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In discussing multiple disabilities, especially in young children, it is important to gain a perspective about the interactional factors in multiple impairments. Each disability does not act in isolation (and should not be managed in isolation). There is a hierarchy of impact that might be best explained by a comparison to a submarine (see image below). When operating "on instruments" (sonar, radio, periscope), the captain must rely on what his instruments tell him about the surrounding environment. His periscope gives "straight ahead" visual information (or side vision, if the periscope is turned); the sonar tells what might be "out there" at a distance; the radio antenna permits incoming verbal information (receptive language) or allows out-going responses (expressive language). The motor mechanisms allow the captain to maneuver his submarine ahead, make turns, stop, reverse, rise, or descend. The captain must take in all of the information given to him, make sense of it, and make decisions that affect the whole submarine and its crew. Survival may depend on the experience, knowledge, and data processing ability of the captain.

The best captain in the world is hampered in decision making when one or more of his information gathering systems is defective or disabled, but at least he has the ability to draw conclusions based on what information he has, or has stored from past experience. The more data-gathering systems are malfunctioning, the harder it is to make wise decisions. As long as the motor system is intact, he can maneuver, allowing for incomplete data. If the motor system also malfunctions, the captain may have a difficult time making progress of any kind; he may know where he wants to go, but can't seem to get there. Obviously, the more severe or serious the malfunction in any system, the more difficult it is to make progress, and greater the reliance is on the better-functioning systems.

If it is the captain who is ill, tired, or (for whatever reason) unable to function properly, it doesn't matter how intact the motor and data-gathering/communication systems are, they will not be used efficiently or effectively. They may appear to be somewhat disabled because the captain is unable to make-full and best use of them. This submarine may make some progress, but it may be slow, occur in unpredictable spurts and directions, and may never quite get to where it wants to go. If the captain's malady is incurable and permanent, the submarine may never make it to harbor - at least not on schedule.

So it is with the human organism. An intact brain can make innumerable compensations for impairments in vision, hearing, speech and language and motor abilities, enabling the person to function reasonably well. The more impairments, and the more severe they are, the more compensations, modifications, and adjustments are needed. But, with effort and perseverance, it is possible to become a contributing member of society. However, when the brain is damaged, defective, or otherwise malfunctioning, the other body systems will not be used effectively or efficiently, no matter how intact; they will appear to be poorly developed.[see note] In the case of vision, functional vision skills may be more closely linked to developmental level than chronological level, but intervention - especially in the early years - can have positive long term results. This is an important concept in evaluation of vision, since the potential for improved functioning will also be related to developmental level.

Note: A thorough and ongoing evaluation by the program team can help to identify whether delays are more related to brain malfunction that to visual impairment. When in doubt, provide intervention; the VI teacher should be involved until it can be demonstrated that activities to improve functional use of vision are ineffective.

Multiple disabilities in an infant or young child require the coordinated efforts of multiple experts" (one from every identified disability area). Because of the interactive, multiplicative effects of multiple disabilities, it is essential that intervention and/or programming efforts be focused cooperatively on functional tasks. Whenever possible, intervention should be aimed toward minimizing or preventing developmental delays. Since there seems to be an ever-increasing number of infants and young children with multiple disabilities, the cooperative approach to early intervention seems to have the best potential for enhancing the potential of these children.


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