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A baby with a visual impairment and wearing a hearing aid plays with a toy.As a Teacher of the Visually Impaired, you are aware of the importance of hearing for a child with a visual impairment.  The Functional Vision Evaluation and the Learning Media Assessment both consider how the child uses his/her hearing for learning.  Here are some things that you should try to determine through parent and staff interviews and/or the student’s records.  (Adapted from the Checklist for Deafblind Census of Texas)

Does the student have a documented auditory impairment meeting Texas eligibility requirements as cited in the Commissioner’s Rules?

Does the student have a documented unilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?

Does the student have a documented bilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?

Does the student have a documented syndrome, disease or disorder associated with hearing loss?

  • Bacterial meningitis
  • Cytomegalovirus (CMV)
  • Usher Syndrome
  • Down Syndrome
  • Microcephaly
  • Rubella

 Does the student have a documented syndrome/disorder associated with a progressive hearing loss?

  • Cytomegalovirus (CMV)
  • Norrie Syndrome
  • Goldenhar Syndrome
  • Hurler Syndrome

Does the student have a diagnosis of a central auditory processing disorder (CAPD) by a speech language pathologist or an audiologist? 

May also be called central auditory processing problem, central auditory processing dysfunction, auditory neuropathy. 


Does the family or staff report the child having difficulty understanding what he is hearing?

Is the student at risk for hearing loss? 

Factors to alert to include:

  • Documented chronic/persistent otitis media
  • Caregivers/professionals who know the child suspect impaired hearing based on:
    • significant and otherwise unanticipated delay in receptive and/or expressive speech-language skills or
    • Responses to full range of auditory stimuli in the environment is less than anticipated
    • Ototoxic medications such as those given for cancer, serious infections, etc.
    • Prematurity
    • Balance problems
    • Family history of hearing loss

Other risk factors include:

  • Drug or alcohol consumption during pregnancy
  • APGAR scores lower than 4 at one minute and below 6 at five minutes (APGAR scores measure newborn vital signs at birth)
  • Low birth weight (below 3.5 pounds)
  • Neonatal jaundice at birth requiring transfusion
  • Craniofacial anomalies 
  • Visible malformations of the head, neck or ears including middle and/or inner ear structures
  • Family history of permanent or progressive hearing loss in childhood
  • Childhood injuries (especially skull fracture, sharp blow to the head or ears, loud noise exposure, and items accidentally inserted into ears resulting in damage)

 Average Speech and Hearing Behavior by Age Level

Speech and language development are impacted greatly by hearing impairment.  Even mild to moderate impairment can have dramatic consequences, especially if the child also has some type of vision loss.  Below are typical milestones for a child with normal hearing according to the Alexander Graham Bell Association for the Deaf and Hearing Impaired.  Be sure to visit their website at for more detailed information.   

Birth-3 Months

  • Startled by loud sounds
  • Soothed by caretakers’ voices

3-6 Months

  • Reacts to the sound of your voice
  • Turns eyes and head in the direction of the source of sounds
  • Enjoys rattles and noisy toys

7-10 Months

  • Responds to his/her own name
  • Understands “mama,” “dada,” “no,” “bye bye” and other common words
  • Turns head toward familiar sounds, even when he/she cannot see what is happening: e.g., dog barking or paper rustling, familiar footsteps, telephone, person’s voice

11-15 Months

  • Imitates and matches sounds with own speech production (though frequently unintelligible), especially in response to human voices or loud noises
  • Locates or points to familiar objects when asked
  • Understands words by making appropriate responses or behavior: “Where’s the dog?” “Find the truck.”

15-18 Months

  • Identifies things in response to questions, such as parts of the body
  • Uses a few single words; while not complete or perfectly pronounced, the words should be clearly meaningful
  • Follows simple spoken directions

2 Years

  • Understands yes/no questions
  • Uses everyday words heard at home or at daycare/school
  • Enjoys being read to and shown pictures in books; points out pictures upon request
  •  Interested in radio/television as shown by word or action
  • Puts words together to make simple sentences, although they are not complete or grammatically correct: “Juice all gone” “Go bye-bye car”
  • Follows simple commands without visual clues from the speaker: “Bring me that ball.” “Get your book and give it to Daddy.”

2 ½ Years

  • Says or sings short rhymes and songs; enjoys music
  • Vocabulary approximately 270 words
  • Investigates noises or tells others when interesting sounds are heard:  Car door slamming, Telephone ringing

3 Years

  • Understands and uses simple verbs, pronouns and adjectives: Go, come, run, sing, me, you, him, her, big, green, sweet
  • Locates the source of a sound automatically
  • Often uses complete sentences
  • Vocabulary approximately 1000 words

4 Years

  • Gives connected account of some recent experiences
  • Can carry out a sequence of two simple directions: “Find your shoe and bring it here.” “Get the ball and throw it to the dog.”

5 Years

  • Speech should be intelligible, although some sounds may still be mispronounced—such as the /s/ sound, particularly in blends with other consonants (e.g., “street”, “sleep”, “ask”).
  • Neighbors and people outside the family can understand most of what your child says and her grammatical patterns should match theirs most of the time.
  • Child carries on conversations, although vocabulary may be limited
  • Pronouns should be used correctly: “I” instead of “me” “He” instead of “him”

By Gigi Newton, INSITE Specialist and Kate Moss, Family Specialist, TSBVI, Texas Deafblind Outreach

Originally published in Summer 2001 edition of See/Hear Newsletter

Importance of vision and hearing to development and learning

Although every one of our senses plays a role in early development, vision and hearing certainly seem to lead the way. Much of early parent/child bonding has to do with the child's ability to make eye contact and sustain a gaze with his parents, respond to their voices by gurgling and cooing, and to be comforted by the sight and sound of them. Much of the reason an infant tries to move is because he sees or hears something that intrigues him. He learns that things and people exist in the world primarily because he sees and hears them come and go. He visually tracks an object he pitches to the ground or hears it hit the floor. That tells him the object still exists, even though it is not in his hands any longer. When she cries she can hear Daddy calling to her or see Momma walk into the room. She can inspire her parents to linger and play with her by cooing and making eye contact, the earliest form of conversation. He learns about size, shape, color, functions of objects, social interactions, and so much more just by listening and looking at the world at work. Early development has critical links to a child having full use of his/her vision and hearing. When these senses don't work perfectly or not very well, everything is impacted.

It's hard to tell a parent there may be vision and hearing issues

Professionals working with infants and families may have a hard time suggesting that there is a problem with a child's vision or hearing. This is especially true when the family is already dealing with their child's other medical or disability issues. After all, a family can only deal with so much at one time. Because infants are much harder to test for vision and hearing loss, many mild impairments (or sometimes even major impairments) may not be diagnosed quickly. Subjecting the family to another round of testing is always a hard call.

Learning about hearing and vision loss immediately is critical

As we said earlier, much of the sensory information that is vital to children's development comes through the senses of vision and hearing. During the first three years of a child's life major neural networks are being formed in the brain. Much of this development comes from distance senses, i.e., vision and hearing, which allows us to know about things and people in the world even when we are not in physical contact with them. After the first three years, development of these neural networks becomes slower. Skills that may be gained in early intervention cannot be made as quickly when the child is older.

For these and other reasons, children should be regularly checked for vision and hearing problems. We know that even mild problems with these senses can have major impact on learning. A mild hearing loss in a noisy home or daycare center can result in a child who misses critical bits of information. He may miss sounds that let him develop normal language and speech patterns. He may miss instructions his parents or babysitter gave him and appear to be misbehaving. He may become withdrawn because he is not sure what is expected of him. If he has a visual field loss he may constantly be stumbling over things. This has great impact on self-concept. A child who is sensitive to light may not enjoy or feel secure playing out of doors.

Every child, with or without a disability, should have regular and periodic vision and hearing checks. If the child is severely disabled, this can be even more important since their other senses may not be as useful in compensating for what they miss visually and auditorially. In fact, this is so important that schools complete vision and hearing screenings at regular intervals throughout the remainder of the child's educational career. These types of screenings are even more critical from birth to age three.

Parents should trust their intuition

Parents know more about their child than anyone else does. Often we meet parents who tell us that they knew something was wrong with their child's vision and hearing before any of the doctors mentioned it. In fact, many have been told that they shouldn't go looking for trouble or that their child would "grow out of it."

Parents should trust themselves when they feel there is something wrong with the way their baby uses his vision or hearing. They should feel comfortable insisting that vision and hearing are tested, especially if their child is at high risk for vision and hearing loss.

Red flags

There are many red flags associated with vision and hearing loss. Below are the syndromes, diseases and conditions, listed on the Texas Deafblind Census, that put a child at high risk for deafblindness. Children with these etiologies should be watched closely for vision and hearing problems.

Syndromes, Diseases and Conditions


  • Congenital Rubella
  • Congenital Syphilis
  • Congenital Toxoplasmosis
  • Cytomegalovirus
  • Fetal Alcohol Syndrome
  • Hydrocephaly
  • Maternal Drug Use
  • Microcephaly
  • Neonatal Herpes Simplex


  • Asphyxia
  • Direct Trauma to the Eye and/or Ear
  • Encephalitis
  • Infections
  • Meningitis
  • Severe Head Injury
  • Stroke
  • Tumors
  • Chemically Induced

Related to Prematurity

  • Complications of Prematurity


  • Aicardi
  • Alport
  • Alstrom
  • Apert
  • Bardet-Biedl
  • Batten Disease
  • Chromosome 18, Ring 18
  • Cockayne
  • Cogan
  • Cornelia de Lange
  • Cri du Chat
  • Crigler-Najjar
  • Crouzon
  • Dandy Walker
  • Down
  • Goldenhar
  • Hand-Schuller-Christian
  • Hallgren
  • Herpes-Zoster (or Hunt)
  • Hunter (MPS II)
  • Hurler (MPS I-H)
  • Kearns-Sayre
  • Klippel-Feil Sequence
  • Klippel-Trenaunay-Weber
  • Kniest Dysplasia
  • Leber's Congenital Amaurosis
  • Leigh Disease
  • Marfan
  • Marshall
  • Maroteaux-Lamy
  • Moebius
  • Monosomy 10p
  • Morquio
  • Norrie
  • NF-Neurofibromatosis (von Recklinghausen Disease)
  • NF2-Bilateral Acoustic
  • Neurofibromatosis
  • Optico-Cochleo-Dentate
  • Degeneration
  • Pfieffer
  • Prader-Willi
  • Pierre-Robin
  • Refsum
  • Scheie (MPS I-S)
  • Smith-Lemli-Opitz
  • Stickler
  • Sturge-Weber
  • Treacher Collins
  • Trisomy 13 (Trisomy 13-15, Patau)
  • Trisomy 18 (Edwards)
  • Turner
  • Usher I
  • Usher II
  • Usher III
  • Vogt-Koyanagi-Harada
  • Waardenburg
  • Wildervanck
  • Wolf-Hirschhorn (Trisomy 4p)

Sometimes the child's etiology is unknown or the child may have only one diagnosed sensory loss. Professionals working with infants and young babies, as well as parents, should be aware of the red flags that may indicate a problem with either vision or hearing.

Hearing Loss

At Risk Factors

  • Malformation of the ear, nose, and throat
  • Rubella during pregnancy
  • Rh incompatibility
  • Family history of hearing loss
  • Apgar score from 0-3
  • Severe neonatal infections
  • Meningitis
  • Low birth weight (under 3.3 lbs.)
  • Hyperbilirubinemia
  • Ototoxic medications
  • Severe respiratory distress and/or prolonged mechanical ventilation (10 days or more)
  • Neurodegenerative disorders
  • Childhood infectious diseases such as mumps and measles

(Hearing, Speech and Deafness Center website,, June 2001)

Behavioral Indicators

  • The child does not stop moving, does not quiet in response to speech, and/or does not arouse from light sleep to sudden loud noises.
  • At about 4-7 months, the child does not turn to sounds and voices or give an indication of detecting a sound source by eyes widening or blinking, fussing or quieting, increasing or decreasing overall activity level, changes in breathing or sucking patterns.
  • There is a lack of babbling, cooing, grunting, or the child stops these behaviors and does not progress to speech.
  • The child does not respond to familiar sounds (such as mom's and dad's voices) by cooing/gurgling when he cannot see them.
  • The child does not use speech at an age when most children are beginning to use speech (approximately 9-12 months).

(SKI-HI Institute, 1998)

Vision Loss

At Risk Factors

  • Family history of vision loss (Retinoblastoma or Albinism)
  • Malformation of the ear, nose, and throat
  • Prematurity and low birth weight less than 3 lbs.
  • Birth trauma/head trauma
  • Anoxia
  • Cerebral Palsy
  • Congenital viral or bacterial infections (Rubella, CMV, Syphilis, Group B Streptococcus Infection, Toxoplasmosis, Chicken Pox, HIV)
  • Meningitis, Encephalitis, Hyperthyroidism, Microcephaly

Behavioral Indicators

  • The child does not have eyes or eyelids that look typical.
  • The child does not recognize caregivers' faces or smile in response to their smiles around the age of 3 months.
  • He does not get excited when he sees his bottle or other familiar objects he likes.
  • At 4-6 months, the child's eyes do not seem to move together when following an object or person.
  • The child may turn or tilt his head in unusual positions when looking at an object.
  • The child may hold an object very close to his eyes.
  • The child may over-reach or under-reach for objects (accurate reaching usually occurs around 6 months).

What do you do?

If there is a concern about vision or hearing, your ECI program should make a referral to the appropriate medical professional. We would like to encourage ECI personnel to work closely with their Teacher of the Visually Impaired, Teacher of the Deaf and Hearing Impaired, and/or TCB Children's Caseworkers in helping the families prepare for the doctor visits. These professionals have much to offer to the process. They can usually share the names of doctors, audiologists, and vision specialists who have more experience working with disabled children. Often they can guide the ECI professional and parents in compiling a list of concerns related to the way the child uses his vision and hearing. More importantly, they can provide parents with information about the types of testing that may be done and how to help prepare the child for testing. This level of support can be provided before an actual vision or hearing referral has been made.

Parents and professionals must keep a close watch on a child's progress related to vision and hearing. Hearing and vision issues must not be ignored, especially if the child has other disabilities. When a problem is suspected, no time should be lost in following up on the concern. We owe it to our children not to lose that critical window of time between birth and age three. When early intervention can make such major differences in life-long functioning, they can't afford to wait.

References and Resources

  • Hearing, Speech and Deafness Center website,, June 2001. Early identification of hearing loss. From Communication Update, published on HSDC Website, copyright 1996-99.
  • Moss, Kate. Syndromes which often result in combined vision and hearing loss. Texas School for the Blind and Visually Impaired website,, 2001.
  • SKI-HI Institute, 1998. Auditory development. Understanding Deafblindness: Issues, Perspectives, and Strategies. SKI-HI, Utah State University, Logan, Utah, p. 21.
  • Texas School for the Blind and Visually Impaired website,, June 2001. Primary identified etiology - deafblind.

Elaine Kitchel, M.Ed.

American Printing House for the Blind

Why should we care about blue light?

For years now, professionals in the fields of light energy and vision have known about the hazards ultraviolet (UV) light presents to ocular health. We are gradually having longer and more intense exposures to blue light; much of the world of commercial display and industry is lit with cool white fluorescent tubes which emit a strong spike of light in the blue range. Indeed many homes and offices are lit with cool white fluorescent tubes. No one doubts more people are spending time in front of video display terminals (VDTs) which produce blue light. While some people find blue light irritates their eyes or causes headache, most are able to ignore it. Scientists only now are beginning to investigate its long‑term effects and offer some solutions for maintaining ocular health in the presence of blue light.

What is blue light?

Experts differ as to the exact wavelength of UV light waves, but generally speaking, UV light is defined as that part of the invisible spectrum which ranges from 380nm to 200nm. (Nm stands for nanometer which is one billionth of a meter.) This part of the spectrum is divided into UV‑A, (380nm to 315nm), UV‑B, (314nm to 280nm,) and UV‑C (279 to 200nm.)

UV‑C, the shortest wavelength for purposes of this report,  is virtually absent from ordinary lamps, blacklight and sunlight within the earth's atmosphere. It is largely germicidal in nature and is used by dentists and in industry for sterilization purposes. One of the primary benefits of the ozone layer is that it filters out virtually all of UV‑C. However, UV‑B and UV‑A do manage to enter our atmosphere where UV‑B and to some degree UV‑A, have been implicated in the formation of skin cancers and cataracts and in the degeneration of retinal tissue. (Van der Leun and Gruijl, 1993). UV‑A is particularly plentiful in the light emitted from black light bulbs, so popular in "sensory stimulation" activities. However, until recently, little was said about near UV, or "blue light" and its effects upon the eye. Blue light is that light with wavelengths in the 500nm to 381nm range. Both blue light and UV‑A are sometimes referred to as "near UV," but for purposes of this report, "near UV" refers to blue light.

What about "black light?"

Of special concern is the blue light given off by "black light" tubes and bulbs. These are glass tubes/bulbs coated with special phosphors on the inside surface. When the gas in the tube is excited by an electrical current, it glows; when the light passes through the coated glass, only the wavelengths in the UV‑A and blue light range are emitted. When viewed under black light, many objects fluoresce. This fluorescence is deemed desirable by party‑goers, artists and even educators.

In 1980 the team of Poland and Doebler used black light to test eye‑contact training with children who had cerebral palsy. They found  their subjects performed better under black light than under ordinary room light. In 1983 these findings were again supported by Potenski in a similar experiment with multiply handicapped, deaf‑blind children. The conclusion was that severely brain‑damaged children seemed better able to use their vision when only the task was highlighted and the rest of the environment lay in darkness. Neither study remarked about any safeguards employed to protect the practitioner or the students from the effects of UV‑A or blue light emitted by the black‑light tube. Further, neither study employed a control group which performed the same tasks in a dark room under an ordinary spot lamp, for comparison.

Review of Literature

Retinal Damage

In an early study conducted by Ham, Ruffolo, Mueller and Guerry, (1980) rhesus monkeys were exposed to high‑intensity blue light at 441nm for a duration of 1000 seconds. Two days later lesions were formed in the retinal pigmented epithelium (RPE.) These lesions consisted of an "inflammatory reaction accompanied with clumping of melanosomes and some macrophage invasion with engulfment of melanosomes which produce hypopigmentation of the RPE" (Ham et al., 1980, p.1110). Since melanin, a common pigment component present in the RPE, strongly absorbs blue light, there is reason to be concerned that the retina is subject to actinic injury from blue light. However, the lens strongly absorbs blue light as well but runs a high risk of possible opacification.

Human studies have not been conducted due to the obvious ethical problems involved in deliberately subjecting humans to potentially hazardous conditions. However, Taylor et al., found an association between cataract formation and exposure to UV-B when he studied 838 watermen who worked on Chesapeake Bay. He was not, however looking for a link between near UV and retinal or lens cell anomaly. The closest studies available are ones which use animals. Among researchers and scientists who have studied blue light, many are of the opinion that blue light might be a hazard and precautions would be wise. Some researchers are more certain: Ham et al., after conducting studies on animals, suggested "long term, chronic exposure to short wavelength light is a strong contributing factor to senile macular degeneration" (p. 1110).

In 1992, Chen, a researcher at St. Erik's Eye Hospital in Sweden, sought to explore the basis to explain why blue light reactions cause retinal degeneration. Drawing on the research of E. L. Paulter, Morika and Beenley (1989), who found that a chemical chemical called cytochrome oxidase is a key enzyme in the respiration of the retina in higher mammals, Chen decided to investigate this phenomenon in rats. Cytochrome oxidase is found in the RPE and in the inner segment of the photoreceptors. Paulter's in vitro studies of bovine REP tissue showed that blue‑light exposure destroyed cytochrome oxidase and inhibited cellular respiration. This inhibition was followed by retinal degeneration. Chen then performed a similar experiment upon rats in which he exposed them to 15 minutes of 404nm blue light which was not strong enough to cause thermal damage. He then killed some rats immediately, and one for each of the next three days. Upon examining their retinas, he found the blue light exposure had indeed inhibited the production of cytochrome oxidase. This was evident in his observation of the photoreceptor cells which had been destroyed. He concluded inhibition of cytochrome oxidase by blue‑light exposure and the consequent  suppression of the cellular metabolism is a potential cause of retinal degenation (1993, p. 422).

One might argue that results in laboratory rats are not necessarily indicative of human results. For this reason, primate research often follows other mammalian research. In 1980 the group of Sperling, Johnson and Harwerth irradiated the retinas of baboons and rhesus monkeys with blue light. The eye tissues of these primates are very similar to those of humans. In addition to color blindness in the blue‑to‑green range, Sperling et al. found extensive damage in the RPE resulting from absorption of energy  by the melanin granules. It should be pointed out that the damage seen . . . including macrophagic activity, disrupted cells and plaque formation, is characteristic of that seen by Ham et al. (1978), and others in what he calls the photochemical lesion.

In light of findings like these, ophthalmologists are beginning to filter the blue light emitted from their ophthalmoscopes through a yellow lens. A study by Bradnam, Montgomery, Moseley and Dutton concluded: "This study has shown that the use of a yellow lens is very effective at reducing the blue‑light hazard and extends the safe operating period by a factor of approximately 20x. . . In the interests of patient safety, it is recommended that yellow lenses are considered for use for routine indirect ophthalmoscopy" (1994, p. 799).

Lens Damage      

After some yellowing, by the age of 20, the lens becomes a natural, though imperfect, absorber of wavelengths between 400 and 320nm. It helps protect the retina from damage by near UV radiation. The lens also provides partial but imperfect protection to  the retina from blue light. In early studies it was thought that UV‑B was the only wavelength band responsible for cataracts. However

Most authorities now believe that the near UV radiation absorbed  throughout life by the lens is a contributing factor to aging and senile cataract. Thus, by protecting the retina from near UV radiation, the lens may become cataractous. My own personal opinion is that both the retina and the lens should be protected throughout life from both blue light and near UV radiation. This would delay the onset of senescence in both lens and retina (senile cataract and senile macular degeneration.) (Ham, 1983, p. 101).

Youths under the age of 20, and especially very young children, have little or no yellowing of the lens. Therefore any UV or blue light which enters the eye is unfiltered and strikes the retina at full‑strength exposing not only the retina, but the lens to damage.

Nancy Quinn, a registered nurse and an expert on blue light emissions from VDTs wrote:
Blue light wavelengths and part of the blue spectrum are focused in front of the retina, while green and yellow are focused on the retina, and some red spectrum is focused behind. Thus blue light contributes little to visual acuity and visual perception loses sharpness as the blue light component adds significantly to the eye's energy expenditure for focusing, and if reduced can greatly reduce eyestrain without loss of acuity.

There is mounting medical evidence that prolonged exposure to blue light  may permanently damage the eyes, contribute to the formation of cataracts and to the destruction of cells in the center of the retina (n.d.).

What can be done?

Ham et al. (1980) and Gorgels and van Norren (1995) pointed out that actinic, or photochemical damage to retinal tissue, is more a function of wavelength than either intensity or duration. Gorgels and van Norren, after examining rat retinas damaged by blue light, wrote "duration had no influence on damage threshold dose, nor on morphology. We conclude that wavelength (and neither irradiance nor duration) is the factor responsible for the encountered morphological differences"(p.859).

These studies suggest neither the human cornea nor lens provides sufficient protection from blue light for our modern environment. Our ancestors did not have to deal with many hours under cool white fluorescent light, nor did they spend any time looking at video display terminals at close range. Our eyes' natural filters do not provide sufficient protection from the sunlight, let alone blue light emitted by these devices nor from the blue light emitted from black‑light tubes.

As a feature of their molecular structure, many plastics have the ability to filter out UV‑A and UV‑B light. Clear polycarbonate spectacles are now available which are labeled "filters 100% UV." Clear plastic, however, will not filter out blue light. In order to accomplish this, the filter must be tinted. Yellow is the preferred color because it allows  the best contrast for the most people while still offering UV and blue light protection. Bradnam, (1994) showed the yellow lens to be very effective in protecting the retinas of their patients who were being exposed to blue light during ophthalmoscopy. In the case of black light activities, yellow is the only color which gives adequate blue light and UV protection, under which fluorescent materials will still appear to fluoresce. Both Solar Shield and NoIR produce a yellow lens which filters out 100% UV and 100% blue light. Filters should always be between the light source and the eyes. For this reason, visors or spectacles work best. Acetate sheets, which are often used, offer little or no protection from blue light.

The blue light factor should be of maximum importance to persons working with young children and with individuals who may have albinism, aphakia, achromatopsia, coloboma, sub-luxated lenses and other conditions in which the light reaching the retina is unfiltered, or causes extreme light sensitivity. Professionals in the field of vision would profit by, at the very least, employing proper filtering precautions and limits of exposure to both subject and practitioner, when using black light and other sources of blue light during sensory stimulation, and visual training activities.

Practical Suggestions

  1. Student and practitioner should always wear yellow-tinted lenses or visors which offer 95-100% UV and blue light protection during the use of black light.
  2. Black light usage should be very limited. Recent studies suggest that the old guidelines of 2-3 times per week per child with sessions less than 15 minutes each (Moore, 1986) may be too much. Efforts should be made to wean the student from black light into dim light and then into daylight vision development activities.
  3. UV screen filters which fit over the display terminal, or UV filtering spectacles should be worn during the use of a video display terminal (computer screen.)
  4. If possible, limit the use of cool white fluorescent tubes or mercury lights in the environment. Substitute warm white tubes or incandescent lamps if possible.
  5. Students or practitioners with albinism, aphakia, coloboma, sub-luxated lenses or achromatopsia should wear UV/blue filtering lenses or visors outdoors and also indoors if under cool white fluorescent or mercury lights.
  6. lways make sure the source of blue light is below waist level, or behind the student. Blue light sources should not be near eye level.

These few simple precautions may help to preserve the ocular health and comfort of students, rehabilitation clients, and the professionals and paraprofessionals who serve them.

This research synthesis has been published in the Journal of Visual Impairment and Blindness, June (2000). NY: AFB Press

References and Resources

Bergmanson, J. P. (1993).  Ultraviolet radiation damage to the corneal endothelium?  Ophthalmology, 100(4), 442-443.

Bradnam, M.S., Montgomery, D. M., Moseley, H., & Dutton, G. N. (1995).  Quantitative assessment of the blue-light hazard during indirect ophthalmoscopy and the increase in the Asafe@ operating period achieved using a yellow lens.  Opthamology, 102(5), 799-804.

Chen, E.  (1993).  Inhibition of cytochrome oxidase and blue-light damage in rat retina.  Graefe's Archive for Clinical and Experimental Ophthalmology, 231(7), 416-423.

Chou, B. R. (n.d.). Ocular health and the atmospheric environment.  Ontario, Canada: University of Waterloo, School of Optometry.

Creech, L. L., & Mayer, J. A. (1997).  Ultraviolet radiation exposure in children: a review of measurement strategies.  Ann­­als of Behavioral Medicine, 19(4), 399-407.

Fedorovich, I. B., Zak, P. P., & Ostrovskii, M. A. (1994).  Enhanced transmission of UV light by human eye lens in early childhood and age-related yellowing of the lens.  Doklady Biological Sciences, 336(1), 204-206.

Gorgels, T. G., & van Norren, D.  (1995).  Ultraviolet and green light cause different types of damage in rat retina.  Investigative Ophthalmology & Visual Science, 36(5), 851-863.

Ham, W. T., Jr. (1983).  Ocular hazards of light sources: review of current knowledge.  Journal of Occupational Medicine, 25(2), 101-103.

Ham, W. T., Jr., Ruffolo, J. J., Jr., Mueller, H. A., & Guerry, D., III.  (1980).  The nature of retinal radiation damage: dependence on wavelength, power level and exposure time; the quantitative dimensions of intense light damage as obtained from animal studies, Section II.  Applied Research, 20, 1005-1111.

Hao, W., & Fong, H. K. (1996).  Blue and ultraviolet light-absorbing opsin from the retinal pigment epithelium.  Biochemistry, 35, 6251-6256.

Hightower, K. R. (1995).  The role of the lens epithelium in development of UV cataract.  Current Eye Research, 14, 71-78.

Organisciak, D. T., Darrow, R. M., Barsalou, L., Darrow, R. A., Kutty, R. K., Kutty, G., & Wiggert, B. (1998).  Light history and age-related changes in retinal light damage.  Investigative Ophthalmology & Visual Science, 39(7), 1107-1116.

Pautler, E. L., Morita, M., & Beezley, D. (1989).  Reversible and irreversible blue light damage to the isolated, mammalian pigment epithelium. Proceedings of the International Symposium on Retinal Degeneration (pp. 555-567).  New York: Liss.

Poland, D. J., & Doebler, L. K. (1980).  Effects of a blacklight visual field on eye-contact training of spastic cerebral palsied children.  Perceptual and Motor Skills, 51, 335-338.

Potenski, D. H. (1983).  Use of black light in training retarded, multiply handicapped, deaf-blind children.  Journal of Visual Impairment & Blindness, 77(7). 347-348.

Quinn, N. (n.d.).  Resume and research into the effects of video display terminals use and office environmental lighting.  Miami, FL: Brain Power International LTD.

Rapp, L. M. & Smith, S. C. (1992).  Morphologic comparisons between rhodopsin-mediated and short-wavelength classes of retinal light damage.  Investigative Ophthalmology & Visual Science, 33, 3367-3377.

Sperling, H. G. (n.d.).  Position paper for workshop on long-term visual health risks of optical radiation.  Houston: University of Texas, Health Science Center.

Sperling, H. G., Johnson, C., & Harwerth, R. S.  (1980). Differential spectral photic damage to primate cones.  Vision Research, 20, 1117-1125.

Taylor, H. R., West, S. K., Rosenthal, F. S., Munoz, B., Newland, H. S., Abbey, H., & Emmett, E. A. (1998).  Effect of ultraviolet radiation on cataract formation.  The New England Journal of Medicine, 319(22), 1429-1433.

Tezel, T. H., & Kaplan, H. J. (1998).  Harvest and storage of adult human photoreceptor cells: the vibratome compared to the excimer laser.  Current Eye Research, 17, 748-756.

Yegorova, E. V., Babizhayev, M. A., Ivanina, T. A., Zuyeva, M. V., & Ioshin, I. E.  (1988). Spectral characteristics of intraocluar lenses and damage to the retina by visible light.  Biophysics, 33(6), 1108-1114.

(de Primavera 2006 Ver/Oír)

English version of this article (Versión Inglesa)

Por Mary Sue Welch, Miembro del Directorio de la TSBVI, Dallas, TX

Resumen: Un Miembro del Directorio de la TSBVI comparte sus recuerdos de esta escuela y reflexiona sobre la forma en que ellos han tenido influencia en la persona que ella es hoy día.

Palabras Clave: familia, ciegos, discapacidades visuales, experiencia personal, Historia de la TSBVI.

Nota del Editor: El siguiente es un extracto de la contribución de Mary Sue a la página dedicada a los Recuerdos del Sesquicentenario en el sitio web de la TSBVI. Lo invitamos a leer por completo su fascinante artículo en ¿Tiene alguna anécdota divertida sobre la escuela? ¿Se encariñó con alguno de los profesores que tuvo aquí? Por favor, contribuya con su propia historia o con una historia sobre sus amigos o familiares que pudieran haber asistido a esta escuela.

Mi vida no siempre ha sido un cuento de hadas como es hoy. Actualmente, vivo en el piso número 23 de un edificio muy alto en el centro de Dallas con una maravillosa vista de la ciudad. Mi esposo (que también es ciego) tiene un buen trabajo y compró un automóvil Mercury Monterrey nuevo, de color negro, que es conducido por un maravilloso joven. Este joven me lleva de compras y facilita nuestras vidas de muchas maneras. No, no siempre he tenido una vida así.

Fui la hija ciega de una familia blanca, vidente, de clase media de Huntsville. Sí, mi madre, mi padre, mi hermano Walter Charles, mi medio hermano Tommy y mi media hermana Marie eran todos videntes. Tenían otros problemas, pero ninguno era ciego. Mi madre dice que mi nacimiento fue tormentoso y que ella experimentó grandes dolores físicos. Muy a mi pesar, ella nunca me describió como un bebé hermoso. En realidad, me dijeron que tenía una tez azulada y que nunca tuve los ojos abiertos cuando me llevaban a mi madre en el hospital.

Mi madre simplemente pensó que estaba dormida todo el tiempo, pero mi padre se preocupó. El día que llegué a casa, mi padre me llevó al dormitorio y me alumbró en los ojos con una linterna. Mi ojo derecho respondió, pero el izquierdo no hizo absolutamente nada. Después de compartir sus preocupaciones con mi madre, ellos se separaron. Cuando tenía seis semanas de edad, comenzamos las visitas a los oftalmólogos que duraron hasta que tenía tres años, cuando un médico de Austin le dijo a mis padres que no se podía hacer nada respecto a mi visión. Les recomendó que planificaran enviarme a la Escuela para los Ciegos de Texas y que me preparara para mi vida como una persona ciega. Realmente, creo que las cosas fueron más fáciles para mis padres en ese momento porque sabían qué esperar.

Me fui de casa para asistir a la Escuela para los Ciegos de Texas el 26 de septiembre de 1954, el día después de cumplir seis años. Temprano ese domingo en la mañana, mi abuela materna tuvo un derrame cerebral. Mi madre estaba desolada, pensando que perdía a su madre y a su niña. A pesar de eso, mis padres me pusieron a mí y a mi equipaje en el automóvil y me llevaron a Austin. Fue un acto muy generoso que les agradezco hasta hoy.

Les dijeron que no podrían visitarme ni llamarme durante tres semanas. Les explicaron que yo necesitaría ese tiempo para aclimatarme a mi nuevo entorno. Me dejaron jugando en los balancines con mi primer amigo en la escuela. Todo estuvo bien hasta la noche, pero entonces comencé a extrañar mi casa. Los padres de turno en la residencia no eran muy cariñosos, así que lloré hasta que pude quedarme dormida sin recibir consuelo de nadie. No se permitía que los niños salieran de la cama, pero ellos habrían ido a consolarme si hubieran podido. Los padres de la residencia pensaron que sería mejor que aprendiera por medio del sufrimiento y así lo hice.

A la mañana siguiente, realmente comencé mi entrenamiento para adquirir independencia ya que aprendí a hacer mi cama. Me imagino que fue un desastre, pero ahora puedo hacerla bastante bien.

Mi profesora de primer grado tenía una voz muy hermosa. Ella era tranquila y amable y la quise mucho. Comenzó a trabajar conmigo en Braille de inmediato. Me encantó y aprendí rápido. Todavía me gusta el Braille y estoy tomando un curso para ser transcriptora de Braille certificada ahora que ya soy vieja.

Recuerdo mi primera visita a la biblioteca de la escuela como un hecho que marcó mi vida. Estaba fascinada con tantos libros en un solo lugar. Con el transcurso de los años, pasé gran parte de mi tiempo estudiando y leyendo en la biblioteca. Los libros han seguido siendo una verdadera fuente de placer para mí durante toda mi vida. Agradezco a nuestra maravillosa bibliotecaria por incentivar mi amor por la lectura y mi deseo por saber más sobre los demás. Probablemente ella estaría un poco desilusionada si supiera que los libros que más me gustan son las novelas de misterio y las con tramas legales. Creo que ella habría querido que me gustaran los clásicos.

Aunque nunca fui buena en música, tomé lecciones de piano durante 7 años. Mi profesora de piano siempre me incentivó. Me decía que aunque nunca pudiera tocar bien, aprendería mucho sobre la confianza en mí misma y la serenidad gracias a mi entrenamiento musical. Pienso que fue a partir de esos días que desarrollé el gusto por hablar en público. Mi música también logró mi aceptación como una adolescente en mi grupo de Rainbow Girls. Yo era músico y eso era mucho para las niñas que no podían tocar ningún instrumento. A propósito, ingresé a las Rainbows con la ayuda de mi profesora de cocina en la escuela. Le mencioné que estaba interesada y ella me presentó a sus amigas que me auspiciaron.

Me gradué de la Escuela para los Ciegos de Texas en 1966. Asistí a la escuela durante unos años muy interesantes. Más que las grandes aceras que dividen el campus en la mitad, separando el lado de las niñas del de los niños. Incluso dentro del edificio principal, había escaleras y fuentes de agua separadas para los niños y las niñas. Y por supuesto, nos sentábamos en lados separados en el auditorio. Hasta que tuve 16 años, tenía miedo de beber de la fuente de agua de los niños por temor a quedar embarazada. Debíamos tener mucho cuidado de tomarnos las manos en el pasillo porque si el director nos veía hacer eso, la pareja daría mucho que hablar. Teníamos una calificación en conducta y una vez tuve una C simplemente porque bebí de la fuente de agua equivocada. ¿O fue porque me sorprendieron besándome en la fuente? Fue una de las dos. De todas maneras, tuve problemas en casa y en la escuela.

Cuando pienso en mis días en la Escuela para los Ciegos de Texas, recuerdo todo tipo de sonidos y aromas. Aún percibo algunos de ellos cuando visito la escuela. El edificio principal aún huele a libros – no sólo a libros – a libros en Braille. El timbre no es exactamente el mismo que cuando yo era estudiante, pero me encanta oírlo sonar. Aunque sé que puedo usar cualquiera de las escaleras, sigo usando la “escalera de las niñas”. ¡Sólo esa es la correcta!

Recuerdo especialmente las mañanas de invierno. Usábamos radiadores de vapor para calefaccionar nuestros dormitorios. Muy temprano en la mañana me despertaba el sonido de esos radiadores mientras se calentaban. Sonaban con un ruido estrepitoso y luego silbaban y me encantaba oír todo ese ruido. Me sentía segura. Me aferraba a uno de mis libros en Braille y leía hasta que sonaba el timbre para despertarnos.

La primavera era casi tan buena. Teníamos reuniones los lunes, miércoles y viernes en el auditorio de la escuela. Los miércoles eran nuestros favoritos. Casi siempre teníamos recitales de estudiantes ese día. Las ventanas del auditorio estaban abiertas. Los pájaros cantaban y nuestros amigos hacían sus presentaciones. Eran momentos maravillosos para todos nosotros.

Como una pequeña niña en la escuela, me encantaban los días de lluvia. A veces los padres de la residencia nos preparaban dulces de chocolate o palomitas de maíz. Escuchábamos historias en la radio o simplemente jugábamos adentro. Teníamos pequeñas sillas en el dormitorio justo de nuestro tamaño. Aún podía ver un poco entonces y recuerdo que estaban pintadas de color rojo, azul, verde y amarillo. Reuníamos todas las sillas en la parte de atrás del dormitorio y construíamos un bote – al menos lo que percibíamos como un bote.

Los sábados asoleados, a menudo íbamos a patinar afuera o jugábamos juegos como Red Rover, Red Rover. Esto sólo podía suceder después de que terminábamos nuestras tareas domésticas. Siempre teníamos que hacer nuestras camas, sacudir los muebles, limpiar el piso y limpiar los radiadores. No nos desagradaban esos trabajos. Nos daba la sensación de estar a cargo de nuestros dormitorios. Al menos eso era lo que yo sentía. Aprendíamos responsabilidad y cómo cuidarnos nosotros mismos y nuestros hogares.

En mi último año en la escuela tuvimos a un nuevo superintendente. Bill Allen había sido el superintendente por 40 años y jubiló el año en que nuestra escuela fue integrada. El nuevo superintendente tenía a sus propios niños y las cosas en el campus cambiaron enormemente. La integración se realizó sin dificultades, al menos yo no supe que hubiera dificultades hasta hace poco, cuando leí la historia publicada aquí por Gene Brooks. Simplemente estábamos felices por conocer a algunos chicos nuevos. Por primera vez tuvimos un Consejo de Estudiantes y votaron por mí como presidente. También tuvimos por primera vez un anuario y yo fui co-editora de The Wildcat. También gané el prestigioso premio Crisco por mis habilidades para cocinar y para coser.

La graduación fue triste y emocionante, como lo es para todos los jóvenes alrededor del mundo. Planeaba ir al college, pero estaba terriblemente asustada de que nunca pudiera aprender a movilizarme por el campus. Aunque había sido miembro de la Sociedad de Honor Nacional, no tenía mucha confianza en mi habilidad de aprender sin el apoyo de la escuela. Además, estaba enamorada, así que cuando tuve la oportunidad, opté por el amor y me casé poco después de cumplir 18 años.

Tengo la fortuna de participar en el Directorio de la TSBVI. Me da un gran placer compensar en algo a la escuela que me enseñó independencia y confianza en mí misma. Aquellos viejos edificios me refugiaron y creo que muchos de nuestros profesores realmente nos amaban. Este lugar, esos tiempos, me ayudaron a ser lo que soy hoy día.

¡Esa es la pregunta! ¿Quién soy? Soy una profesional, una esposa, una madre y una persona ciega. ¡Soy yo! Y eso me hace muy feliz.

Hereditary/Chromosomal Syndromes and Disorders

101 Aicardi syndrome

102 Alport syndrome

103 Alstrom syndrome

104 Apert syndrome (Acrocephalosyndactyly, Type 1)

105 Bardet-Biedl syndrome (Laurence Moon-Biedl)

106 Batten disease

107 CHARGE association

108 Chromosome 18, Ring 18

109 Cockayne syndrome

110 Cogan Syndrome

111 Cornelia de Lange

112 Cri du chat syndrome (Chromosome 5p- syndrome)

113 Crigler-Najjar syndrome

114 Crouzon syndrome (Craniofacial Dysotosis)

115 Dandy Walker syndrome

116 Down syndrome (Trisomy 21 syndrome)

117 Goldenhar syndrome

118 Hand-Schuller-Christian (Histiocytosis X)

119 Hallgren syndrome

120 Herpes-Zoster (or Hunt)

121 Hunter Syndrome (MPS II)

122 Hurler syndrome (MPS I-H)

123 Kearns-Sayre syndrome

124 Klippel-Feil sequence

125 Klippel-Trenaunay-Weber syndrome

126 Kniest Dysplasia

127 Leber congenital amaurosis

128 Leigh Disease

129 Marfan syndrome

130 Marshall syndrome

131 Maroteaux-Lamy syndrome (MPS VI)

132 Moebius syndrome

133 Monosomy 10p

134 Morquio syndrome (MPS IV-B)

135 NF1 - Neurofibromatosis (von Recklinghausen disease)

136 NF2 - Bilateral Acoustic Neurofibromatosis

137 Norrie disease

138 Optico-Cochleo-Dentate Degeneration

139 Pfieffer syndrome

140 Prader-Willi

141 Pierre-Robin syndrome

142 Refsum syndrome

143 Scheie syndrome (MPS I-S)

144 Smith-Lemli-Opitz (SLO) syndrome

145 Stickler syndrome

146 Sturge-Weber syndrome

147 Treacher Collins syndrome

148 Trisomy 13 (Trisomy 13-15, Patau syndrome)

149 Trisomy 18 (Edwards syndrome)

150 Turner syndrome

151 Usher I syndrome

152 Usher II syndrome

153 Usher III syndrome

154 Vogt-Koyanagi-Harada syndrome

155 Waardenburg syndrome

156 Wildervanck syndrome

157 Wolf-Hirschhorn syndrome (Trisomy 4p)

199 Other __________________________

Pre-Natal/Congenital Complications

201 Congenital Rubella

202 Congenital Syphilis

203 Congenital Toxoplasmosis

204 Cytomegalovirus (CMV)

205 Fetal Alcohol syndrome

206 Hydrocephaly

207 Maternal Drug Use

208 Microcephaly

209 Neonatal Herpes Simplex (HSV)

299 Other_______________________

301 Asphyxia

302 Direct Trauma to the eye and/or ear

303 Encephalitis

304 Infections

305 Meningitis

306 Severe Head Injury

307 Stroke

308 Tumors

309 Chemically Induced

399 Other _______________________

Related to Prematurity

401 Complications of Prematurity


501 No Determination of Etiology


By Terri Bohling, TVI

Originally published in the TX SenseAbilities in 2009.

Each week he would cut out his real object and paste it onto a piece of braille paper. At the end of the year, I put the pages in a large-ring binder. It was a wonderful book for him.

As an outgrowth of that list, I expanded to a listing of real objects that would fit in a manipulative tub. From there, I added body parts, actions, animals, concepts of position, foods and things (too big for a book or tub). Terri Bohling - 

Download Alphabet chart in RTF (465k)

Alphabet Book Objects, Manipulatives and Other Things
LetterObject BookManipulative TubDemonstrate
        Body PartActionAnimalPositionConceptFoodThing
A Aluminum Abacus Apricot Arm   Ant     Apricot Ashes Airplane
Arrow Acorn Apple Ankle         Asparagus Ax April
  Airplane Asparagus           Apple August  
B Bean Book Bowl   Bow (motion) Bird       Boat Bread
Bag Ball Box     Butterfly       Beard Brick
Bandaid Banana Bow (tie)     Bat       Bike Brush
Barrette Basket Bone     Bear          
Book Bell Block     Bugs          
Button Berry Beanbag                
C Comb Candle Can   Crawl Cricket   Corner Cake Clock  
Cotton ball Cassette Candy   Cry Cat       Computer  
Candle (b-day) Camera Cap   Cut Cow       Compact disc  
Cardboard Clay Car   Clap         Cover  
Crayon Cookie Corn   Cough         Claw  
  Crown Cup             Calendar  
D Dot Dice Dinosaur   Draw Deer       Door Drag
Diamond (shape) Dog collar Dollar   Drink Dog       Day Drawer
  Dress Daisy   Drop Dolphin       Desk Drip
  Doll     Dig Donkey       Dirt Drill
          Duck       Drum December
E Envelope Egg   Ear Exercise Eagle   Edge Egg    
Eggshells     Elbow Echo  Eat Elephant          
8     Eye Empty            
F Feather Film Flag Face Fall Fish Front Flat Flour Family February
Fork Flashlight Flower Foot Fast Fly   Full Food Fat Friday
4 Football Frame Finger Find Frog       Farm  
5 Fur   Fist Fill Fox       Field  
      Fingernail Fold         Fire  
        Fly         Floor  
        Float         Fence  
        Follow         Fence  
        Freeze         Freeze  
G Gum Gift Glue   Gallop Goose       Game Ground
Glasses Glove Grape   Giggle Goat       Garage Guitar
Glove Grapefruit     Give         Gate Grass
                  Girl Garden
H Hair Hammer Hat Hand Hang Hen High Half Hamburger Hall Hole
Heart Helicopter Helmet Head Hear Hippo   Hard Honey Handle Hill
Hanger Horn   Heel Hide Horse   Heavy   Happy Helicopter
      Hip Hurry         Heat  
I In Ivy Iris Iris Imitate Iguana Inside Inch Ice Cream Ink Incline
Ivy       Imagine Insect   Inside   Iron Ivory
Inch       Inhale         Infant  
        Itch         Indian  
J Jellybean Jar Jacket Jaw Jog       Jam Jeans  
        Jump       Jelly January  
        Jerk       Jellybean June  
        Join         July  
K Key Kernel     Kick Kangaroo     Ketchup Kite  
        Kiss Kitten     Kiwi Kindergarten  
          Koala       Kitchen  
L Lace Lock Lime Leg Laugh Lamb Layer Large Licorice Love Lump
Leather Leash Lollipop Lip Lay Ladybug Left Loud Lemon Ladder Lullaby
Lavender Licorice Lily Lap Lead Leopard Line Light Lettuce Lake Lens
Leaf Lemon Lilac   Listen Lion Last Little Lime Lamp Ledge
  Lettuce     Lean Lizard   Long Lollipop Lid Lunch
        Leave Llama   Loose Lunch Lawn Library
        Lick     Less   Leaf Letter
        Lie     Little   Loaf  
M Macaroni Magnet Mouth Muscle Measure Monkey Middle Many Milk Melt  
Match Marble Mask   Mix Mouse   Most Marmalade Metal  
Marshmallow Magazine Mail   Move Moose   Much Melon Model Mustache
Mitten Marigold Moccasin   March Mosquito     Mint Month Map
  Mint Mug   Mash Mule     Muffin Mud Monday
    Mustard     Mole     Mustard Music Mat
                  March May
N Nail Newspaper Nut Neck Nod Nest Next Narrow Nut Name New
Needle Net Nylons Nose Noisy   Near None Nutmeg Night No
Name Badge 9   Navel Nap         November  
Noodle     Nostril Nibble            
O Oval Overalls       Octopus Over Open Omelet Oil October
Oatmeal Oak leave       Ostrich Out Other Onion Office Old
          Otter   Off Orange Opera Outdoors
          Owl   On Oatmeal Organ Outline
          Orangutan   Old   Oak tree Oven
          Opossum   One   Orchid  
          Ox   Only      
P Pebble Paper Plate Palm Pass Panda   Pair Peach Page Pants
Pen Pocket Puppet   Pat Parrot   Pile Pancake Paint Pajamas
Pin Purse Puzzle   Peel Peacock     Pea Pan Petal
Paper Powder Pipe   Pet Penguin     Peanut Picture Plant
Paintbrush Plug     Pick Pig     Pepper Poem Pot
Paperclip       Play Polar Bear     Pie Parachute Pattern
Patch       Please Pony     Pizza Pedal Piano
Peg       Point Puppy     Popcorn Pillow Playground
Pencil       Pull Parakeet     Potato Pole Powder
Penny       Press Paw     Pudding Pansy Petal
Postcard       Push       Pumpkin Pipe Police
Putty       Pour       Pickle Pulse  
        Pump       Prune    
Q Quarter Quilt     Quiet Quail       Quack  
        Quick         Question  
R Rectangle Radio     Race Rabbit Right Rough Radish Refrigerator Rain
Ribbon Ring     Raise Rat   Round Raisin Rake Road
Rice Rope     Run Reindeer   Row Raspberry Robot Rhyme
Rock Ruler     Reach Reptile     Rhubarb Room Rose
Ruler Rattle     Read Rhino       Rubber Rug
Ring Racket     Rest Robin       Ramp Razor
Rubber Band Rose     Ride Rooster       Recess Recipe
        Roar Raccoon          
        Roll Ram          
S Seed Saucer     Swallow Seal Second Sharp Salad    
Shell Scarf   Shoulder Sit   Say Shark Side Short Salt Sail School
Soap Scissors   Skin Skip  Sew Sheep   Shut Sandwich Shelf Sand
Spoon Shoe   Skull Scratch Snail   Slow Soup Screen Shirt
Star Sock     Scream Snake   Small Spaghetti Scale Season
Square       Search Spider   Smooth Snickerdoodles Sign Seat
Stick       Shake Sweep Squirrel   Soft Squash Seesaw Sink
Straw       Share  Sort Swan   Square Sour Shade Sheet
String       Shout  Sing     Straight   Skirt Shower
6       Sleep  Spill         Slice Song
7       Slide  Smell         Sour Stairs
        Smash         Step Statue
        Smile  Spin         Stem Store
        Sneeze         Story Stove
        Splash         Street Student
        Squash         Summer Sum
        Squeeze         Sunshine Sweater
        Stand         Sweat Saturday
        Statue-game         September Sunday
        Stay  Swing            
        Stop  Stretch            
T Triangle Tongs Train Teeth Talk  Tap Tail Third Tall Tomato Table Teacher
Tissue Tweezers Timer Tears Tear  Tie Tiger Through Thin Tangerine Television Temperature
Terri Telephone Thread Thumb Tired Toad Toward Tiny   Thirsty Time
2 Towel Toy Toe Trip  Taste Turtle   Top   Tent Tire
10 Tub Tube Tongue Tiptoe     Thick   Tree Trumpet
Tape T-shirt Tennis ball   Turn  Twist     Tight   Trunk Teepee
Twig Tape recorder Tie   Taste     Together   Tower Tuesday
  Tissue     Throw         Thursday  
U Umbrella Umbrella Undress     Unicorn Under     Unhappy Uncomfortable
Under   Undo       Up     Underground United States
    Unfold       Upside down        
V Valentine Vase Video                
Velvet Vine Visor           Vanilla Volume (sound) Vending Machine
Velcro Veil Vest           Vegetable VCR     Van Violin
                Vinegar Violet Vacation
                  Vitamin Vacuum cleaner
W Wax Wool Web Waist Wait  Wrap Whale   Wet Waffle Wagon Warm
Wire Wallet Whistle   Wake Wolf   Wide Walnut Wall Water
Watch Walnut     Whisper Worm   Whole Watermelon Weather Week
        Wave  Wind Weasel     Wheat Wheel Wheelbarrow
        Wash  Walk Whisker       Win Wind
        Weigh Wing       Wish Window
        Whistle Woodpecker       Wing Wood
        Write         Winter Wednesday
X   Xylophone               Xerox X-ray
Y Yarn Yardstick Yo-yo   Yawn Yak   Yesterday Yolk Yellow Yes
        Yell     Yard Yeast You Year
        Yodel       Yogurt    
Z Zipper       Zip Zebra   Zero Zucchini Zinnia  
Zigzag       Zoom            


Family members of children with visual impairments and deafblindness have a wealth of support and resources to help both the child and the family live a rich and productive life.  Here are just a few of the many resources you may want to explore.

Family Organizations

Disability Organizations

Texas State Agencies and Programs

Family Listserv, Blogs, and Distance Learning Connections


Videos and Web-based Informational Materials

TSBVI Parent Page

Training Events

Texas Deafblind Outreach is actively involved in the development of materials specifically addressing issues about deafblindness for families and professionals.  Among the many materials available through Texas School for the Blind & Visually Impaired Curriculum Department of special interest to staff serving individuals with deafblindness are these items.

Available from TSBVI Curriculum 

Documents and Articles (English)

Causes of Deafblindness

Syndromes/Conditions Associated with Deafblindness

Minimal Losses...Major Implications


IEP Quality Indicators for Student with Deafblindness

Interveners for Students with Deafblindness in Texas

New to Deafblindness? Five Tips for Administrators


Assessment of Biobehavioral States and Analysis of Related Influences

Assessment of Deafblind Access to Manual Language  Systems  (ADAMLS)

Assessment Resources for Vision and Hearing

Bringing It All Back Home: Family-Driven Assessment and Intervention for Children Who Are Deafblind

Home Talk: A Family Assessment of Children Who Are Deafblind

The van Dijk Approach to Child-Guided Assessment

Behavioral Challenges

Looking at Self-Stimulation in the Pursuit of Leisure or I'm Okay, You Have a Mannerism

Calendars, Routines and Interactions

Let Me Check My Calendar

Make it Routine

Supporting High Quality Interactions with Students who are Deafblind: Part 1 A Summary of Current Research

Supporting High Quality Interactions with Students who are Deafblind: Part 2 Research to Practice

Communication and Language

A Standard Tactile Symbol System- Graphic Language for Individuals who are Blind and Unable to Learn Braille

Learning to Communicate

What A Concept!

Expanded Core Curriculum Areas

Braille/Print Literacy Issues and the Learning Media Assessment

Orientation and Mobility Training for Students Who Are Deafblind: Going Beyond the Blue Book

Sexual Health Care -- Excerpts from Introduction to Sexuality Education for Individuals Who Are Deaf-Blind and Significantly Developmentally Delayed

Strategies for Minimizing the Risk of Sexual Abuse

Toilet Training Children with Deafblindness- Issues and Strategies

What's Your Pleasure? Teaching Leisure Skills

Identification of Deafblindness

A Process for Identifying Students Who May Be At-Risk for Deafblindness

Early Identification of Hearing and Vision Loss is Critical to a Child's Development

How Well Can Your Child with Hearing Loss See?

Instructional Strategies

Education Protocol for Cornelia de Lange Syndrome

The Importance of Auditory Training for Children Who are Deafblind


Intervener Competency Resources Matrix (.doc 272k)

Interveners for Students with Deafblindness in Texas

Intervener Portfolio Summary 

Portfolios for Interveners

For Families

A Trip to the Doctor Turns GOOD!Driving with Usher Syndrome

Planning and Supporting a More Active Life at Home

Parenting a Child with Deafblindness

Preparing Your Daughter for Her Menstrual Cycle

Brothers and Sisters: Strategies for Supporting Siblings Of Children who are Deaf Blind

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Twelve Things You Can Do to Plan for Your Child's Future Today

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My First Scuba Diving Lesson

"Tuff" Love or Raising Laurie

When Planning for Adult Life, How is a "Life-style" Different than a "Program"?


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Indicadores de Calidad del IEP para Estudiantes con Sordoceguera

Interventores para Alumnos con Sordoceguera en Texas

 ¿Qué tan bien puede ver un niño con pérdida de audición?

¿Qué tan bien puede ver un niño con pérdida de audición?

Protocolo de educación para niños que padecen del síndrome Cornelia de Lange

by David Wiley, Texas Deafblind Outreach, TSBVI

Abstract: A discussion about a person-centered or "life-style" approach to developing programs.

Key Word: blind, deafblind, program development, transition, intervener

A few years ago I made a videotape for families and teachers helping young people with deafblindness making the transition from school to adult life in the community. The tape depicts several young adults with deafblindness. One is a young man with Congenital Rubella Syndrome, who is deafblind with additional disabilities, lives with his mother, and has the support of an intervener who comes to his home to work with him for several hours per day. The intervener is paid for through a Medicaid "waiver."

When the intervener comes to the home, he uses a tactile symbol calendar, made of poster board, Velcro, and homemade tactile symbols to inform the young man of the day's and week's events. He then helps the young man take part in meaningful activities in the community and at home. These activities include: making a grocery list; going to the grocery store; making fresh-squeezed juice; doing strength and flexibility exercises; chopping raw vegetables in a food processor; and taking a ride in the neighborhood on a tandem bike. The tape mentions that they often go to a swimming hole in a local creek.

Recently, after showing the videotape to a group of teachers in a rural area, I was asked where the young man lived when I made the tape. I answered that he lived in Austin, our state capital, with more than a million people in the metropolitan area. To this, a teacher replied, "You can find programs like that in big cities, but we don't have any of those kinds of programs in small towns and rural areas."

This comment made me stop and think, because I am conscious of the fact that resources are often not distributed equally in all areas. But as I thought, it occurred to me to ask, "What `program' is not available in small towns?" A local man was hired to serve as an intervener, and he and the young man's mother got together to plan daily activities. The intervener went to the young man's home to work with him. From there they went to stores and swimming holes, rode bikes in the neighborhood, and did enjoyable activities surrounding food and physical movement in his home and yard. All of these activities were chosen because they are meaningful activities based on the young man's preferences, which kept him active, motivated, and content. The young man's support is funded by a Medicaid Waiver available in all the rural counties I was visiting.

What part of that situation couldn't be done in a small town? All that is needed is posterboard, Velcro, a grocery store, juicer, food processor, exercise mat, bicycle, road, and swimming hole. It could be anywhere.

I think this misunderstanding arose because we have been conditioned to think in terms of programs, a system-centered approach, rather than life-styles, a person-centered approach, when thinking about adult lives for people with disabilities that need extensive support.

System-Centered Programs

In the past, it was usual to think about support for adults with significant disabilities in terms of getting into a "program", and going to the program, a place, to get needed services. These programs might include, day-activity centers, sheltered workshops, residential facilities, supervised recreation centers, therapy centers, supported-living apartments, etc. These programs are created by the "system" of service providers to meet the needs of clients or consumers in the area. Programs that now exist certainly fill a vital role in meeting some people's needs.

However, programs are usually created to meet the needs of groups of people. Consequently, they are most often found in larger population areas and often are designed to meet the common needs of most people, rather than focusing on individual needs. As a result, in order to gain services, people must qualify as eligible and fit in to the agenda followed by the group. Consequently, some people are unable to get the kind of services they need in the place they want because there are no programs in the area, or the existing programs and the individual are not a good fits.

Person-Centered Life-styles

Rather than planning by starting with what programs are available, I prefer to start by asking what kind of life-style and activities the person would like as an adult. The creation of new ways to fund services in the community allows us to plan by discussing preferred life-styles rather than available programs. For over ten years now, support for adults with disabilities can be provided to individuals through Medicaid "Waiver" services. In Texas some of these "Waivers" are called: Home and Community-Based Services (HCS), Community Living Assistance and Support Services (CLASS), The Texas Waiver for Deafblindness and Multiple Disabilities (DB-MD), Community-Based Alternatives (CBA). Waiver Services are designed to be flexible in developing a plan to meet individual needs.

This allows a person-centered, rather than system-centered, planning approach. Rather than asking what programs might be available, transition teams can start by asking, "What are the person's abilities and preferences? What would the person like to do with his or her time? What kind of support would enable the person to do these things?"

This can lead to solutions like those in the videotape. The young man's preferences lean toward food and physical movement. On the other hand, unpredictable events (having no schedule, or not knowing what is happening) lead him to become frustrated, agitated, and sometimes self-abusive. Preferred activities include getting, preparing and eating the foods he likes, as well as exercising, swimming, and riding bikes. He needs emotional support in the form of consistent routines, and being informed of what to expect so he can anticipate and look forward to things. He needs guidance and physical support to stay active and accomplish the activities he likes. He needs these activities to be planned for him in a schedule that keeps him interested and involved, and at a pace that leads him to be successful. There is no preexisting program that meets all his individual needs, in any large city or small town. Instead, the people who support him created the life-style.

It Can Happen Anywhere

I recently made a videotape of another young man who is deafblind with additional disabilities. He lives in a small west Texas town. His parents had applied for him to get services from the Texas Department of Human Services through the DB-MD Waiver. They planned together with his case manager, who works for a service provider organization in the nearest city, and developed an individual plan of care. The service provider hired an intervener in their small town. She comes to his home, does activities with him there, and takes him out into the community. With her support, he keeps a garden in his yard, helps out with domestic chores like laundry, enjoys music-related activities for fun, goes to the park and stores, and volunteers his time at a regional VA medical center, helping his grandfather with Bingo games for older patients. He takes swimming lessons at the local YMCA. He visits with friends at the hospital, and in his intervener's neighborhood, as well as often running into acquaintances at the Walmart or the pool. This is a life-style he enjoys based on his abilities and preferences. As his Dad says in the video, "We made our own program."

Starting with a life-style: that is how transition planning becomes person-centered. Sometimes the plan may involve taking part in existing programs, if they are available and provide a good fit for an individual's goals. Sometimes teams will need to "make their own program." It can be done anywhere: large cities, small towns, and rural areas. It starts by thinking about life-styles.

When this talk of programs came up, I remembered a poem written by the keynote speaker of one of our workshops many years ago. At the time I first heard it, I enjoyed the poem, but I think I didn't fully appreciate it, because I was still too close to the system-centered approach to planning. I recently reread the poem with a new appreciation. It is called "Beyond Programs".

Beyond Programs: A Parable

By Michael McCarthy

In the beginning, there was placement, and lo we were happy when it happened, as placement was not mandated for adults who happened to experience severe disabilities.
And so, we said, this is good.
And placements multiplied and filled the earth.

And then we said, let us make programs, which focus on serving clients.
And clients were defined and labeled, and grouped according to their labels and assigned to programs based on their label.
And programs created services for each label, and state agencies developed unit costs for each service.
And programs prospered and multiplied, and we said, this is very good.

And as programs multiplied, a cry arose: Let us evaluate these programs to see how good they really are.
And program evaluation, state regulations, quality assurance, compliance plans, and other program measures were created.
And they multiplied and filled volumes.

And in those times, a person arose who was a client, but who was also a prophet, and said:

"I don't want to be a client,
I want to be a person.
I don't want a label,
I want a name.
I don't want services,
I want support and help.
I don't want a residential placement,
I want a home.
I don't want a day program,
I want to do meaningful and productive things.
I don't want to be "programmed" all my life;
I want to learn to do things I like, and go places, which I like.
I want to have fun, to enjoy life and have friends.
I want the same opportunities as all of you:
I want to be happy."

And there was a long silence.
And lo, everyone realized that they must look beyond their programs.

But they were troubled, and they asked:
"How can we do this? Would not each person need their own unique program and system of support and his own individual measure of its quality?"

And the prophet replied:
"Even as you say, so should it be done-
Just as you do for yourselves."

This poem was originally published in HKNC TAC News, Vol. 4, No. 1, Spring/Summer 1989. Mike McCarthy is currently Coordinator for Community Education and Outreach at the University of Missouri-Kansas City Institute for Human Development, a University Center on Excellence on Disability. He also serves on the advisory board for the National Technical Assistance Center on Deaf-blindness (NTAC). He tries to stay grounded in the lives of people with deaf-blindness by serving as an advocate and guardian for Calvin.

By David Wiley, Transition Specialist TSBVI, Texas Deafblind Outreach

Editor's note: While David's article is written about people with deafblindness, the ideas he discusses are relevant for a much wider population.

Helping a young person with deafblindness develop an active lifestyle is one of the important issues to consider when planning for the future. People with deafblindness, especially those with additional disabilities, may develop a routine of remaining passive and uninvolved with basic life activities around the home, and experience an unsatisfying use of free time. Families, educators, and any others who work with a young person, all have a role in planning and supporting a more active life at home.

Why an active life is important

It is important that kids develop the expectation of being actively involved in home life. Without this expectation, children are at risk of developing a "learned helplessness" that can continue throughout the adult years. Most people feel that being actively involved in everyday activities leads to a higher quality of life. A person who is actively involved in common daily activities, such as taking care of the home and personal care, has several advantages:

  1. Active participation allows a person to avoid boredom and inactivity.
  2. Active participation allows a person to gain a sense of competence and accomplishment.
  3. Active participation allows a person to have a greater sense of control over the circumstances of his or her life and more influence over the way things are done.
  4. Active participation allows a person to have more opportunities for making choices and expressing preferences.
  5. Active participation allows a person to have a better understanding of how everyday things happen (e.g. how long it takes for meals to be prepared, or how clean laundry gets back into drawers).
  6. Active participation supports communication development by providing a person with more topics to use in interactions with others.

Creating opportunities for more participation

When individuals are able to complete activities around the home independently or with minimal supervision, they should be given opportunities and support to do them. This may involve:

  1. Giving him or her responsibilities and chances to use current skills in regular household activities.
  2. Teaching new skills so he or she can take responsibility for regular household activities.
  3. Creating new household routines as opportunities for the person to use his or her skills (e.g. create a garden, get a fish tank, or start recycling).

Partial participation in activities is a way to encourage a more active life for individuals who are not very independent. Even when a person is not able to fully complete an activity, he or she should be given the opportunity to participate at a level in keeping with his or her capabilities. No one should be left out.

Partial participation can involve selecting those steps within an activity routine that a person is able to accomplish independently, and providing a chance for him or her to complete those steps while someone else completes the rest. Activity routines should be "task analyzed," by breaking them into small steps and identifying those steps the person can complete.

When steps cannot be completed independently, people should be allowed to participate in a wide variety of activities with the support of prompts or physical assistance from another person. Once a person is actively involved in a routine, the level of participation and independence can be increased over time, by reducing prompts, adding more steps, or fading the level of support.

Adapting materials and the environment can allow a greater level of participation. Adapted materials may include things such as tactile markers on appliance dials, a non-skid surface on a countertop, an electric razor, or a food processor to cut and stir. Adaptations to the environment include things such as storing materials in consistent locations, reducing clutter, and defining work spaces clearly.

Creating new expectations

It is not unusual for someone to initially protest when asked to join in new activities. Because daily routines are familiar, any person might become upset when these routines are disrupted. People may have a sense of uneasiness when they skip their morning coffee, miss the evening news, or alter some other routine activity. The difficulty of starting new routines is very evident to someone who attempts to change diets, stop smoking, or begin an exercise program.

Being accustomed to a routine of inactivity may cause a young person with deafblindness to initially resist more active participation. This is to be expected, even when the new activities are enjoyable, as would be the case if any routine is replaced by another. Once an individual becomes familiar and comfortable with new expectations and opportunities to be more active, however, the new routines will gradually take the place of inactivity. When that happens, the person will more easily grow to accept and enjoy new chances to participate.

Of course, if someone continues to resist a particular activity over a period of time, there comes a point when this must be accepted and honored as the communication of a preference. Before giving up, however, the person must have had enough opportunities to participate and fully understand the activity.

Free time can present a challenge

A significant portion of every person's time at home is spent with self-directed leisure. Leisure can be defined as unobligated time in which people perceive themselves to be free to choose activities they find meaningful, enjoyable, and intrinsically motivating. During free time, a person may be given the opportunity to "do anything he or she wants to do." But what does it mean to "do anything you want?" There are many steps that must be successfully completed before a person can initiate a leisure activity:

  1. The person must know how to do a number of activities from which he or she can choose.
  2. The person must understand the concept of free time, and know that it represents a time to choose for oneself.
  3. The person must know how to make a choice.
  4. The person must be able to think of, or have a reminder of, the activities he or she is able to do, and from which he or she is able to choose.
  5. The person must know when the free time will end, and how it fits in with other daily activities and events, as well as what activities are appropriate within that time frame.
  6. The person must be able to locate and get the materials needed to participate in an activity.

If any of these steps cause a problem, the person needs more support during free time, just as during self-care or other tasks. When given no support, many people with deafblindness may be unable to successfully initiate a leisure activity. This can be recognized when someone consistently chooses sleeping, sitting idly, or engaging in problem behaviors during free time.

How deafblindness affects the level of activity

Some problems experienced during leisure time are directly related to deafblindness. For example:

  1. People who are deafblind with multiple disabilities are often unable to enjoy many "old standbys" - simple, common leisure activities that people often fall back on (e.g. TV, music, books, conversation, sight-seeing and board games)
  2. Most people are motivated to try new activities they hear about or see others doing, and consequently build a repertOíre of leisure choices. People with deafblindness often receive less information through modeling and other sources in the environment. As a result, they may not have many leisure options from which to choose.
  3. People with deafblindness receive fewer natural environmental cues that prompt self-initiation and independent participation. Most people observe these cues and are reminded of the activities they might want to select when they have free time.
  4. People who are not strong communicators may be unaccustomed to making choices, and unable to easily communicate preferences. They may not be good self-advocates either.
  5. Sensory stimulation often takes on great importance. Activities that do not provide sensory stimulation may not be as motivating.

How to help someone have a more active life

Enhancing participation and increasing self-initiation is beneficial for a higher quality of life. These steps can help a young person become more active:

  1. Create and practice consistent routines that increase participation around the house.
  2. Develop and communicate a daily schedule, so the person will have expectations of what will happen. (Include both "chores" and leisure activities.)
  3. "Label" the concept of free time and support concrete choice-making.
  4. Support the person in learning about self-determination and self-advocacy.
  5. Arrange a system that reminds the person about possible leisure activities.
  6. Assess the person's interests, and plan new experiences for him or her to try.

Assessing and planning new experiences

In assessing interests and planning new experiences, consider the following:

  1. The person's past experiences.
  2. The person's preferences and attitudes.
  3. The expectations and interests of friends and family.
  4. Opportunities available in the person's home.

After gathering this information, support the person to become more active. Enjoyable and familiar preferred activities should be balanced with new things a person can learn more about. Honor the person's choices when possible. When it is not practical to accept a person's preference, because it is inappropriate for some situations, frustrating to the person, or potentially harmful, help the person by adapting these preferred activities to make them more appropriate. New skills should also be taught for specific activities, to increase the number of options the person has, and to provide a larger array of opportunities to choose from.

The Activity Planning Sheet can be used to "brainstorm" new activity ideas. By knowing the young person's preferences and abilities, and working together to encourage a more active life at home, everyone involved can help a young person with deafblindness have a more productive and satisfying lifestyle, now and in the future.

The Process of Planning and Supporting a More Active Home Life

Teacher's Role

  1. Talk to the family and work as a team to determine what routines might work well at home for the student.
  2. Work on similar routines at school, and communicate with the family to create as much consistency as possible.
  3. Make sure daily living and independent leisure activities are routinely discussed during IEP and ITP development.
  4. In order to plan effectively, find out about the activity level and typical support available to adults with deafblindness in their homes.
  5. Document both proficiency and preference, and make a list of activities the student has tried in the past. Documentation can be written and/or videotaped.
  6. Remember that the family has obligations in addition to supporting the student's active home life. Work, doctor appointments, other children, home maintenance, meal preparation and relaxation are only a few of the competing priorities families face.

Family's Role

  1. Make your child's active participation a regular and expected part of family life. Try to be as consistent as possible.
  2. Give your child chores, or find ways to include your child in household duties, even if only in a small way.
  3. Consider all the regular routines that involve your child, and discover some active role for your child in each.
  4. Use a calendar or other way to let your child know what is expected every day.
  5. Help your child make satisfying and productive choices during free time.
  6. Develop new ideas with your child's teacher or care providers, and be consistent across different settings.
  7. Remember your other family obligations, and find a way to support your child consistently without placing too much stress on other aspects of family life.

Other Caregiver's Role (Group Home Staff, Member, Respite Care Worker, etc.)

  1. Work with the individual and family as a team to determine what routines might work well at home.
  2. Make active participation a regular and expected part of the young person's life. Be consistent.
  3. Do things with, not for, the person you are supporting.
  4. During free time, help him/her make choices and participate in satisfying, productive activities.
  5. When necessary, schedule activities with or for the person. Keep in mind the appropriate level of support and his/her preferences.
  6. Use a calendar or other way to let him/her know and anticipate what to expect throughout the day.
  7. Document both proficiency and preference in making a list of activities the student has tried in the past. Documentation can be written and/or videotaped.

Activity Planning Sheet

Developing and Adapting Activities to Improve or Expand Options at Home

  1. What does the person currently enjoy doing or show an interest in?
  2. What might be motivating about this activity?
  3. Does this activity currently create such a problem that it needs to be changed? If not, skip ahead to Question 5.
  4. If so, answer the following three questions:
    • If this activity's location creates the problem, how could changing the setting make the activity better?
    • If the materials used in this activity create the problem, how could changing the materials make the activity better?
    • If the person's inability to finish this activity completely or correctly creates the problem, how could changing the expectations or level of support make the activity better?
  5. What are five new activities that could be motivating or interesting to the person, based on the qualities listed in Question 2?

Worksheet accompanying article "Planning & Supporting a More Active Life at Home" by David Wiley, Texas Deafblind Outreach