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An Interest in Interaction: It may not be obvious at first because of how difficult it can be to communicate, but most children want interactions, and DB students do, too. ASSUME that the child wants interactions and proceed with the idea that one of your main goals is to establish a relationship. Everything you do will work better if you take the time to make relationship first, to secure an attachment that will make both of your comfortable.

Extended periods of play on the body  At the times when other children begin to move through and explore their environments, DB children sometimes prefer to stay in one place and keep themselves occupied by engaging in vocal or sensory play. This may continue through the first year of life if there is no intervention to help the child develop an interest in, and the skills to maneuver in, her environment. PT and OT can be a huge help by providing age appropriate motor activities, adapted for absence of vision and hearing, and focusing on interactive strategies.

Atypical motor skill development: Largely because of the tendency to extend play on the body well into the first year, instead of learning to crawl and explore, motor development milestones are often reached later than might be expected for sighted, typically-developing peers. A few of these motor features are:

Muscle tone: Were not sure exactly why, but children with low vision often have low muscle tone, especially at the proximal joints.

Static and dynamic balance: Visual, tactile and proprioceptive input is bundled as it travels through the nervous system, which means that many DB students will have balance problems.(See CHARGE Association info)

Non-purposeful movement: The social signals that teach us how to (and make us want to) control non-purposeful movements such as flicking a pen, or wiggling a foot, are largely absent for the DB child. Without the social constraints, there is little to compete with the pleasure of the movement itself.

Gait pattern deviations: Children with visual impairment, blindness and DB are prone to:

Toe walking:
Walking on tip toes. This is often a sensory strategy. Try it: Youll see immediately that by walking on your toes, you get amazingly more sensory information (through calf muscles, across the metatarsal heads) than using a heel strike. Toe-walking is part of typical motor development, usually diminishing within 4 6 months of full weight bearing. If you work with a DB child of child with visual impairment who is still toe-walking a few months after they begin ambulation, its time to intervene. Many of these children respond well to a short course of supramalleolar AFOs.
Toe-out gait pattern:
Because many DB children use wide-based gait patterns due to instability at the hip (low proximal tone and sometimes muscle weakness), it is not uncommon to note a toe-out gait. Toe-out is a compensatory adaptation for weakness or lack of sensation in the hip, alignment problems at the knee, etc. If it persists as long as 6 months after ambulation begins, an orthopedic check is indicated.
Pronation at the midfoot:
Toe-out gait, and weakness or internal rotation at the hip, can cause a child or adult to walk with foot pronated, which later can cause hip and back problems. There is no period in which walking in pronation will be beneficial to the child, and it should be addressed early.

Need More Info? See:

Strickling, Chris. "Motor Focus: Promotiing Movement Experiences and Motor Development," in Early Focus: Working with Young Children Who are Blind or Visually Impaired and Their Families. Rona L. Progurnd and Dianes Lfazzi, editors. American Foundation for the Blind, 11 Penn Plaza, Suite 300, New York, NY 10011, pp 287-325.

Versión español de este artículo (Spanish Version)

doctor-childA child with a hearing loss relies heavily on his vision to compensate for what he cannot hear. He may read lips or facial and body language, sign language, speech cues, print, and pictures. He relies on his vision to detect cars he cant hear approaching, flashing alarms instead of the typical fire alarm, and many other things. Most of his instruction is adapted to make use of the vision channel for learning or to support his use of residual hearing. In other words, good vision is an important thing for a child with hearing loss!

Anyone, even children with hearing loss, can experience problems with their vision at any age. As a parent or teacher you are the one most likely to notice some of the subtle signs that your child is having problems with his vision. Here are some of the things to be on the look out for related to vision problems:

Problems Seeing at Night

  • Cant see when coming in from the bright sunlight for a longer period of time than normal
  • Trips over things when the light changes or gets dim
  • Stays near light in a dark room or at night
  • Positions himself so light falls on the face of the speaker
  • May express a desire to enter a room before it is darkened (e.g. movie theater)
  • Avoids conversations in a darkened area
  • May appear to stagger or lose balance after an oncoming car has passed at night
  • Has problems reading under some lights or in dimly lit areas

Problems Seeing a Full Visual Field

  • Stumbles on stairs and curbs
  • Bumps into people, tables, and chairs
  • May have accidents or spilling at mealtimes with objects placed to the side
  • Startles easily
  • Seems to hold eyes in different directions when looking at some things
  • Turns head while reading across a page
  • Uses fingers to mark place while reading
  • Cant find small objects that have been dropped
  • Fails to glance at another persons hand waving from the side
  • Is quiet or may edge to one side when in a large group
  • Frequently misses or fails to understand group instruction

Problems with Glare

  • Squints and shades eyes in bright lights or fluorescent lighting
  • Likes to wear sunglasses even in a building, but especially in bright sunlight
  • May appear awkward when exiting from a building (when faced with bright lights)

Problems with Contrast

  • Has difficulty reading light copies or ditto copies
  • Cant see stars at night
  • Often spills when pouring liquids

Problems Seeing Clearly

  • Holds book close to eyes, or bends to read
  • Sits near blackboard

Other Behaviors Sometimes Related to Problems with Vision

  • Exhibits anxiety in new areas or unfamiliar places
  • Often last to enter room
  • May have repetitive behavior or routines at particular times
  • May fail to participate fully in group activities associated with new situations in the dark (e.g. evening football game, movies)
  • Frequently hesitates at the top or bottom of the stairs
  • Avoids walking or running in unfamiliar areas especially in bright sunlight or darkened areas
  • Constantly appears to be visually scanning a group
  • Tilts head, covers or closes one eyes for critical seeing
  • Holds printed material in unusual position

APPEARANCE of the eye

  • Eyes turn in or out
  • Crusty or red eyelids
  • Different size pupils or eyes
  • Swelling of eyelids
  • Conjunctivitis (Pink eye)
  • Drooping lid(s)
  • Any other observation about "eyes that just don't "look right"?

(Davenport, 1994 and VibrationsNewsletter of Colorado Services for Children who are Deafblind, Winter 2000)

If your child seems to exhibit some of these problems, discuss your concerns with your educational team and/or your family doctor. It is a good idea to periodically take your child to a certified optometrist or ophthalmologist for a thorough eye examination. Be sure to take along this list to share any concerns you might have. It is very important to make sure your child with hearing loss can see as well as possible to ensure his success in school.

If you would like the names of qualified optometrists or ophthalmologists in your area who work with children with disabilities, ask your special education program to put you in touch with a local teacher of the visually impaired. Other resources for finding one of these professionals in Texas include the regional Education Service Center Vision Consultant or a Childrens Specialist at the Department of Rehabilitative and Assistive Service  Division of Blind Services in your area.