in the Fall 1996 edition of SEE/HEAR newsletter published by Texas School for the Blind and Visually Impaired and Texas Commission for the Blind. It was developed in response to requests we have had from teachers who are working with children who have the most profound disabilities. Typical assessment information provided little for the teachers to use in developing programming for this type of child.

(P.S. NEWS!, Vol. IV, No. 3, July 1991, pages 10-12.)

by Robbie Blaha, Teacher Trainer and Kate Moss (Hurst), Family Training Coordinator

En Espanol

There are few events in our day to day lives that do not become routines. Whether it is brushing our teeth, putting gas in our cars, or going bowling there exists in our minds a series of predictable steps and specific objects associated with those steps. Often we move through these familiar activities with little notice. However, there are aspects of these routine activities that deserve a second look. A well organized routine can have a powerful effect on a child with severe disabilities. Children with severe disabilities have been shown to benefit from learning through routines.

If you consider your child's day, you probably have already established a variety of routines. Think about changing a diaper, eating a meal, bath time, etc. These events happen daily and generally in a predictable or routine way. Here are some things that these routines are providing your child.


You may notice during these activities your child seems to communicate a great deal with you. His subtle or sometimes not so subtle responses during these events might "tell" you, "I'm not hungry," "I'm ready to get out of the tub," etc. You understand and respond to these communications by skipping to dessert or pulling the plug on the tub and wrapping the child in a towel.


Routines feel comfortable and the child uses his energy and attention more efficiently. When a person who is not familiar with your routine way of doing an activity, attempts to feed or bathe your child, the child might become anxious or uncooperative. Yet if you direct that person to do it your way the child will often calm and respond better. He's familiar with the routine. That helps him to better anticipate and participate in the activity.


Routines develop a sense of a beginning, middle and an end to an activity. They also help weave a cluster of people, actions, objects and locations into a meaningful whole. Routines make use of natural cues, i.e. one step acts as a cue for the next step. This type of cueing does not require another person to always prompt the child because the objects used in the activity serve as the prompts. In addition routines can help a child anticipate an end to an undesired activity or recognize the beginning of a desired activity.


Routines build a memory foundation for other learning. Paul Carreiro and Sue Townsend (Routines: Understanding Their Power) note that the development of a sophisticated memory is dependent on a core memory system referred to as "procedural memory." Procedural memory is defined as "the ability to retain a simple everyday 'low attentional' understanding of how things work." If a child does not have an organized experience he can not understand. If he can not understand an experience he will not learn from it.


When a child has an internal picture of an activity he can recognize when something changes. He is alerted to attend and learn the new part. He can become aware of specific bits of information that impact him and is more likely to tune in to that particular concept. For example, if a child has a routine for making pudding, you can introduce a new flavor. The child will tune in to the flavor being different because everything else in the activity has stayed the same. The difference in flavor can be "spotlighted."

Using routines at home can reinforce learning, improve communication between the child and family, and reduce frustration for everyone. The information that follows will help you formalize your existing home routines. If you do not use routines, you might want to consider developing some. As you develop routines, share them with school personnel. If your school is not using routines currently with your child, you might encourage them to become familiar with the concept of using routines in learning.


Before you set up your routines it is important to decide which of your child's daily activities you want to formalize into routines. The following tips will help you in this process:

1. Map out a typical week day and weekend day for your child. (Figure 1)

2. Begin by picking obvious activities where routines are likely to exist already such as eating, toileting. Give special consideration to those activities that will be most beneficial to the child's mental and physical health. Next look at those activities that adults must do for the child. Would these activities be made easier if your child could participate partially? For example, it would be helpful if the older child could anticipate when you need to slide a diaper under him and participate by raising his bottom rather than requiring you to have to lift him. Finally look at those activities that could be done as vocational activities.

Figure 1 - Mapping out a typical week day and weekend schedule helps to identify existing routines which can be formalized. It can also help to identify times when routines might be helpful to the child and family.
6:30 a.m. wake up 7:30 a.m. wake up
6:40 a.m. bathroom 7:40 a.m. bathroom
6:50 a.m. breakfast & medications 7:45 a.m. help dad cook pancakes
7:15 a.m. brush teeth 8:30 a.m. breakfast & medications
7:30 a.m. dress 9:00 a.m. brush teeth
8:00 a.m. catch bus 9:15 a.m. dress
AT SCHOOL 9:45 a.m. free time
10:45 a.m. family activity
3:30 p.m. return home 1:00 p.m. lunch time
3:45 p.m. bathroom 2:45 p.m. continue family activity
3:50 p.m. snack 4:00 p.m. snack
4:15 p.m. freetime 4:15 p.m. freetime
6:00 p.m. dinner 6:00 p.m. dinner
7:00 p.m. plays with dad 7:00 p.m. plays with dad
8:00 p.m. bath 8:00 p.m. bath
8:30 p.m. bedtime 8:30 p.m. bedtime


After you have identified activities for routines it will be helpful to write these routines out. List all the steps in the activity in the order in which they occur. The amount of detail in each step will depend on the expectations you have for your child. You might have the staff at your child's school review these routines and decide which specific IEP objectives could be worked on during the routine. These objectives could be written into your routine script. One objective might be included in several different routines. (Figure 2.)


  1. Walk to dining table (Trail wall from hall to dining room)
  2. Find chair and sit down
  3. Wait for mom/dad to put on bib
  4. Look for spoon when tapped on table and pick it up (Use visions to explore space and locate objects. Grasp object)
  5. Allow mom/dad to help scoop and carry spoon to mouth (hand over hand)
  6. Set down spoon and reach for cup when drink is offered, or set down cup and reach for dessert (Indicate choice by reaching for preferred item)
  7. Help move plate away when meal is finished
  8. Allow mom/dad to wipe off hands and face
  9. Drink medication from medicine cup
  10. Remove bib (Remove clothing independently)
  11. Get down from chair

Figure 2 - A mealtime routine might include steps in which IEP objectives can be imbedded. The objectives appear in italics.

You might enjoy tracking your child's success in carrying out the routine. A nice way to do that is by making periodic video tapes of the activity or keeping a log that you share with school. You may even come up with some other method to note the changes. It is important to remember that this type of information can and should be shared with the ARD committee when assessment data is being reviewed.


Family life is subject to unexpected events and unplanned for crises. Given that, set up a schedule that is reasonable for you. Don't plan to take on too many new routines until you feel comfortable with the existing routines. When a routine becomes formalized, it may take longer to do especially if you expect your child to participate more in the activity. Allow for more time to complete the activity, or if that is not possible, opt to reduce the level of the child's expected participation. For example, family meal times may prove to be too hectic for encouraging the child to try emerging self feeding skills; however, snack time might be more relaxed. Instead of writing out a meal routine that includes using new self feeding skills, you might focus on these during the snack activity.

Once you have identified some routines that exist in your day write out a schedule. You may not be able to follow it exactly everyday, but if you have a schedule and everyone knows it, you will be more likely to follow it. Post the schedule on the refrigerator. Tape up the individual routines near the area where the activity will take place. Share this schedule and the routines with those individuals who may fill in for you such as grandparents, baby sitters, and siblings. It is especially important to share these routines with the educational staff who work with your child. This will help the staff to design their routines to be consistent with the routines that take place at home.

Editor's Notes: There is much more to learn about routines and their uses with children who are deaf-blind. Look for future P.S. NEWS !!! articles to cover this material. If you have questions about this article please contact Robbie at or Kate at . This article is based on two articles by Paul Carreiro and Sue Townsend who are communicative disorder consultants with Student Services in Edmonton Public Schools in Alberta, Canada. The articles are titled Routines: Understanding Their Power and Implementing the Routine Model.

Originally published in See/Hear Newsletter, Summer 2007
Versión Español de este artículo (Spanish Version)seis

Chris Montgomery, TSBVI Outreach, Deafblind Education Consultant

Abstract: A former classroom teacher, now Outreach deafblind consultant, shares the observations and educational intervention strategies he compiled when working with one student a few years ago. Natasha had cortical visual impairment, central auditory processing disorder, seizure disorder, and additional sensory integration problems.

Keywords: visually impaired, cortical visual impairment, central auditory processing disorder, deafblind.

Natasha is a seven-year-old girl who has been labeled deafblind. She has a severe bilateral hearing loss, a cortical visual impairment, and a long history of severe seizure disorder that began at four months of age. To restrict and lateralize her seizures, by age three she needed a corpus callosotomy to separate the anterior two-thirds of the corpus callosum. After surgery Natasha made significant improvements in her general health, sleep, growth, development, midline control, and sustained visual gaze. Her seizures continued, and at age six she received a Vagus Nerve Stimulator (VNS). The VNS is a device that sends an electric signal to the Vagus nerve at consistent intervals so regular brain waves can be established, thus minimizing seizure activity.

It has been approximately three years since Natasha's neural surgery. Research suggests that the first three to four years of a child's life is the most critical for the development of neural pathways. Early identification of Natasha's neurological conditions, including CVI provide the best opportunity to take advantage of the brain's plasticity. I feel we are just in time in this regard, and I am noticing improvement in her use of vision weekly.


In Natasha's case, her CVI had a more profound effect on her vision before her corpus callosotomy. According to her mother her depth perception problems have improved. Her ability to stay on task and recognize people and calendar symbols is also improving. Natasha still exhibits a strong preference for bright primary colors, and usually attends better when her environment is kept visually uncluttered. She does not demonstrate fluctuations in her vision.

Natasha is starting to respond to my voice during familiar activities such as eating breakfast. She will lean her ear toward my mouth to listen to familiar phrases that I say to her. I try to keep these vocalizations as consistent as possible during the routines so they will in effect be paired with the routine we are doing. I am hoping the next step will be her hearing these vocalizations from a further distance, and associating my vocalizations with the particular activity by signal or gesture when we are away from the activity. Natasha is motivated by her near senses including:

  • Vestibular: swinging, being flipped, rocking, swaying, and extreme extension in a inverted position.
  • Oral/Tactile: oral exploration, smelling, tasting, textures (e.g. pegboard, carpet, familiar blanket), water, vibration.
  • Touch/Proprioceptive: deep pressure, physical rough house play, tapping, stomping feet.

Cortical Visual Impairment

Cortical visual impairment (CVI) is a temporary or permanent visual impairment caused by the disturbance of the posterior visual pathways and/or the occipital lobes of the brain. The degree of neurological damage and visual impairment varies with the time of the onset, as well as the location and intensity of the injury. It is a condition in which the visual systems of the brain do not consistently understand or interpret what the eyes see. CVI can have wide-ranging effects. Individuals can have multiple disabilities, and other cognitive disorders, as well as motor impairments that compound their CVI.

The major causes of CVI are asphyxia, developmental brain defects, head injury, hydrocephalus, and infections to the central nervous system, such as meningitis and encephalitis. (Jan & Groenveld, 1993) The damage may be localized to a

specific area of the brain or generalized to different cerebral regions. Additionally the severity of the visual impairment is related to both the gestational age at the time of insult and neonatal seizures. Other causes for cortical visual impairment include toxoplasmosis, cytomegalovirus, and such cerebral degenerative conditions as Tay-Sachs disease, and galactosemia. (Cogan, 1966) Similar injuries to an adult's nervous system may have very different outcomes than those effecting children.

Individuals with CVI may exhibit any of the following characteristics:

  • Their visual acuities may range from light perception to print reading ability.
  • There is almost always a field deficit present.
  • Nystagmus is absent unless there is an additional ocular disorder.
  • The eyes show no apparent abnormality.
  • A high percentage demonstrate light gazing, even though about the same percentage are light sensitive.
  • Visual functioning fluctuates.
  • Color perception is generally intact and many students seem to perceive red or yellow more easily.
  • Difficulties with depth perception are frequently present, particularly with foreground/background perception.
  • Suppressing unnecessary visual information may be difficult. Close viewing may be preferred even though visual acuities are normal.
  • Perception of objects is difficult when they are spaced close together.
  • Avoiding obstacles during travel is easier than using vision for close work. (Smith & Levack, 1997)

While Natasha uses the distance senses of vision and audition, these senses are less reliable. The information gained through them seems to be more difficult for her to process. Natasha sometimes exhibits signs of auditory overload. She may have a difficult time filtering out environmental noises. Sensitivity reactions observed in the past have included withdrawal, covering her ears, vocalizations indicating stress, and shut-down behavior. Extraneous objects in the environment tend to distract her if they are brightly colored or if they have a desirable texture for touching or mouthing. People walking past or about the room also distract Natasha.

Central Auditory Processing Disorder and Auditory Neuropathy

Central auditory processing disorder (CAPD) is a term that refers to some type of problem in the auditory system, which occurs neurologically instead of in the ear itself. A person may have one or more auditory processing problems for a variety of reasons. Differences in auditory nerve (auditory neuropathy) might cause some of these problems, however there is more to the neurology of the auditory system than the auditory nerve.

As the nerve fibers enter the brainstem at the base of the skull they split and cross (similar to the optic nerve at the optic chiasm). Then the fibers go to various parts of the cortex of the brain. Most of the fibers go to the temporal lobe. Differences in neurology, anywhere along the line, might result in the symptoms of CAPD. (Durkel, 2001)

CAPD is similar to CVI in that it results from neurological causes instead of damage to the sensory system itself. Children with cortical visual impairments are at a greater risk of having CAPD, because the damage to their neurological systems which caused the visual impairment may also have caused damage to the auditory system.

CAPD is defined as a disorder with problems in one or more of the following six areas:

  • Sound localization and lateralization (knowing where in space a sound is located).
  • Auditory discrimination (usually with reference to speech, but the ability to tell one sound is different from another).
  • Auditory pattern recognition (musical rhythms are one example of an auditory pattern).
  • Temporal aspects of audition (auditory processing relies on making fine discriminations of timing changes in auditory input, especially in differences in the way the input comes through one ear as opposed to the other).
  • Auditory performance decrements with competing signals (listening in noise).
  • Auditory performance decrements with degraded acoustic signals (listening to sounds that are muffled, missing information or for some reason are unclear, e.g. trying to listen to speech from the other side of a wall. The wall filters or blocks out certain parts of speech, but a typical listener can often understand the conversations.).

Both at home and at school Natasha associates specific locations with specific actions. She travels to various locations in the classroom to perform these actions, leaving and returning to a given activity repeatedly. Natasha seems to process information by interacting with a person or object for several minutes then withdrawing to a calming activity for several minutes. She has recently begun to associate her calming activities with familiar people, and is attaching her calming activities to places or objects in the room with less and less frequency.

Natasha shows significant signs of sensory disorganization. It is not easy for her to attach meaning to what she sees, hears, or how her body feels within a movement or activity. This means it requires a lot of effort on her part to combine her skills. Natasha's sensory processing skills vary throughout the day, and from day to day. There are occasions when it appears she is using her vision to actively explore and search within her environment. There are other situations in which she is less actively attending to her vision, but seems more aware of her own body through movement, sound, or oral/tactile involvement. The appropriate educational strategies and methods are modified according to her responses.

Body position is a strong contributor to functional use of vision. Natasha is able to hold her head steady to scan the environment and make visual contact with adults. However, there are long periods of time in which her head position is constantly changing and the ability for her to combine her vision and midline control is limited. Movements that promote controlled head and neck extension are helpful.

Epilepsy Surgery and Corpus Callosotomy

Most seizures can be controlled with medicine. When medications are unable to eliminate seizures, other therapies are considered, including surgery. When a part of the brain can be identified as the source of seizures, surgical removal of that source will often eliminate the seizures all together. Several different types of surgery can be offered. The temporal lobe is the most common part of the brain involved in seizures and these patients undergo lobectomy. Extratemporal lobectomy, hemispherotomy, and corpus callosotomy are also used in patients with seizure sources in different parts of the brain. In patients who are not candidates for brain surgery, the Vagus nerve stimulator can be used to reduce seizure frequency.

The surgical procedure corpus callosotomy is resection of the anterior two thirds of the corpus callosum. In many cases, limiting the resection provides significant seizure reduction and may avoid some of the cognitive complications that may arise from complete corpus callosotomy. Anterior corpus callosotomy is less likely to lead to significant cognitive difficulties, so-called split-brain phenomenon, than larger resections. More extensive corpus callosum resections can disrupt the cross-hemispheric communication of visual information and may lead to more noticeable neuropsychological problems. All divisions likely cause some deficit and acute, transient problems are common, especially in total resections.

Nevertheless, when anterior corpus callosotomy fails to provide significant seizure reduction, some patients may benefit from a secondary procedure to resect the remaining posterior one third of the corpus callosum.

The goal of these procedures is seizure reduction, not cure. Accordingly, reduction in seizures to a certain percentage is used as a measure of success. Overall outcome has been reported as 8% seizure free, 61% improved, and 31% not improved. In children who undergo corpus callosotomy, quality of life measures improved with seizure reduction, even in the absence of seizure-free status. (Beach, 1998)

A Vagus Nerve Stimulator is used with patients who have medically intractable epilepsy, and are not candidates for resective surgery. The stimulator is placed on the left Vagus nerve, in the neck. A battery is placed under the skin in the chest, like a pacemaker. By using the stimulator, a significant reduction in seizure frequency can be achieved. Although complete seizure freedom is unlikely, the effect of the stimulator seems to improve with continued use. Seizure reduction is greater the longer the device is used.

Learning Implications

In order to address Natasha's unique learning style, the educational team has adopted the following educational strategies.

  • Provide opportunities for a variety of vestibular and tactile stimuli. Allow Natasha to swing for at least 20 minutes prior to a structured activity. This type of vestibular input has great impact on increasing her eye contact and focus on objects and people. Vibration and deep touch are also calming to her nervous system.
  • For sensory motor participation and play, Natasha should direct her own movements as much as possible. Sensory motor play is a chance for Natasha to experience comfort within her own body. The caregiver's role should be to establish trust, offer options, and make themselves available for interaction.
  • Use the near senses (tactile, oral, vestibular, proprioceptive) to gain Natasha's attention and motivate her to attend to visual and auditory information.
  • To promote self-initiation, provide opportunities for Natasha to build a sense of anticipation. The layout and organization of the classroom and calendar systems must be predictable. A quiet uncluttered environment with a limited number of people will help her focus. Combining object symbols, voice, and gesture (e.g. pointing, gestural sign) will help to direct Natasha's attention. Adding rhythmic sounds and singing while Natasha is engaged in an activity helps her to focus her attention as well.


Research indicates that the ear and the eyes neurologically function and develop in much the same way. I feel Natasha still has time to establish neuro-pathways that will facilitate her use of both vision and hearing in meaningful ways. Through the use of consistent activities and communication strategies we are already seeing Natasha make more sense of her world and use her vision and hearing in more functional ways. I feel the future is very bright for Natasha.


Beach, S. (1998). Washington University Neurosurgery (retrieved 2001) (

Cogan, D. (1966). "Neurology of the visual system". Springfield, Ill: C.C. Thomas.

Durkel, J. (2001). "Central Auditory Processing Disorder and Auditory Neuropathy." See/Hear, 6 (1).

Jan, J., & Groenveld, M. (1993). Visual behaviors and adaptations associated with cortical and ocular impairment in children. Journal of visual impairment and blindness (JVIB), 87, 101-105.

Jan J., Wong P., Groenwell M., Flodmark O., & Hoyt CS. (1986) Travel vision Collicular visual system? Pediatr. Neurol. 2 (6) 359-62.

Morse, M. (1990). Cortical visual impairment in young children with multiple disabilities. Journal of Visual Impairment & Blindness, 84, 200-203.

Smith and Levack, (1997). Teaching students with visual and multiple impairments. Austin, TX: Texas School for the Blind and Visually Impaired.

Chrissy Cowan, TVI

Texas School for the Blind and Visually Impaired




  • Your VI teacher (TVI) should give you a copy of the Functional Vision Evaluation and Learning Media Assessment with detailed information about how your particular student uses his/her vision

  • Students with low vision should be encouraged to use their eyes to the maximum. Vision is not diminished by use

  • A student with albinism will be sensitive to the light and will sometimes require an adjustment period of about 10 minutes when he or she comes in from being in the sun

  • Allow the student to adjust his/her work to a position that he/she is most comfortable with

  • Do not use large print materials when regular print will suffice

  • Whenever an assignment refers to a picture (as in math workbooks) allow the student to look at the picture in a regular print book. The large print process distorts pictures

Reading the Board


  • Seat student near the board (within 3 to 5 feet) and in a central location, but within a group of students

  • Verbalize as you write on board

  • If possible, provide a copy of what you have written on the board to the student

  • Have another student with good handwriting copy off the board and make a copy of these notes.

  • Allow student to use a telescope supplied by the TVI (if this is done the student will probably need to be seated back away from the board to increase his/her visual field)

  • A clean board makes a better contrast and is easier to read

  • Avoid red/orange/yellow markers when writing on charts/white boards

Overhead Projectors/Video


  • Seat student close to the screen

  • Provide student with your overhead projector sheet or master copy so he or she can read and/or copy from it

  • Use a dark (preferably black) Vis-à-vis pen on the overhead sheet

  • Discuss movies thoroughly afterwards to make sure the student understands major concepts presented

  • A darkened room provides more contrast

  • Move the projector closer to the screen to produce a smaller, more distinct image

  • Make a good photo copy of your master

  • Do not use red ink

  • Record the assignment, provided that the student can function as well with a recording

  • Please be sure that your tests are completely legible. Ask the student to read parts of the test to you privately to be sure he or she can see all parts of the test

  • Give the student a little extra time

  • Avoid handing the student a paper and saying, “Do the best you can”. This only cheats the student out of the continuity of your lesson and can be frustrating



  • Light intensity can be regulated by adjusting distance from the window or light source

  • Artificial lights should be used whenever brightness levels become low in any part of the room.

  • Avoid glares on working surfaces (a piece of dark colored paper taped to the entire desk surface diminishes glare off the desk)



  • Avoid having students work in their own shadow or facing the light

  • Students may need to change their seats whenever they desire more or less light



  • White chalk offers more contrast on a clean chalkboard

  • Dry erase boards used with dark markers offer better contrast

  • Soft lead pencils and felt-tipped pens with black ink are recommended for use on unglazed light and tinted paper

  • Good contrast and white space between lines of print offer the best viewing comfort for lengthy reading assignments

  • Avoid using red/orange/yellow on Smartboards



  • Tests should be dark and clear

  • If there is a time element, please remember that a person with poor sight will frequently be a slower reader than a person with normal sight of the same intelligence. His or her eyes will tire much faster, so tests in the afternoon can be particularly difficult to read

  • On timed drills allow at least double the time for a student with low vision. Ideally they should be untimed

  • If the student is comfortable performing orally, tests could be given orally by another person who fills in the blanks. Please be careful here, as some people are not auditory performers, and it is a misconception that all blind and low vision students can perform better auditorily.

Physical Education/Recess


  • Check with TVI to see if there are any restrictions of activity or on visual fields

  • Ball Sports: practice catching, kicking, and batting with students to check whether or not he/she can see the ball in time to catch, kick, or bat

  • Use audible goals and/or balls (available from TVI) or use a radio as a goal locator (as in basketball)



  • Students with a visual impairment should be expected to participate in art. Consult with the TVI on adaptations for the art curriculum

Mobility and Orientation


  • Allow student to explore your room during the first week and whenever you make any major changes

  • Show student where his or her desk is, where materials are located, papers turned in, etc.

  • Point out the restrooms, water fountains, library, office, cafeteria, gym, and bus stops and ask that braille labels be placed outside each entry for blind students

  • Contact O&M specialist for detailed information