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By Elaine Kitchel, American Printing House for the Blind

Fluorescent light is the most common source of lighting today for industry and commerce. The cool white fluorescent tube is the light source of choice for most designers of interior spaces.  Fluorescent light is cheap, efficient and long-lasting and the tubes are available in a wide array of styles and choices, from the common cool white fluorescent tube (4100K and 5000K) to specialty tubes such as plant growth tubes and actinic tubes for aquarium lighting.

Most schools are lit with cool white fluorescent tubes as well, owing to the qualities of economy and long life afforded by them. However, recent studies in cellular activity of the human retina indicate cool white tubes should probably not be considered as a good lighting source for persons with eye disease or eye injury.

When the eye is healthy and carrying on the process of photoreception, each photoreceptor in the retina does one unit of work for each peak in a wavelength of light which strikes it.  Each unit of work done by a single photoreceptor, generates one unit of cellular waste product which must be carried away by the eye’s natural system of waste disposal.

In the diseased or injured eye, the natural system of waste disposal is often compromised. Thus, while the retinal cells are working hard to process light information, they often produce more waste product than the eye’s disposal system can handle. Waste products build up in the eye and are perceived by the brain as “glare.” 

Glare is often characterized as “fog, whiteness, blackness, or an irritating feeling.” Whatever it is, it’s unpleasant to the person who experiences it.  For the person suffering from diseased or injured eyes, it is more than unpleasant, it can be extremely painful and it can last a very long time after the source of light is removed.

How does cool white light, or light with an output in the predominantly blue portion of the spectrum exacerbate glare? It is simple mathematics.  For every peak in a lightwave which strikes a photoreceptor, the cell does one unit of work. UV and light in the blue part of the spectrum have peaks which are very close together, working the eye at a much higher rate than that of the warm white (2700K) fluorescent tube. Conversely, light in the red part of the spectrum, tends to allow the retinal cells to operate at a slower rate, often giving them a better chance to keep pace with the disposal of the by-products of photoreception. This then, results in less glare.

It is not too harsh to state that virtually all persons with vision problems should be removed from a light environment where the predominant light waves are a temperature above 3500K or a wavelength less than approximately 500 nm. 

Not only is it uncomfortable for persons with diseased or damaged eyes, there is adequate information available to safely state blue light, in addition to UV, causes irreparable damage, over time, to the human retina, especially in young children. Numerous studies by Dr. Chen of Sweden and Drs. Ham and Ruffolo, suggest it is wavelength alone, not duration or intensity which is responsible for cellular damage and death in the presence of blue light. Serious consideration as to how we light environments of persons with visual problems cannot come too soon.

While warm white fluorescent tubes are a much better environmental choice than cool white, incandescent bulbs offer an even better environment. Because of the slow processing of visual information in the diseased or injured eye, many persons with limited vision are able to perceive the flicker in fluorescent lights which is imperceptible to persons with healthy eyes. While this does not present a health problem to most people (persons with epilepsy are excepted,) it does become a source of annoyance for some. 

If a school, workplace or home has the choice between fluorescent and incandescent light, then incandescent bulbs, which are translucent, but not transparent and have a strong spike in the red end of the spectrum are preferred. However if the choice is limited to cool white vs warm white fluorescent, then warm white tubes are the obvious choice.

If overhead warm white tubes are selected, they can perform even better for the low vision user by the addition of a 1” peracube lens. This lens looks like a silver grid with cross pieces being 1” apart. Acrylic or Lucite lenses, which look more like sheets of semi-translucent material over the tubes, tend to scatter the light throughout the room and thus rebound it within the eye several times. Use of these lenses should be discouraged.

A new product, the RobinSpring 32 lamp, is now available.  Even though it is flourescent, it employs a new technology which reduces the flicker rate to almost nothing.  Additionally, it uses a combination of fluorescent and and other lamp technologies to produce light that is in the 3200K range.  It is perfect for most persons with compromised vision, and those persons with typical vision for whom typical fluorescent lighting is not advisable.

It is important that those of us who make decisions about the environments of others, especially children, take the safety and the comfort of their visual experience into consideration.

Resources and References

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.

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.

Hall-Lueck, A. (1986, May).  Facts and fads: what works and what doesn't.  Paper presented at the National Forum on Critical Issues in Infant and Preschool  Education of Blind and Visually Impaired Children, American Foundation for the Blind.

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.

Holyoak, E., (1988), UV Filters, NoIRs and Low Vision, Research paper, 1-9.

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.

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.

Rozanowska, M., Wessels, J., Boulton, M., Burke, J. M., Rodgers, M. A., Truscott, T. G., & Sarna, T. (1998).  Blue light-induced singlet oxygen generation by retinal lipofuscin in non-polar media.  Free Radical Biology and Medicine, 24, 1107-1112.

Sliney, D. H.  (1983).  Biohazards of ultraviolet, visible and infrared radiation.  Journal of Occupational Medicine, 25(3), 203-206.

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.

There are few other resources as valuable to family members of children with visual impairments and deafblindness as state and national family organizations.

State Organizations (Texas)
National Organizations (United States)

 State Level

DBMAT

Deaf-Blind Multihandicapped Association of Texas - The mission of DBMAT is to promote and improve the quality of life for all Texans who are deaf-blind multi-handicapped, deaf multi-handicapped, and blind multi-handicapped.  Listen to a message from the members..

TAPVI

Texas Association of Parents of Children with Visual Impairments - The Texas Chapter of the NAPVI supports parents of children with visual impairments. - Listen to a message from the members..

TXChargers

Texas Chargers - Texas Chargers, Inc. encourages, educates, and enriches individuals and families living with CHARGE Syndrome.   - Listen to a message from the members..

TXHandVoices

Texas Hands and Voices - Texas Hands & Voices (TX H&V) offers support, information and resources in an unbiased manner to families with children who are deaf and hard of hearing.  Our outreach activities, parent/professional/community collaboration, and advocacy efforts are focused on enabling Deaf and Hard-of-Hearing children to reach their highest potential.  - Listen to a message from their members.

TXPBC

Texas Parents of Blind Children - Texas Parents of Blind Children (TPOBC) is the state chapter of the National Organization of Parents of Blind Children (NOPBC), a division of the NFB of Texas, a national membership organization of parents and friends of blind children. Our state chapter was formed at the NFB of Texas State Convention in 2006 in order to reach out to parents of blind children and provide vital support, encouragement, and information. - Listen to a message from the members..

TxP2P

Texas Parent to Parent (TxP2P) is committed to improving the lives of Texas children who have disabilities, chronic illness, and/or special health care needs. TxP2P empowers families to be strong advocates through parent-to-parent support, resource referral, and education. 

ARC

The ARC of Texas - The Arc of Texas creates opportunities for all people with intellectual and developmental disabilities to actively participate in their communities and make the choices that affect their lives in a positive manner.

TxProject1st

Texas Project FIRST, created by parents, for parents...this web site is a project of the Texas Education Agency and is committed to providing accurate and consistent information to parents & families of students with disabilities

Family to Family Network

The mission of Family to Family Network is to help families of children with disabilities by providing information, training, referral and support 13150 FM 529, Suite 106 Houston, TX 77041 Phone:  713-466-6304 Email:  Website:  www.familytofamilynetwork.org/ Texas Project First Website:  http://texasprojectfirst.org/index.html    

 National Level

CdLS

 

 

 

The Cornelia de Lange Syndrome (CdLS) Foundation is a family support organization that exists to ensure early and accurate diagnosis of CdLS, promote research into the causes and manifestations of the syndrome, and help people with a diagnosis of CdLS, and others with similar characteristics, make informed decisions throughout their lives.

The CdLS Foundation is a national non-profit organization that has served people with CdLS and their families since 1981. The Foundation’s mission is reflected in its slogan: Reaching Out, Providing Help, and Giving Hope.

The Foundation is the only organization dedicated to CdLS in the nation. It distributes a number of publications to families and professionals caring for children with CdLS, and hosts meetings and conferences where researchers and families can meet to exchange information. The Foundation also acts as a facilitator between families and professionals, utilizing a team of professionals who lend their expertise to those caring for a child with CdLS.

NAPVIJewishGuild

National Association of Parents of Children with Visual Impairments - NAPVI and the American Foundation for the Blind (AFB) are so pleased to bring you our web site, www.FamilyConnect.org, an online, multimedia community for parents and guardians of children with visual impairments. FamilyConnect gives parents, grandparents and other caretakers a place to find comprehensive resources and support 24 hours a day, with access to message boards where they can talk to other parents, compelling videos featuring real-life families, parenting articles, a mom-authored blog, and links to local resources. The site also features sections dedicated to multiple disabilities, technology, education, and every age group from infants to teens. Visitors to www.FamilyConnect.org can also create a personal profile and receive information on news and events based on their child's age, eye condition, and location.  Listen to a message from NAPVI.

NFADB

National Family Association for Deaf-Blind - NFADB exists to empower the voices of families of individuals who are deaf-blind and to advocate for their unique needs.  NFADB Videos on Deaf-Blindness (English long and short versions), Spanish (NEW)

Duncan McGregor
Jean Huehn
Janet McAdam

York Region District School Board
Vision Services Department
300 Harry Walker Parkway
Newmarket, Ontario
L3H 8E2
(905) 727-0022, ext. 3324

Presented at the AER International Conference, Toronto, Ontario, Canada, Saturday, July 20, 2002.

Rationale and Benefits to Students:

Students with visual impairments have many educational needs that are not addressed by the core (academic) curriculum taught to all students. The Extended Core Curriculum for students who are visually impaired addresses these needs. However, some aspects of the Extended Core Curriculum are often best taught outside of the school environment.

At camp, we give students the opportunity to develop:

  • Daily living skills
  • Social skills
  • Orientation and mobility skills
  • Physical fitness
  • Independence and responsibility

This is done by:

  • providing students with an opportunity to interact with other students who are visually impaired
  • developing appropriate social skills in a variety of settings
  • assigning positions of responsibility in the areas of daily living and personal hygiene
  • providing a wide range of outdoor experiences, that engage the senses and allow students to expand their repertoires of recreation and leisure activities.
  • promoting physical fitness

Camp Activities:

Daily Living Skills

  • food preparation
  • table setting
  • clean up
  • washing, drying and putting away dishes
  • unpacking personal items when arriving at camp, and packing them to return home.
  • organizing and caring for personal items
  • personal hygiene

Social Skills

  • group interaction
  • peer tutoring, modelling of appropriate behavoiur
  • leadership training

Orientation and Mobility

  • hiking
  • orienteering
  • scavenger hunts

Physical Fitness

  • hiking
  • running
  • snowshoeing
  • cross-country skiing
  • horseback riding
  • canoeing, rowing, paddleboats
  • ball games and activities: soccer, softball, t-ball, soccer baseball, “catch”
  • relays
  • tug-of-war

Independence and Responsibility

  • chores
  • organizing and caring for personal items
  • giving students the opportunity to organize activities themselves

Things to Keep in Mind When Organizing a Camp

  • Book facility well in advance of the dates you want.
  • Information package for parents should include:
    • address and phone number of camp, and map showing how to get there
    • list of things to bring (and to leave at home)
    • medical information form—include food allergies/religious dietary restrictions
    • permission forms, as required by school board
    • field trip insurance forms, as required by school board
  • Plan kid-friendly meals—things kids like to eat, and can either help themselves to (e.g. sandwich bar) or prepare themselves.
  • Be sure to have suitable alternatives for students with food allergies or dietary restrictions.
  • Think out safety plans in advance.
    • emergency contact numbers for students
    • phone numbers and locations of nearby medical facilities.
    • orientation to camp upon arrival should include fire drill, emergency exits, and where to gather outside in the event of an emergency.

Sample Student Checklist
(3 days, 2 nights—fall camp)

  • Sleeping bag and pillow
  • 4 shirts and turtleneck
  • 3 pairs of pants
  • socks
  • 3 pairs of underwear
  • 2 sweatshirts or sweaters
  • warm jacket suitable for rain
  • change of outdoor footwear, including boots
  • indoor shoes (sneakers)
  • hat for cool weather
  • mitts or gloves
  • towel and face cloth
  • zipper bag containing soap, comb/brush, shampoo, toothbrush, toothpaste
  • a book to read
  • board games/cards (optional)
  • minimal spending money for snacks and small souvenirs

Important:

  • Please put your name on all belongings.
  • All gear should be packed in one soft-sided duffle bag due to space restrictions.
  • * We request that Walkmans and electronic games remain at home.

A syndrome is a group of symptoms that occur together and may affect the whole body or any of its parts. The following selected syndromes affect the eye.

see Specific Eye Conditions, Corresponding Impact on Vision, And Related Educational Considerations for more information.

SyndromeGeneral CharacteristicsOcular Involvement

Bassen-Kornzweig Syndrome

It is an autosomal recessive condition that more often affects males. It is caused by a defect in a gene that tells the body to create lipoproteins (molecules of fat combined with protein). The defect makes it hard for the body to properly digest fat and essential vitamins.

  • Progressive degeneration of the retina that can advance to near-blindness
  • Night blindness is an early and prominent symptom
  • Atypical retinitis pigmentosa
  • The macula may or may not be affected while peripheral fields are often severely constricted
  • Loss of photoreceptors  continues throughout life

Batten-Vogt-Mayou Disease (also called Speilmeyer-Batten-Vogt)

Batten disease is the juvenile form of a group of progressive neurological diseases known as neuronal ceroid lipofuscinoses (NCL). It is characterized by accumulation of a fatty substance in the brain as well as in tissue that does not contain nerve cells. This disorder is inherited, and is marked by rapidly progressive vision failure (optic atrophy), and neurological disturbances, which may begin before eight years of age. The disorder affects the brain and may cause both deterioration of intellect and neurological functions

  • Development of pigment disturbances resembling retinitis pigmentosa
  • Progressive primary optic atrophy
  • Granular pigmentary change of macula (macular degeneration)

Borneville's Disease (also called Tuberous Sclerosis)

This condition is inherited as autosomal dominant. It is characterized by adenoma sebaceum (large "blackheads"), central nervous system tumors, renal tumors, multiple lung cysts, seizures, and intellectual disabilities. This disease appears at birth or within the first few years and results in death during the teenage years.

  • Retinal tumors

C.H.A.R.G.E. Syndrome

CHARGE stands for Coloboma, Heart defect, Atresia choanae (a congenital disorder where the back of the nasal passage or choana is blocked), Retarded growth and development, Genital abnormality, and Ear abnormality.

  • A coloboma may be present in one or both eyes and can affect vision, depending on its size and location
  • Some people also have microphthalmia (abnormally small eyes)
  • CHARGE syndrome is the leading cause of congenital deafblindness

Cri-du-chat

Cri-du-chat is a chromosomal condition that results when a piece of chromosome 5 is missing. Infants with this condition often have a high-pitched cry that sounds like that of a cat. The disorder is characterized by intellectual disability and delayed development, small head size (microcephaly), low birth weight, and weak muscle tone (hypotonia) in infancy. Affected individuals also have distinctive facial features, including widely set eyes (hypertelorism), low-set ears, a small jaw, and a rounded face.

  • Strabismus
  • Eyes spaced wide apart
  • Folds of skin over the eyelids

Crouzon’s Syndrome

Crouzon’s is a rare genetic abnormality, affecting 15 in every million babies. Although brain development is normal, the plates of the skull fuse before birth. With no space for the brain to grow further, pressure builds up often causing a string of problems: the tubes behind the nose are constricted, teeth are bunched up, the throat is squeezed causing reflux, and ear infections are common.

  • The optic nerves swell and become damaged

DeGrouchy’s Syndrome

A person who has DeGrouchy’s will have a short stature, hypotonia (lack of muscle tone), hearing impairment, and foot abnormalities. Poor coordination, seizures, a small head, underdeveloped mid-face, a carp-shaped mouth, and autistic behavior are all characteristics of this disorder.

  • Nystagmus (involuntary eye movement)
  • Deep-set eyes
  • Slanted spaces between the eyelids
  • Widely spaced eyes
  • Small eyes
  • Corneal abnormalities

Down's Syndrome (Trisomy 21)

Characteristics of Down’s syndrome include small stature, flattened/round faces with an extra fold on the eyelids, saddle nose (a nose in which the bridge has an externally visible concavity and loss of height), thick lower lip, large tongue, an inflammatory skin disorder, smooth hair, obesity, small genitalia, short fingers, congenital heart anomalies and intellectual disabilities.

  • Hyperplasia of iris
  • Narrow palpebral fissures (the opening between upper and lower eyelids)
  • High myopia
  • Strabismus
  • Cataracts
  • Grey spots on the iris

Duane’s Syndrome

A congenital rare type of strabismus.  Duane’s is most commonly characterized by the inability of the eye to move outwards.  While usually isolated to the eye abnormalities, Duane’s syndrome can be associated with other problems including cervical spine abnormalities.

  • Limitation of outward movement of the affected eye
  • Less marked limitation of inward movement of the same eye
  • Poor convergence
  • Often uses a head turn to the side of the affected eye to compensate for the movement limitations of the eye(s) and to maintain binocular vision

Edward's Syndrome (Trisomy18)

Edward’s is characterized by intellectual disabilities and developmental delays, congenital heart defects, and renal abnormalities.

  • Corneal and lenticular opacities
  • Unilateral ptosis (droopy eyelids)
  • Optic atrophy

Galactosemia Syndrome

This syndrome is characterized by allergy to milk; autosomal recessive inheritance pattern. If not identified and treated (withdrawal of milk products), can cause enlarged liver and intellectual disabilities.

  • If untreated, cataracts develop

Gillespie Syndrome

Gillespie Syndrome is a rare genetic disorder in which there is absence of all or part of the iris (aniridia). Gillespie Syndrome is described to look like “a fixed dilated pupil.” Systemic features frequently include hand tremors and hypertonia. There is usually some degree of developmental delay ranging from fine motor difficulties to intellectual disabilities.

  • Visual acuity is usually about 20/60 which can be classified as reduced but functional vision
  • Nystagmus (involuntary eye movements)
  • Ptosis (droopy eyelids)

Goldman-Favre Syndrome

This is an inherited eye disease. There are no general systemic manifestations associated with Goldman-Favre syndrome.

  • Increased sensitivity to blue light
  • Varying degrees of red and green vision
  • Night blindness occurring from early life
  • Vision loss
  • Retinal degeneration

Grave's Disease (Hypothyroidism)

Graves is an endocrine and immune response problem that results in overproduction of thyroid hormones. It is sometimes referred to as hyperthyroidism. Every body system is affected. Some common symptoms include rapid heartbeat, shortness of breath, changes in eyes and vision, tremors and muscle weakness, anxiety, difficulty concentrating and insomnia. This is most common in women

  • Lid retraction
  • Proptosis (abnormal protrusion or bulging of the eyeball)
  • Extraocular (outside of eyeball) muscle involvement
  • Corneal involvement
  • Optic nerve involvement

Hallerman-Streiff-Francois Syndrome

This is a rare genetic disorder in which the primary symptom is the malformation of the bones of the head and face. This leads to an abnormal facial structure involving the mouth, teeth, nose, and eyes. This can result in developmental problems affecting speech, normal chewing and swallowing patterns, and vision.

  • Abnormally small eyes
  • Cataracts
  • Detached retinas developed by teen years

Hermansky-Pudlac Syndrome

This syndome is characterized by a condition called oculocutaneous albinism, which causes abnormally light coloring (pigmentation) of the skin, hair, and eyes; problems with blood clotting; breathing problems due to a lung disease called pulmonary fibrosis; inflammation of the large intestine (colitis) and kidney failure.

  • Oculocutaneous albinism, which causes vision problems such as nystagmus and photophobia
  • Vision problems usually remain stable after early childhood

Hurler's Syndrome (Type I)

Hurler’s is an autosomal recessive condition that is characterized by gargoylism, a thickened tongue, puffy cheeks, umbilical hernia, flat nose-bridge and intellectual disability.

  • Corneal clouding
  • Buphthalmos (abnormally large eyeball)
  • Esotropia (eye deviates inward)
  • Slight ptosis (droopy eyelids)
  • Pigmentary retinopathy
  • Optic atrophy

Laurence-Moon-Bardet-Biedl Syndrome

This is an autosomal recessive condition that is characterized by obesity, intellectual disabilities, polydactyly, and hypogenitalism.

  • Retinitis Pigmentosa

Lowe's Syndrome

Lowe’s is an X-linked syndrome resulting in cerebral defects, intellectual disabilities, dwarfism, renal dysfucntion and high early mortality rate. This occurs only in males.

  • Congenital cataracts
  • Infantile glaucoma
  • Nystagmus

Marchesani's Syndrome

This is an autosomal recessive syndrome that results in multiple skeletal abnormalities. Individuals are short and stocky with well-developed muscles, with hands and feet that are spade-shaped. Childhood x-rays show delayed carpal and tarsal ossification.

  • Spherophakia (congenital bilateral anomaly in which the lenses of the eye are small, spherical and prone to subluxation
  • Ectopia lentis (partial displacement of the lens) which leads to lenticular myopia
  • Iridonesis (an iris that is not held in place by the lens)
  • Glaucoma (which resists treatment)
  • Poor visual prognosis

Marfan's Syndrome

Marfan's is an autosomal dominant, hereditary disorder. Marfan’s is characterized by  arachnodactyly (increased length of long bones especially in fingers and toes); scanty subcutaneous fat (relaxed ligaments); congenital heart disease; spine/joint deformities; high infant mortality rate.

  • Dislocated lens (usually superiorly and nasally)
  • Severe refractive errors
  • Megalocornea (front third of the eye is larger than normal)
  • Cataracts
  • Uveal colobomas
  • Secondary glaucoma

Moebius’ Syndrome

This is an extremely rare congenital neurological disorder, which is characterized by facial paralysis due to underdevelopment of cranial nerves. Respiratory problems, speech and swallowing disorders, visual impairments, sensory integration dysfunction, sleep disorders, and weak upper body strength may also be present.

  • Eye sensitivity due to inability to squint
  • Absence of lateral eye movement
  • Absence of blinking
  • Strabismus

Norrie’s Disease

This is a rare X-linked genetic disorder that causes abnormal development of the retina.  About one third of individuals with Norrie's disease develop progressive hearing loss, and more than half experience developmental delays in motor skills such as sitting up and walking. Other problems may include mild to moderate intellectual disability, often with psychosis, and abnormalities that can affect circulation, breathing, digestion, excretion, or reproduction.

  • Cataracts
  • Leukocoria (a condition in which the pupils appear white when light is shone on them)
  • Developmental issues in the eye, such as shrinking of the eyeball (phthisis bulbi)

Peter’s Plus Syndrome

This congenital condition is characterized by developmental delays, short stature, cleft lip, distinctive facial features, and abnormal development of the front part of the eye (Peter's anomaly). Most cases occur by chance, but it sometimes runs in families (autosomal dominant). A child may then "inherit" the condition from one parent.

  • Central corneal opacity
  • Corneal thinning
  • Adhesions on the iris and cornea, which usually result in glaucoma
  • Frequently leads to amblyopia (suppression of visual information from the affected eye)
  • May be associated with cataracts and other lens abnormalities

Refsum's Disease

This congenital, genetic disease affects neurological and metabolic processes that break down and eliminate certain fatty acids and toxic substances from the body. It results in Spinocerebellar ataxia, deafness and polyneuritis. It is also characterized by retinitis pigmentosa, anosmia (loss of sense of smell), and neuropathy in the hands and feet. The condition is progressive, and symptoms may not appear until middle age.

  • Retinal degeneration

Reiter’s syndrome

Reiter syndrome is a type of reactive arthritis that happens as a reaction to a bacterial infection in the body. The infection usually happens in the intestines, genitals, or urinary tract. Reiter syndrome includes joint swelling and pain, often in knees, ankles, and feet, along with inflammation of the eyes and urinary tract. It is not contagious, but the bacteria that trigger it can be passed from one person to another.

  • Conjunctivitis (inflammation of the eye)
  • Iritis (inflammation of the iris of the eye that needs immediate treatment to avoid eye damage)
  • Uvieitis (inflammation of the inner eye that needs immediate treatment to avoid eye damage)

Rubella syndrome

Rubella syndrome is caused by maternal infection of the fetus resulting in heart abnormalities, vision and hearing defects and sometimes-intellectual disabilities.

  • Bilateral cataracts
  • Uveal colobomas
  • Searching nystagmus
  • Microphthalmus
  • Strabismus
  • Retinopathy
  • Glaucoma

Scheie syndrome

Scheie syndrome is a condition characterized by corneal clouding, facial abnormalities and normal lifespan. Also known as "MPS I-S"; it is a less severe version of Hurler syndrome.

  • Corneal clouding

Septo-Optic Dysplasia
(SOD, DeMorsier’s Syndrome)

SOD is a rare disorder, present at birth, in which the optic nerve is underdeveloped, the pituitary gland does not function properly, and often a portion of the brain tissue is not formed (septum pellucidum). Some children with SOD have normal intelligence, while others may be developmentally delayed, learning disabled, or intellectually disabled. Some symptoms of this disorder can be treated, but the visual impairment usually cannot be corrected.

  • Optic nerve hypoplasia (underdevelopment of the optic nerve)
    • Hypoplasia is generally manifested by nystagmus (involuntary eye movements, often side-to-side) and a smaller-than-usual optic disc
  • The degree of visual impairment is variable, and ranges from near normal vision to complete blindness

Stevens-Johnson Syndrome

SJS is a rare, life-threatening disorder caused by a reaction to medication, infection, or food. A rash with blisters and lesions on the skin and mucus membranes develops, which damages the eyes and causes the top layer of the skin to separate and die.

  • Purulent conjunctivitis
  • Occlusion of lacrimal gland ducts, which produces a “dry eye”
  • Corneal ulcers
  • Panophthalmitis (infection in all structures of the eyeball)

Still's Disease
(Juvenile Rheumatoid Arthritis & Systemic-Onset Juvenile Idiomatic Arthritis)

This is an inflammatory disorder characterized by arthritis (especially in the knee joints), high spiking fever, and intermittent rash. Also inflammation of the lungs, lymph glands, ocular tissues, and around the heart may occur. Ocular complications occur three times as often in girls.

  • Chronic uveitis
  • Cataracts
  • Secondary glaucoma
  • Band-shaped keratopathy (corneal abnormality)

Sturge-Weber Syndrome

This is an autosomal dominant condition characterized by port-wine-stain tumor on one side of the face, central nervous system disorders and seizures. There is no treatment and it often results in death by age thirty.

  • Unilateral infantile glaucoma on the effected side which appears at birth
  • Choroidal tumor

Tay-Sachs Disease

Tay-Sach’s is an autosomal recessive syndrome that results in mental and physical deterioration in the first two to three years of life. Death occurs shortly after.

  • Cerebromacular degeneration
  • Degeneration of the inner layer of the retina
  • Retinal pigmentary changes
  • Optic atrophy
  • "Cherry red" spot in macula

Turner's syndrome

This syndrome affects females. It is characterized by retarded growth, rudimentary ovaries in female genitalia, and amenorrhea (absence of menstruation).

  • Pterygium (wedge-shaped growth that may affect conjunctiva cornea)
  • Epicanthus (vertical skin fold on either side of the nose
  • Ptosis (droopy eyelids)
  • Color blindness.

Usher's Syndrome

Usher's Syndrome is a genetic disorder that causes abnormalities of the inner ear and retinal degeneration. It is characterized by some degree of congenital hearing loss and progressive visual impairment. Vision usually deteriorates in the teen years.

  • Retinitis Pigmentosa

WAGR Syndrome

This is a rare genetic syndrome in which affected children are predisposed to develop Wilm's tumor (a tumor of the kidneys), Aniridia (absence of the colored part of the eye, the iris), Genitourinary anomalies, and mental Retardation (intellectual disability)

  • Absence of the iris which can cause reduction in the sharpness of vision (visual acuity) and increased sensitivity to light (photophobia)
  • Cataracts
  • Glaucoma
  • Nystagmus

Wilm's Tumor

Wilm's tumor results in malignancy of the kidney, small stature, and developmental delays. This often accompanies aniridia.

  • Total or partial absence of the iris
  • Cataracts
  • Ptosis
  • Decreased visual acuity
  • Photophobia
  • Nystagmus

Wilson's Disease

This is a recessive inheritance pattern, which includes neurological symptoms, cirrhosis of the liver, and faulty renal function. It is linked to defects in copper metabolism.

  • Pigment ring in periphery of cornea (progressive, but rarely occludes the pupil)
  • Sometimes cataracts

Zellweger's Syndrome

This is one of a group of diseases which are caused by defects in Peroxisomes which are required for normal brain development and function and the formation of myelin, the whitish substance that coats nerve fibers. Peroxisomes are also required for normal eye, liver, kidney and bone functions.

  • Glaucoma
  • Retinal degeneration

ELAINE HOLYOAK KITCHEL, Research Scientist
1990

Abstract

Choices of UV filters and NoIR filters from 60 low-vision subjects were obtained from clients receiving services within Indiana Blind and Visually Impaired Section, Indiana Vocational Rehabilitation Services, Bosma Industries for the Blind and persons at large. Another group of 20 subjects was selected among non-visually impaired employees who worked for those institutions to provide a comparison. Subjects were asked to select for eye comfort, and contrast from among the following filters provided by NoIR Medical technologies: U50 (yellow), U81 (medium plum), U80 (dark plum), U21 (medium grey), U70 (pink), 102 (medium grey green), U10 (clear), U93 (red), U60 (orange), U22 (dark grey), 101 (amber), 708 (dark grey green). Twenty-eight percent of the experimental group chose medium plum filters, 25% chose yellow, with pink being chosen at a rate of 13%. Clients had been asked to select filters in standard indoor light and medium-to-bright outdoor light and judge filters according to the following criteria:

  1. Best contrast achieved and;
  2. Eye comfort

Determinations were then made about which persons most often chose which filters based on statistical frequency. Subjects performed a daily task while wearing the filters in order to determine if the filters actually helped improve contrast or eye comfort. It was found that the subjects who suffered from macular degeneration, glaucoma, retinitis pigmentosa most often chose yellow filters. Persons with histoplasmosis, toxoplasmosis and the category of "other" which consisted mostly of refractive errors and retinopathy most often chose plum, with plum being the most chosen color overall. Filters of red, green, orange and clear all were chosen by at least one subject. Grey was preferred by the control group overwhelmingly. Dark grey, amber, and dark grey green were not selected by any subjects with visual impairments.

Introduction

For many years now experts in low vision have been aware that persons with low-vision often suffer super-sensitivity to light and glare. In 1985, Joseph H. Maino, O.D., and Timothy T. McMahon, O.D., did a study determining their patient's preferences for the NoIR series of light filters. NoIRs are filters which incorporate infrared and ultraviolet absorbers, as well as blue light absorbers in some models. They then determined patient preferences for filters based upon ocular disease and visual acuity.

Drs. Maino and McMahon determined that more than 50% of the patients chose the #101, or medium amber filter. These were mostly patients with dry macular degeneration, glaucoma, and retinitis pigmentosa. About a third of their subjects chose the #102 or grey green in medium tone. This color was preferred by subjects with eye diseases other than those named above. But it should be noted that the Maino-McMahon study included five colors of NoIRs only and did not include the broad color range and the greater light transmissions of the newer NoIR and UV filters available today. This researcher could find no literature which sought to determine the types of UV shields preferred by low-vision persons, especially in colors other than grey-green and amber.

Greater range of color is an important distinction because colored filters have improved greatly since the 1985 study. Traditionally the older NoIRs were very dark and did not allow for much of a color range. In fact, the Main-McMahon study used only five shades, medium amber, medium grey-green, dark amber, dark grey-green, and very dark green. But filters produced now by NoIR Medical Technologies have a wide range of color, shade, and light transmission.

This study uses a wide range of color and light transmission using the new filters produced by NoIR Medical Technologies. This provides for consistent color, shade and light transmission throughout the study:

  • Model U50 medium yellow, transmits 54% of available light.
  • Model U81 medium plum, transmits 20% of available light.
  • Model U80 dark plum, transmits 4% of available light.
  • Model U21 medium gray, transmits 32% of available light.
  • Model U70 light pink, transmits 44% of available light.
  • Model 102 medium gray-green, transmits 18% of available light.
  • Model U10 clear, transmits 90% of available light.
  • Model U93 dark red, transmits 4% of available light.
  • Model U60 medium orange, transmits 49% of available light.
  • Model U22 dark gray, transmits 13% of available light.
  • Model 101 medium amber, transmits 10% of available light.
  • Model 708 dark gray-green, transmits 1% of available light.

All these filters were used in the study.

Methods

The study was conducted on 60 low-vision subjects within the State of Indiana.

These subjects were recruited from among people being served through Vocational Rehabilitation Services, Services for the Blind and Visually Impaired Section and Bosma Industries for the Blind. Another group of 20 persons was recruited from among persons who were not visually impaired who were working or serving in those same agencies to see if their selections were different from those of persons with low vision. Each visually impaired person had been certified as visually impaired by a qualified physician.

The subjects were asked to try on each of the 12 pair of filters mentioned in the introduction in typical indoor light, and medium-to-bright outdoor light and to select a single pair of filters based upon:

  1. Best overall contrast achieved and;
  2. Overall eye comfort.

Each subject was then asked to wear the filters to perform one of his usual tasks and to report whether or not the filters actually provided better contrast or eye comfort. All but one of the subjects reported that the chosen filter actually helped either to achieve better contrast, or helped achieve more eye comfort. Information was obtained on the filter chosen, and primary ocular disease.

Results

Sixty visually impaired subjects presented with 13 different eye diseases or conditions, visual acuity ranged from 20/70 to less than 20/800. Individual conditions which constituted less than 2% of the cases were placed in the "other" category. Persons with Stargaardt's disease were placed in macular degeneration category, Usher's syndrome placed in retinitis pigmentosa category.

TABLE 1: Ocular Disease Represented in the study
Disease/Conditon# of Subjects% of Total

Macular Degeneration

16

27% (includes Stargaard's)

Diabetic Retinopathy

6

10%

Glaucoma

6

10%

Retinitis Pigmentosa

6

10% (includes Usher's)

Histo-Toxoplasmosis

6

10%

Uveitis

4

6%

Other

13

21%

Subjects preferences for the filters in descending order were:

  1. Medium Plum 28%
  2. Yellow 25%
  3. Pink 13%
  4. Medium Grey-Green 10%
  5. Orange 10%
  6. Medium Grey 7%
  7. Red 3%
  8. Clear 2%
  9. Dark Plum 2%
  10. Dark Grey 0%
  11. Amber 0%
  12. Dark Grey-Green 0%

Typical Vision Group Preferences for the Filters in descending order were:

  • Medium Grey 85%
  • Orange 5%
  • Pink 5%
  • Medium Plum 5%

Persons with macular degeneration generally preferred yellow, but plum ran a close second place in this group at a ratio of 5:3. Persons with diabetic retinopathy preferred plum at a ratio of 3:1. Persons with glaucoma preferred yellow at a ratio of 3:1. Persons with retinitis pigmentosa preferred yellow over other colors at a ratio of 2:1. Persons with histoplasmosis and toxoplasmosis preferred plum over other colors at a ratio of 4:1 and persons with uveitis preferred grey over other colors at a ratio of 2:1. Persons in the category of "other" preferred plum at a ratio of almost 6:1. And the typical vision group preferred grey over other colors at a ratio of 17:1.

Discussion

It is interesting to make a few comparisons of the different disease groups within the study and their choices of filters. In general, the groups in which visual field was a main complaint, i.e., macular degeneration, glaucoma and retinitis pigmentosa, tended to choose the filter which let in the greatest amount of light while still affording good elimination of blue and ultraviolet light. This was demonstrated by their preference for the yellow filter with 54% light transmission.

This information tends to support the results of Maino and McMahon who discovered that their patients with dry macular degeneration, open-angle glaucoma, and retinitis pigmentosa preferred filters #101 (light amber) by 2:1 in the cases of macular degeneration and glaucoma, and 17:1 in the cases of the retinitis pigmentosa patients. One could argue this is because the filter #101 in that study was the one which let in the greatest amount of light.

In our study the model U50 or yellow filter lets in light of the same part of the spectrum as the #101 amber filters, but lets in 54% of total available light as compared to 10% in the #101. This underscores the need for maximum light for people with macular degeneration, glaucoma, and retinitis pigmentosa while shielding them from the irritating ultraviolet and blue end of the visible light spectrum.

Persons with Diabetic retinopathy, histo-and toxoplasmosis in which the field is not necessarily small or peripheral, but rather scattered with scotomas preferred less light as afforded by their choice of the medium plum filter, 20% TLT (total light transmission) while still allowing good ultraviolet and blue light protection. Many cited "eye comfort" as their primary consideration.

Persons in the "other" group which consisted of those with refractive errors, cataracts, malformations, and brain injuries preferred the plum also, but there again, narrow or peripheral field is not usually a consideration.

The typical vision group overwhelmingly preferred medium grey, demonstrating that since improving their vision is not a consideration, they prefer to stay with a color they are comfortable with and have traditionally used in the past. Many of the typical vision group stated that they were resistant to change.

It is also notable that no one chose the filters with less than 18% light transmission in the grey, amber or grey-green colors. One person did select the 4% dark plum. But overwhelmingly all groups chose filters with at least 20% TLT.

These choices eliminated virtually all of the NoIR choices, in favor of the UV filters with more light transmission. Yet, oddly, many optometrists and opthalmologists still favor dark green, gray-green and dark amber when they prescribe or dispense a filter.

Conclusion

Given a choice, persons with low vision in this study will choose filters to promote maximum contrast and eye comfort. Persons with macular degeneration glaucoma, and retinitis pigmentosa demonstrated a need for more light than other persons with other diseases, as demonstrated by their choices of the yellow U50 in 60-75% of those cases. Persons with diabetic retinopathy, histo and toxoplasmosis and other eye diseases, prefer plum filters in a clear majority of the cases, 80-91%. The IR only filters were not preferred by any group. A few subjects did choose the medium grey-green NoIR, but not with enough frequency to be statistically important. We can conclude that people, both Visually Impaired and those with good vision, seem to prefer filters which eliminate ultraviolet over those which eliminate only infra-red. Of the UV filters tested, Plum U81, was the one most preferred, with yellow U50 running a close second. U21, medium grey was preferred by the typical vision group. Thus we may conclude that the choices of filters made by persons with low vision, do differ from those made by persons with typical vision. These choices are greatly impacted by the eye pathology of the person doing the selecting. This information implies that the color and wavelength of light entering and light reflected in the environment of the person with visual impairment affects his/her eye comfort and ability to detect visual contrasts. These results could be helpful to those designing environments for persons with low vision, and those recommending solutions to lighting problems.

TABLE 2: OCULAR DISEASES REPRESENTING 2% OR LESS OF TOTAL CASES STUDIED
Photophobia of unknown etiology 1
Severe Myopia 2
Retinal Detachment 2
Retinopathy of Prematurity 2
Papilledema 1
Brain Injury 2
Congenital Malformation 1
Cataract 2
TABLE 3: COLOR CHOICES IN DESCENDING ORDER USING TOTAL SAMPLE
FREQUENCYCOLOR CHOSENFILTER #TOTAL LIGHT TRANSMISSION
28% Medium Plum U81 20% TLT
25% Yellow U50 54% TLT
13% Pink U70 44% TLT
10% Orange U60 49% TLT
10% Med Grey Green 102 18% TLT
7% Medium Grey U21 32% TLT
3% Red U93 4% TLT
2% Dark Plum U80 4% TLT
2% Clear U10 90% TLT
0% Amber 101 10% TLT
0% Dark Grey U22 13% TLT
0% Dark Grey Green 708 1% TLT

Resources

  1. Legge, G.E. & Rubin, G.S. (1986). Psychophysics of reading. IV. Wavelength effects in normal and low vision. Journal of the Optical Society of America, A3, 40-51.
  2. Maino, Joseph H. and Timothy T. McMahon, O.D., "NoIRs and Low Vision," JOURNAL OF AMERICAN OPTOMETRIC ASSOCIATION, Vol.57, Num.7, July, 1986.
  3. "Light Transmission Curves of the UV Shield," NoIR Medical Technologies, South Lyon, MI.
  4. "Light Transmission Curves of the NoIR," NoIr Medical Technologies, South Lyon, MI.

Presented at AER 2002, Toronto by Kimberly Avila M.A., COMS

College is an exciting time of learning, growing and achieving goals. Any person attending college, regardless of age and background, goes through a period of transition in which they adjust their lives to accommodate new demands brought on by higher education requirements. Persons who are blind or vision impaired must deal with these challenges along with an entire different dimension of transitional issues that can be challenging. The American Foundation for the Blind found that students with vision impairments are less likely, than their sighted peers, to finish college. (1993) Why are persons with vision impairments less likely to finish college? Furthermore, for those who do complete higher education, how can they prepare themselves for the transition to college to alleviate the added stress of being a college student with a visual impairment?

As a teacher for the vision impaired who works with high school students, I wanted to explore the challenges college students with visual impairments encounter so I could assist my students in preparing themselves for college. As a result, I conducted a study during the summer of 2001 surveying 23 adults who are blind and vision impaired who have had at least some college experience and dealt with challenges in higher education. Participants were asked to provide their input on how upcoming college students can best prepare themselves for a smooth transition. A continual dialogue has developed with several of the adults who responded to the surveys in order to clarify and get further remarks about college life for the vision impaired.

Correspondence, including the distribution of surveys, was done electronically and at meetings of consumer organizations of the blind. Surveys reached all over the United States and beyond, including a rehabilitation program for the blind in New Zealand. Participants were quite diverse in age, background, ethnicities and differed in the amount of years they attended college and degrees earned. Some respondents are current college students; others are successful professionals, business owners, homemakers, members of the Peace Corps, graduate students, farmers and clients of a rehabilitation program for the blind.

The responses to the survey were interesting, yet not surprising. As participants described what areas they could have been better prepared in for a smoother transition, I was quickly reminded of the “Expanded Core Curriculum” Phil Hatlen published years ago. The Expanded Core Curriculum defines areas in which students with vision impairments should receive further instruction. These areas are:

  • Compensatory Skills, including communication models
  • Visual Efficiency Skills
  • Social Skills
  • Independent Living Skills,
  • Recreation and Leisure Skills,
  • Orientation and Mobility
  • Vocational Education and
  • Assistive Technology
    (Hatlen, 1996)

Long before I conducted my survey, the Expanded Core Curriculum had been in place and implemented into the National Agenda as areas defined as needs neglected in general education. However, according to my study, these areas are still being neglected and students are not getting what they need for a smooth transition to college. In the 1998 National Agenda; Report to the Nation by the American Foundation for the Blind, studies also concluded that schools are not allowing adequate time for instruction in and do not have qualified personnel to teach in these areas.

Consistently, respondents marked a need to receive instruction in all of the above-mentioned categories. Moreover, EVERY participant marked an intense need for instruction in the use of adaptive technology in order to be successful and independent in college and employment. All respondents remarked that this is a heavily neglected area that is one of most detrimental factors that impedes their success in college. Several participants stated that they had to pay a large amount of money and spend an excessive amount of time to learn the technologies while in college, which ultimately affected their academics, work and social lives. Below are just some of the quotes made by respondents emphasizing the need for adequate adaptive technology instruction.

“Adaptive technology, this is the bulldozer that levels the playing field” Undergraduate Student who is also employed

“There is no way ANY college student will make it through school without technology. A blind or vision impaired person must have these skills in order to have a fighting chance in school, and to be independent.” Undergraduate Student

“Technology is needed to set the student at an even playing ground. It is vital in a quality education.” Information Technology Consultant

“Technology can, and will make the difference between some semblance of independence and total dependency. Further survival may come down to the issue of adaptive technology” Doctoral Graduate Student

“… the world of employment centers almost exclusively around computers and the ability to access them is vital.” Graduate Student

“…OCR’s, screen magnifiers, screen readers, good computer skills; I am struggling to learn these skills just to be competitive.” Business owner and former Peace Corps Member

“In these ever-more-technical times, I believe it's getting harder and harder to find a job that doesn't require some computer knowledge.” Software Engineer

The other areas that participants felt teachers and rehabilitation programs should focus on are advocacy and social skills, including working with readers and others who assist them. Several participants remarked that they felt very alone moving to college from high school when they realized they had to rely on themselves for taking care of their needs.

“We must learn that we cannot totally rely on services which are supposed to assist us, because there are limited resources and service providers. In order to show that we are independent thinkers and able to take care of ourselves, we must learn how to rely on our self-advocacy skills in order to make gains in employment, etc.” Graduate Student

“Confidence, communication, advocacy, working with people, problem solving, knowing what you want and creating a plan to obtain your goal, these are the crucial skills students with vision impairments must have in order to succeed in college. College Professor

“Social skills go along with fighting the misconceptions and stereotypes some have about blind people. Eye contact should be taught at an early age, and kids should also be taught that "blindisms", like eye poking, rocking, etc. are not appropriate. I am not saying that one should try to look sighted; it is just that we need to look our best and present a confident figure when seeking employment and college admissions.” Graduate Student

“Confidence, Confidence, Confidence” Business owner

“Self advocacy is a very important self confidence and identity builder.” Rehabilitation teacher

“Knowing how to direct readers around a library, knowing how to communicate with those who do not understand my blindness, coming up with reasonable accommodations with my professors, these are things I really had to work on in college.” Business owner

When responding to questions related to Orientation and Mobility and travel, all respondents emphasized how important good cane travel is to their independence and success. However, in almost every survey, participants consistently remarked that one of the most challenging aspects of being blind are issues surrounding transportation and not being able to drive. Some respondents discussed in depth how difficult it was to attend college on a campus that had several mobility obstacles, such as busy streets cutting through campus and several difficult to follow paths around the school. These factors physically put a barrier between these students and their college education.

In regard to independent living, personal care and home management, respondents gave a wide variety of perspectives. Some felt that the training they received from their families or rehabilitation programs in home management was adequate. Others indicated that they had minimal rehabilitation teaching and limited family support, which affected their preparedness to manage their personal lives, finances, home and the like.

“If a young person going off to college does not have a sense of balancing a checkbook and paying bills, disaster could result. I think so many parents do not allow their blind children to handle their own money, but this is something kids must learn.” College Student

“I am glad I had the opportunity to learn how to take care of a home while still living at my parent’s home, I could not imagine learning all of that now with everything else going on.” College Student

“Families cannot shelter their blind children from the world, hoping it will go away. Kids will grow up, and the best way to help them is to let them help themselves. Parents who do everything for their children are not doing them a favor, let them have experiences, and let them make mistakes. It will hurt them a lot less if they make a mistake with a small allowance, or a minor cooking mistake under your care, but if these mistakes are made for the first time outside of your home, the consequences could be horrible.” Teacher

After reading the wide variety of responses, it was evident that some people encounter their most trouble in college because of a lack of instruction in the above-mentioned areas from teachers for the vision impaired, rehabilitation facilities and families. These factors, along with the lack of training in technology, use of self-advocacy and social skills, management of their personal lives impacted the respondent’s academics and social lives in college.

Despite the publicity on the importance of including the Expanded Core Curriculum in a student’s education and the continued findings that pinpoint exactly where discrepancies lie in preparing students for college and employment, thousands of people with vision impairments go to college without the basic tools they need to achieve their goals without undue challenges. Yet, as the National Agenda stated, and the results of my survey confirmed, these crucial areas are still being neglected. I wondered why and so began researching why so many students are lacking these skills. I surveyed teachers, service providers, rehabilitation professionals and persons with vision impairments to get a more conclusive understanding. Most professionals in rehabilitation and education of blind persons are aware that their students and clients will face challenges in college. Many professionals are simply unaware that many resources exist that assist visually impaired people. They realize that their students must take the College Board tests, but do not understand the extensive amount of work it will take to get the accommodations in place for the test.

Students and professionals know that students will receive service from the student’s with disabilities office on campus, but how are those services set up and who is responsible for what? It is known that while on campus, students must attend to their own needs, but how are students to advocate for their needs, work with a reader and manage their personal lives while still maintaining good academic standing in order to actually stay in college? In many cases, it was evident that the challenges these students would face began long before they started their first college class. Participants in the study often remarked that they did not realize they should have investigated the campus and surrounding community even before applying to evaluate the accessibility of the campus. Many respondents indicated that they were in for a rude awakening the first day on campus when they realized the campus was inaccessible to them.

It became clear in my study that students, parents, teachers and rehabilitation professionals need guidelines to teach these skills. This is why I developed the E.X.P.L.O.R.E. Curriculum. My work on E.X.P.L.O.R.E. began as I had some challenges in college as a visually impaired student. It continued as I worked in my graduate school’s office for students with disabilities where I saw other students who are blind enduring the same struggles I had overcome a few years earlier. Now, as a teacher for the vision impaired and after completing this study, the flaws that exist in transition are very clear. E.X.P.L.O.R.E. is an acronym that outlines the steps a person with a vision impairment may use to facilitate a smooth transition. It can be used as an educational curriculum in a school or rehabilitation facility, or by a student alone, or with a parent. It can be adapted for non-traditional aged students and those wishing to attend a community college program or other non-four year degree program.

Below is an outline of the E.X.P.L.O.R.E curriculum.

E: the Eliminator:

This section contains a list of common criteria many participants in the study indicated are crucial in selecting a college that meets the unique needs of people with visual impairments. A student may also customize this list to include, or exclude features that they may or may not need on the college campus.

X: eXamine

Examine what you need for college and devise a plan to work on your areas of need. This section comes straight out of one of the respondent’s suggestions. She said that whenever she faced a challenge, she made two lists, one with all of the positive things that are going on and that she is proud of, and another with a list of what needs to change in order for her to be successful. She picked a couple of things to work on from this list and set goals. In this section, the student will evaluate him or her self and decide what areas need to be worked on for a smooth transition to college. Goals are set from these areas. If the student is in high school, this section assists the student in becoming a leader in creating necessary IEP annual goals that are relevant to the transition plan.

P: Paperwork:

This section outlines and discusses all of the different types of paperwork and documentation you may need in college. It briefly describes where and how to gather this information and guidelines, along with factors to consider when applying to college when you have a disability. Establishing services with your office for students with disabilities is described in this section, along with working with the Department of Rehabilitation Services and other professionals people with vision impairments work with on a regular basis.

L: Legislation:

Learn what laws entitle you to rights in higher education; also learn what your responsibilities are and how to fulfill your end of the bargain.

O: Obligations:

You will have many obligations you need to commit to prior to your first day of classes. Using an agenda book, either in braille, print or electronically is a must. In this section, you will read about scheduling appointments ahead of time with Orientation and Mobility specialists to assist you in getting to know the campus, the cafeteria and the rest of your new environment. You may need to schedule a lesson with a rehabilitation teacher to help you learn how to use the laundry machines at your dorm. Ordering materials, communicating with professors and the office for students with disabilities and taking care of all of those little, but crucial, details is outlined in this section.

R: Rehabilitation:

Attend a rehabilitation program if that is part of your plan you created in the eXamine section. If you do not need a residential program, devise your own rehab program with local resources. This could be attending a community college course to familiarize yourself with attending a college class before you move on to the university. Also, consider the suggestions in this section, such as making your parents have you cook dinner, do your own laundry, assist in grocery shopping and managing money. Although these skills should be taught and practiced all throughout life, they should be focused on during the months before leaving for college.

E: Extra Curricular and Enjoy

Most of the college experience is not academic; it is social. In this section, the student will read some of the funny, and not so funny circumstances other people who are blind and vision impaired experienced in school. Information on dealing with roommates, getting involved, socializing and having an all around “college experience” is outlined in this section.

Materials:

The following are materials used for the E.X.P.L.O.R.E. curriculum.

  • Student day planner book. It is highly recommended the student keep track of appointments, deadlines and goal dates with a day planner in either print, large print, braille or in electronic format.
  • Student data collection book. This is a three ring binder that is used to store important documents. Plastic three-ring sheet covers are put in the blinder that hold and protect documents. The eye-doctor verification sheet, letters of recommendation, transcripts, college essays, résumés, college acceptance letter, are just some of the types of papers stored in this notebook inside the sheet protectors. Braille labels can be put on each sheet protector to allow a totally blind student knowledge of what is inside that pocket. I recommend each student make several copies of these important documents once they are obtained or completed and place the original and copies in one plastic sheet protector. This way, when applications are being completed, or if these papers are needed immediately, the student may simply locate that pocket and remove one copy needed.
  • An E.X.P.L.O.R.E. lesson plan book is also part of the materials. A teacher, parent or rehabilitation professional may use it as a guide for creating transition enrichment activities, or students may use it independently as a guide for their own transition program. Also in this notebook, students may collect other information and articles pertinent to their individual needs. Scholarship applications and other resources are filed in this notebook as well for the student to refer to throughout the college admissions and financial aid procedures. These documents are retained for the student to refer to in following years as a reminder of available scholarships and for contact information so a current application can be obtained.

E.X.P.L.O.R.E. in the Future

The E.X.P.L.O.R.E. curriculum has another phase of study ahead. I have begun to implement it in with high school students I work with. However, within the next few years, I plan to use it with upcoming juniors and seniors. After completing some college, I will have them respond to a survey about the training effectiveness of the E.X.P.L.O.R.E. program. It is my hope to distribute a “beta-testing” version of E.X.P.L.O.R.E. to itinerant teachers, rehabilitation programs and adults with vision impairments to further assess and revise the program.

Works Cited

American Foundation for the Blind, Corn, Anne, Kathleen Huebner ed. A Report to the Nation; The National Agenda for the Education of Children and Youths with Visual Impairments, Including Those with Multiple Disabilities. New York, NY: AFB Press, 1998

American Foundation for the Blind Statistics: Education Attainment http://www.afb.org/info_document_view.asp?documentid=1374#ed 6/4/01

Hatlen, Phil The Core Curriculum for Blind and Visually Impaired Students, Including Those with Additional Disabilities 1996.

Jennifer Urosevic
Orientation And Mobility Instructor, Early Intervention Specialist
Canadian National Institute For The Blind

Lee-Anne Cross
Early Childhood Educator, Early Intervention Specialist
Canadian National Institute For The Blind

Download Word version 268k

Introduction

Concept development and sensory awareness begin in infancy and continue to develop throughout a child's life. They are intertwined in every part of one's life, whether as a preschooler learning left from right, as a child learning Braille, or as a teenager learning to use cardinal directions. When these skills are continuously reinforced in all aspects of a child's life, and throughout daily routines, the child will ultimately gain greater independence.

In our fast–paced society, it is tempting to search for the perfect toy which will teach children, while overlooking the many opportunities and tools which exist within our own homes and communities. The benefits of using household items and daily routines are many.

We need to provide activities and opportunities which are rich, varied, and which help to develop concepts and life skills. It is easy to begin to search for the ideal toy, flashy and bright, which will teach these skills. And certainly, these types of toys do have a place in a child's play. However, we need to question which type of activity the child will learn more from: an electronic toy which has only hard plastic textures, with sounds which are not meaningful except within the context of that toy, or household objects which the child will experience throughout daily activities.

For example, an electronic toy can teach a child to sort shapes, with sounds which correspond to a picture of an animal on each shape. These pictures or plastic shapes of animals are likely meaningless to a blind or visually impaired child, and thus the sounds may be meaningless too. Over-reliance on toys to develop concepts may lead to the risk of developing empty vocabulary and over-simplified concepts. In contrast, the child could use a cutlery tray and cutlery to sort; the sounds will be familiar, the shapes are more interesting and give more auditory feedback, the child can match as well as sort, count, and create sets (sequencing and pre-math.) The child may easily transfer this shape sorting to a functional task of setting the table. This activity could also involve a daily routine of washing and drying dishes, and setting the table. Differences in size and shape of utensils may also be discussed. The activity of sorting shapes thus becomes a life skill as well.

Use of household objects is more likely to be appropriate and respectful of a child's culture and circumstances. Some cultures continue to live a simple lifestyle, with an absence of modern technology. Families with lower incomes may feel pressure to spend money on the latest and greatest electronic toy if we inadvertently give them the impression that this is what their child needs. Sometimes the very fact that we, as professionals, are using a particular toy conveys a message that this is the best item to use. We need to be aware of the values and resources of each family. Use of their own household items and routines makes this easy and effective.

Families are now living extremely complicated lives, filled with many demands on their time and resources. Teaching through the use of daily routines allows learning opportunities to occur on a consistent and frequent basis. Transfer of skills from play situations to life skills will also occur more smoothly. And finally, using homemade materials is cost effective and environmentally friendly.

Professionals and parents of children who are blind or visually impaired continually seek new opportunities to teach and reinforce concepts and sensory skills to children. This document is intended to provide parents and professionals with hands–on activities and resources to enhance the development of concepts and sensory skills by using tools that are easily available. Toys and activities that will be described are homemade using inexpensive and accessible items. The advantages of using real objects (as opposed to toy representations) are many, as are the advantages of teaching through daily routines and opportunities.

We have drawn heavily on the approaches of Maria Montessori and Lilli Nielsen in the process of collecting the activities contained in this book.

This collection is merely a beginning: we have included a sampling of ideas which we believe to be most useful. There are an unlimited number of activities to be found or created. We have chosen a binder format so that you can easily add new activities to this collection.

Be creative, be imaginative, be safe and have fun!

The Montessori Approach

The Montessori approach to early childhood education makes use of items which promote life skills as well as skills in all developmental areas. Montessori activities are "hands on" tasks which provide a solid grounding for later abstractions. Because of the strong foundation laid, these more complex tasks are more fully understood and are not carried out as mere rote operations. Materials developed within the Montessori approach are simple, and often made of natural materials which are rich in sensory features.

The underlying principle in Montessori theory is that the learning capacity of a young child is fundamentally different from that of an adult. The difference is not merely the quantity that can be learned: unlike the adult the child appears able simply to absorb, without effort, through participating in an activity. The young child has an "absorbent mind," which lasts until the child is approximately six years of age.

The first phase of this absorbent mind period is from birth to three years; the Montessori theory emphasizes that this is the most formative time in a child's development. During this phase the child absorbs all available impressions in detail, and each impression is instantly incarnated into, and superimposed upon, all previous ones. The child responds most to human stimuli, especially the human voice.

Utilizing the surroundings as substance to absorb, the early absorbent mind helps create, at about age three, the child's basic human abilities.

In the second phase of the child's development, from age three to six, the absorbent mind continues to function but now appears to be more specific. The mind is focused on certain impressions gained through intentional interaction with the material as well as human environment. These new experiences integrate the abilities earlier created.

The Montessori method always starts with the concrete and gradually builds up to the abstract. For example, a child may begin by grouping and counting beads, and then progress to understanding literal and material sense, and what is meant by adding quantities, before proceeding to work with numbers themselves.

Maria Montessori had one aim: to assist the child's natural development. The end result of this development would be a self-sufficient, well-adjusted adult. Therefore, any assistance we offer to the child's development must, by definition, foster independence and self-sufficiency.

The Montessori approach fosters independence in two ways. First, it provides freedom and independence in learning. Second, it helps the child acquire tools for living: that is, the skills and abilities which give a person choices in life and which make one free from dependence on others.

Lilli Nielsen's Active Learning Approach

Lilli Nielsen is a world-renowned educator of children who have visual impairment in addition to multiple disabilities. She has published numerous books, lectured all over the world, and completed scientific research on spatial relations in congenitally blind infants. Lilli Nielsen has developed an Active Learning Approach which emphasizes the use of household items for sensory stimulation and concept development.

Lillie Nielsen has stated that children who are at very young developmental levels cannot be "trained" or "taught." If we provide too much direction, and too much hand-over-hand assistance, we may teach children that only adults direct learning. We may teach them to be extremely passive, and to expect physical assistance. Instead, we need to provide activities and opportunities which are rich and which the child can explore independently. Lilli Nielsen's choice of materials is both cost-efficient and logical. Electronic toys certainly do have potential for learning, but their appeal is often fleeting. Household items are often rich in sensory features, they are inexpensive and readily available, and the range of items available is almost unlimited.

The main emphasis of the Active Learning Approach is on promoting independent interaction rather than passive participation. Children at very young developmental stages learn by doing; they need to initiate their own tasks and to explore independently. Adults must be willing to set up the environment and help to reinforce what the child has done rather than impose their own priorities. Lilli Nielsen also states that "Repetition, repetition and more repetition creates the necessary conditions for the beginning of experimentation with noises and the desire to experiment keeps alive the sense of curiosity, as well as giving the child even more experience patterns." (The Comprehending Hand, 1979.)

It is essential to have good understanding of a child's developmental level, and of the concepts involved in the task we are asking them to perform. For example, when we ask a child to sort blocks according to size, we are asking him to understand the concepts of same, different, large and small. Although the task appears simple, the concepts may be complex. Lilli Nielsen goes on to state, "Problems of this kind should at any rate not be given to the child except in connection with the handling of ordinary, real-life objects as met with in everyday situations." (The Comprehending Hand, 1979.)

"When the child is able to sort bricks, balls, etc., or articles of the same size but with different kinds of surfaces, then it would be meaningless to keep on exercising just that sorting ability. The ability to sort objects must be extended and combined with other tasks. For example: "˜Here are your jumpers-today you are going to put on the woolly one.' "˜Here are some forks and spoons. Put one fork and one spoon on each plate.' "˜Here are the rods. Take the wooden ones, they're the best ones to use for this game.' "˜Here's a basket with eggs. The larger ones we are going to use for hard-boiled eggs; the smaller ones are for baking. Take all the smaller ones because we are going to bake today.'" (The Comprehending Hand, 1979.)

The Active Learning Approach is one which emphasizes the need for materials and learning opportunities which directly relate to meaningful life skills.

Source Disclaimer

It is in no way our intent to claim "ownership" of these ideas. There are many creative and imaginative individuals working with young children. By choice or necessity, these individuals have learned to make something from nothing. This manual is a collection of activities we have encountered, or created ourselves over the years. It would be impossible to credit each activity, and thus we acknowledge that credit for this collection is shared among many persons.

Safety Disclaimer

While every effort has been made to suggest toys and activities which are safe for young children, there is no substitute for individual use of sound judgment. The toys and activities in this collection are suggestions, not recommendations. It is the reader's responsibility to use their own judgment and knowledge of safety when presenting activities. Children can be unpredictable, and close supervision is essential at all times. It is also essential that adults are aware of possible chemical contaminants or substances which may cause allergic reactions. This may include awareness of latex-containing objects (eg. erasers, balloons) and peanut products (eg. containers which may have contained, or been in contact with, peanut products.) The presenters accept no responsibility for damages resulting from the use of any activities included in this collection.

Nesting Boxes

Focus: concept of large, small, nesting, stacking.

Materials:

  • boxes of various sizes, with removeable lids
  • wallpaper/construction paper in several bold colours.

Procedure: Cover boxes and lids with wallpaper in matching colours (eg. large box and lid blue, smaller box and lid yellow, etc.). Child can match lids and boxes, nest boxes inside each other, stack boxes, hide items inside box.

CURLER CAN

Focus: tactile awareness, fine motor development, concept of matching size/shape, concept of in/out.

Materials:

  • coffee can with lid
  • scissors/ craft knife
  • several sizes of velcro-style curlers in bold colours

Procedure: Trace sizes of curlers onto the lid, and cut out with scissors or craft knife. Lid may be reinforced with duct tape on the underside. Child may then push curlers through the correct sized hole. Velcro curlers have an interesting texture and sounds, and will cling together.

Notes: you may vary this activity by covering blocks or thread spools with different textures, and cutting corresponding holes in the lid.

CEREAL BOX FELT BOARD

Focus: vision stimulation, letters, shapes, understanding of abstract pictures.

Materials:

  • empty cereal box
  • navy blue/black and white felt (8"x12")
  • felt scraps in bold colours
  • glue

Procedure: Glue the larger felt pieces onto the box; white on one side, black/navy blue on the other. Cut the felt scraps into shapes, letters or numbers. Be sure to choose colours which will contrast with the dark or light felt colours on the box. Store pieces inside the box when not in use.

Notes: You may also use a felt-covered box to demonstrate a Braille cell. On the white felt side, use a juice can lid (from a pull-tab an which is not sharp) to trace six circles onto the felt in the pattern of a Braille cell. Use fabric paint or hot glue to make a tactile and visual outline of each circle. Glue the "scratchy" side of velcro on to the back of six juice can lids, and use them as the dots when demonstrating the patterns of Braille letters.

SCENT BOTTLES

Focus: awareness of sense of smell, matching scents with pictures

Materials:

  • small containers (baby food jars, M&M tubes, etc.)
  • scented items (eg. peppermint, peanut butter, lemon,
  • coffee, shaving cream, cinnamon, etc.)
  • pictures of the above items.

Procedure: Place scented items in containers, and poke holes in lids. Child may smell each container, and verbally tell you what they smell, or match the corresponding picture. You may also discuss with the child where they may find these items/scents (eg. kitchen, bathroom, etc.)

FEEL AND TELL BOX

Focus: tactile discrimination, concept of matching.

Materials:

  • cereal box or shoe box with lid
  • felt (enough to cover top of box)
  • scraps of different textures (eg. wallpaper, sandpaper, fabric)
  • juice can lids from pull-tab cans (no sharp edges on lids)
  • glue

Procedure: Cut scraps into circles the size of the juice can lids. Glue scraps on, making two lids with each texture. On one lid of each pair, glue the "scratchy" side of velcro on to the back. The non-velcro=d lids go inside the box; their matching lids are placed on the felt on the outside of the box. The child may then reach inside and try to find the lids which match the ones on the outside of the box. You may wish to begin with a limited number of textures and choices, and gradually build up to a wider range of textures as well as textures which are more difficult to discriminate between.

TIN CAN WIND CHIME

Focus: auditory awareness, localizing sound, orientation

Materials:

  • 4 tin cans of various sizes, one end removed, and edges not sharp.
  • string
  • waterproof paint in bold colours
  • juice can lid (no sharp edges)

Procedure: Paint each can a different colour and allow to dry. String cans in order of size, with largest at the top. Overlap cans slightly so that the cans easily bump against each other. Hang the juice can lid from the bottom end of the string. Hang wind chime outside, and keep the location consistent. Help the child to explore his surroundings and then locate the sound of the wind chimes again.

COMPACT DISK MOBILES

Focus: vision stimulation

Materials:

  • elastic
  • plastic clothes hanger or laundry hanger
  • compact disks
  • yellow, black, white and red craft foam or felt
  • black marker

Procedure: Leave the shiny silver side of the compact disk uncovered; it will reflect lots of light and colour, especially when placed in sunlight. Cover the other side with contrasting colours of felt or craft foam. You may wish to create bold geometric patterns and faces which infants tend to be attracted to. You may string the disks so that they will reflect each other's patterns. Disks may be hung horizontally or vertically, depending on where the child will be positioned (ie. lying or sitting)

TOOTHBRUSH HOLDER RATTLE

Focus: sensory stimulation, wrist rotation, cause and effect

Materials:

  • travel case for toothbrush (choose one which is grooved or has an interesting texture
  • rice
  • glue

Procedure: place a few grains of dry rice into the case and securely glue shut. Encourage the child to explore the texture and sound of the rattle, and to move their hand in different ways to produce different sounds.

HOT WATER BOTTLES

Focus: sensory stimulation, concept of warm/cold, heavy/light

Materials:

  • small rubber hot water bottle

Procedure: fill the bottle with amounts of warm or cold water. Encourage the child to explore the texture and temperature of the bottle, and to make noises by rubbing their hands on the bottle. You can encourage mid-line play by placing the bottle on the child's tummy while encouraging them to explore with their hands. Some children find the weight of a water bottle to be comforting.

CAMPING BLANKET PLAY

Focus: sensory awareness, motivation to move and explore

Materials:

  • silver camping/car emergency blanket

Procedure: Camping blankets are durable, light and shiny. They are quite resistant to being ripped/bitten (but always closely supervise their use.) You may place the blanket on the floor under a child: any movement will cause an interesting noise and give the child immediate reward for moving. You may wish to use a flashlight to add visual stimulation/appeal: this may be helpful in encouraging a child to tolerate being on their tummy and raising their head. The blanket may be placed near the child's hands to encourage them to grasp and release, shake, etc. You may also hang a blanket flat against a wall to create an interesting vision stimulation area.

MARBLE MASSAGE

Focus: sensory awareness, relaxation

Materials:

  • marbles
  • Cloth bag

Procedure: place marbles into the cloth bag and securely sew the bag shut. You can now use the bag to massage a child's back, or to encourage them to manipulate the marbles through the cloth. Marbles have an interesting weight and sound. Supervise closely to ensure that no marbles have become loose and may be swallowed.

HAT BOX TOYS

Focus: visual and auditory stimulation, cause and effect

Materials:

  • small round (6" to 8" diameter) boxes in bold colours
  • elastic
  • compact disks
  • metal measuring spoons
  • glue

Procedure: Glue a compact disk to the inside of the top of the box, and thread elastic through so that the box lid hangs vertically. This will catch any breeze and will twist. With elastic, hang a few measuring spoons inside the bottom of the box, and hang the box vertically. This will create an appealing visual effect, as well as providing auditory feedback if the child touches the box. You may also place a large (too large to be swallowed) marble or a heavy ball inside a box, and securely seal the lid. Place the box on it's side and allow the child to roll it. The child will hear the marble moving inside the box, and the box will move in an interesting pattern. You may wish to add shiny stickers or geometric patterns to the box to increase visual appeal.

BEACHBALL STRETCH

Focus: upper body strength, cause and effect, visual and auditory stimulation

Materials:

  • brightly coloured beachball or balloons
  • dry rice
  • string

Procedure: Place several grains of dry rice into the balloon or beachball, and inflate. Hang the balloon from the ceiling, and encourage the child to reach up, hit the balloon, listen to the sound and try to aim for the balloon again.

SENSORY MITTENS

Focus: tactile stimulation, hand movement, body awareness

Materials:

  • various fabrics of different and distinct textures
  • thread
  • bells (optional)

Procedure: Cut fabric into rectangles large enough to fold over and completely cover a child's hand. Sew the fabric together with the texture on the inside, leaving one end open for the child to place their hand in. Children who are unable to grasp and hold objects can experience different textures by moving their fingers within the mittens. You may securely sew on bells to add auditory appeal, but be careful as this may pose a choking hazard.

SCOOTER BOARD

Focus: The child can lie on his stomach and push with his feet or pull with arms. This activity will enhance locomotion and develop gross motor skills.

Material:

  • square piece of wood at least 2 inches thick
  • 4 wheels
  • screws
  • sponge
  • felt or material (if needed)

Procedure: Glue the sponge onto the wood. Screw in the wheels, one at each corner. Cover sponge with felt or material.

RING AROUND THE BABY

Focus: sitting, trunk rotation, tactile exploration

Material:

  • two pieces of fabric, each two feet by six feet.
  • quilt batting
  • thread
  • sewing machine
  • two cords, two feet long each
  • velcro

Procedure: Cut one piece of fabric to measure 5 feet 8 inches by one foot ten inches. Fold lengthwise, and sew along the long edge and one short edge to form a tube. Fill with quilt batting, or shredded foam/old nylons. The tube should be firm enough to offer support, but still be able to be bent into a curved shape. Sew the final seam shut. On the other piece of fabric, fold each short edge (wrong sides together) and sew, to create a casing for the cord to go through. Now fold the fabric lengthwise, right sides together, and sew along the long edge. Turn right side out. Insert cords through casing, pull ends shut and tie cords. Sew or glue Velcro to the top of the ring.

The tube can be bent into a circular shape. Child may sit or be propped within the ring. Interesting toys or objects may be attached with Velcro. This will encourage tactile exploration as well as trunk rotation as the child reaches for the objects.

CAUSE AND EFFECT BOARD

Focus: cause and effect, visual stimulation, hand strength and coordination

Materials:

  • 8" by 11" plywood, sanded smooth, with six holes drilled
  • heavy cord or rope
  • 2 matching plastic lids
  • 2 matching hair curlers
  • 2 large bells

Procedure: Make a hole in one plastic lid and knot one end of a 20" piece of cord. Thread the cord through the lid until the lid reaches the knot. Thread the opposite end of the rope through one hole in the plywood, so that the lid is at the front. Bring the rope back up through another hole, towards the front, and tie on the other lid. Repeat for the other two pairs of items. When the child pulls one item, the matching item will move in the opposite direction.

Notes: You may wish to paint the plywood a solid colour, and use highly contrasting colours of rope or items.

PAPERBAG KICKBALL

Focus: Provides an easy object for practicing kicking and throwing. Encourages large motor coordination, eye hand/eye foot coordination.

Materials:

  • medium size paper bag
  • newspaper
  • stapler
  • masking tape

Procedure: Tear newspaper up into strips or pieces. Stuff newspaper into paper bag until it is about ¾ full, compacting so it forms a roundish shape. Fold the top down and staple it. cover the staples with a piece of tape to secure the bag. You may wish to paint the ball a bright/fluorescent colour.

POM POM SORTING

Focus: colour identification and matching, vision stimulation, fine motor

Materials:

  • black felt
  • white felt
  • pom-poms, various sizes and colours
  • containers in matching colours (tubes from M&M minis work great!)

Procedure: Place black and white felt squares on a flat surface. Scatter pom poms across both pieces of felt. Instruct the child to place pom poms in the container of the same colour. Observe closely to see if the child misses pom poms of a certain size or in certain areas. Colour perception and contrast sensitivity may also be observed.

BEAN SORTING

Focus: sorting, matching, fine motor (pincer grasp,) tactile awareness, colour awareness.

Materials:

  • several varieties of dried beans (bulk food stores are a great source.) Be sure to choose beans which contrast in colour, size, shape, texture.
  • muffin tin
  • storage container for beans

Procedure: Place one of each type of bean into a muffin tin hole. Help the child to match and sort the remaining beans.

Notes: You may wish to use paint or paper to add contrast to the bottom of the muffin tin holes. You may also sort beans into an egg carton, but muffin tins provide more auditory appeal. Locally available types of nuts may also be used such as acorns, pinecones, sunflower seeds, etc. (be aware of potential allergies!)

RUBBER BAND SORTING

Focus: sorting, matching, finger strength, concepts of stretch, snap, long, short.

Materials:

  • rubber bands of all sizes, shapes, widths, lengths, colours.

Procedure: Help the child to match according to the different attributes of the rubber bands. You may also show them how to stretch the bands so that a shorter band is temporarily the same length as a longer band. This will also help to work on finger strength and coordination.

ERASER SORT

Focus: fine motor activity, tactile awareness, concept of same/different/sorting/matching.

Materials:

  • two-bowl plastic pet dish in a pale colour
  • Novelty erasers: at least three of each shape
  • Black permanent marker or tape

Procedure: outline the top of each bowl with a black permanent marker or tape to increase contrast. You may wish to glue contrast colour papers to the bottom of each bowl. Have the child sort the erasers into the two bowls. ***Be aware that erasers often contain latex, and some children may be allergic to this.

FUNNY FISHING GEAR

Focus: fine motor control, finger strength, vision stimulation, colour awareness, sorting

Materials:

  • small plastic fishing tackle box
  • Aquarium stones or "jewels": several of each colour
  • Tongs for topping strawberries

Procedure: Have the child sort the stones according to colour. Have them use the tongs to make the task more challenging.

WATER PLAY

Focus: tactile awareness, hand and finger strength, pouring, concepts of hot/cold, empty/full, heavy/light, conservation.

Materials:

  • metal bowls
  • cups, bowls, small containers
  • eyedropper
  • turkey baster
  • syringe
  • sponges
  • squirt bottles (eg. dish soap)
  • pump bottles (eg. soap dispenser)
  • tray

Procedure: Place supplies on tray (to minimize spillage.) Help the child explore the many ways they can play with water. They may use the eyedropper, turkey baster, syringe and pump bottle to explore suction and pressure while developing hand strength. Using metal bowls will increase auditory feedback. The child can explore soaking up water with a sponge, and wringing it out (hand strength, using two hands together) while discussing the differences in weight when the sponge is empty or full. The child may experiment with the different containers, pouring water from one to the other, comparing the amount of water each will hold.

TEXTURE STICKS

Focus: To match pairs of sticks tactually. Tactile discrimination and concentration

Material:

  • 6 textured fabrics
  • 24 tongue depressors
  • white glue
  • storage container

Procedure: Cut four strips of each fabrics 16 mm wide and 127 mm long. Brush white glue on the sticks. Center the fabrics and press firmly. Be sure all edges are glued securely. The child may be asked to find all four of one texture, or to organize sticks into sets (one each of several textures) You may present the child with three sticks of the same texture, and one of a different texture, and ask the child to give you the one which is different. You could also create a pattern of textures for the child to copy.

SANDPAPER STICKS

Focus: to match sticks of like-textured sandpaper by feel

Material:

  • 12 tongue depressors
  • sandpaper in coarse to fine textures
  • white glue
  • storage container

Procedure: Cut 2 strips of sandpaper for each texture and glue to sticks. Place sticks in random order on a flat surface. By feeling the sticks the child will match the textures together.

CEREAL SORTING

Focus: sensory awareness, sorting, matching.

Materials:

  • ice cube tray/muffin tin/containers
  • different types of breakfast cereals: Fruit Loops, Cheerios, Rice Krispies, Corn Flakes, Shreddies, Lucky Charms.

Procedure: The child may sort the cereals into the different containers/compartments. They can sort by size, texture, taste, smell, shape, etc. For example, Cheerios are the same shape as Fruit Loops, but will smell and taste different.

SOFT AND HARD SORTING

Focus: tactile discrimination, concept of hard/soft, sorting

Materials:

  • 2 cardboard sheets, approximately 9" by 12" each or two bins or boxes
  • marker
  • Braille labeler
  • small piece of wood (to be labeled)
  • small piece of sponge (to be labeled)
  • glue
  • collection of hard and soft materials (eg. hammer, coins, mirror, cup, seashell, marbles, shirt, grapes, bread, sweater, feather, teddy bear, slippers, towels, yarn).

Procedure: Glue piece of wood to one piece of cardboard or onto the bin/container, and label it "hard" in large print and Braille. Glue the piece of sponge to the other piece of cardboard or onto the other bin/container, and label it "soft" in large print and Braille. Give the child the collection of hard and soft objects, and help them to sort them into the appropriate areas.

LID MATCHING

Focus: matching size and shape, fine motor coordination, hand strength, wrist rotation.

Materials:

  • various containers with removable lids. Eg. coffee cans, baby food jars, screw-top containers, dish soap bottles.

Procedure: Present all containers to the child . They must match lids to containers, and use two hands together to screw on lids. Containers may fit inside each other, giving the opportunity to explore size, etc.

CYLINDER SIZES

Focus: sorting, size concepts

Materials:

  • cardboard cylinders (all same circumference): paper
  • towel rolls, toilet paper rolls
  • scissors

Procedure: With scissors, cut the cylinders into different lengths. The child can then sort them from smallest to largest.

Notes: You may wish to cut the cylinders at very regular lengths, and make several of each length, so that the child may explore quarters, halves, thirds, etc.

WEIGHT BOTTLES

Focus: awareness of weight, comparisons.

Materials:

  • 6 plastic bottles with lids
  • water
  • glue

Procedure: Fill each bottle with increasing amounts of water, from empty to full. Glue lids on securely. Children can compare the weights of each bottle, and place them in order from lightest to heaviest. You may wish to add food colouring to the water for use with children with low vision.

MYSTERY SOCKS

Focus: identifying objects by touch, labeling objects/vocabulary, matching pictures to objects.

Materials:

  • adult-size thick socks
  • labels: Braille and large print
  • pictures of objects
  • objects: eg. feather, pencil, toothbrush, nail, toy car, rubber
  • band, spoon, wool.

Procedure: Place one object inside each sock. The child must reach into the sock, and without looking, identify the object and then find the correct picture or label.

ROCK SORTING

Focus: sorting, matching, comparing sizes, shapes weights.

Materials:

  • several pairs of rocks, of different shapes and sizes

Procedure: Help the child to match up the rocks, and to make comparisons of size, shape, colour, texture and weight.

Notes: You may also vary the temperature of the rocks by refrigerating them or heating them with hot water. The child may then sort by temperature. Rocks will tend to hold temperatures for longer periods of time.

SLIDING BALL

Focus: hand-eye coordination, tracking, upper body strength.

Materials:

  • newspaper
  • knitting needle
  • non-toxic paints in bold/neon colours
  • 4 feet sturdy string or nylon rope
  • craft knife
  • round balloon
  • water and flour/wall paper paste/glue
  • dish pan

Procedure: Mix flour, water and wallpaper paste in dishpan to make paste. Tear newspapers into strips. Blow up balloon and tie knot. Cover balloon to about 1/4 inch thick with strips of newspaper which have been dipped in the glue mixture. Allow to dry thoroughly, then paint with bright colours. Cut two holes in opposite ends of the ball, with each hold being about 2 inch diameter. Thread rope through both holes with the knitting needle, then double back again. Tie ends of rope together. Near each end, tie knots so that rope won't slip back through the ball. The child can hold the loop in both hands so that the ball slides back and forth.

Notes: Use bold contrasts, black and white stripes, or shiny tape to make the ball more visually interesting. You may wish to seal a bell inside the ball.

FLOAT AND SINK

Focus: categorizing, properties of water, concepts of float/sink, concept of opposites.

Materials:

  • dishpan
  • water
  • two bins
  • Braille labels
  • marker
  • clear Mac tac
  • objects: bar soaps, cork, wood, marbles,

Procedure: Label one bin "sink" and the other "float" with both Braille and large print. Cover the print label with clear Mactac. Fill the dishpan with water. The child can experiment with the objects to see which sink and which float, and then place them in the appropriate bin. Try to include some items which are similar in shape and material, but which may not both float or sink. For example, some brands of bar soap float while others do not.

Notes: For older children, you may wish to expand on this topic. Help children to make a tactile mark of water level in the dishpan. The child may then add various objects, and check how the water level has changed. The child may then try to predict how the water level will change when various objects are added, and check the accuracy of their prediction.

ICE CUBE TRAY TEXTURE MATCHING

Focus: tactile awareness, concept of same/different/matching

Materials:

  • one 12-cube ice cube tray
  • 12 one-inch blocks
  • six different fabrics/textures

Procedure: Glue matching textures onto pairs of blocks. You may need to cover only two or three sides so that the blocks will still fit into the ice cube tray spaces. Place six different textures along one side of the tray. Present the tray to the child and ask them to match the blocks by placing a block in the space beside it's match.

Notes: This activity may be expanded to involve a pattern of blocks for the child to match or continue.

FOLLOWING FOOTSTEPS GAME

Focus: encourages children to develop large muscle skills. Child will develop skills in counting as well as the concepts of left and right.

Material:

  • vinyl, rug sample or shower curtain
  • felt
  • scissors
  • dice
  • Velcro

Procedure: Cut out felt footprints and put Velcro on one side. The footprints are placed on the mat close enough together so the child can step or hop from one another. Child will roll the dice and move forward on the footprints. Add music to this activities or add different tasks (ie: hop on one foot, take a long stride, use right foot "¦)

MAGNET SORT

Focus: to sort magnets by attaching them to a metal cookie sheet.

Materials:

  • 5 identical sets of magnets
  • non-aluminum cookie sheet
  • storage container

Procedure: Sort magnets by rows wither vertical or horizontal. Depending on the type of magnets you use the child may sort by colour, texture, shape or similar features.

PEG BOARD

Focus: to develop fine motor skills.

Materials:

  • 2 pieces of peg board, each 12" square
  • golf tees
  • sandpaper
  • four one-inch blocks

Procedure: Use sandpaper and blunt the points of the tees. Glue the blocks in each corner between the two pieces of pegboard (to separate them.) Separating the two pieces allows the child to see and feel where the peg has gone when it goes "through." The objective of this activity is to place the golf tee into the pegboard creating a design and increase fine motor skills. You may wish to paint one or both pieces of peg board to improve colour contrast.

SENSORY BOTTLES

Focus: To pair the matching bottles by sound or smell. This activity will encourage sound distinction and olfactory perception.

Material:

  • bottles with lids, film containers
  • sound bottle material- salt, pennies, paperclips, rice etc.
  • aroma bottles- cinnamon, vanilla, peppermint, ginger, nutmeg

Procedure: Wash the bottles out really well. Fill the bottles with the material of your choice, making sure you make two of each. Encourage the child to sort and match the bottles together.

SIMPLE SORTING

Focus: sorting tasks encourage children to recognize likenesses and differences and to organize items by categories based on identifying characteristics. This activity will also enhance fine motor development and perceptual skills.

Material:

  • 6 cup muffin tin
  • beads of different size and shape
  • storage container

Procedure: The child will sort the beads or shapes into the muffin tin cups.

PAPER BAG SEARCH

Focus: colour, shape and number recognition, categorizing, problem solving

Materials:

  • paper bags
  • pieces of paper, different colours
  • pieces of cardboard cut into different shapes
  • pieces of cardboard with numbers in print and/or Braille

Procedure: each child receives a bag to collect items in. Each child is given a card with directions regarding what they are to find. Eg. a piece of red paper will tell them to locate red items. A piece of cardboard with a circle on it will tell them to find items which are circular/round. The child may then collect items from within the classroom/home or outside.

POKE & PEEK

Focus: encourages fine motor development and eye-hand coordination.

Materials:

  • colander
  • tin bowl
  • coloured toothpicks

Procedure: Invert the colander. The child will insert the toothpicks into the holes. Add a tin bowl underneath the colander and it will give auditory feedback to the child.

AQUARIUM GRAVEL SCOOP AND SEARCH

Focus: fine and gross motor skills, tactile and auditory awareness, concepts of heavy/light, empty/full, scoop/pour.

Materials:

  • metal cake pan
  • Aquarium gravel (wide variety of bold colours available)
  • Stones, shells
  • Cups and containers

Procedure: pour gravel into pan. Encourage child to scoop and pour gravel (good sound on metal pan, and fairly heavy to increase feedback from muscles) You may also wish to hide shells and stones in the gravel and have the child do a tactile or visual search for them. The pan and gravel may also be used to have the child trace shapes or letters.

TEE BOWL

Focus: to fit the golf tees into the holes in the bowl lid. This activity will enhance manual dexterity and fine motor skills.

Materials:

  • large plastic bowl with snap on lid
  • golf tees
  • paper hole punch
  • sand paper

Procedure: Blunt the points of the tees using the sand paper. Use the hole punch to punch holes around the rim of the lid spacing them an inch apart. Put the lid on the container. The child may then place the golf tees into the holes. You may wish to add a high contrast colour around the holes to make them more visible.

MUSICAL PIPES

Focus: This activity provides opportunity for the child to associate words and sounds, such as loud or soft.

Material:

  • piece of pipe 2 ½ inches long
  • wire or string
  • empty thread spool
  • spoon

Procedure: Place string through pipe and spool and tie, allowing the pipe to swing freely. The spool would act as the handle and the pipe would echo the sound of the spoon tapping it.

SOUND MATCHING

Focus: auditory awareness, concept of matching, concept of loud/soft sounds

Materials:

  • 10 watchmaker tins (available in hardware stores)
    or
    10 tubes from M&M minis candy
  • 2 teaspoons oatmeal
  • 2 teaspoons sugar
  • 2 teaspoons flour
  • 8 Cheerios
  • 8 kernels unpopped popcorn

Procedure: Place equal amounts of food into pairs of tubes (eg. Two with one teaspoon of oatmeal each.) Glue lids shut tightly. When completed, give the child one of each pair, and instruct them to find the matching container. You may also help the child to become aware of high/low/loud/soft sounds.

CONCEPT GAME

Focus: concept development (cardinal directions, left, right, body parts, under/over, etc.)

Materials:

  • 20" x 20" cardboard sheet
  • approximately 50 4" x 6" cards
  • black felt-tip marker
  • hot glue gun and bold coloured glue

Procedure: Create a tactile/high contrast grid on the cardboard, as shown below. Each space should be approximately 2" square. On the cards, write the following questions in large print using the felt-tip marker. Braille may be added if desired. Players take turns answering questions, with each moving ahead one space for each correct answer. Questions may be customized to work on any concepts you wish, for example:

  • What body part goes into your pant leg first?
  • Blow a kiss
  • Which side of the road do you walk on when there are no sidewalks?
  • This body part helps you to taste
  • Wink
  • Place the dice in the palm of your hand
  • What is the function of your teeth?
  • Place your hand at shoulder height
  • In what cardinal direction does the sun set?
  • Hold this card under the table
  • Stand behind your chair
  • Place your arms perpendicular to each other
  • Where would you hear an echo?
  • What part of the cane touches the ground?

Contributed by: Brenda Peacock, Orientation and Mobility Instructor, CNIB

TAPPING HELPER

Focus: to teach child to move a white cane in a proper, side to side, "sweeping" motion. As the cane comes in contact with the "helper" the child will get auditory feedback from the cane tip hitting the tin lids.

Materials:

  • 6 pieces wood (1" by 3"), each 30" long
  • 4 pieces wood, 8" long
  • hinges
  • screws
  • juice can lids from pull-tab cans (never use lids which are sharp!)

Procedure: Make two separate "helpers." For each helper, attach 3 long pieces of wood to each other with hinges (folding will allow for ease of transportation.) At each end, attach an 8" length onto the longer board (so that it is now 2" thick.) This will allow more stability when you stand up the helper. Screw juice can lids on one side of each helper, making sure there is no space left between lids. Set helpers up parallel to each other. Demonstrate or assist the child to move their cane from side to side so that the cane makes contact with the lids. Width of the path can be varied according to cane length. Alternately, a single helper may be used, with a wall as the other side. Hinge types may be varied so that you can create a path with curves or corners.

Contributed by: Brenda Peacock, Orientation and Mobility Instructor, CNIB

BRACELETS AND BUTTONS

Focus: numbers one to ten, sorting, grouping, fine motor skills

Materials:

  • ten brightly coloured bracelets
  • white felt
  • 55 buttons

Procedure: Lay the felt out flat on the table (it provides colour contrast and also helps to keep the bracelets and buttons from slipping.) Lay the bracelets side by side in a row. The child can place one button in the first bracelet, two in the second bracelet, and so on.

KEY MATCHING

Focus: tactile discrimination, finger coordination, matching

Materials:

  • plywood, 8" by 10" sanded smooth
  • six hooks (screw-in type)
  • six pairs of keys

Procedure: Screw the hooks into the board in two rows of three hooks each. Place one key from each pair on a hook, and have the child attempt to find the identical key and place it on the same hook.

LOCKS AND KEYS

Focus: fine motor skills, practical life skill, concept of open/shut.

Materials:

  • padlocks
  • bicycle locks
  • doorknob with lock
  • key ring (easily opened)

Procedure: Present one or more locks and keys to the child, and have the child try to match keys to locks. Show the child how to insert the key and turn it, listening and feeling to see if the lock has opened. Prompt the child to try another key if the first one does not work. Help the child to strategize about awareness of sizes and types of keys, what to do when locks won't open.

KEYS FOR LEARNING

Focus: putting keys on hooks develop fine motor skills. Matching the key shapes provides a perceptual task for older children.

Materials:

  • 6 keys
  • Square piece of wood
  • 6 hooks
  • Glue
  • Bristol board

Procedure: Lay the six keys on to bristol board and trace around the keys with a marker then cut them out. Glue them on the wood. Screw the hooks on to the wood 2 ½ inches apart in 2 rows. The child then will match the shape of the keys with the keys attached to the wood.

BUTTON SORTING

Focus: fine motor, tactile discrimination, sorting, large/small.

Materials:

  • egg carton or muffin tin, or ice cube tray
  • buttons: various sizes, colours, shapes and textures

Procedure: Children can sort the buttons into sections of the containers. They can sort by size, colour, texture, or shape.

PINCUSHIONS

Focus: fine motor, number concepts

Materials:

  • pieces of foam or corkboard, approximately 4" by 4"
  • pins with coloured plastic tops, or bulletin board pins
  • fabric paint
  • marker
  • Braille labeler

Procedure: Mark each piece of foam or corkboard with a print and/or Braille number. You may also wish to add the corresponding number of dots with fabric paint. The child can push the correct number of pins into each piece of foam/corkboard.

CLOTHESPIN MATCHING GAME

Focus: fine motor control, concept of matching

Materials:

  • coffee can
  • wallpaper/Mactac to cover can
  • spring-type wooden clothespins
  • scraps of different textures
  • glue

Procedure: Glue wallpaper onto coffee can. Mark the can into at least six sections (vertical.) Glue one texture on to one section. Glue the same texture on to one clothespin. Repeat until you have six different textures on the can, and six clothespins with matching textures. The child will develop finger strength as they try to clip the clothespeg to the top of the can in the matching section.

Notes: This game can be used for any type of matching: colours, textures, Braille letters, tactile or high contrast shapes, etc.

MATERIAL SORTING

Focus: sorting, matching, tactile discrimination, vocabulary

Materials:

  • tin pie plates
  • glue
  • small pieces of the following materials: leather,
  • plastic, rubber, glass, metal, wood,
  • black felt-tip marker
  • Braille labeler
  • assorted objects (eg. wallet, belt, necklace, key chain, cup, key zipper, tin box, can, eyeglasses, mirror, bottle, washers, mat, gloves, ball, toys, thread spool, block, stick.)

Procedure: Label each pie plate in large print and Braille, and glue on the corresponding material sample. The child may then sort the objects into the correct material category.

PIGGIE BANKS

Focus: sorting, matching, fine motor, money

Materials:

  • baby food jars with lids
  • assortment of coins: loonies, quarters, dimes, nickels, pennies.
  • marker
  • white paper for labels
  • Braille labeler

Procedure: Cut a slit in each jar lid, large enough for coins to go through. Label each jar with a name of coin. You may wish to glue a coin on the front of each jar as well. The child may then sort coins into the various jars.

Notes: You may vary the activity by labeling the jars with different amounts of money; the child must then place the correct combination of coins in the jar (eg. label 35 cents, and child can find combinations of coins that add up to 35 cents.)

HOUSEHOLD SORTING

Focus: sorting, classifying

Materials:

  • various items used for different tasks (eg. sock, shirt, mitten, necklace, ring, watch, spoon, fork, cup, toothbrush, comb, soap, toothpaste, pencil, crayon, pen, eraser, paper, doll, block, marble, toy car, etc.)

Procedure: The child can explore the items, discuss what each item is used for, and sort the items into classifications: clothing, hygiene, toys, eating/cooking utensils, etc.

MARBLE SORTING

Focus: sorting, classifying, fine motor skills, Braille awareness

Materials:

  • marbles of different sizes, textures and colours
  • Ice cube trays, containers
  • Novelty ice cube tray (makes ½ inch round ice)

Procedure: have the child sort the marbles by size or colour. You can use the novelty ice cube tray to place small marbles in the holes to increase fine-motor skills, or to place them in patterns of Braille letters

NUMBER CANS

Focus: counting, number concepts

Materials:

  • tin cans with no sharp edges, lids removed
  • Braille labeler
  • marker
  • tactile dots/fabric paint
  • tongue depressor/Popsicle sticks

Procedure: Label each can with a number. You may wish to add the corresponding number of dots. The child can then place the correct number of sticks into each can.

Notes: You may also label the cans with addition and subtraction questions. You can vary the game by using vases and flowers instead of cans and sticks.

THE SCREW GAME

Focus: observing size difference, fine motor skills, life skill, wrist rotation

Materials:

  • plywood board, sanded smooth
  • bolts and nuts (various sizes)
  • screwdriver
  • drill

Procedure: Use drill to drill holes into the wood. Glue nuts over the holes in the wood. The child may then match bolts to the nuts, and use the screwdriver to screw in the bolt.

RELATED OBJECTS JARS

Focus: associating objects which belong together, vocabulary, logic

Materials:

  • baby food jars
  • glue
  • objects: stamp/envelope, key/lock, tire/toy car, needle/thread,
  • eraser/pencil, slate/stylus, flower/vase, nail/hammer

Procedure: Fasten one item of each pair onto the jar. The child must then place the corresponding object in the jar.

OUTLINES

Focus: one-to-one correspondence, observing size and shape of objects, noticing similarities and differences, matching, understanding of abstract representation.

Materials:

  • sturdy cardboard, 12" by 18"
  • hot glue gun and glue sticks
  • objects (eg. key, pencil, comb, blunt scissors, paper clip, clothespin, toy car)

Procedure: On cardboard, trace each object in pencil. Use glue gun to cover pencil marks with glue to make a tactile outline. The child must then match the object to the correct outline.

BOLT BOARD

Focus: fine motor development, matching size, life skills

Materials:

  • nuts, bolts and knobs of various sizes and types
  • glue (optional)
  • thin wooden board (optional)

Procedure: Present the child with nuts and bolts and have them screw the correct nut onto the corresponding bolt. Optional: mount bolts by inserting bolts through a sheet of wood, and secure in place by gluing the underside of the board.

MEASURING SPOONS

Focus: nesting, sorting sizes, fine motor coordination

Materials:

  • metal measuring spoons

Procedure: Help the child to stack the spoons according to size, and discuss concepts such as biggest, smallest, etc. Talk about what spoons may be used for. Have child scoop materials to compare the different quantities each spoon will hold.

HOOK BOARD

Focus: fine motor coordination, hand-eye coordination, one-to-one correspondence, size comparison.

Materials:

  • plywood board
  • 25 hooks (screw-in type)
  • washers (five sizes)

Procedure: Ensure that the board is sanded smooth. Screw in hooks in 5 rows of 5 hooks each. The child can then place washers on the hooks in a random fashion, or you may have them order the washers from largest to smallest, or to copy a pattern of sizes. You may wish to prop the board up vertically, so that the child has to reach upwards to place the washers on the hooks, building upper body strength.

CORNERS

Focus: concept of corners, categorizing, sorting

Materials:

  • two containers (to sort items into)
  • objects with angles/corners (eg. boxes, blocks, cardboard squares/triangles/rectangles)
  • objects without corners (eg. marbles, cardboard circles, bottles)

Procedure: Help the child to sort the objects according to whether or not they have corners. Discuss other places you might find corners, where they are used in buildings, other ways in which rooms are constructed.

TACTILE GRAPHING

Focus: tactile discrimination, matching, sorting, categorizing shapes

Materials:

  • craft foam
  • scissors
  • heavy cardboard
  • hot glue gun

Procedure: On the cardboard, draw a 12" by 12" square. Create a grid by dividing the square into four columns and four rows (3" by 3" squares.) Outline all squares with hot glue to create tactile lines. Cut the craft foam into four each of four different shapes. Glue one of each shape in the top square of each column. The child may then sort the remaining shapes into the correct columns.

DOMINO STICKS

Focus: tactile discrimination, matching

Materials:

  • wooden tongue depressor sticks
  • scraps of different textures
  • glue

Procedure: Glue a texture on to one end of a stick, covering the width of the stick and about one inch of the length. Glue a different texture to the opposite end of the stick. Continue to glue textures onto sticks, ensuring that the same texture is used on several sticks, so that the child can later match the textures by laying the sticks end to end, and play dominos.

Notes: you can vary this activity by using shapes or Braille letters instead of textures.

SHAPE STICKS

Focus: to match pairs of sticks containing like shape combinations.

Materials:

  • tongue depressors
  • foam shape pieces
  • glue
  • storage container

Procedure: Make two sticks of each shape combination. Use shapes like: triangle, square, oval, circle, diamond, cross, semi-circle, heart. Create stick that have two of the same shape and tow different shapes. Place sticks randomly on flat surface and match together. Point out to the child that they need to match both designs.

TACTILE LOTTO

Focus: tactile discrimination, turn-taking, following instructions and rules

Materials:

  • heavy cardboard
  • hot glue gun
  • various textured materials (sandpaper, velvet, corrugated paper)

Procedure: cut cardboard into several 15" squares. On each square, create a grid of 3" squares. Outline the grid with hot glue to make tactile lines. Cut fabrics into 2" squares, and glue textures into the squares. To play, the adult describes a texture, and the child must check their board to see if they have a fabric that matches that texture. Players may continue until they have identified all of the textures in a row, or all of the textures on the card.

DOWEL MATCHING

Focus: size discrimination, sorting and matching, ordering

Materials:

  • wooden doweling, five difference diameters, 3 feet of each
  • Velcro
  • glue

Procedure: Cut each strip of dowelling into three sections of 12" each. Glue Velcro onto the ends of each segment. Help the child to compare the sizes of dowelling, to attach the matching sizes together, and then to place the completed sets in order from largest to smallest.

Notes: You may vary this activity by attaching hooks instead of Velcro, and hanging the dowels from a horizontal rod. The child may still match the sizes, but will have the more challenging task of hooking the dowels together, as well as developing upper body strength by reaching up to hook the dowels.

BELL STICKS

Focus: to match the bells according to their sound.

Materials:

  • tongue depressors
  • bells of different size (two of each size)
  • ribbon
  • glue
  • storage container

Procedure: Attach bells to sticks by tying them on to ribbon, then securely gluing the ribbon to the sticks. By ringing the bell sticks the child must match the sounds.

WEAVING BOARD

Focus: to weave the ribbon over and under the elastic. This will enhance skills of manual dexterity, fine motor skills and concepts of over and under.

Material:

  • square board
  • 1" wide elastic
  • staple gun
  • ribbon
  • storage container

Procedure: Cut elastic into 12" lengths and place them on the board side by side. Staple the ends of them to the back of the board. Cut the ribbons into equal lengths and dip the ends into glue so that they will not fray. This child will take the ribbons and weave them over and under the elastics. Be sure to use solid coloured ribbons which will contrast with each other and with the board. Various textures of ribbon may also be used.

TOP THE BOX

Focus: increase fine motor development and perceptual skills in recognizing and matching sizes. This activity also promotes concepts of open, closed, top and bottom.

Materials:

  • boxes with lids (different sizes)
  • foam numbers or puffy paint
  • glue
  • buttons or foam shapes

Procedure: Glue the foam numbers inside the box and on the lid of the same box. Glue buttons or foam shapes also on the lid of the box to encourage the child to count. Place boxes and lids randomly on a flat surface. The object is for the child to match the correct box with its proper lid.

SHAPE MATCHING GAME

Focus: turn-taking, following directions, matching shapes, tactile discrimination

Materials:

  • heavy cardboard or foam core board, 18" by 24"
  • hot glue gun
  • coloured glue sticks
  • craft foam
  • cardboard cut into 2" by 2" squares

Procedure: Using the hot glue gun and high contrasting colours of glue sticks, create a winding pathway of squares across the board. Cut sets of matching shapes from the craft foam (eg. star, circle, square, diamond, etc.) Glue these shapes in the squares on the pathway in a random order. Glue the remaining shapes onto the cardboard squares. Children must determine which shape is on the next square on the path. They then draw from the pile of cardboard squares. If the shapes match, they move ahead one space. If the shapes do not match, their opponent takes a turn.

Notes: Textures or Braille letters may be used instead of shapes.

SCALE

Focus: to experiment with weight and balance.

Materials:

  • an 18" length of 1"x2" board
  • 2 small plastic containers
  • contact cement or epoxy glue
  • heavy cord, 12 " long
  • screw eye
  • S Hook (optional)
  • small nuts in the shell
  • storage container for nuts

Procedure: Glue the containers on the ends of beam. Put the screw eye in the centre of the beam. Tie one end of the cord through the screw eye and tie the other end in a loop. Use the S hook to hang the beam from a curtain rod, tension bar, or in a doorway. The board should hang flat. The child can then experiment with placing different sizes or quantities of nuts in the containers, to see which end of the scale will dip, how they can make the two ends balance, etc.

WASHER BAR

Focus: to sort and grade the washers according to size as you place them on the board. Will enhance manual dexterity, comparing skills and problem solving skills.

Material:

  • piece of wood 1"x2" 12" long
  • 5 finishing nails
  • 25 washers: 5 sets of 5 each in graduated sizes
  • storage container

Procedure: The child can sort the washers according to size or sort In sequence.

Notes: You may wish to add a screw eye to the centre of this board, and use six evenly spaced nails, so that the board may be hung and used as a scale. Children may experiment with sizes, combinations, and placements of washers.

STOP AND GO RACE

Focus: turn-taking, counting, left/right, stop/go

Materials:

  • piece of heavy cardboard/foam core, 12" by 24"
  • hot glue gun
  • coloured glue sticks
  • marker
  • Braille labeler (optional)
  • two small toy cars
  • 20 pieces of Braille paper, 2" by 3" each
  • red and green construction paper or craft foam

Procedure: Using the hot glue gun and high contrast colours of glue, create a grid with two columns and 12 rows. The top row should read "finish" and the bottom row should read "start." Each child chooses a car to use as their marker. On the cards, print or Braille instructions: go ahead, go back, go left, go right, stop. There should be several of each instruction. Children may take turns choosing a card from the pile and following the directions.

SHAPE FINDER

Focus: encourages the child to recognize shapes patterning and a sequential pattern.

Materials:

  • craft foam
  • index cards
  • scissors

Procedure: Cut out shapes from the craft foam and glue them on the index cards in a sequential order. Cut out extra shapes so that the child can match the pattern or expand the pattern.

PIZZA PIN UPS

Focus: encourages the child to learn correct numerical value by counting and matching. Clothes pins provides fine motor development.

Materials:

  • circle cardboard cut out
  • tactile object to be glue for counting
  • clothes pins
  • ruler
  • marker
  • puff paint

Procedure: Divide the circle into 5 even sections (like a pizza). Place the tactile marking in each of the section of the board in quantities from 1-5. On the clothes pins use puff paint to write the number and corresponding number of dots. The child will clip the correct clothespin with the corresponding section on the circle.

CUBE IT

Focus: Provides practice in counting objects and matching the correct amount to each number.

Materials:

  • tag board
  • puff paint
  • cubes or blocks

Procedure: On the Tag board draw a number using the Puff Paint, beside the number add the corresponding dots. Write the number in any order along the left side of the board. This will allow enough space for the blocks to be built beside the number.

BOTTLE CAP COUNTER

Focus: this activity reinforce the concept of 1 to 1 number correspondence

Materials:

  • bottle caps
  • puff paint
  • bristol board/Tag board

Procedure: Use puff paint to write numbers 1-5 across the top of the board. Trace the corresponding number of bottle caps underneath each of the numbers. Once dry the child can match the bottle caps underneath the numbers in the outlines provided.

HAIRSTYLE FUN

Focus: fine motor skills, tactile awareness, life skills

Materials:

  • peg board cut into 6" by 4" oval
  • Ribbons: various widths, colours and textures
  • Hair clips, bobby pins, barrettes of various sizes, colours and types

Procedure: Pull ribbons through holes and knot securely at back of board. Have the child put the hair clips onto the ribbons to increase fine motor coordination, awareness of colour contrast, and exposure to textures.

MICROWAVE MARBLES

Focus: pre-Braille skills, fine motor control

Materials:

  • microwave dish with grooves
  • marbles to fit into grooves

Procedure: Place one marble in each groove, and push all marbles to the left side. Some microwave dishes are shaped in way that will keep the marbles at the side without slipping down to the next groove. Help the child to start at the top left marble, and push it across to the right side of the dish. The child must then follow the edge of the groove back to the left side of the dish, and find the next marble down. Continue to track the marbles from left to right, top to bottom, in the pattern that the child will eventually need to track lines of Braille.

Daily Routines

Many skills can be worked on throughout daily routines. Rather than providing detailed descriptions of activities, we have listed skills which may be developed while participating in daily routines. We hope that these lists will remind parents and professionals of the many skills that children may develop while also developing skills of independence.

Washing Dishes

  • On/off (taps)
  • Wrist and hand strength
  • Concept of wet/dry
  • Concept of clean/dirty
  • Stacking (to fit dishes in cupboard)
  • Sorting (to fit dishes into draining rack, into cupboard)
  • Nesting (to put bowls in cupboard, cups together)
  • hot/cold (water)
  • olfactory awareness (smell of food, dish soap)
  • concept of full/empty (pouring, rinsing)
  • auditory awareness (squeak when clean)
  • tactile awareness (sticky, bubbly, slippery)

Laundry

  • Clean/dirty
  • Size comparison
  • Matching colours (find same colour socks)
  • Sorting colours
  • Sorting by size/owner of clothes
  • Sorting by type of clothing (socks, towels)
  • Matching patterns (socks, towels)
  • Folding
  • Large/small
  • Shapes (towels are rectangular, fold to be square)
  • Textures

Setting The Table

  • One-to-one correspondence (one plate for each)
  • Matching shapes/objects (may wish to use bold marker
  • to outline shapes of dishes, or use dishes to set one place for the child to use as a model)
  • stacking/nesting (to carry dishes)
  • matching colours of dishes
  • comparing sizes of dishes
  • comparing shapes of dishes
  • awareness of social skills

Cooking/Baking

  • Measuring
  • Pouring
  • scooping
  • Textures (wet, dry, rough, smooth, sticky)
  • Scents (of each ingredient, combinations of ingredients, changes when cooked)
  • Tastes (of each ingredient, combinations of ingredients, changes when cooked)
  • Stirring/mixing (hand strength)
  • Reading recipe (literacy)
  • Hot/cold
  • Discuss safety issues regarding stoves, knives, etc.
  • Change in texture/form when foods are raw, mixed, cooked, frozen
  • Life skills/self help skills
  • Social skills (independence, hosting others)

Feeding Pets

  • Full/empty dishes
  • Scents (of food and pets)
  • Clean/dirty (dishes)
  • Discuss and demonstrate responsibility for pets
  • Pouring
  • Measuring
  • Discuss and understand needs of animals

Caring for Plants

  • Wet/dry
  • Textures of dirt, leaves, stems, water
  • Observe growth
  • Shapes of leaves, blossoms
  • Scents of plants
  • Discuss and demonstrate responsibility for plants
  • Discuss and understand needs of growing things

Tidying

  • Sorting (types, sets, rooms items belong in)
  • Clean/dirty
  • Discuss safety, mobility issues
  • Develop organization skills
  • Discuss and demonstrate responsibility
  • Stacking, nesting
  • Awareness of containers (sizes, empty/full, open/shut)

Vending Machines/Pay phones

  • Cause and effect
  • Fine motor skills
  • Money concepts
  • Social skills

Toys From Around The House

There are a number of common objects which can be used in a variety of ways to elicit vision, hearing and touch. These objects cost very little or no money to construct. They can be used in unusual ways with the visually impaired and multiply-handicapped, to encourage their individual creativity. It is important to not limit the child's experience with that object to the perceived "right way" only. Be aware of any opportunity and show of interest from the child. If they are interested in an object -use it!

The following is only a beginning. Every individual situation and child will lead to the creation of more ideas.

Plastic Pot Scrubbers

  • can be used for their tactile component and can also be used as a noise make on cement, sandpaper, pots, etc.

Tin Foil Plates

  • can be used for folding into different shapes
  • can also be used for noise-making by scratching on it.
  • great for sorting games
  • great to hang as part of a mobile

Balloons

  • great for fine motor development
  • can feel, squeeze, build into shapes
  • can make squeeky sounds by squeezing the neck as the air escapes, can have the escaping air flow into the child's face/body (watch that it does not startle the child)

Tin Cans

  • great to drop things into the can and listen to the different sounds: pennies, macaroni, stones, buttons, nails, etc.
  • can use the can empty or filled with water to note the differences
  • can be used as nesting cups - use graduated cans from large juice cans, vegetable sized cans and baby food cans...

Bottles and Jars

  • can be used for matching in size, colour, weight, (put sand in, etc.)
  • can be used to practice screwing and unscrewing of lids (best used in appropriate settings, such as at meal time preparation)

Boxes

  • all sizes, big, small, square, rectangular, appliance-sized (which can be made into little rooms and then played in, on or around)
  • can take a fridge sized box and replicate a room, complete with door, windows, wall paper, rug ceiling, etc. to have the child experience all four walls, ceiling, etc. for concept of room
  • it would be best to have the child build as much of the "room" with you to understand the start-to-finish aspects of the project

Bean Bags

  • can use all different shapes and sizes as well as textures
  • can have the child help to fill the individual bags with all sorts of objects (beans, stones, marbles, sand, etc.)

Wading Pools

  • can fill them with different materials - water, water and sand, water and mud (our children must have all sorts of experience), water and bubbles, Indian corn, etc.

Bags

  • all different sizes and texture - plastic, green garbage bags, paper, aluminum foil bags, etc. can be used to put things in, take things our, crumple up, etc.
  • the thin, plastic bags from Sears have an especially interesting sound

Sandpaper

  • can rub it together
  • can use the different grades of sandpaper for different sounds and textures
  • can tack sandpaper onto blocks of wood to rub together
  • great to colour on with crayons. After colouring, you may carefully heat the sandpaper to melt the crayon; very interesting effects.

Eggbeater

  • can use it in different textures - water, water with soap, water with jello, water with sand, water with loose muck, etc.

Tools

  • real hammers (can be small) and nails may be easier to manipulate, especially if the child is at a hand over hand level
  • can use real nuts and bolts (large, stove or big equipment size may be easier to hold in terms of weight instead of the usual plastic ones which can be slippery)
  • real sanders can be used with little fear of the child hurting themselves if the finest sandpaper is used. This is excellent for children who love and respond positively to vibration
  • can use saws in a hand over hand approach. The child can learn the concept of cutting, etc.

Sorting Activities

  • many different common household items can be sorted. This has a dual purpose. The child can practice sorting and at the same time become familiar with objects that he will be using all of his life. The child can learn to sort silverware, towels, washcloths, socks, underwear. He can also sort crayons, buttons, jars, and jar lids, plastic bowls, measuring spoons, etc.

Mobiles

  • can use many different types of materials - paper, coloured objects, shiny pictures and wrapping paper, noise-makers, hanging objects, spinning toys, ribbons, cotton balls, tin foil, mirrors, paper towel rolls covered with different textures, etc.
  • can have the child make the mobile with adult
  • can hang it over the bed, wheel chair
  • can change the mobile to different sides of the room or bed
  • can change the mobile with different themes
  • can test the different responses from the child to different materials, noise-makers (look for the child's preference)

Scrapbooks

  • can be made from different types of paper, cardboard, corrugated paper, felt on cardboard, etc.
  • can use it to identify texture (paper, wood, cork, plastic, flat buttons, toothpicks, Popsicles. etc.)
  • can make up daily activity books with souvenirs from the child's different activities so he can read them

Toy Storage

  • Scott (1977) suggests using a large toy box with wheels. This box would keep the toys nearby the child as it could be wheeled around with the child. It could be big enough for riding in. It should be made in such a way that it would be easy for the child to push it. This would encourage some mobility on the part of the child. It would also help the child learn about neatness. It would prevent losing toys. It would also help to prevent the child from slipping or ripping on the toys when they learn to pick them up and put them in the box.

Christmas lights

  • can use the outdoor Christmas lights, starting with one colour - perhaps red. With close supervision, they could be bunched up in a handful size and used in a darkened room to work on tracking abilities. The use of the flasher plug can also elicit good results of responding. (Check with the medical personnel if the child has seizures as this may not be an appropriate activity.)

Plastic tubes

  • can be used for tracking activities
  • can use transparent plastic tubes (12 - 18 inches) filled with oil - drop solid coloured marbles in the tube, one at a time. Move the tube in a variety of movements and follow the movement of the marble.

Musical Toys

The ability to perceive sound is very important for all visually impaired children and especially so for the multiply-handicapped. Auditory awareness is an excellent tool for the child to develop and can be done in a variety of ways with a variety of toys and instruments. The child can first team about the instrument and what it does and how to produce the sound. The multiply-handicapped child may need quite a bit of hand-over-hand manipulation. They can learn to produce and then to match patterns of beats. They can team the difference between fast and slow, between high and low, and between loud and soft sounds.

The following list includes just some of the numerous instruments - both commercially produced or homemade.

Drums

  • all sizes, with different sizes of strikers. Different sized drums produce different sounds. It is possible to make drums from different sizes of cans, with rubber placed on the top. Strikers can be made by piercing a rubber ball with a sharpened piece of doweling. The child can help to construct the drums, then colour or paint the cans. The cans could also be covered with wallpaper or yarn.

Bells

  • all sizes, from tiny ones to big school bells. Belts could be attached to wrist bands if the child has poor motor control. They could also be attached to ankle bands and finger bands.

Tambourines

  • all sizes, different tones, some can be used with strikers. These are great for children with poor motor control as only a little effort can produce a noise. They can be made using tin plates or strong cardboard and pop bottle caps. They could also be made by using the tin foil plates turned to face each other with little bells placed inside. The child can help to make these and then paint, crayon and/or glue materials and ribbons on as streamers. The streamers are a good addition for children who are not too mobile, as they can feel the movement of the streamers past their bodies along with the sound.

Pianos / Organs

  • all sizes, all types (real and play size). Pianos and organs are great for these children. The vibration of these instruments is great, especially if the child is at a beginning awareness stage. Put the child right beside (or inside, if possible) so many parts of their body are touching the piano. Watch for initial startling, it is best to avoid this, so start by playing soft, soft sounds and build up volume and variety as soon as the child seems comfortable. Many of the toy pianos are very colourful, so this may also attract the child.

Blowing instruments

  • whistles, horns, trumpets, etc. -all kinds and sizes, and all tones. The child needs the skill of blowing first. If they can blow, give as much exposure as possible to different types. They may not be able to blow one kind, but they may have success with another kind of blowing instrument.

Traditional Musical Instruments

  • clappers, tone blocks, triangles, maracas, hand castanets, etc. These are all valuable instruments. Ensure that the child has all the necessary fine and gross motor control. These are the types of instruments commonly found in regular music circle times and if the multiply-handicapped child can use them, either alone or with some hand-over- hand help, they can participate in the group.

Homemade Instruments

  • plastic tubes, metal film cans. etc. filled with flour, rice, pebbles, salt, peach pits. seeds, marbles, etc. These can all be made with the child. They can be used for matching of similar or same kinds of sounds. They could also be used for sorting sounds into loud and soft. They could also be used to sequence sounds from soft to loud.

Auditory Awareness

  • can also occur around the house. Sound cues such as wind chimes, radios, loud ticking clocks and cassettes can be used to help the child figure out where he is.

TACTILE EXPERIENCES FOR SENSORY AWARENESS

Have the child take their shoes off both indoors and outside in order to feel different textures - rugs, tile, wood, rungs on the crib, legs on the furniture, grass, mud, stones, rocks, sand, gravel, cement, logs, garden dirt, etc. (just watch for glass, dangerous objects?)

Textured Floor Coverings

  • these are great for the child who is starting to move around and explore - corrugated paper - all colours, plywood, rubber mats, plastic mats, linoleum, velour, different piles of carpet, etc. Many children only experience laying in the playpen or on blankets on the floor.

Tactile/Texture Bins

  • can use sand and water tables for: dry sand, wet sand, cornmeal, Indian corn (very colourful), macaroni - all shapes, bran (good for children who like to put things in their mouths as it will not hurt them), Ivory Snow Flake Goop)

Painting

  • finger paints are great for children who like to get their fingers dirty - can use chocolate pudding for the children who are more timid. Shaving cream, regular and menthol, are also good for painting.

Textured Boundaries

  • good for children who tend to use too much space - can use masking tape, wood pieces, popsicle sticks, cork, coarse sandpaper, glue spread around a sheet and sand sprinkled on it. Placemats can also be used to define a child's space.

Sewing Cards

  • can be homemade with large holes around the perimeter of the image to allow a child to both see and feet the outline of the images, then use a large needle and wool.

Textures

Visually impaired children should experience as many different textures as possible. Safford (1978) feels that children should learn about tactile attributes and the differentiation (like vs. unlike) and the classification of them. Some of the textures suggested are: soft, hard, fuzzy, scratchy, smooth, rough, cold, warm, sharp, crisp, thick, spongy, furry, bristly, springy, bumpy, stiff, prickly, flexible, etc.

Several textures can be joined together for furthur experiences: cotton is both soft and light, feathers are soft and stiff, plastic Is both smooth and flexible, styrofoam is smooth and scratchy, metal is cold and smooth, and a coil Is cold and springy.

It is good to start with textures in the child's immediate environment. In this way, the child will have more opportunity to experience the particular textures.

Recommended Reading

Gilbert, LaBritta (1984.) I Can Do It! I Can Do It! 135 Successful Independent Learning Activities. Mt. Ranier Maryland: Gryphon House Inc. ISBN 0-87659-107-1

Bishop, Denise (2000.) Independent Life Skills Trays. Phoenix Arizona: The Foundation For Blind Children. ISBN: 1-930178-01-8.

Leary, Bernadette and von Schneden, Margaret (1982.) "Simon Says" Is Not The Only Game. New York, New York: American Foundation For The Blind. ISBN: 0-89128-109-6

Redleaf, Rhoda (1987.) Teachables II: Homemade Toys That Teach. St. Paul Minnesota: Toys "˜N' Things Press. ISBN: 0-934140-41-3.

Nielsen, Lilli (1979.) The Comprehending Hand. Copenhagen, Denmark : Socialstyrelsen-National Board of Social Welfare.

Nielsen, Lilli, (1992.) Space and Self. Copenhagen, Denmark: Sikon. ISBN: 87-503-9566-1.

Nielsen, Lilli (1992.) Educational Approaches. Copenhagen, Denmark: Sikon. ISBN: 87-503-9568-8.

Gilbert, Labritta (1989.) Do Touch: Instant, Easy Hands-On Learning Experiences For Young Children. Mt. Rainier, Maryland: Gryphon House.

Chmela, Harriet; Mitchell, Grace and Dewsnap, Lois (1992.) I Am! I Can! A Preschool Curriculum. Activities For The Classroom. Chelsea, Mass.: TelShare Publishing Company, Inc.

Gettman, David (1987.) Basic Montessori: Learning Activities for Under Five. New York, New York, St. Martin Press Inc ISBN: 0-312-01215-2.

Kids Who Are Different

Here's to the kids who are different,

The kids who don't always get A's.

The kids who have ears twice the size of their peers,

And noses that go on for days.

Here's to the kids who are different,

The kids they call crazy and dumb.

The kids who aren't cute and don't give a hoot,

Who dance to a different drum.

Here's to the kids who are different,

The kids with the mischievous streak.

For when they have grown,

As history's shown,

It's their difference that makes them unique.

By: Digby Wolf

http://www.magicinterludes.net/differentkids.html

Excerpts From An Article On The "Mothering" Website: Article About Home-made Toys

http://www.findarticles.com/cf_0/m0838/1999_July/59116009/p1/article.jhtml

"Some of the kites took to the air with ease, and some of them never got aloft no matter what flying strategies were used. Other kites appeared incapable of flight, but suddenly became airborne when a child made a slight adjustment to the strut or the tail or the tension on the string. When these reluctant kites finally went up, there was much rejoicing along with animated explanations of kite-flying strategies. As kites rose and fell, heated debates arose about what makes a kite fly well, followed by vows to make even more aerodynamic kites in the future. The kids' sense of pride in their kites was palpabie. No store-bought kites could have brought these children as close to the mystery and physics of flight as their own creations."

Continued…

"When we give children the chance to play with homemade toys, we give them more than just toys. The boy who observes his sister gradually constructing a treehouse comes to understand the meaning of patience and careful workmanship. The friends who make a tent out of blankets and chairs intuitively grasp the meaning of self-reliance; they know how to construct their own amusements. The girl who creates an entire airport out of shoe boxes, paper cups, and pipe cleaners learns to value her creativity. Her planes take to the air and fly further than any adult would have foreseen, propelled by her own vision and wisdom."

The Case For Functional Skills

He is 18 years old, TMH (30-40 I.Q.) and has been in school 12 years. He has had a number of years of "individual instruction" and he has learned to do a lot of things!

He can now do lots of things he couldn't do before!

He can put 100 pegs in a board in less than 10 minutes while in his seat with 95% accuracy.
But he can't put quarters in vending machines.

Upon command he can "touch" nose, shoulder, leg, foot, hair, ear. He's still working on wrist, ankle, hips.
But, he can't blow his nose when needed.

He can now do a 12 piece Big Bird puzzle with 100 percent accuracy and color an Easter Bunny and stay in the lines!
But, he prefers music, but was never taught how to use a radio or record player.

He can now fold primary paper in halves and even quarters.
But, he can't fold his clothes.

He can sort blocks by color, up to 10 different colors!
But, he can't sort clothes; white from colors for washing.

He can roll Play Dough and make wonderful clay snakes!
But he can't roll bread dough and cut out biscuits.

He can string beads in alternating colors and match it to a pattern on a DLM card.
But, he can't lace his shoes.

He can sing his ABC's and tell me names of all the letters of the alphabet when presented on a card in upper case with 80 percent accuracy.
But, he can't tell the men's room from the ladies' room when we go to McDonald's.

He can be told it's cloudy/rainy and take a black felt cloud and put it on the day of the week on an enlarged calendar (with assistance.)
But he still goes out in the rain without a raincoat or hat.

He can identify with 100 percent accuracy 100 different Peabody Picture Cards by pointing!
But he can't order a hamburger by pointing to a picture or gesturing.

He can walk a balance beam frontwards, sideways and backwards!
But he can't walk up the steps or bleachers unassisted in the gym to go to a basketball game.

He can count to 100 by rote memory!
But he doesn't know how many dollars to pay the waitress for a $2.59 McDonald's coupon special.

He can put the cube in the box, under the box, beside the box, and behind the box.
But he can't find the trash bin in McDonald's and empty his trash into it.

He can sit in a circle with appropriate behavior and sing songs and play "Duck, Duck, Goose."
But, nobody else in his neighborhood his age seems to want to do that. I guess he's just not ready yet.

By: Preston Lewis

http://members.tripod.com/~imaware/functional.html

Eye ConditionEffects On VisionEducational Considerations

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with  nystagmus  and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information

Albinism

Total or partial absence of pigment, causing abnormal optic nerve development

Lenses and tinted lenses may be prescribed.

  • Decreased acuity
  • Photophobia
  • Increased sensitivity to glare
  • High refractive error
  • Astigmatism
  • Central scotomas
  • Nystagmus
  • Muscle imbalance
  • Eye fatigue with close or detailed work
  • Reduced depth perception
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Close viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Lighting from behind
  • Reduced glare
  • Line markers and templates - placeholders
  • Frequent breaks

Amblyopia (was Anopsia, called “lazy eye”) See strabismus

Reduced visual functioning in one eye, which causes the person to use one eye instead of both.

With young children, eye exercises, oclusion or patching of one eye or surgery may help.

  • Monocular vision
  • Reduced visual field
  • Reduced depth perception
  • May develop blindness in one eye
  • Reduced visual-motor abilities
  • Eye fatigue with close or detailed work
  • Frequent breaks
  • Seating should favor functional eye.
  • Familiarization with new environments
  • Time to adjust in new situations
  • May need adaptations for activities requiring visual-motor coordination

Aniridia

A rare genetic disorder that causes absence of all or part of the iris, usually affecting both eyes

It also causes the cornea to lose clarity over time by inhibiting the stem cells that “refresh” it with new, clear epithelial cells. Aniridia is often associated with amblyopia, cataracts, the development of closed angle glaucoma, and sometimes, displaced lens, under-developed retina, and nystagmus. Contact lenses with an artificial iris, tinted spectacles, or bioptic glasses may be prescribed. iris and stem cell implant surgeries are now possible.

Hereditary aniridia is associated with Gillespie syndrome. Sporatic Aniridia may cause nephroblastoma (Wilm’s tumor), and it is associated with WAGR syndrome

  • Decreased acuity
  • Photophobia
  • Large pupil that may be misshapen
  • Generally, respond very well to use of low vision devices
  • Corneal involvement: Scattered light, increased glare, blurred vision, and further reduction of  acuity
  • If cataracts develop: further reduction of visual acuity, blurred vision, and decreased color vision
  • Fovial involvement: loss of detailed (fine) vision
  • If glaucoma develops: fluctuating visual functioning, field loss, poor night vision, and decreased sensitivity to contrast

 

  • Vision stimulation for infants to maximally develop the visual cortex
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Allow time for adjustment to lighting changes
  • Provide seating in the front of the classroom with back to windows
  • Reduced glare
  • Provide lighting from behind
  • Reduced or diffused lighting
  • Lamps with rheostats and adjustable arms
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Use of a black chalkboard and bold chalk
  • If white board is used, bold black markers are recommended over other colors
  • Felt-tipped pens and tinted paper with bold lines
  • Place paper/worksheets on a dark/black background (e.g., blotter, construction or butcher paper, posterboard, etc.)
  • Provide copies of materials presented on the board.
  • Use black backgrounds and white san serif fonts in slide presentations

Anophthalmia

Absence of one or both eyeballs

Causes can be heredity, injury, or secondary to disease. Prosthetic eyes are prescribed to preserve the health of the eyelids and surrounding tissues.

  • Monocular vision:
  • Reduced fields
  • Reduced depth perception
  • Blindness
  • May need visual efficiency training to develop scanning skills
  • Seating and presentation of materials should favor functional eye
  • May need tactile and auditory learning media

Aphakia

Absence of the lens

Although it can be caused by injury, aphakia is usually a result of cataract surgery. Treatments include lens implants, contact lenses, and/or glasses.

  • Inability to accommodate to varying focal distance
  • Inability to accommodate to lighting changes
  • Reduced depth perception
  • May have peripheral field distortions
  • Support wearing of any prescribed lenses
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing
  • Adequate lighting (e.g., lights with rheostats and adjustable arms)
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Allow time for adjustment to lighting changes

Astigmatism

Irregularity in the curvature of the cornea and/or lens, which prevents light rays from being properly focused on a single point on the retina

Astigmatism commonly occurs with myopia and hyperopia. It also can be associated with albinism and keratoconus. Corrective lenses may be prescribed.

  • Blurred vision at any distance (uncorrected)
  • Distorted vision
  • Tendency to squint to create a pinhole effect
  • Visual fatigue associated with close work
  • High contrast materials
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Frequent breaks from close/detailed work

Buphthalmos (Infantile glaucoma)

Enlarged eyeballs

Caused by congenital glaucoma; hereditary; onset from birth to three years; can cause enlargement and increased depth of the anterior chamber, damage to the optic disc, and/or increased diameter and thinning of the cornea; requires surgery, and blindness occurs if left untreated.

  • Photophobia
  • Reduced central acuity
  • Corneal opacity
  • Excessive tearing
  • Refractive error
  • Eye pain

 

  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting from behind
  • Sunglasses, visors or hats may be worn indoors
  • Allow time for adjustment to lighting changes
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing

Cataracts

Opacity or cloudiness of the lens, which restricts passage of light to the retina; usually bilateral

Opacity increases over time until “mature” cataracts can obscure the fundus and the pupil may appear white. Mature cataracts are usually removed surgically, requiring lens implants or contact lenses.

  • Reduced visual acuity
  • Blurred vision
  • Reduced color discrimination
  • Photophobia
  • Associated with nystagmus
  • Visual ability fluctuates according to light
  • If cataracts are centrally located, near vision will be reduced
  • Increased sensitivity to glare

 

  • Support of the wearing of any prescribed lenses
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing
  • Support of eccentric viewing
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • May need reduced or diffused lighting
  • Lighting from behind
  • May need lamps with rheostats and adjustable arms
  • Reduced glare

Chorioretinitis

Posterior uveitis, or an inflamation of the choroid that spreads to the retina

This can be caused by tuberculosis, histoplasmosis, or toxoplasmosis.

  • Blurred vision
  • Photophobia
  • Distorted images
  • Central scotomas
  • Support of eccentric viewing
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing
  • Diffused, less intense light to enlarge the pupil
  • Telescope
  • May need to use tinted lenses, sunglasses, visors, or hats outdoors and indoors as well
  • High contrast line markers or templates for reading, finding math problems, or locating other information

Coats’ Disease  (Exudative Retinitis or retinitis telangiectasia)

A congenital, nonhereditary, and progressive disorder that is characterized by abnormal development of the blood vessels behind the retina

Coats’ occurs mostly in males. Symptoms typically appear in children around six to eight years old but they can appear in infancy. Coats' usually affects only one eye. Severity depends on the size and number of affected blood vessels. Leakage of blood and fluids cause retinal swelling and detachment. Cryotherapy and laser photo-coagulation sometimes are used to stop the progression of blood vessel growth and leakage. 

  • Decreased central acuity
  • Loss of detail
  • Progressive central field loss
  • Reduced night vision
  • Loss of color vision
  • May develop strabysmus
  • May have iritis
  • May have glaucoma
  • May develop cataracts
  • May be blind in one eye
  • Peripheral fields can be affected
  • Avoid contact sports and other high risk activities to prevent retinal detachment
  • Seating and presentation of work should favor more functional eye
  • Visual efficiency training to develop scanning skills

 

Coloboma

Hereditary birth defect that causes a notch or cleft in the pupil, iris, ciliary body, lens, retina, choroid, or optic nerve

A “Keyhole” pupil often occurs. It can be associated with refractive error, cataracts, nystagmus, strabismus, and glaucoma (later in life).

  • Decreased acuity
  • Photophobia
  • Muscle imbalance
  • Restricted fields (if retina is affected)
  • Reduced depth perception

 

  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Average to bright light
  • Reduced glare
  • May need to use sunglasses, visors, or hats outdoors and indoors as well (if iris is affected)
  • High contrast line markers and templates may be helpful for reading, finding math problems, or locating other information

Color deficiency (colorblindness) 

See Achromotopsia

 

 

Cone Monochromacy

See Achromotopsia

 

 

Corneal Ulcers, Corneal Opacities, Corneal Scarring, Keratitis, and Interstitial Keratitis

An open sore or scarring on any part of the cornea

It can be caused by bacteria, viruses (herpes), fungi, vitamin deficiency, injury, a hypersensitive reaction, diabetes, or severe dry eye. Superficial ulcers (called abrasions) usually heal quickly and completely, but deep ulcers cause growth of scar tissue or new blood vessels that impair vision. Corneal ulcers are usually quite painful, and other symptoms may include vision loss, squinting, and tearing (watering). Early diagnosis and treatment are crucial. With extensive scarring, a corneal transplant may be necessary. There are promising results with use of artificial corneas, which seem to be less likely to be rejected.

  • Photophobia
  • Fracturing of light (like looking through broken glass)
  • Increased glare
  • Blurred vision
  • Reduced acuity
  • Blindness

 

  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Sunglasses, visors or hats may be worn indoors
  • Seating in front of room with back toward windows
  • Reduced glare
  • High contrast materials
  • Diffused lighting from behind
  • Lights with rheostats and adjustable arms are helpful for close work.
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Frequent breaks from visual tasks
  • Support of eccentric viewing
  • May need auditory materials for longer reading assignments

Cortical Visual Impairment (CVI)

A neurological visual disorder resulting from damage to the optic nerve and/or parts of the brain that process and interpret visual information (i.e., visual cortex)

CVI is characterized by:

  • Specific color preference, especially for red and/or yellow
  • Attraction to movement
  • Visual field preference, especially for peripheral fields
  • Visual latency: delayed visual processing - in directing gaze, identification, recognition, and/or discrimination
  • Difficulties with discrimination and interpretation of complex visual information
  • Poor visual attention
  • Atypical visual responses (e.g., looking at something while appearing not to look)
  • May not look at an object and reach for it simultaneously (look first, then look away while reaching)
  • Better visual performance with familiar objects/settings
  • Unique visual features (i.e., light gazing and non-purposeful gaze)
  • Fluctuation in visual functioning
  • Reduced visual fields
  • Photophobia
  • Fatigue has a negative impact on visual performance
  • Use of movement to increase visual attention
  • Use of preferred color to increase visual attention
  • Present visual information in preferred visual field
  • Present visual information on a solid background (e.g., black or white cloth)
  • Use of bright, high contrast materials
  • Increase line spacing and white space on a page of text and/or images to reduce visual clutter and complexity
  • Use high contrast templates to reduce the amount of information seen at one time
  • Close viewing
  • Vision efficiency training
  • Frequent breaks from visual tasks
  • High illumination from behind
  • Sunglasses, visors or hats may be worn indoors
  • Support use of one sense at a time
  • Reduce visual, auditory, and tactile distractions
  • Extra time to respond
  • Extra time to adjust to new environments
  • Use of consistent language
  • Use of color coding as visual cues for recognition
  • Use of consistent visual cues across settings

Diabetic Retinopathy

Changes in the blood vessels of the retina, causing hemorrhaging in the retina and vitreous

It is caused by juvenile or type 2 diabetes. It may lead to retinal detachment and blindness.

  • Increased sensitivity to glare
  • Lack of accommodation
  • Floating obstructions in the vitreous
  • Fluctuating acuity
  • Diminished color vision
  • Reduced visual fields
  • Double vision
  • Blindness
  • Adequate high quality lighting (e.g., lamps with rheostats and adjustable arms)
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Large button/key technology may be helpful
  • Training in use of auditory materials may be needed due to loss of vision and tactile sensitivity
  • Training in use of speech recognition input software may be helpful
  • Precautions related to decreased sensitivity in hands and feet (e.g., burns, cuts, falls)

Diplopia

Muscular defect that restricts the ability of the eyes to work together

It causes double vision, as the image from one eye is imposed on the image from the other eye. Left untreated, this condition can develop into amblyopia. Corrective lenses may be prescribed.

  • Visual confusion
  • Double vision
  • Dizziness
  • Suppression of the image from one eye, causing monocular vision
  • Eye fatigue
  • Blurring of print
  • Headache
  • Loss of place in visual tasks
  • High contrast materials
  • Reduced glare
  • Extended time to adjust to new situations
  • Frequent breaks from visual tasks
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Familiarization with new environments

Dislocated Lens

The lens is not in its natural position.

It is sometimes associated with coloboma, Marfan’s syndrome, or Marchesani’s syndrome. Also, it may be associated with diplopia or cataracts.

  • Blurred vision
  • Double Vision
  • Visual fatigue during close or detailed visual tasks

 

  • Frequent breaks from visual tasks
  • High contrast materials
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Reduced or diffused lighting
  • High contrast line markers or templates for reading, finding math problems, or locating other information

Enucleation

The anterior chamber or the entire eyeball is surgically removed from the orbit (eye socket).

Prosthetic eyes or scleral shells are usually recommended.

  • If one eye is removed, there is no depth perception.
  • Monocular vision
  • Reduced visual field
  • Effects of any eye condition(s) of the remaining eye
  • Blindness
  • Effects visual-motor skills, especially reach and negotiation of steps and drop-offs
  • Training in care of prostheses
  • Vision efficiency training (i.e., scanning)
  • Considerations related to the visual impairment of the remaining eye
  • Considerations related to possible changes in learning media

Esophoria, Esotropia, Exophoria, and Exotropia   See strabismus

 

 

Glaucoma

An eye disease which causes increased pressure in the eye because of blockage in the normal flow of the fluid in the aqueous humor

Causes include changes in the lens or uveal tract, trauma, reaction to a medication, surgical procedures, and heredity. Eye pain and headaches are associated with glaucoma. Prescription eye drops to reduce pressure must be used regularly, and surgery may be necessary. Untreated, glaucoma can lead to degeneration of the optic disk and blindness.

  • Fluctuating visual functioning
  • Field loss
  • Poor night vision
  • Photophobia
  • Difficulty reading
  • Difficulty seeing large objects presented at close range
  • Decreased sensitivity to contrast
  • Eye redness
  • Hazy cornea
  • Wide open pupil
  • Stress and fatigue have a negative affect on visual performance

 

  • Support use of sunglasses, visors, or hats in bright sunlight and bright lighting indoors
  • Allow time for adjustment to lighting changes
  • Reduced glare
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • High contrast materials
  • May benefit from magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May need visual efficiency training to develop scanning skills
  • Frequent breaks from visual tasks
  • May need instruction in tactile learning and braille
  • Teachers must be alert to signs of pain and increased ocular pressure.

Hemianopia (hemianopsia)

Blindness or impaired vision in one half of the visual field in one or both eyes

If both eyes are affected, vision loss may occur on the same side in both nasal fields, or in both temporal fields. Visual acuity in the unaffected field(s) remains unchanged. Hemianopia can be caused by stroke, other brain trauma, tumors, infection, or surgery.

  • Field loss
  • May be unaware of missing visual information
  • Visual efficiency training to develop scanning skills
  • Use markers at the beginning and/or ending of each line of text to facilitate reading the entire line

Histoplasmosis (Presumed Histoplasmosis Syndrome - POHS)

This is a syndrome affecting the choroid and retina, which is characterized by peripheral atrophic chorioretinal scars, maculopathy, and atrophy or scarring adjacent to the optic disc. Vision loss is secondary to macular and choroidal neovascularization (CNV).

POHS is most likely caused by a fungal infection acquired through exposure to spores in bird droppings and bat guano. Treatments include steroids to treat the initial infection, laser, anti-vascular endothelial growth factors, and photodynamic therapy. Prism lenses may be prescribed.

  • Distorted vision
  • Blind spots
  • Macular damage or central scotomas cause “patchy” fields, central vision loss, and reduced color vision.
  • Peripheral damage causes loss of night vision
  • Lamps with rheostats and adjustable arms
  • High contrast line markers or templates for reading, finding math problems, or locating other information.

Central damage:

  • Eccentric viewing
  • Magnification to enlarge an image beyond the scotoma
  • Enlarged printed materials
  • Close viewing
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Diffused, less intense light to enlarge the pupil so that more area can be viewed
  • CCTV with reversable foreground and background (white on black)

Peripheral damage:

  • High illumnation
  • NOIR lenses or overlay filters may be helpful
  • CCTV for maximum contrast
  •  Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc)
  • Visual efficiency training in organized search (grid) patterns
  • May need to be seated farther away from the front to see more of the viewing area (e.g., board, screen, chart, etc)

Hyperopia (Farsightedness)

A refractive error in which the focal point for light rays is behind the retina

It is caused by the eyeball being too short from front to back. Corrective lenses are usually prescribed.

  • Distance acuity is better than near acuity
  • Uncorrected, close visual tasks may cause headache, nausea, dizziness, and eye rubbing

 

  • Support use of prescription lenses for close visual tasks
  • Magnification for near tasks (e.g., hand-held magnifier, electronic magnifier, screen enlargement software)
  • Frequent breaks from close visual tasks
  • Alternate near and distance visual tasks

Hyperphoria, Hypertropia, Hypophoria, Hypotropia    See strabismus

 

 

Hypoplasia  See Optic Atrophy

 

 

Keratitis See Corneal Ulcer

 

 

Keratoconus (KC)

Degenerative disorder in which the cornea thins and takes on a conical shape

Keratoconus is often bilateral but not symmetrical, so vision may be significantly better in one eye than the other. Vision deteriorates at varying rates (sometimes quite rapidly), and plateaus of stable vision can occur. Although it seems to be hereditary, keratoconus is typically diagnosed in adolescence. It is sometimes associated with retinitis pigmentosa, Down’s syndrome, Marfan’s syndrome, and aniridia.  Treatments include prescription lenses and various surgeries: intrastromal corneal ring segments, cross-linking, mini asymmetrical radial keratotomy, and corneal transplants. There are promising results in transplants with use of artificial corneas, which seem to be less likely to be rejected.

  • Slightly blurred vision in early stages, increasing as KC progresses
  • Distortion of entire visual field, which worsens in low light
  • Decreased visual acuity especially distance vision
  • Irregular astigmatism (parts of the field are in focus, and parts are out of focus)
  • Increased sensitivity to glare
  • Decreased night vision
  • Multiple images
  • Flaring of images
  • Streaking
  • Stationary objects/lights may appear to move
  • May develop photophobia
  • Cornea can rupture
  • Can lead to blindness
  • Avoid activities that could cause corneal damage, such as  contact sports and swimming in heavily chlorinated water
  • Reduced glare
  • Diffused lighting
  • Lamps with rheostats and adjustable arms
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)

Leber’s Congenital Amaurosis (LCA, Leber’s Congenital Amaurosis)

A rare hereditary disorder that leads to degeneration of the macula

LCA becomes evident within the first few months of life. Progressive central field loss can occur, although vision is generally stable. LCA is a subset of retinitis pigmentosa with at least thirteen described types that are distinguished by genetic cause, patterns of vision loss, and associated eye conditions. Nystagmus, keratoconus, photophobia, extreme hyperopia, and sluggish (or absent) pupilary response to light are often present with LCA. Excessive rubbing of eyes (also poking or pressing) is a characteristic behavior. 

 

  • Decreased acuity
  • Reduced night vision
  • Progressive central field loss
  • Loss of color vision
  • Loss of detail
  • Peripheral fields can be affected
  • May need visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Enlarged printed materials
  • Close viewing
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Lamps with rheostats and adjustable arms
  • Support use of sunglasses, visors, or hats in bright sunlight
  • Seat in the front of the room with windows behind back
  • May need frequent breaks from visual tasks
  • May need instruction in use of auditory materials
  • May need instruction in tactile learning and braille

Leber’s Hereditary Optic Neuropathy (LHON, Leber’s Optic Atrophy)

It is a rare hereditary disease caused by a mitochondrial mutation and passed on by the mother. It is characterized by rapidly progressive and severe optic nerve degeneration (atrophy).

It occurs in young men and, rarely, young women. Onset is usually in young adulthood. Most often, there is acute vision loss in one eye and then, a few weeks or months later, in the other eye, but vision loss sometimes occurs in both eyes simultaneously. It can include other types of central nervous system involvement.

  • Reduced central acuity
  • Vision may be blurred
  • Fluctuating visual performance
  • Color vision may be impaired
  • Visual perception may be impaired

 

  • High illumination
  • High contrast
  • Enlarged printed materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Avoid visual clutter:
  • Present visual information in isolation
  • Avoid busy backgrounds
  • Avoid wearing patterned clothing when presenting visual information

Macular Degeneration (Macular Disease, Congenital Macular Disease, and Age-Related Macular Degeneration)

Progressive (degenerating) damage to the central part of the retinal cones

The dry form involves yellow deposits (celluar debris) on the macula and eventually, thinning of cells in the macula, which leads to tissue death. In the wet form, there is abnormal growth of blood vessels in the choroid underneath the macula. These blood vessels leak blood and fluid into the retina, causing distortion, blind spots, loss of central vision, retinal scarring, and risk of retinal detachment. Macular degeneration is the leading cause of blindness in people over sixty, but it also can occur in children below age seven. Factors contributing to the development of the disease include heredity, diabetes, head injury, nutritional deficits, high cholesterol, smoking, and exposure to sunlight without eye protection. There is no cure, but treatment can slow progress of the disease. Treatments include nutritional supplements, laser therapy, and medication. 

  • Reduced central acuity
  • Peripheral vision is not affected
  • Central scotomas
  • Distorted vision
  • Blurred vision
  • Decreased color vision
  • Slow recovery from changes in light
  • Loss of contrast sensitivity
  • Visual fatigue
  • Support of eccentric viewing
  • Support use of sunglasses, hats, or visors in bright sunlight
  • Allow time for adjustment to lighting changes
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Diffused lighting may allow the pupil to enlarge so that more area can be viewed
  • Close viewing
  • Magnification (e.g., hand-held magnifier, electronic magnifier with light text on dark background, screen enlargement software, telescope for distance viewing etc.)
  • Reduced glare
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Seating in front with back to window
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Frequent breaks from visual tasks
  • Avoid standing in front of a light source when speaking to the student

Microphthalmia (Microphthalmos, nanophthalmia, nanophthalmos)

A hereditary, developmental disorder that causes one or both eyes to be abnormally small

It may occur with other congenital abnormalities such as club foot, additional fingers or toes, webbed digits, polycystic kidneys, and cystic liver. This disorder can be associated with Patau Syndrome, Triploid Syndrome, or Wolf-Hirschhorn Syndrome. It may result in  cataracts, glaucoma, aniridia, and coloboma.

  • Decreased visual acuity
  • Photophobia
  • May have fluctuating visual abilities

 

  • High contrast
  • Reduced glare
  • Average to bright light
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Expectations may need to be adjusted due to the frustration related to fluctuating visual abilities
  • Frequent breaks from visual tasks
  • Instruction in strategies for stress reduction and dealing with frustration related to fluctuating visual abilities

Muscle Imbalance See Strabismus and Amblyopia

 

 

Myopia (Simple and Degenerative Myopia, nearsightedness)

A refractive error in which the image of a distant object is formed in front of the retina and cannot be seen distinctly; eyeball is elongated from front to back

Degenerative myopia is progressive, causing increasingly severe nearsightedness, so that visual acuity often cannot be corrected to normal with lenses. It can lead to retinal detachment, choroidal hemorrhages, reduced central vision, opacities in the vitreous, macular swelling, and cataracts. Treatments include corrective lenses and LASIC surgery.

  • Reduced distance acuity
  • Near vision is better than distance vision
  • May squint and frown when trying to see at a distance

 

  • High illumination
  • Reduced glare
  • May need to be seated closer to the front in order to see written information, videos, and demonstrations
  • If myopia is progressive, take precautions to protect the retina

Nystagmus

Involuntary eye movements, which can be horizontal, vertical, circular, or mixed

Causes can be heredity, neurological disorders, toxicity, pharmaceutical drugs, alcohol, inner ear disturbance, or unknown. Nystagmus can be increased by stress, spinning, and rhythmic movements. 

  • Inability to maintain steady fixation
  • Reduced visual acuity
  • Visual fatigue
  • Vertigo (rare)
  • Stripes and other patterns may increase the rate of the nystagmus
  • Shifting gaze or tilting the head may help to find the null point at which the nystagmus slows.
  • Frequent breaks from close visual tasks
  • Vary visual tasks
  • Adequate lighting
  • Good contrast
  • Line markers, rulers, typoscopes, and other templates may be helpful for keeping the place on a page
  • Instruction in stress reduction strategies

Optic Atrophy (Optic Nerve Atrophy)

Hereditary or acquired damage to the optic nerve that limits or stops transmission of visual information from the eye to the brain

It is evidenced by a pale optic disc and reduced pupilary response. Acquired optic atrophy can be caused by disease, pressure on the optic nerve, trauma, glaucoma, or toxicity. Type 1 optic atrophy is progressive.

 

  • Fluctuating visual performance
  • Color vision may be reduced
  • Night vision may be reduced
  • Visual perception may be impaired
  • May have photophobia
  • Visual stimulation in infancy and early childhood.
  • Low vision training in early childhood to help the child interpret visual information
  • Supplement visual information with tactile and auditory information
  • High illumination
  • If photophobia is present:
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Provide adequate lighting through use of lamps with rheostats and adjustable arms)
  • High contrast
  • Enlarged print
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Avoid visual clutter:
  • Present visual information in isolation
  • Avoid busy backgrounds
  • Avoid wearing patterned clothing when presenting visual information
  • May need adapted color dependent activities
  • May need alternate methods for matching clothing
  • May need instruction in tactile learning and braille

Optic Nerve Hypoplasia(ONH)

ONH and Septo-Optic Dysplasia (SOD) are related disorders of early brain development. ONH is a congenital, nonprogressive condition in which the optic nerve is under-developed and small.

It may affect one or both eyes, and when both are affected, side-to-side nystagmus is frequently present. During the first few years of life, vision may improve as the brain continues to develop. The incidence of strabismus is increased with ONH. It is one of the three defining characteristics of Septo-Optic Dysplasia, which is also called DeMorsier’s Syndrome. Learning disability, autism, cerebral palsy, and intellectual developmental delays can occur with ONH and SOD. Possible causes include young maternal age, genetic mutation, fetal alcohol syndrome, trauma, and viral infection.

  • May have decreased visual acuity
  • May have better acuity In one eye than in the other
  • May have nystagmus
  • May have strabismus
  • May have variable field restrictions
  • Visual perception may be impaired
  • High illumination
  • High contrast
  • Enlarged printed materials
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Avoid visual clutter:
  • Present visual information in isolation
  • Avoid busy backgrounds
  • Avoid wearing patterned clothing when presenting visual information
  • Provide opportunities to confirm or clarify visual information through tactile exploration
  • May benefit from verbal descriptions to help make sense of visual information.
  • May need adapted color dependent activities
  • May need alternate methods for matching clothing
  • May need instruction in tactile learning and braille

Peter’s Anomaly

A congenital, genetic disorder that involves clouding (opacity) and thinning of the cornea

It is caused by abnormal development of the front third of the eye (anterior segment), and central opacities are most common. The iris may or may not be attached to the cornea (Type 1), and cataracts and other lens abnormalities may be present (Type 2). It is very common for amblyopia and glaucoma to develop. This condition can be associated with peters plus syndrome.

  • Blurred vision
  • Decreased central acuity
  • May have scotomas in peripheral fields
  • Photophobia
  • Increased sensitivity to glare
  • Reduced color discrimination
  • Visual ability fluctuates according to lighting
  • May have reduced near vision

 

  • Support of eccentric viewing
  • May need visual efficiency training to develop scanning skills
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Adequate lighting from behind using lamps with rheostats and adjustable arms
  • Reduced glare
  • Seat with back to windows
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Close viewing
  • May need adapted color-dependent activities
  • May need alternate methods for matching clothing
  • Frequent breaks from visual tasks

Photophobia

Abnormal sensitivity to light (any type)

It is usually associated with an eye disease or disorder (e.g., iritis, ocular albinism, aphakia, aniridia, dislocated lens, cataracts, glaucoma, etc.). However, many people experience mild photophobia that is unrelated to another eye condition. Other causes include corneal inflammation, some medications, and eye injuries. Severe photophobia can be quite painful, even in relatively dim light. 

  • Squinting
  • Closing the eyes
  • Eye pain
  • Headaches
  • Eye fatigue
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Provide lighting from behind
  • Use of shielded lamps with rheostats and adjustable arms)
  • Reduced glare
  • May benefit from use of NOIR sunglasses and/or filters (colored overlays) when reading
  • May need breaks from visual tasks or rest periods in a darkened area

Phthisis bulbi

Abnormally low intraocular pressure, which can cause shrinkage of the eye

It may occur as a complication of eye surgery, or it can be caused by eye diseases, serious and long-term inflammation, or injury. Low pressure damages the macula. The tissues inside the eye deteriorate, become disorganized, and scar tissue is formed. In some cases, the eye can become completely nonfunctional. Sometimes a scleral shell prosthesis is prescribed for proper lid function, eyelash direction, healthy tearing, protection of the cornea, and aesthetics. 

  • Reduced central acuity
  • Reduced color vision
  • Blindness
  • Average or bright light
  • Reduced glare
  • May need high contrast
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from use of high contrast line markers or templates for reading, finding math problems, or locating other information
  • May need some materials presented auditorily
  • May need instruction in tactile learning and braille

Presbyopia

The gradual loss of flexibility of the lens that occurs with age

It results in inability of the eye to focus at near distance. Presbyopia generally begins to noticeably affect visual functioning around age 40, and people often need prescription lenses by age 45. Options for prescription lenses include glasses for near-distance tasks, bifocals, transition lenses, and monovision contact lenses. Vision also can be corrected by reshaping the cornea using lasers (LASIK), radio waves (conductive keratoplasty - CK), or gas bubbles (IntraCor). Other surgical treatments include artificial lens implants, corneal inlays, and corneal overlays.

  • Blurred vision at normal reading distance
  • Headaches from doing close visual tasks
  • Further compromises the vision of aging adults who have existing visual impairments

 

  • Adequate lighting
  • High contrast
  • Frequent breaks from near-distance visual tasks

Ptosis

Drooping (sagging) of the eyelid

It may affect upper and/or lower lids and one or both eyes. Ptosis is usually due to weakness of the muscles that control the eyelids, damage to the nerves that control these muscles, or very loose skin of the upper eyelids.  Commonly associated with the aging process, ptosis also can be congenital and hereditary, or caused by injury or disease. A ptosis crutch may be prescribed to elevate the eyelid. Medications may be prescribed for those who have myasthenias gravis. Children with severe ptosis need eyelid lift surgery early in life to insure normal visual development and to prevent amblyopia.

  • Severe ptosis obscures the upper visual field
  • Long-term reduction of visual field can cause amblyopia

 

  • May need visual efficiency training to develop scanning skills
  • Ensure access to information that is elevated (bulletin boards, black/white boards, video screens, etc.)

Retinal Detachment

An emergency situation in which parts of the retina pull away from the underlying tissue that nourishes it and from the supporting structure of the eye

Detachments can be repaired if treated within 24-72 hours, but detached parts deteriorate rapidly. Any detachment endangers the entire retina. Detachments are caused by retinal tears, fluid under it, or shrinkage of the vitreous. These conditions may be due to injury, inflammatory eye disorders, advanced diabetes, degenerative myopia, and other retinal disorders.  

  • Field loss
  • Blind spots (scotomas)
  • Blurred vision
  • Possible loss of central vision
  • May develop myopia and/or strabismus
  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May need visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • High illumination
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Seating in front with back to window
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Frequent breaks from visual tasks

Retinal Dysplasia

A rare, hereditary disorder resulting in abnormal development or growth of the retina and characterized by retinal folds, overgrowth of cells, and rosettes of retinal tissue

It can be associated with Meckel syndrome. 

  • Field loss
  • Blind spots (scotomas)
  • Blurred vision
  • Possible loss of central vision
  • Reduced visual functioning at night or in dimly lit places
  • Nighttime orientation and mobility evaluation
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • Lamps with rheostats and adjustable arms
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Frequent breaks from visual tasks

Retinitis Pigmentosa (RP)

A group of hereditary disorders causing degeneration of the retina

It is characterized by progressive loss of vision and reduction of visual fields, usually from the periphery inward. However, in some cases, central vision is affected first. RP may be associated with Usher’s syndrome, Leber congenital amaurosis, Laurence-Moon Biedl, and Bassen-Kornzweig syndrome. 

 

  • Loss of peripheral vision
  • Night blindness
  • Tunnel vision
  • Decreased acuity
  • Decreased depth perception
  • Blind spots (scotomas due to retinal scarring
  • Photophobia
  • May develop cataracts
  • May become totally blind
  • May be associated with myopia, vitreous opacities, cataracts, and keratoconus
  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • High illumination
  • Reduced glare
  • NOIR lenses or overlay filters may be helpful
  • Video magnifier for maximum contrast
  • Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc.)
  • Visual efficiency training in organized search (grid) patterns
  • Orientation and mobility evaluation at night and in dimly lit places
  • For central vision loss: magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • For peripheral field loss: increase viewing distance to see more area.

Retinoblastoma

A rare type of cancer in which malignant cells grow in the retina

It usually develops in early childhood. The majority of children who develop this cancer have mutations only in eye cells (non-germinal). They will not pass on the mutation, and usually, retinoblastoma develops only in one eye. When the mutation occurs in all body cells (germinal retinoblastoma), the disease is hereditary. These children are more likely to develop retinoblastoma in both eyes, pineal brain tumors (trilateral retinoblastoma), and other forms of cancer anywhere in the body. Current treatments include surgery, radiation, and chemotherapy. Retinoblastoma can become life threatening if the tumor extends beyond the eye, so enucleation is frequently necessary.

  • Strabismus is one of the first signs of retinoblastoma.
  • Restricted fields due to removal of tumors
  • Blind spots (scotomas) due to removal of small tumors
  • With monocular vision, there is no depth perception and visual field is restricted.
  • Blindness
  • Medications can negatively affect residual vision.

 

  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • Orientation and mobility evaluation at night and in dimly lit places recommended
  • May need visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from access to auditory materials
  • May require instruction in tactile learning and braille

Retinopathy of Prematurity (ROP, retrolental Fibroplasia)

Incomplete development of the blood vessels of the retina

It occurs in premature infants. The vessels also may grow abnormally from the retina into the back of the eye. They may bleed into the eye, scar tissue may develop, and retinal detachment may occur. The major risk factors are degree of prematurity and low birth weight. There are five stages of ROP, ranging from mildly abnormal blood vessel growth in stage one to retinal detachment in stage five. ROP may be associated with other issues caused by incomplete development. Lasers or freezing (photocoagulation and cryotherapy) may be used to stop the abnormal blood vessels from continuing to grow. Also, surgery may be done to re-attach the retina. 

  • Retinal scarring
  • Decreased visual acuity
  • Severe myopia
  • Field loss
  • Partial or complete retinal detachment
  • Blind spots (scotomas)
  • Strabismus
  • Total blindness
  • May develop glaucoma

 

  • Early intervention and sensory stimulation
  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • Nighttime orientation and mobility evaluation
  •  May need visual efficiency training to develop scanning skills
  • Visual efficiency training in organized search (grid) patterns
  • Adequate to high illumination (e.g., lamps with rheostats and adjustable arms)
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Frequent breaks from visual tasks
  • May benefit from access to auditory materials
  • May need instruction in tactile learning and braille
  • May benefit from magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Reduced glare
  • Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc.)
  • Balance need for a larger viewing area with the need for magnification
  • Balance need for close viewing against the need for increased distance and a larger portion of the text/pictures
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing

Retinoschisis

A degenerative disorder in which the retina splits into two separate layers, resulting in progressive loss of vision, beginning in the fields that correspond to the areas where the retina splits

The hereditary form (juvenile X-linked retinoschisis) affects mostly boys and young men. The more common form can affect both men and women, and it usually is acquired in middle age or older (senile retinoschisis). Both forms may be associated with cysts (sack-like blisters) that form a spoke-like pattern in the retina. Retinal detachments can occur, and if detected early, they sometimes can be repaired with surgery. Prismatic glasses may be prescribed to increase field of vision.

  • Strabismus
  • Nystagmus
  • Central field loss
  • Peripheral field loss
  • Reduced visual acuity
  • Reduced color discrimination
  • Blind spots (scotomas)
  • Blindness

 

  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • May need visual efficiency training to develop scanning skills
  • May need visual efficiency training in organized search (grid) patterns
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Frequent breaks from visual tasks
  • May benefit from access to auditory materials
  • May need instruction in tactile learning and braille

For central vision loss:

  • Nighttime orientation and mobility evaluation
  • Magnification (e.g., hand-held lighted magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • High illumination
  • Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc.)
  • Adapted color-dependent activities
  • Alternate methods for matching clothing

For peripheral field loss:

  • Increase viewing distance to see more area
  • Support of eccentric viewing
  • Balance need for a larger viewing area with the need for magnification

Rod Achromacy     See Achromotopsia

 

 

Scotoma (pl. scotomata, scotomas)

A portion of the visual field that is blind or partially blind and surrounded by relatively normal vision, depending on the presence of other eye conditions

Scotomas can occur in any part of the visual field. They can be caused by retinal disorders, tumors, stroke, or traumatic brain injury. 

  • May affect central or peripheral fields
  • Reduced acuity
  • May cause loss of detail
  • May cause photophobia
  • May cause reduced color vision
  • Visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • Seating and presentation of work should favor more functional eye
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced glare
  • May need lighting from behind using adjustable lamps with rheostats and adjustable arms
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from enlarged printed materials
  • May benefit from close viewing
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • May need adapted color-dependent activities
  • May need alternate methods for matching clothing

Septo-Optic Dysplasia See Optic Nerve Hypoplasia and "Syndromes"

 

 

Strabismus (muscle imbalance

Abnormal alignment of the eyes; an inability to look at the same point in space with both eyes at the same time

It can be caused by a defect in the extra-ocular muscles or in the part of the brain that controls eye movement. It can be hereditary, and it may be associated with brain tumors, cerebral palsy, Down syndrome, extreme farsightedness, cataracts, or having much better vision in one eye than in the other. Strabismus includes:

  • “phorias”– muscle imbalances that are controlled by the brain's efforts toward binocular vision. Not always present, they tend to manifest when the person is tired.
  • “tropias” - observable deviations that the brain cannot resolve. They are always present.
  • Eso – turned inward/nasal (esophoria and esotropia)
  • Exo – turned outward/temporal (exophoria and exotropia)
  • Hyper – turned upward (hyperphoria and hypertropia)
  • Hypo – turned downward (hypophoria and hypotropia)

Treatments can be effective for young children: eye exercises, occlusion of the better eye, medications, and surgery. Prismatic glasses may be prescribed to increase field of vision.

  • Impaired ability to achieve binocular vision
  • Decreased depth perception
  • Affects eye-hand coordination
  • Difficulty fixating
  • May have difficulty scanning, tracking, and tracing
  • Difficulty following fast-moving objects
  • Difficulty making eye contact

 

  • Orientation and mobility evaluation recommended, specifically for negotiation of drop-offs and stairs in unfamiliar places
  • Vision efficiency training in scanning, tracking, and tracing

 

Toxoplasmosis

Congenital or acquired inflammation of the retina and choroid (retinochoroiditis), which can cause retinal scarring

Toxoplasmosis is caused by infection with the toxoplasma parasite found in animal feces and unpasteurized milk. Unborn babies are most vulnerable to the infection, and it can cause damage to the brain, eyes, or other organs. Treatments include anti-inflammatory medications, photocoagulation (laser) therapy, and cryotherapy (freezing).

  • Scotomas
  • Peripheral field loss
  • Central field loss
  • Loss of visual acuity
  • Decreased color vision
  • Photophobia
  • Increased sensitivity to glare
  • Visual efficiency training to develop scanning and eccentric viewing skills
  • Reduced glare
  • May need lighting from behind using adjustable lamps with rheostats and adjustable arms
  • Magnification (e.g., microscopic lenses, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from enlarged printed materials
  • May benefit from close viewing
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • May need adapted color-dependent activities
  • May need alternate methods for matching clothing

Trachoma

A contagious bacterial infection of the eyes and eyelids, causing scarring and buckling of the eyelids

This causes the eyelashes to turn under, which leads to corneal scarring. Repeated and prolonged infection causes permanent visual impairment and blindness. Trachoma is spread through direct contact with secretions from the eyes, eyelids, or nose of an infected person. It is the leading cause of preventable blindness worldwide.

  • Photophobia
  • Fracturing or scattering of light (as in looking through a broken windshield
  • Increased glare
  • Blurred vision
  • Reduced acuity
  •  
  • Sunglasses, visors or hats outdoors, and indoors as well
  • Reduced or diffused lighting from behind (e.g., lamps with rheostats and adjustable arms)
  • Front row seating with back toward windows
  • Reduced glare
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Frequent breaks from visual tasks
  • Support of eccentric viewing
  • Auditory materials for long reading assignments
  • May need instruction in tactile learning and braille

Uveitis

Inflammation of the uveal tract (middle layer of the eye), which consists of the iris, choroid, and ciliary body

The most common form affects the iris, and it may be called anterior uveitis or iritis. The cause may be unknown. Known causes include autoimmune disorders, infection, toxoplasmosis, tuberculosis, and histoplasmosis. Complications can cause glaucoma and damage to the retina or cornea, leading to permanent vision loss.

  • Photophobia
  • Blurred vision
  • Floaters
  • Decreased acuity
  • Glaucoma
  • Retinal scarring
  • Corneal damage

 

  • High contrast materials
  • Reduced glare
  • Allow additional time for adjustment to new visual conditions
  • Use of lamps with rheostats and adjustable arms
  • May need visual efficiency training to develop scanning and eccentric viewing skills

Wilm’s Tumor (nephroblastoma)

Rare abnormalities of the eye, especially aniridia, related to a malignancy of the kidneys

Although the cause is sometimes unknown, this form of cancer can be caused by genetic changes, which also can be hereditary. Pinhole contact lenses and sunglasses may be prescribed.

See “Syndromes" for associated conditions.

  • Decreased acuity, further reduced by other conditions
  • Photophobia
  • Large pupil (misshapen)
  • With corneal involvement: Fractured light, increased glare, blurred vision
  • With cataracts: blurred vision, and decreased color vision
  • Fovial involvement: loss of detail vision
  • With glaucoma: fluctuating visual functioning, field loss, poor night vision, and decreased sensitivity to contrast
  • May have nystagmus
  • May have ptosis
  • Vision stimulation for infants to develop the visual cortex
  • Sunglasses, tinted contact lenses, visors or hats in bright light outdoors and indoors
  • Allow time for adjustment to lighting changes
  • Front row seating with back to windows
  • Reduced glare
  • Provide reduced or diffused lighting from behind
  • Lamps with rheostats and adjustable arms
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Use a blackboard and bold chalk
  • Use of bold, black markers on a white board
  • Felt-tipped pens and tinted paper with bold lines
  • Use of dark/black background
  • Provide copies of materials presented on the board.

January 2015

A Hands on Workshop to Help Elementary School Children Learn About Visual Impairments

Presented at AER 2002, Troonto
By Sarah Abdelnour, O&M Specialist
Blind Children’s Learning Center
Santa Ana, California

Download presentation book

1.0 - Introduction and Overview of the Workshop

This hand’s on workshop is designed to help elementary school-aged children learn about visual impairments. It provides an opportunity for sighted peers to learn about a low incident disability and to broaden their understanding of visual impairments. If it is presented in a class where there is a visually impaired student, it helps the sighted peers develop an understanding of their friend.

It can also be used with teachers and other support staff involved with students who have visual impairments as an inservice. The workshop serves as a great refresher for the teachers/aides about the demands these children are faced with in school and how taxing they can be mentally and physically. For staff newly involved with a VI student it also works very well to teach them about visual impairments.

This package includes all the information you will need to prepare for and set-up the workshop. The workshop begins with an information session. I have provided an outline for you to use. After the introduction, the students will rotate through a series of stations. Each station focuses on a different aspect of visual impairments and has a hands-on activity for the students to do and learn from. There are also information cards (provided in this package) that can be placed at the stations to provide more information for the students about how that particular station relates to visual impairments. There are 8 different station ideas for you to choose from. Feel free to invent and add on your own. Each suggested station in this package lists the supplies that are needed, instructions and follow-up activity suggestions. At the end of this package, I have copied two sets of question and answer sheets that can be photocopied and handed out for the students to take home with them. One is about guide dogs and the other is a list of common questions asked about visual impairments. Use your judgement as to whether they are appropriate for the age group you are doing the workshop with.

2.0 - Set-up and Preparations

2.1 Necessary Preparation Prior to the Presentation

  • · Ask the teacher to divide the class into groups of 4 –6 children
  • · The number of groups determines the number of stations to choose
  • · Number each group ahead of time
  • · Ask the teacher to have desks cleared and grouped together according to the number of students per group and stations
  • · See if the teacher can find a volunteer to help out
  • · Arrange a starting time for first thing in the morning or after lunch
  • · Photocopy information hand-outs (included in this package)
  • · Prepare station supplies
  • · Prepare information cards for stations (card samples are included in this package)

2.2 Plan for Day of Presentation

  • · Allow 15 – 20 minutes to set up stations before class arrives
  • · Begin with introductory information session to provide an overview of visual impairments, causes, and what it is like (a general one is included in this package)
  • · Allow 5 minutes at the end of introduction for questions
  • · Go through every station and explain what they will be doing; answer any questions
  • · Call out group numbers with students and direct them to their starting station
  • Allow for 10 minutes per station with 3 –5 minutes in between.

3.0 - Introductory Presentation Notes

Use these notes as a guide to begin the workshop. It provides a general overview for the students and gets them to start thinking about visual impairments.

Introduction:

Introduce yourself, how you are involved with visually impaired people and explain that they will be learning how visually impaired people use their senses and equipment to obtain information.

Question 1: Ask the students what they think it is like for someone with a visual impairment.

Answer 1: Explain how most visually impaired people are able to see something. It can range from detecting light from dark to seeing large objects to seeing everything, but blurry.
It is also important to stress that everyday activities such as crossing streets and going to school seem very difficult, that visually impaired people receive special training. The special training allows people with visual impairments to do everything sighted people do, just differently.

Question 2: Visually impaired people have to rely on their other sense for information. What are the five senses?

Answer 2: Smell, taste, hearing, touch and sight. Describe to the students how a visually impaired person may use smell to help them know they are passing a bakery, taste to enjoy their food, hearing to help them cross the street, touch to read Braille and remaining vision for reading large print signs.

Question 3: What are some causes of visual impairments?

Answer 3: Explain to the students that causes of vision loss in children are often different than adults. In children it can be caused by premature birth, genetics, accidents, cancer or eye conditions such as glaucoma. As people get older, there are other eye conditions that happen such as macular degeneration or cataracts that can cause vision loss.

Question 4: How do visually impaired people get around?

Answer 4: Visually impaired people can get around in many different ways and it depends on the amount of vision they have. Most people use a white cane. Some people choose to use guide dogs. People who have vision may be able to travel around without using either the cane or the guide dog but use a monocular to help them when needed.

4.0 - Station Ideas

There are eight station ideas for you to choose from. The number of stations should equal the number of groups you have divided the students into.

STATION 1 THE SENSE OF SMELL

Objective How the sense of smell can provide information.Using the sense of smell, students will distinguish between different odors provided.

Supplies Needed 1. Set of 10 containers (film canisters work well) filled with 10 different smelly items such as: parmesan cheese, vinegar, vanilla, shampoo, cinnamon, coffee, chocolate, coconut, apple, orange

Set-Up Place small amount of each item into separate container. Label each container with a number.***BE SURE TO ASK TEACHER ABOUT ANY ALLERGIES IN THE CLASSROOM

Instruction Starting with container number 1, open up the lid and each student will smell the item and then pass it along to the person beside him/her until all students have had a turn. Continue with container 2 and so on. Adult supervision is recommended.

Follow-Up Have students think of smells in the community that will give them an idea of where they are.

STATION 2 TRUST WALK

Objective For students to get an idea of what it is like to move around without their vision.

Supplies Needed 1. Blindfold 2. White cane (if desired)

Set-Up None required

Instruction Demonstrate sighted guide. Have student’s pair up. One person will wear a blindfold and the other will be the guide. Students will walk to the water-fountain to get a drink and walk back. The partners then switch. A white cane can also be used along with the blindfolds.

Follow-Up Have the students discuss situations where they think it would be difficult to travel without having sight.

STATION 3 THE SENSE OF HEARING

Objective For the students to use their hearing to distinguish between sounds.For the students to learn how much information their hearing can provide.

Supplies Needed 1. Record 15 – 20 different sounds onto a cassette tape. As you record, number each sound so the students are aware of when there is a new sound starting.

Record each sound for 10 seconds. Examples are: traffic, microwave, dishwasher, television, people talking, truck backing up, bacon frying, children playing, dog barking, bathtub running, car starting up. 2. A cassette player in the classroom.

Set-Up Have the tape rewound and ready in the cassette player. If you want, you could have a sheet of paper for the students to write their answers onto.

Instruction Students will listen to each sound as a group and guess what the sound is. They can rewind the tape and listen as much as they want in the time provided.

Follow-Up Have the students discuss sounds they might hear in the environment that could help them figure out where they are.

STATION 4 BRAILLE STATION

Objective For the students to learn what braille looks like and how it is brailled.

Supplies Needed 1. Brailler 2. Braille paper 3. Brailled alphabet cards for every student, 4. 10 silly sentences brailled, 5. Paper for the students to transcribe the sentences 6. Braille books7. Example of tactual maps or graphs

Set-Up Have paper loaded into the brailler

Instruction Students have several activities they can do at this station:· Try brailling their name on the brailler· Braille the alphabet· Transcribe silly sentences· Look at braille books

Follow-Up Students could read a book about Louis Braille. They could talk about where they have seen Braille out in the public.

STATION 5 PUZZLE STATION

Objective For the children to use their sense of touch or hearing to play games and solve manipulative puzzles.

Supplies Needed 1. Blindfolds for each member of the group2. Activity for each group member. Suggestions:a)Tactile dominoesb) Matching texturesc) Matching soundsd) Deck of braille cards

Set-Up Have an activity and blindfold set up onto each desk at the station.

Instruction Each student will have a few minutes to try and complete the task. In the case of braille cards, they can use the time to just explore them and feel the braille. When a student finishes, they can pass it along to the person beside them.

Follow-Up Students can discuss how different things feel such as: animals, trees, streets etc.

STATION 6 DEAF-BLIND STATION

Objective For the students to experience a dual-sensory loss.

Supplies Needed 1. Five containers for each pair of students in a group.2. 15 beans for each pair of students in a group.3. One blindfold for each pair of students in a group.

Set-Up Partners need to be sitting across from each other.Place containers side by side in a row.Beans are placed in front of one of the seats.Set of instructions for the table because the person who will be blindfolded is not allowed to know what the task is ahead of time. See below.

Instruction Partners sit across from each other. One partner will wear a blindfold. Neither partner is allowed to speak. The sighted partner has the task of instructing the blindfolded partner to place one bean in the first container, 2 beans in the second container, 3 beans in the third etc. etc. all without speaking.

Follow-Up Learn about sign language. Read a book about Helen Keller.

STATION 7 TACTUAL DISCRIMINATION

Objective For the students to use their sense of touch to describe and label objects.

Supplies Needed 1. A bag with different items inside. Examples: baby sock, Popsicle stick, leaf, spoon, toothbrush, Q-tip, Band-Aid, toy truck.2. One blindfold per group.

Set-Up Place all items into a bag that can’t be seen through.

Instruction One at a time, a blindfolded student will reach into the bag, locate one item and pull it out. The student will describe and attempt to guess at what he/she is holding.

Follow-Up Have students write a paragraph describing in detail one object, such as a tree.

STATION 8 DESCRIPTIVE DRAWING

Objective For students to use descriptive words such as left/right/top/bottom/big/small to describe a picture to their classmates for them to draw.

Supplies Needed 1. A picture of patterns or geometric shapes. *See example included with package.2. Blank sheets of paper for each student 3. Pencils for each student in the group.

Set-Up Have the picture face down on the table with a sheet of paper and pencil at each desk.

Instruction The students will sit down at the desks without looking at the picture. As a group, they will choose one person to look at the picture while the remaining students will be drawing. The person describing the picture is not allowed to show the others in the group the picture until they are finished. The person looking at the picture will do their best to describe to their friends what the picture looks like.

Follow-Up Have the students write a set of directions to get from their house to a store, or school.

5.0 - Information Cards

These information ‘cards’ can be copied and glued onto colored paper to be used at stations for additional information about visual impairments. At the bottom of each ‘card’ is a number that corresponds to the station it could be used along with.5.0 INFORMATION CARDS

5.1 The Sense of Smell

How a visually impaired person uses smell:

  • · To help them know where they are
  • · What’s cooking for dinner?
  • · To help recognize a person by their perfume or cologne
  • · To know if food has gone bad
  • · To learn about what is going on around them (smell of cut grass, rain, flowers)

5.2 The White Cane

  • · 1931 the white cane became a symbol indicating that somebody was blind or visually impaired
  • · the white cane is designed to be used as a device to walk with and also to help identify visually impaired people
  • · it helps people to walk around safely
  • · the cane can help someone find changes in surfaces such as grass or pavement, it can help find curbs, stairs or objects in the path

5.3 The Sense of Hearing

How a visually impaired person uses hearing:

  • · To listen to traffic and figure out when it is safe to cross a street
  • · To help them walk a straight line
  • · To figure out who or what is in a room
  • · To find open doorways or hallways
  • · To locate objects (trees, walls, posts) in their path

5.4 The Sense of Sight

How visually impaired people can use their remaining sight:

  • · To find objects (trees, walls, chairs)
  • · To read signs
  • · To see color
  • · To recognize people

5.5 Braille

  • · Braille was invented by Louis Braille
  • · Braille is a system of raised dots called a ‘cell’
  • · A braille ‘cell’ is a combination of 1 – 6 raised dots arranged like the 6 on a dice
  • · Each letter, word, punctuation, number or musical note can be made up using different combinations of these dots
  • · Grade I braille is learning each letter on it’s own
  • · Grade II braille is groups of dots to represent combinations of letters such as ‘ing’ in the word swimming.
  • · Braille is can be done on a brailler, a special computer laptop or typed onto a regular computer and printed with a special braille printer called an embosser

5.6 The Sense of Touch

How visually impaired people use touch:

  • · To look at objects
  • · To identify money
  • · To read Braille
  • · To find their clothes
  • · To get information about their surroundings by using a white cane (slopes in the sidewalk, grass, pavement
  • · To help cook food; cooked chicken feels different than raw chicken

5.7 Deaf-Blindness

  • · Deaf-blindness is the combination of both hearing and vision impairments.
  • · People with deaf-blindness have different hearing and vision impairments. A person may be hard of hearing and totally blind, or profoundly deaf and partially sighted, or have complete loss of both hearing and vision
  • · A person with deaf-blindness experiences the world through any vision or hearing they have and by using touch, smell and taste
  • · Deafblind people communicate through various types of sign language that can be done in the hands of the deaf-blind person
  • · Deaf-blind people travel around by using a person guide or some people use a guide dog along with sound devices

6.0 - Example for Descriptive Drawing – Station 8

The following design is a sample that could be used for the descriptive drawing. Make your own design if you wish.

 

7.0 - Questions and Answers About Guide Dogs

Courtesy of Guide Dogs for the Blind, Inc.,
San Rafael,CAThese questions and answers provide the students with additional information about guide dogs.
7.0 Questions and Answers About Guide Dogs
Courtesy of Guide Dogs for the Blind, Inc., San Rafael,CA

Q: What is a Guide Dog?
A: A Guide Dog is a dog trained to help a blind person get around.

Q: How does a Guide Dog help a blind person?
A: A Guide Dog helps its blind partner by walking the person around obstacles like telephone poles, mail boxes, street barricades, and by refusing to lead the blind person into a street when cars are coming.

Q: Does the Guide Dog know where the blind person wants to go?
A: No. All the Guide Dog does is follow orders; so the blind person has to know where the store of the post office or the bus stop is and then give the dog a series of commands in order to get there. Samples of commands are: “Forwards,” “Left,” “Right.”

Q: How much does the blind person pay for the Guide Dog?
A: Nothing. The dog, the training course, all food and housing during the course, the dog harness and other equipment are provided for free. Plus, we send an instructor to visit each of our graduates regularly to make sure the person and dog are doing all right.

Q: Can any blind person get a Guide Dog?
A: Any legally blind person who is 16 years old and physically fit can apply for a Guide Dog.

Q: Is it O.K. to pet a Guide Dog?
A: Ask the blind person for permission first. Sometimes when a stranger comes up and pets it, it distracts the Guide Dog from its work.

Q: Why don’t all blind people use Guide Dogs?
A: Not every blind person wants a dog. Some blind people prefer using a cane or going places with friends who can see. Having a Guide Dog is a big responsibility. The dog needs care, food, grooming, attention and love. Some people are allergic to dogs.

8.0 - Common Questions About Blindness

By National Federation of the Blind

These questions and answers provide the students with additional information about blindness.

What kind of jobs do blind people have?
Just about anything. Here's a list of some occupations in which blind people are working today -farmers, lawyers, secretaries, factory workers, computer programmers, insurance salespeople, chemists, housewives, doctors, and many, many more. If you believe you can do the job, and if your employer believes you can, there are very few jobs blind people cannot do. It is most important for blind people to have the chance to choose whatever job they want, and for the public to give blind people the opportunity.

What causes blindness?
There are many things which cause blindness. Sometimes babies are born blind, but most blind people become blind later on. Glaucoma, cataracts, and diabetic retinopathy are the three most common causes of blindness today. Many older persons lose their vision from macular degeneration. Some people become blind through accidents.

Where do blind children go to school?
In the past most blind children went away from home to attend residential schools for the blind. Now, however, most blind children are able to attend school in their home communities. Blind children in public schools are in regular classrooms, and use a cane and read and write Braille. These blind students might work some of the time with a special teacher who would also help get the special books needed by blind children. These Braille books would contain the same things your books would have in print. Blind children take the same classes that the other kids the same age take.

How does a blind person identify money?
Coins such as nickels, pennies, dimes, and quarters are easy to tell apart. They all are different sizes, and quarters and dimes have ridges around them, while pennies and nickels are smooth. There are many ways that paper money—like one, five, ten, or twenty dollar bills—can be identified. The most common way to tell paper money apart is to fold the bills in different ways. When we get money back from someone else, we ask which bill is which and then fold it.

How do blind people identify their clothes?
Most articles of clothing will have at least one distinct way of identifying them by feel. They will have different buttons or snaps or bows or ties or the fabric or texture will be different. Some dresses or skirts will have belts or elastic at the waist or different kinds of pockets. In this way, blind people can tell their clothes apart by touch, and they can tell what clothes match each other.

How do blind people recognize colors?
Some blind people are able to see some colors. Sometimes a blind person might have enough vision to see all colors, or maybe he or she can only tell bright colors. Some blind people can see some colors but not all of them, or they might have a hard time telling blue or black or brown apart, or pink from white. Some blind people do not see any colors. It is important to learn about colors even if you cannot see them. You need to learn what colors look nice together, and what colors do not match, and about stripes, plaids, and other patterns. This is important for clothing and decorating. You need to understand that the sky is mostly blue and grass is mostly green, and the colors of the ocean and the colors of leaves in the fall are just as important for the blind to know as everyone else.

How do blind people read Braille?
It takes some practice to become a good reader of Braille, just as it does with print. We learn Braille by feeling the different dots in each Braille “cell” and memorizing what the different combinations of dots stand for. Today blind people use Braille to take notes in high school and college, to write letters, to read books and magazines, to keep addresses and phone numbers, to keep recipe files, to write books and other materials, and to do the other things you might do using print. There are special libraries that provide Braille and recorded books and magazines for the blind free of charge. Most states have one or more of these libraries where blind people can borrow these materials.

How do blind people cook?
Blind people can use the same ovens, microwaves, and other kitchen tools and appliances as the sighted use. We can put Braille labels on the microwave touch buttons, and some blind people like to use Braille or a special marking glue to put dots on some of the stove or oven temperature dials. We can tell by the smell, sound, temperature, time of cooking, texture, and consistency how our foods are cooking. Some blind people, just like some sighted people, will enjoy cooking more than others.

How does a blind person tell time?
There are watches that open up so a blind person can feel where the hands are and can feel Braille dots at the different hour points. There are also talking watches that speak the time and have an alarm built in.

How does it feel to be blind?
When you are newly blind, in the beginning, it can feel frustrating or scary. This is because you have not learned how to do things for yourself as a blind person. But once you learn the skills that blind people use, you no longer feel that way. Blind people do the same things as sighted people. We go to school or work, and we do the things that we need to do. We do this naturally, without even thinking about being blind. The blindness becomes just another part of who we are and what we are like. We don't think about being blind every day, just like you don't think every day about whether or not you have red hair or brown hair.

English version of this article (Versión Inglesa)

Por Gigi Newton, entrenadora de maestros, extensión para sordociegos de la TSBVI

En mis viajes por el estado, de visita a niños con sordoceguera en sus hogares y escuelas, siempre controlo los audífonos. Tener los audífonos bien colocados y funcionando correctamente es muy importante para estos niños porque necesitan utilizar toda la información sensorial disponible. Sin embargo y desafortunadamente, muchas veces encuentro audífonos que no funcionan bien. Una vez, al llegar a la escuela al mediodía, controlé el audífono de un niño y descubrí que durante dos horas había estado escuchando un "silbido" porque el interruptor estaba colocado en "T" para cuando se usa el audífono con el teléfono. Efectivamente, los audífonos habían bloqueado toda posibilidad de escuchar otro sonido que no fuera ese silbido. Esto sucedió porque tanto la maestra como su asistente no sabían cómo hacer el control de audífonos. ¡Algo así no debería nunca acontecerle a un niño con una discapacidad auditiva y especialmente jamas a un niño sordociego!

Cuando una clase tiene un niño con discapacidad auditiva, debe tener un estetoscopio para controlar audífonos y un probador de baterías para verificar el funcionamiento de los mismos todos los días. Debería haber también baterías de repuesto. Además, las estrategias y modificaciones al IEP deben incluir la asignación de un miembro del personal que será responsable de controlar los audífonos diariamente. El personal de las escuelas regionales para sordos (Regional Day School Programs for the Deaf) puede hacer una demostración de cómo controlar audífonos.

Existe una cinta de vídeo que puede ser de ayuda llamada Hearing Aid Management Skills for Famili es of Young Children Who Are Deaf or Hard of Hearing (Item #206), y se puede adquirir por medio de Hope, Inc. por $42.00. La explicación y demostración de conceptos básicos y técnicas relacionadas al manejo de los audífonos está hecha por padres consejeros. Esto incluye entender la anatomía del oído, las pruebas de audición, los audiogramas, partes y funciones de los audífonos, colocación en el niño, cómo hacer un control de audición diario en el audífono, cómo establecer el uso continuo del audífono y cómo encontrar la fuente de ruidos y silbidos. Además el curriculum INSITE, Volumen I (pgs. 300-397) también habla del manejo de audífonos. Incluye los mismos temas que la cinta de vídeo, en impresión. Se pueden obtener los dos volúmenes por medio de Hope, Inc. por $90.00. Para ordenar la cinta o la impresión:

HOPE Inc. (Home and Family Oriented Program Essentials) 1856 North 1200 East North Logan, UT 84341 Teléfono: (435) 245-2888Sitio: www.hopepubl.com correo electrónico:

Además se puede obtener de HARC Mercantile, Ltd. un equipo para mantenimiento de audífonos; el que cuesta $40.00 incluye un deshumidificador, un estuche, un estetoscopio, una bomba a aire comprimido para secar audífonos, un pincel pequeño para limpiar la parte de afuera del audífono, una herramienta para remover la cera y un probador de baterías. Otras compañías venden instrumentos semejantes; puede verificar con su audiólogo o distribuidor de audífonos. Información:

HARC Mercantile, Ltd. http://www.harc.com Phone - Voz/TTY: (800) 445-9968Phone - Voz/TTY: (269) 324-1615 Sitio: http://www.harc.com

Primer paso: Verificar daños

Los audífonos reciben golpes, especialmente en manos de niños. Verifique si la estructura no está rajada o rota, si no hay señales de que el audífono haya recientemente visitado el inodoro y que no esté tapado con cera. Si encuentra problemas mayores, notifique a los padres del niño inmediatamente. Los asistentes de clases pueden a veces resolver problemas como quitar cera del audífono, pero otras veces el audífono tendrá que ser devuelto a la tienda. Problemas simples como la ruptura de un cable o la humedad depositada en el audífono, pueden ser resueltos por un buen audiólogo, un ortofonista, o un maestro para sordos y discapacitados auditivos. El personal de la escuela debe recibir instrucción sobre el mantenimiento regular de audífonos y tener en claro quién puede resolver qué tipo de problemas.

Segundo paso: Verificar las baterías

Los probadores de baterías se pueden comprar en ferreterías o comercios del tipo Walmart, Home Depot, o Radio Shack. Algunos probadores sirven para todos los tamaños de baterías y otros están diseñados para las baterías pequeñas y chatas usadas en los relojes y audífonos. No son caros, por ejemplo, un probador para batería de audífono puede costar entre $7 y $10. Los diferentes audífonos usarán diferentes baterías, por lo tanto es importante verificar que el probador esté en la posición correcta para controlar la batería del audífono del niño. El tamaño de la batería está indicado en la misma. En general, todo lo que se necesita es hacer contacto entre el extremo + (positivo) de la batería y el + cable o punta (positivo) del probador y después entre el extremo - (negativo) de la batería y el cable o punta - (negativo) del probador. Habrá algún tipo de indicador que le mostrará si la batería está buena aún o necesita ser cambiada. Debe revisarlas todos los días, aunque haya puesto una nueva el día anterior.

Tercer paso: Usar un estetoscopio para escuchar los audífonos

Luego de haber examinado el audífono y verificado la batería, precisa escuchar la calidad de sonido. No es suficiente escuchar un silbido proveniente del audífono para deducir que funciona bien. Necesita hacer la verificación con un estetoscopio para audífonos que se parece al que usan los médicos, excepto que tiene un acoplador que entra en el audífono. Cuando enciende el audífono puede escuchar la calidad de sonido.

Sería ideal escuchar el audífono todos los días para detectar problemas de sonido que pueden ocurrir como resultado de cortos circuitos, depósitos de humedad o de suciedad u otros problemas. También puede detectar sonidos que indican que el audífono está en posición para uso con teléfono. La compañía HARC Mercantile también vende individualmente un estetoscopio a precio moderado para este propósito. El número de la pieza es HAC-3000A y el precio es de $16.00 más $5.00 de envío.

Verifique que el audífono esté en posición "M" de micrófono, que el volumen esté en la posición más baja y que esté prendido. Ajuste el volumen lentamente, escuche los sonidos del ambiente y luego escuche su propia voz diciendo los sonidos de las vocales, a, e, i, o y de consonantes como b, t, s, sh. Los sonidos deben ser claros. Es un buen momento para enseñarle al niño a controlar él mismo su audífono. Puede hacerlo vocalizar mientras usted escucha; luego de colocado el audífono, usted vocaliza y lo hace escuchar. Esta es una buena manera de trabajar con la vocalización y un ejemplo de actividad en la que el niño aprende a esperar su turno.

Cuarto paso: Controlar si hay silbido

Coloque el audífono en el niño, luego de haber regulado el volumen al nivel recomendado por el audiólogo. El audífono debe encajar firmemente en la oreja y no debe haber silbido. Si lo hay, sáquelo de la oreja y cubra la abertura del canal con su pulgar, luego aumente el volumen y verifique si hay silbido. Si tal es el caso, el audífono tiene un problema; si el silbido ha desaparecido, el problema es que el tamaño del audífono ya no sirve para el niño. En el caso de niños pequeños que crecen rápidamente, es necesario cambiar llos audífonos cada 4 a 6 meses.

Conclusión

Igual que los anteojos, los audífonos no ayudan si no se usan y si no funcionan correctamente. Los niños con discapacidades auditivas no deberían tener que pasar por una situación que agrave su discapacidad, simplemente porque los profesionales no verifican que sus audífonos estén prendidos, funcionando y en la posición correcta. Si usted no está seguro de cómo hacer estos controles en los audífonos del niño, póngase en contacto con los maestros para sordos y discapacitados auditivos o con el comerciante o el audiólogo que recetó el audífono. Así como usted no dejaría a un niño andar en una silla de ruedas que está rota, tampoco debe dejar que utilice audífonos que no funcionan.