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  1. Position student in chair with feet on floor and sitting up straight.
  2. Move student's chair or CCTV so that student's eyes are approximately 13 inches from viewing screen. It is imperative that this viewing distance remain constant when measurements are made during the assessment.
  3. Adjust CCTV height to student's eye level.
  4. Place a one inch (1") line drawing under camera, turn on CCTV, zoom to maximum enlargement and focus image. Adjust brightness and contrast if necessary.
  5. Reduce magnification of image until entire drawing fits on the screen and ask student to identify object. Allow student to move closer to screen if necessary, but note the approximate viewing distance.
  6. Show student how to control the zoom lens to adjust magnification. Ask him/her to adjust the size of the image to largest magnification, smallest magnification, make the drawing fill up the screen, and finally, to the magnification where he/she can see it best.
  7. Check the student's distance from the screen. Make sure he/she is approximately 13" from the screen.
  8. Ask the student to adjust the size of the image to the smallest magnification. Place a different one inch (1") line drawing under the camera. The image should remain in focus because the distance between the camera lens and the image has not changed.
  9. Ask the student to adjust the magnification to the best viewing size. Make sure he/she does not lean forward. Ask him/her to identify the drawing.
  10. Measure the approximate height of the image he/she is able to identify and note it on the checklist. Also note the size of the screen being used.
  11. Repeat these steps with text.
  12. Adjust the magnification to its maximum. Adjust the focus to make the image out of focus. Place a different image under the camera.
  13. Ask the student to adjust the focus until the image is clear and then adjust the magnification of the image until it is at the size he/she can see best. Note the student's ability to adjust the size and focus of the image on the checklist.
  14. Most CCTVs have a switch which controls the polarity of the image; black on white, or white on black. Show the student both settings with a graphic image and a text image. Note their preference on the checklist.
  15. Some CCTVs have a feature which allows the setting of various color combinations of the image being enlarged. If the CCTV being used has this feature, explore it with the student and note his/her preference. (Students will sometimes choose what to the examiner may seem like an unusual color combination because it looks, "cool." After working with that combination for awhile they often will choose another combination. However, some students will have a definite color preference and be able to function more efficiently with that color combination. If the CCTV being used for the assessment does not offer color and it is noted that the student has a color preference when he/she works with a computer system offering that feature, then this should be pointed out to the AT specialist or rehabilitation engineer who will do the follow-up assessment. They will be able to bring a color system for the follow-up or arrange with a vendor to borrow one for the assessment.)
  16. Place the CCTV Tracking Samples sheet (located in the References section of the notebook) under the camera and ask the student to adjust the magnification to his/her desired size.
  17. Adjust the friction brake so that the top to bottom movement of the page is stiff but movable. Set the left and right margin stops so that only the desired images are viewable on the screen.
  18. Ask the student to move the X/Y table to locate the target image on the left and then move the X/Y table to locate the same image in the row.
  19. Then ask the student to move to the next row and repeat the task.
  20. Repeat this process for all four samples. Note how the student manipulates the table while viewing from right to left, and how he/she returns to the left edge and moves down to the next line. Many younger students will not be able to perform this task efficiently. However, the information gained from observing this task will allow the examiner to determine if the student has the potential to master the physical and cognitive skills required to use the device. Note the observations on the checklist.
  21. Place a regular sheet of writing paper under the camera and readjust the margin stops accordingly.
  22. Ask the student to write their name on one line and a sentence on the next line.
  23. Replace the regular writing paper with bold line paper and ask the student to write their name on one line and a different sentence on the next line. Record the examiner's evaluation of the print's legibility on the checklist.
  24. Remove the writing assignment and replace it with an appropriate grade level reading selection. Select a passage that is just one column of text. Ask the student to adjust the magnification to his/her desired size.
  25. Adjust the friction brake and the margin stops for this reading selection. Conduct an informal reading rate assessment to be used for comparison purposes later and note it on the assessment checklist.
  26. Place the student's writing samples completed earlier under the camera and as the student to read them. Note their ability to read their own handwriting under the CCTV with regular or bold line paper.

This information will allow the examiner to determine if the student has the potential to use the CCTV effectively as a tool to access printed information.

References

Materials from the following resources were used during the assessment. I leave it to the tester to determine the appropiate pages.

Ann Arbor Tracking Program, (1988) Letter Tracking; Sentence Tracking; Symbol/Letter Tracking; Word Tracking, Novato, CA; Academic Therapy Publications.

D'Andrea, Frances Mary and Farrenkopf, Carol, (2000) Looking to Learn: promoting literacy for students with low vision. New York, NY; AFB Press.

Frostig, Marianne; Horne, David and Miller (1972): Pictures and Patterns, Teacher's Guide, Follet Publishing Co.

Lev, L. Jay, EdD, (1988) Eye-Hand Coordiantion Boosters, Novato, CA; Academic Therapy Publications.

Lund, R. & Watson, G. R. (1997). The CCTV BOOK: Habilitation and rehabilitation with closd circuit television systems. Synsforum ans. Frolund: Norway.

McCall, Karen, (2001) The Box Came Today, Now What Do I Do? A Resource for CCTV Assessment and Training, unpublished.

What Fun! Over 150 Activities. from the editors of Highlights for Children, (1997) Honesdale, PA; Boyds Mills Press.

Super Colossal Book of Hidden Pictures, Vol 2. (2001) Honesdale, PA; Boyds Mills Press.

Home Work Books; Mazes, Pre-K - 1. (1997) Grennsboro, NC; Carson-Dellosa Publishing Company, Inc.

Home Work Books; Hidden Pictures, Pre-K - 1. (1997) Greensboro, NC; Carson-Dellosa Publishing Company, Inc.

Home Work Books; Matching: Similarities & Differences, Pre-K - 1. (1997) Greensboro, NC; Carson-Dellosa Publishing Company, Inc.

Home Work Books; Getting Ready for Kindergarten, Kindergarten. (1998) Greensboro, NC; Carson-Dellosa Publishing Company, Inc.

This document was developed by Ike Presley, American Foundation for the Blind, (100 Peachtree Street, Suite 620, Atlanta, GA 30303) Permission to photocopy is granted for non-commercial purposes if this credit is retained.

Winter 99 Table of Contents
Versión Español de este artículo (Spanish Version)

By Cyral Miller, TSBVI, Outreach Director

Educational systems seem to thrive on acronyms. FVE, or FVA, is the short cut term for a functional vision evaluation or assessment, and is one acronym of especial importance when programming for students with visual impairments. Successfully educating these students depends upon access to accurate, current information about each child's use of his/her vision. In Texas, a functional vision assessment report is the legally required document for bringing this information to an ARD committee. The report helps determine eligibility for services as a special education student with visual impairments. A second report, known as the learning media assessment, or LMA, is also required, to determine (in part) what kinds of literacy and functional learning materials are appropriate.

The FVA report is also shared with the family and entire educational team, including assessment personnel, to ensure general knowledge of how to adapt and modify testing and instruction to best meet the unique needs of each eligible student. A good understanding of each student's needs is necessary in order to properly modify materials, the distance at which materials should be displayed, lighting, seating, reading and writing tools, and other critical aspects of educational programming. Every child uses their vision differently, and even children with similar visual acuities and eye conditions may actually "see" in unique ways. For those who don't see, or whose vision fluctuates and is unreliable, information on how to adapt instruction into tactual or auditory modes is critical for all staff. The functional vision assessment must be performed by a teacher certified in the area of visual impairments and/or an orientation and mobility specialist.

The Federal law governing special education increasingly emphasizes active participation of parents in determining needed areas of assessment. Now, at the annual admission, review and dismissal meeting (ARD) or at specially called meetings, teams discuss together with family members what kinds of assessments should be conducted in order to best develop appropriate programming for each child. In a few cases, such as a stable eye condition or a student who wears prosthetics in both eyes, the functional vision assessment may not be needed to determine whether a student is still eligible as visually impaired. However, the FVA report is still an important report. It should be administered at least every three years, to assess whether programming modifications once appropriate to an earlier age and grade level are still applicable in new settings. Some students will be accessing the community more as they get older. Staff will need to look at visual information or modifications in work settings. In the early grades, materials are presented at quite different rates than in upper grades. Lighting, seating and activity requirements for student learning certainly change over time. The functional use of vision is dependent on many factors in addition to the medical cause of impairment. Medications, the presence of other disabilities, positioning, the type of school and classroom setting, expectations for demonstrating skills both in and out of school, motivation, age, and overall health can all be factors. A period of observation is critical in determining how each visually impaired child's visual and learning needs should be addressed at regular intervals. This ensures adequate and appropriate modifications and instruction. This kind of information is captured in the FVA and can then be shared across the team.

The functional vision assessment (FVA) complements information available from an ophthalmologist or optometrist regarding medical diagnosis, care, prognosis, and health of the visual system. These medical eye specialists assess a child's vision and visual system in their clinics and offices using specific techniques and equipment. That information should be summarized on the FVA report. It will inform and guide the assessment of functional vision by the certified educational staff. The FVA, paired with medical information, helps the VI teacher/O&M describe how each eye condition translates into real life situations. Most of us have experienced reporting a problem to the doctor that simply doesn't show up during examination. On the other hand, we may have problems at the doctor's office that go away once we're safely back home. The FVA report describes how a medical condition such as cataracts impacts the individual child's functioning in the daily environment.

A FVA must be based on observations of a child in a variety of settings, both indoors and out. It should be conducted at different times of day, across different environments, in the situations where the child is going to be asked to learn. Some children may need to be observed in a variety of positions since positioning may also impact visual functioning. Information from parents may indicate that going to the home is important, especially if they report that the child's vision seems different in that setting. (For example, "He does fine until twilight, then he falls and bumps into things. Does he fall at school?") The process can be quite straightforward for updating information on a familiar child whose vision is stable. However, repeated sessions over time may be required for new referrals, very young children, or children whose vision seems to be inconsistent.

There are children in the population with no vision, and functional vision reports are required for them, as well. In that case, the report confirms the absence of vision and presents recommendations on how to modify instruction for the student. The FVA report legally must also address, for all students, whether there is need for a low vision clinical evaluation, or assessment for orientation and mobility services.

The recommendations section of the functional vision assessment report presents guidelines on programming. It discusses the kinds of adaptations and modifications which will most impact learning. This section can be a primary vehicle for the VI professional to communicate the needs of this unique student to all other staff. Staff will want to post these recommendations on their walls and include them in their folders. It is also important that they use these recommendations to determine needed modifications during the IEP process.

The FVA report is critical for ensuring coordination and consistency in educational programming and should be widely shared. There have been dozens of functional vision assessment forms developed. Some are essentially checklists, some are computerized forms customized for each child, and others include mainly narrative. There are a wide variety of styles and methods for testing and reporting. Recognizing that these reports are developed for infants, toddlers, school-aged children and young adults, it makes sense that the format and emphasis will differ by the child. It is helpful if it as free of jargon as possible so that all members of the educational team and the family can understand and implement the recommendations.

We are fortunate in Texas to have a system that requires the FVA. It provides teachers and assessment personnel with critical information about the impact of a child's specific visual loss on learning. It guides them in modifying materials and the environment to build on each child's strengths. The functional vision assessment is the cornerstone upon which an individualized student program can be created. This is one acronym to be sure to LOOK OUT for!

Download Tech Assessment Checklist in RTF (61K)

Student Name _______________________ Date of assessment _____________

Person Completing Checklist _______________________ Position ______________________

During this assessment, informal measures were utilized to evaluate the student's ability to access print, produce written communication, access the computer and use various assistive technologies. Some of the information requested may be obtained from the Learning Media Assessment, the Clinical Low Vision Evaluation or the Functional Low Vision Evaluation.

Accessing Print

Regular Print

When accessing printed information, the

_____ Student is able to read regular print materials at _____ inches without adaptations.

_____ Student is able to read regular print materials with adaptations.

_____ using prescribed glasses or contacts

_____ materials enlarged on photocopying machine - Specify (i.e. 130%, 3 times) __________ Student is able to read regular print materials with or without adaptations for _____ min before experiencing either visual or physical fatigue.

Large Print

When accessing large print with prescribed optical aid (if appropriate) the student is able to read

72 point print at approximately _____ inches.
60 point print at approximately _____ inches.
48 point print at approximately _____ inches.
36 point print at approximately _____ inches.
30 point print at approximately _____ inches.
24 point print at approximately _____ inches.
18 point print at approximately _____ inches.
14 point print at approximately _____ inches.
12 point print at approximately _____ inches.

Student's font preference ___ Arial, ___ Antique Olive, ___ Tahoma, ____ Verdana

Student's preferred point size without prescribed optical aids.

___ 14 ___ 18 ___ 24 ___ 30 ___ 36 ___ 48 ___ 60 ___ 72

Optical Aids

When accessing printed materials with the use of an optical aid, the student is able to use

_____ glasses _____ contact lens

_____ hand held/stand magnifier, power _____

_____ telescope, power ________

Closed Circuit TeleVision (CCTV)

_____ inch graphic _____ inch text on a _____ inch monitor at approximately 13 inches

polarity preference: _____ dark on light _____ light on dark

color combination preference (if available) ______________________________

Use of CCTV controls - The student is able to:

_____ adjust size of image.

_____ focus image.

_____ independently use X/Y table for viewing materials with friction brake and margin stops adjusted by examiner.

_____ write name and a short sentence legibly on regular writing paper.

_____ write name and a short sentence legibly on bold line paper.

read approximately _____ wpm orally when the friction brake and margin stops are adjusted properly by the examiner.

_____ read the sentence he/she wrote on regular writing paper.

_____ read the sentence he/she wrote on bold line paper.

Use of the VisAbility program with optical scanner connected to computer

preferred magnification ____ for viewing at approximately 13-16 inches

polarity preference: _____ dark on light _____ light on dark

color combination preference _________________________________________

Use of VisAbility features - The student was able to:

_____ select menu items and tools from the toolbar with the mouse.

_____ navigate around the magnified image with the mouse.

_____ read text in the panning/review mode with a speed setting of _____.

Non-Optical Aids

When accessing information through the use of non-optical aids, the

_____ student reads materials produced with felt tip pen on bold line paper.

_____ student prefers ___ incandescent lighting, ___ flourescent lighting ___ window lighting.

_____ student experiences glare problems from ___ overhead lighting ___ window lighting

_____ student prefers less lighting than currently available.

_____ student prefers to have materials placed on a reading stand or copy holder.

Braille and Tactile

When accessing information through braille and tactile graphics, the

_____ student is able to use simple tactile graphics.

_____ student is able to read materials in braille. Attach results of formal/informal Braille Assessments conducted by TVI.

_____ student's oral braille reading rate is _____ wpm

_____ student is able to read braille on an electronic/refreshable braille display.

Auditory

When accessing printed information auditorally, the

_____ student is able to demonstrate comprehension by answering simple questions & relating details about a passage when it is read to him/her.

_____ student is able to paraphrase information presented orally (sentence or story.)

_____ student is able to write, type, or braille what he/she heard (sentence dictation) without having it repeated more than twice.

_____ student is able to put tape in and remove tape from player/recorder.

_____ student is able to activate play, pause, stop, fast forward and rewind functions (please underline those demonstrated.)

_____ student is able to understand and comprehend compressed or "fast" speech.

_____ student is able to manipulate variable speed and pitch controls.

Reading Rates

(This is an optional section used when needed to demonstrate to the student, parents, teachers or administrators the benefits of using adaptations when reading.)

When reading printed information, the

student is able to read _____ wpm orally when provided with 12 point materials.

student is able to read _____ wpm orally when provided with materials in the optimum size for viewing at 10 -13 inches (_____ point print.)

student is able to read _____ wpm orally when using a CCTV.

student is able to read _____ wpm orally when using VisAbility.

student is able to read _____ wpm orally when provided with materials in braille.

student is able to read _____ wpm orally when provided with recorded materials.

Other

When using a large print calculator, the

_____ student is able to see _____ inch numerals displayed on a large print calculator.

_____ student is able to accurately manipulate keys on a large print calculator.

student is able to perform basic functions ___ with, ___ without instruction.

When using a talking calculator, the

_____ student is able to understand synthesized speech produced by a talking calculator.

_____ student is able to accurately manipulate keys on a talking calculator.

student is able to perform basic functions ___ with, ___ without instruction.

When using a talking dictionary, the

_____ student is able to understand synthesized speech produced by a talking dictionary.

_____ student is able to accurately manipulate keys on a talking dictionary.

student is able to perform basic functions ___ with, ___ without instruction.

When accessing information presented on black board or overhead projector, the student reported that he/she

_____ sits close enough to read board.
_____ gets a copy from the teacher
_____ gets a copy from other students.
_____ uses a hand held or spectacle mounted telescope
_____ has information read aloud to student and
_____ writes information on paper
_____ types information into computer or portable note taker.
_____ brailles on braille writer
_____ records on tape recorder.
_____ Other, please specify ________________________________________________

Are these options working adequately? ___ yes ___ no Explain briefly: ______________

________________________________________________________________________

Producing Written Communication

When using standard writing tools, the

_____ student's manuscript writing is legible.
_____ student's cursive writing is legible.
_____ student's spacing is intact.
_____ student's writing is labored and difficult.
_____ student is able to write _____ wpm from ___ dictation, ___ copy.
_____ student is able to read his/her own writing.
_____ student is able to sign his/her name legibly in cursive ___ with, ___ without a signature guide.

When writing with the following adaptation the student's _____ manuscript, _____ cursive writing is legible.

_____ a screen board _____ bold line paper
_____ raised line paper _____ a felt tip pen
_____ a white board and erasable marker
_____ Other modifications _________________________________________

When using a braille writing device, the

_____ student is able to use a manual braille writer to emboss characters, words and sentences at ___ wpm from ___ dictation, ___ copy.

_____ student is able to use the slate & stylus to emboss characters, words and sentences at ___ wpm from ___ dictation, ___ copy.

_____ student is able to use the MountBatten brailler to emboss characters, words and sentences at ___ wpm from ___ dictation, ___ copy.

_____ student is able to use a portable note taking device such as the Braille 'n Speak to enter characters, words and sentences at ___ wpm from ___ dictation, ___ copy.

When using an electronic writing device, (computer, portable note taker) the

_____ student is able to write characters, words and sentences.

_____ student is able to perform basic functions ___ with, ___ without instruction from the examiner.

Comments: _________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Computer Access

Visual

When accessing electronic information on a stand alone computer or in the computer lab, the

_____ student is able to read menus and other system text items on a _____ inch monitor at approximately _____ inches.

student was able to read bold _____ point print in an ___ Arial, ___ Antique Olive, ___ Tahoma, ___ Verdana font displayed on a _____ inch monitor at approximately 13 inches.

student is able to see information on the standard computer monitor with

_____ screen magnification hardware (Compu-Lenz) at approximately ____ inches.
_____ flexible arm monitor stand at approximately _____ inches.
_____ screen enhancements provided with computer operating system
_____ WIN 95/98 High Contrast
_____ WIN 95/98 Large
_____ WIN 95/98 Extra Large
_____ screen magnification software with _____ magnification

When accessing the computer through the use of screen magnification software, the

_____ student is able to read 12 point print enlarged to _____x magnification at a viewing distance of approximately 13 inches.

_____ student expressed a polarity preference for; _____ dark on light, _____ light on dark.

_____ student is able to locate and select menu items, buttons and icons with the mouse/pointing device.

_____ student is able to navigate around the magnified image with the mouse/pointing device.

student ___ is, ___ is not able to maintain orientation when navigating around the screen.

_____ student is able to read text in the panning/review mode with a speed setting of _____.

_____ student expressed a viewing mode preference. Specify ___________________________

_____ Student is unable to access the computer visually.

Auditory

When accessing computer based information auditorally, the

_____ student is able to understand synthesized speech produced by

Software synthesizer

_____ Kids Time Deluxe _____ Write Outloud _____ Other

_____ Flextalk _____ TrueVoice

_____ Dectalk Access 32 _____ Eloquence

Hardware synthesizer

_____ Braille/Type 'n Speak _____ Double Talk _____ Other

_____ Accent SA _____ Dectalk

_____ student is able to execute navigation commands with instruction.

Tactile

When accessing computer based information tactually, the

_____ student is able to read braille text displayed on an electronic refreshable braille display.

_____ student is able to execute navigation commands with instruction.

_____ student is able to enter text through the braille keyboard.

Input Devices

Keyboard Use

_____ The student is able to use a standard keyboard without adaptation.
_____ The student is able to locate and identify alphanumeric keys.
_____ The student is able to locate and identify function keys.
_____ The student is able to activate two keys simultaneously.
_____ The student does not demonstrate excessive miss-hits or key repeats.
_____ The student uses good mechanics when typing. (Posture, wrist elevation, etc.)
_____ The student types with ___ fingers of right hand and ___ fingers of left hand.
_____ The student demonstrates keyboard awareness (has a general knowledge of the key locations).
_____ The student is able to touch type while looking at his/her hands.
_____ The student is able to touch type without looking at his/her hands.
_____ The student is able to utilize a standard computer keyboard with adaptations. (Seek assistance from occupational and physical therapist as needed.)

_____ zoom caps _____ keyguard _____ finger guard/pointer

_____ keylatch _____ wrist/arm support _____ head pointer

_____ moisture guard _____ tactile locator dots _____ mouthstick

_____ other Specify _____________________________________________________

The student is able to utilize a standard computer keyboard with the following keyboard utilities. (Seek assistance from general technology specialist, OT or PT to complete this section.)

__ sticky keys __ repeat keys __ slow keys __ toggle keys __ mouse keys _____

_____ The student is not able to utilize a standard keyboard with or without adaptations. (If checked, refer student for a Computer Access Evaluation.)

Use of a Pointing Device

_____ The student is able to navigate the desktop with the standard mouse/trackball.

_____ The student is able to maintain the mouse position while clicking/double-clicking.

_____ The student is able to maintain eye contact with the screen while navigating the desktop.

_____ The student is able to access pull-down menus with the standard mouse.

_____ The student is not able to use a standard mouse. (If checked, please request a Computer Access Evaluation.)

Additional Assessment Information: _________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Recommendations for Assistive Technology

Based on the results of this assessment, the following recommendations are made regarding assistive technology to support this student's educational objectives.

Accessing Printed Materials (Students with visual impairments will use a combination of strategies to access printed information. Some will be appropriate for short reading assignments and others will be necessary for longer passages.)

Check all that apply

_____ Student should use regular print materials for
_____ short reading assignments.
_____ most reading assignments.

_____ Student should use regular print materials with optical aids.
_____ glasses/contact lenses
_____ hand held magnifier
_____ stand magnifier

_____ Student should use materials written with felt tip pen on bold line paper.

_____ Student should use regular print materials enlarged on a photocopying machine.

_____ Student should use large print books.

_____ Student should use regular print materials scanned into a computer, edited and printed out in ______ point print.

_____ Student should use regular print materials with CCTV (Closed Circuit TeleVision).

_____ Student should use regular print materials with the VisAbility program.

_____ Student should use materials in braille.

_____ Student should use recorded materials.

_____ Student should use a computer assisted reading system such as Kurzweil 1000, Open Book, etc.

_____ Student should use a ___ basic, ___ scientific calculator with at least 1/2" numeral display.

_____ Student should use a ___ basic, ___ scientific talking calculator.

_____ Student should use calculator program on computer.

_____ Student should use a large print dictionary with at least 18 point print.

_____ Student should use dictionary/thesaurus program on computer.

_____ Student should use a talking dictionary

_____ Student should use crayons and a screen board to develop basic tactile skills using tactile graphics.

_____ Student should use tactile graphics to access maps, charts, diagrams, etc.

Comments: ____________________________________________________________________

______________________________________________________________________________

Producing Written Communication (Students with visual impairments will use a combination of strategies to produce written communication. Some will be appropriate for short writing assignments and others will be necessary for longer assignments.)

Check all that apply

_____ Student should use pen/pencil and paper

_____ for short writing assignments.

_____ for most writing assignments.

_____ Student should use felt tip pen and bold line paper.

_____ Student should use bold line graph paper for math.

_____ Student should use crayons and a screen board for beginning handwriting.

_____ Student should use a white board with erasable markers.

_____ Student should use a computer with the word processing software most commonly used in the student's school.

_____ Student should use computer with form filling software such as VisAbility.

_____ Student should use manual braille writer.

_____ Student should use manual braille writer with extended keys.

_____ Student should use a unimanual braille writer.

_____ Student should use slate & stylus.

_____ Student should use an electronic braille writer. Specify: __________________________

_____ Student should use portable word processor (Braille 'n Speak/Type 'n Speak, etc.)

Comments: ____________________________________________________________________

______________________________________________________________________________

Computer Access

Input Method

_____ Student should use a standard keyboard.

_____ Student should develop/improve keyboarding skills.

_____ Student should use a standard keyboard with adaptations. Specify __________________

_____ Student should use an alternative keyboard. Specify _____________________________

_____ Student should use a standard pointing device like a mouse or trackball.

_____ Student should use an alternate point device. Specify ____________________________

_____ Student should have access to a copy holder that allows printed materials to be positioned at a comfortable viewing distance.

Output Mode

_____ Student should use a standard computer monitor - Optimal size: ___________________

_____ Student should use a standard computer monitor with hardware adaptations

_____ adjustable monitor arm _____ Compu Lens

_____ Student should use screen magnification software

_____ CloseView _____ inLARGE _____ WIN xxx Accessibility enlargement

_____ Dedicated screen magnification software - Specify ________________________

_____ Student should use a talking word processor. Specify ___________________________

_____ Student should use a speech synthesizer/sound card and screen reading software. Specify

________________________________________________________________________

_____ Student should use an electronic braille display. Specify _________________________

Additional Hardware & Software

Student should be provided with access to the following hardware & software;

_____ Macintosh computer system with

___ Mb memory ___ hard drive ___ CD drive ___ modem

_____ IBM compatible computer system with

___ Mb memory ___ hard drive ___ CD drive ___ modem

_____ Optical Scanner ___ Printer

_____ Word processor used in student's school ___ Internet access

_____ CD Encyclopedia ___ Dictionary ___ Atlas

_____ Other: -_________________________________________________________________

Equipment needed to produce materials for student in appropriate format.

_____ Mac or IBM compatible computer system

_____ Optical scanner _____ OCR software

_____ Word processing software _____ Inkjet or laser printer

_____ braille translating software _____ braille embosser/printer

_____ Tactile graphics production equipment, specify _________________________________

Additional comments/recommendations: ____________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

The recommendations made above do not all have to be implemented immediately. The suggestions are designed for a 2 - 3 year plan in which the student masters certain skills and is provided access to additional technologies that can facilitate his/her educational program. During that time, new technologies will become available that will enhance his/her ability to maximize his/her educational potential. The specific devices recommended may no longer be the most appropriate, but the assistance that they provide will continue to be a need for this student.

_____________________________________   ____________________________________
Assessment Completed by (Signature)             Position

This document was developed by Ike Presley, American Foundation for the Blind, (100 Peachtree Street, Suite 620, Atlanta, GA 30303) Permission to photocopy is granted for non-commercial purposes if this credit is retained.


by Millie Smith, Education Specialist and Stacy Shafer, Early Childhood Specialist, TSBVI Outreach

Biobehavioral states are levels of arousal ranging from asleep to agitated. Students with profound disabilities may not respond to the stimulation and interactions around them because they have difficulty establishing and maintaining alert arousal states. They, like any other student, are available for learning only when they are alert. The primary task of teachers serving this population is to become skillful at using environmental management to create conditions that facilitate establishment and maintenance of alert states. Once students are alert, appropriate learning materials and social interactions must then be provided in order for learning to occur.

Many external as well as internal factors influence arousal states. All significant factors must be considered in determining the best way to facilitate alert states with any given student. For that reason, biobehavioral state assessment is crucial before interventions occur. Under no circumstances should it be assumed that a student is nonresponsive under all conditions before biobehavioral assessment and subsequent intervention has been provided.

Two of the most well known biobehavioral assessments that have come from the research and literature developed during the last twenty-five years are the Carolina Record of Individual Behavior (CRIB) and the Analyzing Behavior State and Learning Environments Profile (ABLE). Each of these tools has strengths, but cost and accessibility limit their use for some teachers. The informal, teacher-made assessment tool which follows this article attempts to assist teachers in their efforts to identify factors influencing their students' arousal states. Teachers are encouraged to change this tool as needed to meet the unique needs of an individual student. Teachers are also encouraged to read the resource material listed and to take advantage of training opportunities related to these tools as they arise.

The success of this type of assessment is highly dependent upon the sharing of information. Parents and staff members who will be recording states and other information should plan the assessment together. All assessors must agree on the characteristics of each state for the student they are assessing. Using a video tape of the student to practice recognition of states before the actual assessment takes place is very helpful.

Resources

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

Guy, B., Ault, M., & Guess, D. (1993). Project ABLE manual: Analyzing behavior state and learning environments profile. Lawrence: University of Kansas Department of Special Education.

Rainforth, B. (1982). Biobehavioral state and orienting: Implications for education of profoundly retarded students. TASH Journal, Volume 6, Winter, 33-37.

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

Editors note: If you have questions regarding the forms that follow contact Millie Smith at (512) 206-9271 or write to her at TSBVI Outreach, 1100 W. 45th Street, Austin, TX 78756, Attention: Millie Smith. The actual forms may be found in Teaching Students with Visual and Multiple Impairments (1996). Austin, TX: Texas School for the Blind & Visually Impaired, Austin, TX.


Assessment of Biobehavioral States and Analysis of Related Influences

by Millie Smith and Stacy Shafer

Student's Name: Catherine              Date of Assessment: 3/5/95

Name(s) of Assessor(s): M. Smith, P. Castro (mother), N. Jones

Assessment Period

School day starts at: 8:15 a.m
School Day ends at: 3:30 p.m.

Nonschool environments:
Place: Home From: 4:00 p.m. To: 8:30 p.m.
Place:           From:                  To:

The total assessment period should be at least one school day. Assessment of the student in nonschool environments on the same day would be extremely helpful.

Recording Schedule

Indicate the length of the interval between recordings in Part II. Intervals should be no shorter than one minute and no longer than 15 minutes. The intervals should be consistent throughout the assessment period. Part II information will be recorded every 15 minutes.

Part I

Provide the information called for in the grids for the 24 hours preceding the beginning of the assessment and throughout the assessment period. Under "Comment" indicate any significant factor that comes to mind and be sure to note when the recorded information is a departure from the student's typical routine. If there are significant departures or if the student is ill on the day of assessment, postpone the assessment.

Note: This is an informal teacher-made assessment based on the Carolina Record of Individual Behavior (CRIB), by R. J. Simeonsson et al. and the Project ABLE Manual: Analyzing Behavior State and Learning Environments Profile by B. Guy et al.

Food and Liquid Information

Each time the student eats something, drinks something, or is tube fed, enter the following information on the grid:
(the grid has five columns titled Type, Start Time, Stop Time, Amount, and Comment)

TypeTime StartTime StopAmountComment
Ensure. 8:20 8:40 16 oz  
Water. 8:40 8:45 6 oz  
Ensure 12:30 1:20 16 oz.  
Water 1:10 1:15 6 oz.  
Ensure 4:30 4:50 16 oz.  
Water 4:50 5:00 6 oz.  
Ensure 8:00 8:20 16 oz.  
Water. 8:20 8:25 6 oz  

Medication Information

Each time the student takes a prescription or over the counter medication enter the following information on the grid:

TypeTimeAmountComment
Tegretol Suspension 8:20 a.m. 200 mg  
Dimetap Elixir 8:20 a.m. 10 cc for congestion
Dimetap Elixir 12:30 p.m. 10 cc  
Tegretol Suspension 4:30 p.m. 200 mg  
Dimetap Elixir 4:30 p.m. 10 cc  

Seizure Information

Each time a seizure occurs, enter the following information on the grid:

Start Time Stop TimeDescriptionComment
       
    none observed  
       
       
       

Sleep Information

Each time the student sleeps for more than five minutes, enter the following information on the grid. If the student's sleep is interrupted for longer than three minutes, enter a stop time and begin a new sleep episode on the next line:

Start TimeStop TimeLocationComments
9:00 p.m. 12:00 p.m. Bedroom Cried to request in bed change in position
12:15 p.m. 3:20 p.m. " "
3:28 p.m. 6:15 p.m.. " Playing quietly in bed when checked at 6:15

Part II - Instructions

Time: Record the clock time for every third interval recorded. This will help show the continuity of the assessment.

State: Record the state at the moment of observation, not the prevalent state for the entire interval.

Position: Indicate the position the student is in at the moment of observation (e.g., sitting, side-lying, prone, supine, standing).

Specific External Stimuli Available: Describe the specific external stimuli available to the student at the moment of observation (e.g., music, vibrator, swing, water, food, Little Room, mobile). If no material is available, enter a zero.

Ambient Conditions: Describe the characteristics of the surrounding (e.g., room temperature, noise level, conspicuous smells, lighting) for the first state recorded and whenever conditions change. When no change occurs, put ditto marks in the column.

Social Conditions: Record the name of the person interacting with the student at the moment of observation. The person must be talking to the student, touching the student, and/or co-actively manipulating an object with the student. The passive presence of another person should not be recorded. If no person is interacting with the student, enter zero.

Key to Part II Assessment

State Key: _ = Seizure; S = Sleep; D = Drowsiness; QA = Quiet Awake;
AA = Active Awake; FA = Fussy Awake; MA = Mild Agitation;
UA = Uncontrollable Agitation.

TimeActivityStatePosition Spec. Ext. Stimuli Avai.lAmbient ConditionsSocial Conditions
8:15 Arrival QA Seated 0 Outdoors cold, windy, noisy chairlift in bus Greeted by TA  Linda
8:30 Breakfast D Supine 0 Normal temperature and lighting 0
8:45 Tooth-brushing MA Seated Toothbrush, toothpaste, water, towel Noisy bathroom,very bright lighting Hand-over-hand   manipulation; L
9:00 Hair Drying QA Seated Hairdryer, mousse, brush Normal temperature and lighting Talking; Linda
9:15 Hair Brushing QA Seated Hairdryer, mousse, brush Normal temperature and lighting Talking; Linda
9:30 Drama Class AA Seated Papier mache material Dark stage area, echoes Surrounded by peers
10:00 Changing AA Supine Cold wipes, talcum  powder Normal temperature  and lighting Patting, talking; Linda
10:15 Mail Delivery AA Rolling  prone stander Variety visual & auditory stimuli avail. Many changes; different noise levels Interaction with 6 different adults
        Remainder of day not shown    

Part III - Summary

Typical duration of alert states: 15 to 20 minutes

(Note: If the student is typically alert less than one minute, a different type of biobehavioral assessment will be necessary. Consider assessing one activity at 30 second intervals. The purpose of this assessment would be to try to determine what influences cause state changes and to provide modifications associated with changes to more alert states.)

Positions during alert states: Seated, standing (in prone stander)

Specific external stimuli available during alert states: Movement; tactual materials (e.g., paper, hairbrush); auditory, especially human voice

Ambient conditions during alert states: Normal lighting, temperature, low noise level

Social conditions during alert states: Talking and touching

Less than alert states typically occurred when: There was no social interaction

Agitated states typically occurred when: There was too much noise or strong smells and just before feeding

If you have concerns about food and liquid intake or medications, talk with parents and other team members about getting more information.

Do you have concerns about food and liquid intake being adequate for maintenance of alert states:

___X__ Yes  ______ No

Do you have concerns about medication and/or medication schedules facilitating alert states at optimum programming times:

___X___Yes   _____  No

Telebraille Assessment Form

Basic Setup

Independent

With Assistance

Other

Plug in power supply cord      
Connect braille box to TDD      
Turn braille box on/off      
Turn TDD on/off      
Separate braille box and TDD      

Functions

Independent

With Assistance

Other

Use "face to face" mode      
Read braille display      
Demonstrate turn taking      
Produce legible braille for TDD      
Correctly edit braille message      

Demonstrates understanding of

Independent

With Assistance

Other

when other user is finished      
Use "telephone" mode      
Turn "telephone" mode on/off      
Detects a busy signal      
Connect to phone line using      
a Y connector      
Activate voice announcer      
Detect phone connection      
Activate auto dial      
Switch from tone to pulse dialing      
Save phone numbers      
Review phone list      
Activate auto answer      
Use message separators      
Skip messages      
Check remaining memory      
Activate battery low warning      
Detect battery low warning      
Charge the battery      
Change the battery      
Connect a printer to Telebraille      

Unlinked Mode

Independent

With Assistance

Other

Activate "unlinked" mode on/off      
Mark text      
Use the advance button      
Use reading commands (6)      
Return to marked text      
Conversation MemoryIndependentWith AssistanceOther
Clear memory      
Recover conversation memory      
Resend section from memory      
Detect error signal      
Dial the phone from      
conversation memory      
Save messages      
Send messages      
Delete messages      

Describe students use of the Telebraille: (in as much detail as possible)

Describe how you envision the student using the Telebraille in the future: 

Developed 12-01-97 by Sharon Nichols, Texas School for the Blind and Visually Impaired

Needs Of Children With Deafblindness

When a child is deaf or hard of hearing, his access to information and interaction relies heavily on the visual channel. Since sign language, fingerspelling, speechreading, and cued speech are intensely visual in nature, vision loss affects the child's ability to access these communication forms. For this reason, it is important to address any vision loss, which might impact the student's ability to access educational information.

The effect of the student's vision loss on the acquisition and use of visual communication forms needs to be evaluated so that appropriate adaptations can be implemented that insures access to his method of communication. Because deafblindness is a low incidence disability, the communication assessment, functional vision evaluation (FVE), or learning media assessment (LMA) do not routinely address this issue. Pre-service programs for teacher of the visually impaired and teachers of the deaf and hearing impaired do not typically teach strategies which are commonly associated with deafblindness.  In addition, the classroom interpreter is trained to provide services to individuals who are deaf or hard of hearing, but may be unfamiliar with the adaptations needed for the child with deafblindness to access these forms of communication. Assessment of vision must be carefully planned for and carried out related to receptive communication.

Working with educators in Texas, we have developed an approach to evaluating the impact of vision loss on the child's ability to access and learn information through these communication forms. We wanted to share this information, hoping it might be useful to others facing the same task.

Assessing the Student's Needs

Step 1: Assemble the assessment team

Obtaining the information that is needed requires a team approach. The evaluation process requires someone who can understand what the child is signing, what is being signed to the child, and what specific visual obstacles must be overcome for the child to detect and interpret these forms of communication. Specifically, the team needs to include both a teacher of the visually impaired and a teacher of the deaf and hard of hearing. Both these teachers have critical information that the other lacks, requiring collaboration between them. Additional team members should include such people as the family, the student, the educational interpreter, intervener, teacher and/or the instructional aide.

Ideally, the team will have support from a professional with a background in deafblindness. Specific training on the assessment and development of programming for students with deafblindness is not typically covered in training programs for teachers of the visually impaired or for teachers of students who are deaf and hard of hearing. This information belongs to the separate field of deafblindness

Step 2: Conduct standard screenings/assessment

The process of evaluating the effects of vision loss on recognizing and using visual forms of communication is tied to the functional vision evaluation (FVE) and the learning media assessment (LMA). Conducting these assessments is the primary responsibility of the teacher of the visually impaired in collaboration with the team. As a team you should determine how to gather this information. The teacher of the visually impaired can report the impact of the student's vision loss on signing, fingerspelling, speechreading, and cued speech in either the FVE or LMA.

There may also be a need to make a referral to a low vision specialist. Many times a child may benefit from the use of such devices as a monocular, telescope, special lightings, or to learn specific strategies to help him access his preferred communication form(s). The teacher of the visually impaired should make this recommendation to the ARD committee if he or she feels it would be beneficial.

Step 3: Compile information

After the functional vision evaluation is completed, the team needs to compile some specific information.

Consider the child's etiology

There are a number of syndromes having both a vision and hearing loss component. This may have bearing on the best educational approaches to use with the child or give direction to long-term medical follow-up. For example, Usher Syndrome brings about a visual field loss. Children with Congenital Rubella syndrome have a risk of developing cataracts and glaucoma. Resources such as the National Organization for Rare Diseases (NORD) and D-B Link can be very helpful in obtaining this important information. There are other etiologies besides syndromes that can cause vision loss. An example of such a condition is spinal meningitis. Cortical visual impairment (CVI) can be associated with this condition and results in fluctuating vision and possible perceptual problems.

Consider the communication system or methodology being used with the child

There are several manual communication methodologies or systems being used in Texas classrooms at this time. Speechreading is used by a number of students. Cued speech is also an option for some children as a communication form. A sentence or thought can be expressed in different ways, depending on which communication methodology or system is used, resulting in different visual demands on the child. Chart 1 gives some very simple definitions of these methodologies or systems. (Chart 1 is not comprehensive and only meant to introduce you to these terms. It is not meant to be an endorsement or criticism of any of these methodologies or systems.)


CHART 1 - Manual Communication Systems and Methodologies

American Sign Language: (ASL): "the native language of thousands of Deaf people who have Deaf parents. For them, it is not only a first language but also carries with it the culture of generations of Deaf people in America. Like other foreign languages, it has its own history, idiomatic expressions, structure and grammatical rules." It is a highly sophisticated visual language and it is not based on nor is it derived from English.-- (Humphries, et al 1980.)

Signing Exact English (S.E.E. signs): A sign system developed in the early 1970's which is based on the English Language. "The most important principle in Signing Exact English is that English should be signed in a manner that is as consistent as possible with how it is spoken or written...." (Gustason, et al 1993.)

Fingerspelling: Individual letters of the alphabet are produced manually by the dominant hand through specific handshapes. In this country, we typically use the American One Hand Manual Alphabet. It is usually used in conjunction with sign language.

Total Communication (TC): English is spoken and signed simultaneously using English syntax and grammar.

Speechreading: Includes lipreading, but also capitalizes on gestures and body language, facial expressions, situational clues, linguistic factors and any auditory input that is available to the individual (Kaplan, H. (1996).

Cued Speech: is a visual communication system which, in English, uses eight hand shapes in four locations ("cues") in combination with the natural mouth movements of speech to make all the sounds of spoken language look different. Cued Speech identifies each distinctive speech sound. Shapes of one hand identify consonant sounds; locations near the mouth identify vowel sounds. A hand shape and a location together cue a syllable. (Discover Cued Speech http://www.cuedspeech.com/ 2002)


Step 4: Observe the child

There are tests designed to check for receptive sign vocabulary. However, these tests typically give the student the advantage of seeing one sign at a time, from a consistent distance, and with a limited number of responses. The results may accurately indicate the signs that the child knows in a clinical environment, but tell you nothing about his ability to recognize them in other environments or situations. His vision loss may impede his "functional" comprehension of these communicative forms, especially if lighting conditions are poor, there is glare, he is across the room for the person signing (with an acuity problem) or very near a person (with a field loss).

Tests to determine the child's ability to speechread also may not take into consideration the impact of a less than perfect visual setting for the student. A child, depending on his or her visual functioning, may do very well in a close one-on-one situation. That same child may not be able to use speechreading at all or only marginally in a typical classroom setting.

Therefore, if you are evaluating a child with deafblindness's ability to use signs, fingerspelling, speechreading or cued speech, you must observe the child in these real environments and situations. Typically, we have taken the assessment questions, which follow, and let these guide our observations of the child in a variety of interactions throughout his regular day. These observations are carried out over the course of several days so that we can get a broad sample of the child's functioning.

A note of caution about what you observe: It is possible to overestimate a child's receptive communication skills. For instance, the student may be able to tell that someone is signing without actually discriminating discrete segments of the sign or signs. For example, the teacher holds up a yellow art folder and signs "Time for art". Twenty feet away, he can see the art folder, note the teacher was signing, and guess that she was telling him to go to art. That does not mean this child can discriminate all signs at twenty feet. Likewise, a child may observe your lips move at the time of day when you typically tell him to go to lunch and be able to guess what comes next in his schedule. He may not have actually been able to tell that you were saying, "time to eat" because he was at a distance of four feet from you and his visual acuity only allows him to see faces clearly at one foot.

Since this guessing method works best in familiar routines, you might expect to observe a significant drop in the child's comprehension of sign language in new situations and environments. He may require different instructional distances to read signs, fingerspelling, speechreading or cued speech without contextual cues or when presented with novel information.

Step 5: Interview the Team

As the next step in the process be sure to interview team members who have the most experience with the child in communicative interactions. This should include such people as the family, the educational interpreter, intervener, teacher and/or the instructional aide. The assessment questions that follow can guide these interviews.

If the student is at a level where he can participate in the interviews, be sure to include him. In many cases he may be the best person to tell the team about problems he is having. However, it is important to remember that some children are not aware that they are missing information in certain situations. Remember, you don't know what you missed, if you missed it.

Step 6: Validate Your Observations

Your observations and interviews should help you formulated a theory about how the child is using his vision. Devise some situations to test your theory. For example, if you think the child may have night vision problems, set up some situations to see how the child using his vision in darkened hallways, in the early evening hours, or when lights are turned off for overhead use.

The results may suggest the specific adaptations you want to try. These adaptations are likely to be very individualized, not only from child to child, but from situation to situation for an individual child. This occurs because one individual may be affected by different lighting conditions, the degree of familiarity with the situation, the number of other visual demands being made, etc. If the child has a progressive or a fluctuation vision loss, then the adaptations he requires may also vary over time or within a short period of time.

Step 7: Document the Findings

It is necessary to document the team's findings. For this reason it is important to amend the learning media assessment (LMA) and functional vision evaluation (FVE) as needed to address the impact of vision loss on the student's ability to access his method of communication. The impact of his vision and hearing loss may require your team to update any communication assessment that may have already been done. Make sure the impact of the vision loss on these assessments has been factored into any of the results. A new assessment may be necessary after appropriate accommodations or adaptations have been made for the student. Specifically, your team should make a determination that a change in the method of communication does or does not need to be made to address the visual impairment. For example, the student may not be able to efficiently use speechreading in most settings as a receptive communication form because of vision problems and may need a different communication method.

Step 8: Convene the ARD/IEP Committee to Update the IEP

The IEP committee should convene to update the changes needed to address the findings. The teacher of the visually impaired's recommendation for modifications, adaptations, and accommodations should be discussed and agreed upon. Additional related and supplemental services may be required, too. The team then needs to consider changes that may be necessary to implement the IEP.

Many of the necessary changes are unique to the field of deafblindness. Training on deafblindness is not typically provided at the preservice or inservice level for either professionals or paraprofessionals in most parts of Texas. For this reason, there may be a need for family and staff training. There are a number of resources for training, including the deafblind specialists at the regional education service centers and the Texas Deafblind Project. The Project also offers training for paraprofessionals serving a child with deafblindness through the Intervener Training Program. For more information on these resources visit the Texas School for the Blind and Visually Impaired website at Intervener Resources

Another possible change is the need for additional staff. The necessary modifications for any student may place such a demand on the existing staff that there is a risk that the IEP will not be implemented. For example, taking the additional time to let the child study pictures or to use a slower pacing of signs necessary to include the child with deafblindness will frequently break up the momentum of a group lesson. Consistently making these changes, while conducting group instruction, may be impossible. As a result, it is easy to deny the same level of instruction to the child with deafblindness. The need for an additional staff person may be needed.

All of these agreed upon changes should be documented in the IEP so that everyone will know what is needed for the student to access communication. Your team may wish to reference these articles, Documenting Modifications in the IEP for the Student with Deaf-Blindness and IEP Quality Indicators, developed by Texas Deafblind Project and available on the Texas School for the Blind and Visually Impaired website at www.tsbvi.edu/

Assessment Questions And Possible Adaptations

What follows is the list of questions that guide the observations along with possible instructional modifications, adaptations, accommodations or teaching strategies that may be considered. This list is by no means comprehensive. There may be other questions your team wants to address. The ones you select for any child are highly individualized and should be based on his or her vision and communication preferences.

1) What is the best space, placement, and distance of communication forms for the child related to his visual fields?

As a rule of thumb, manual communication takes place within a two-foot cubic area. Speechreading and cued speech requires the student to be able to see the face of the speaker, his finger positions for cueing, body expressions and facial expressions. Students with field losses (blank spots) in their vision can have considerable difficulty in seeing some of this information depending on the location and size of their field loss. Missing parts of the message can greatly affect comprehension. It is important to know the child's best area for viewing these communication forms. In order to make this determination, you will need to know the best placement (e.g., central, upper, left, or right quadrant) for signing or cueing space (e.g., a diameter of ten inches) for that child. If the student has a field loss, moving further away from the signer, allows him to see more of their body and provides him more of the information provided by the hands and the body. When a child has both an acuity problem (blurred vision) and a field loss, finding the best distance becomes a much more complex issue. If the child moves far enough away to capture the face, body, and hands in his fields of vision, he may lose clarity of the image. If he gets up close to see features of the hands and face clearly, he may lose information that falls out of his fields of vision.

Be sure to utilize the information you have gathered about the student's fields from the ophthalmologist's report and the functional vision evaluation when determining the space, placement, or distance of the communication forms you want the child to access. In your observations, take note of a student who keeps backing up, when you try to sign to him. He may be trying to see more of you in his reduced fields. Also watch for students who touch your wrist or hand, reach out to reposition your hand, pull their head back or use eccentric viewing positions (e.g., always turns head down and to the left to use their peripheral vision). Teachers may report having trouble getting the child's attention from a particular side. Try systematically signing or gesturing from different distances and locations within a quadrant.

Children who are using cued speech or speechreading may need to sit close to be able to see the speakers face. Does the child struggle to keep the speaker's face in his field of vision? Check to see if this student's comprehension drops dramatically when the speaker is more than a few feet away or if he is in a group discussion situation.

Possible adaptations, accommodations, and modifications:

  • Present signs consistently in the same quadrant, at the same distance and within a precise signing space.
  • Reduce signing space. (e.g., The sign "country" could be signed between the wrist and the elbow rather than at the elbow.) This may be helpful to students with field losses because it moves the sign into their visual field.
  • Fingerspell (rather than sign) some words if the movement of the sign takes it out of the child's field of vision (e.g., "Russia" which is signed by placing the hands on the hips).
  • Substitute a sign which requires a smaller signing space as long as the meaning is not changed.
  • Alter the signing or speaking distance (based on the type of field loss) between you and the person with deafblindness.
  • Consider the use of low vision aids to increase the amount of information the child is receiving (e.g., expanded field telescopes).
  • Allow the child to turn his head to use eccentric viewing positions if needed.
  • Use tactual signing or (tactual) tracking in some situations.
  • Position oral interpreter or speaker so the student can easily see within his/her field of vision.

2) What is the best rate and distance of communication forms for the child related to his acuity?

The appropriate distance and rate for various communication forms can vary according to the complexity of the exchange, the amount of contextual support to aid in guess work, and the characteristics of the individual sign, letter, cue, or facial and body expressions. Some signs are very concrete and have big, clear movements (e.g., "brush teeth"). Others are more abstract and have subtle, less discernible movements (e.g., "seven"). Signs may also resemble each other (e.g., "purple" and "green"). When fingerspelling, the hand stays in one place eliminating the types of cues many signed words provide. For example, "king" is distinctive because of the movement from shoulder to hip. Also, some fingerspelled letters are remarkably similar for people with acuity losses (e.g., a, t, n, m, o, s, e). The typical rate for fingerspelling is a rapid 3-4 letters per second and this may present a problem for the child who is visually impaired. Hand cues used in cued speech do not contrast very well against the face. Information carried by the body and face that is critical to a speechreader may be lost if everything gets blurry. For some students with deafblindness, their best distance vision is only usable up to a foot away.

If the student has acuity problems, he will have to be close enough to his partner to bring the person's hands, face, and torso into focus. When you put any number of signs (and/or fingerspelled words) together, you may need to sign more slowly and distinctly. Cued speech and speechreading may become impossible for a child with acuity problems under less than ideal conditions. Making changes in the rate and distance of your signs, fingerspelling, and hand cues, or accommodating the child's needs when he is speechreading may be very difficult when you have other students to consider. However, you must find the appropriate distance and rate for any of these forms based on the child's rate of comprehension and can vary across settings.

Adaptations you might consider:

  • Vary the rate of signing, fingerspelling, speech or cues according to the situation such as when the information is complex or novel (however, always keep your signing pace predictable).
  • Work individually with the child to improve his comprehension of signs, fingerspelling, speechreading, and cued speech through receptive drills.
  • Make specific determinations about the best receptive distance for him in a variety of situations.
  • Use tactual signing and/or fingerspelling when necessary (see tactual signing question).
  • Consider the use of low vision aids to increase the amount of information the child is receiving (e.g., a monocular distance aid).
  • Consider the use of additional staff if the distance and rate differs significantly from that required by the other students in the class.

3) Can the student visually discern nonmanual signals that give meaning to the signs or spoken words?

American Sign Language (ASL) utilizes an intricate combination of manual sign and non-manual signals. These must be viewed simultaneously because the non-manual signal affect the grammatical outcome of what is being expressed. A few examples of non-manual signals are: pursed lips, puffed cheeks, a raised eyebrow. When specific signals combine with the manual sign for a word, the meaning changes (Baker & Cokely, 1980). The child can perhaps see the large hand movements, but not be able to see the more subtle movement of the eyebrow. Therefore, he is unable to receive the entire message and misunderstands. A child who uses speechreading or cued speech also needs to be able to distinguish and interpret these non-manual signals at times to fully understand what is being conveyed.

Look at the child's overall comprehension of information that is being presented. Also consider the child's ability to read peoples' moods or intents communicated through body language. Try some imitative games that require the child to be able to attend to facial movements and hand or body movements at the same time. Does he see both movements at a variety of distances?

Adaptations you might consider:

  • Providing this information in some other form. For example, instead of relying on your facial expression use additional manual signs or words to convey the meaning (e.g., sign or say "suspicious" as well as narrowing your eyes).
  • Teach that feelings are expressed through body language. The child with a vision impairment may be unaware of this information.
  • Try exaggerating non-manual signals slightly in order to convey them.

4) Does lighting affect a student's ability to visually access information?

For some children, dim or very bright lighting may present challenges. As one friend who has visual impairments put it, "Light can either be my best friend or worst enemy."

Observe the child's ability to understand and respond to manual communication, speechreading or cues in different lighting conditions. Watch for changes in skills as he moves indoors and outdoors, under fluorescent lights and incandescent lights, in shaded or dimly light areas, etc. Some information should be gathered in twilight or at night.

Adaptations you might consider:

  • Have the child shift to tactual signing. For example, when the lights are dimmed for a video tape, a child with peripheral field loss may need this support.
  • Use area lighting. Lamps or overhead spotlighting on the person communicating can be very helpful. Position the light so that shadows don't fall on the signer's or speaker's hands or face (cross-lighting is best).
  • Use visors, hats, and sunglasses to reduce glare. For students with Usher Syndrome or other visual conditions, glare is a big obstacle.
  • The person signing or speaking should not stand with their back toward a light source (e.g., standing in front of a window).
  • Information from overhead transparencies should be provided in another form.

5) Does the visual background affect the child's comprehension?

Professional sign language interpreters wear dark solid colors when interpreting because it provides good contrast to their hands. This makes their signs clearer and easier to read.

The child with visual impairments has to work harder to pick out visual information when there is a "busy" visual background. Watch to see if the child's comprehension skills increase or decrease when decoding signs against different visual backgrounds.

Adaptations you might consider:

  • Dressing in contrasting, solid colors to make signs easier for the child to discriminate. If the teacher's wardrobe does not contain many solid colors, they might consider wearing a smock.
  • Selecting the best color to improve background contrast. (e.g., Some children may be able to see better with purple as the background color rather than black.)

6) Can a student follow signed conversations in group settings?

Group instruction poses different demands on a child's functional use of vision than when he is in one-on-one situations. In a group lesson a teacher may start signing a sentence directly to the student at 6"-12" and then turn to another child to finish the statement. Suddenly the teacher's hands have moved to a distance of 30" from the child. When this occurs, the student with a vision loss misses part of the sign(s) simply because it has moved out of visual range. Likewise, a teacher sitting very close to the child may be accessible visually if he is speechreading, but should she turn her head or step away to address another student, the child misses what is being said.

The distance and angle of the manual communication, cued speech or speechreading continually changes as different people in the group take part in the discussion. The student constantly has to locate the person signing or speaking and refocus to see what is being signed or said. He may even need to physically reposition himself to bring that person into view.

(Note: Taking the additional time to provide even the most basic adaptations necessary to include the child with deafblindness will frequently break up the momentum of a group lesson. A teacher may know the child needs additional time to study pictures, needs other people to sign more slowly, needs to be close by to see her face, or has trouble tracking the movement of hands. However, consistently making these changes, while conducting group instruction, may be impossible. As a result, it is easy to deny the same level of instruction to the child with deafblindness. The same problem arises in always being available to provide tactual support when the child needs it. Because of these things, additional staff may be warranted to address group activities.)

Adaptations to consider include:

  • Consider the use of additional staff to assist in informational access when the child is included in group activities.
  • Point to the person who will sign or speak next, and allow the child time to visually locate them.

7) Would the student benefit from supplemental experience work to assist in understanding the concepts behind the signs or spoken word?

Children who are deaf or hard of hearing have a wealth of incidental visual information to serve as a basis for language. This may not be the case for a child with deafblindness. Significant amounts of this critical information are distorted or missing altogether for a child with a concurrent visual loss. For example, this child may never be able to see a bird flying or sitting in a tree, or for that matter see a "bird" at all. Showing him a picture or giving him a sign for bird assumes he knows not only what the symbol represents, but has a concept of "bird." This may not be true for him.

New information should not be introduced via speech (even with cues), a picture, or sign if the child does not have a firm experiential base to relate to the picture or sign. Even though he may have the ability to understand or remember information, if he is not getting all the information in the first place, it is virtually impossible for him to understand. This is an access issue. Children with deafblindness need extensive, organized experiences with real objects and actions before they can truly understand pictures, spoken word, fingerspelling, or signs which represent these objects and actions. Their sensory losses have denied them this experience.

Even if the child has a good experiential base, there still may be a need for supplemental experience. Demonstrations and modeling are used extensively with deaf or hard of hearing students. If the student cannot see the demonstration, he needs to do the action himself. For students with field restrictions, who can see the demonstrations, watching demonstrations while simultaneously attending to signing or spoken word requires rapid shifts of gaze. In the process, parts of information from both sources may be lost. Objects may need to be examined tactually and visually before they can be recognized when viewed at distance. The child with acuity loss may also miss information or receive distorted information. Class demonstrations may prove equally difficult for him.

Adaptations you might consider:

  • Provide supplemental experience work to build his overall conceptual base.
  • Allow the child to go through the demonstration individually before he participates in the demonstration with the group.

8) Is the child's vision such that he would benefit from the technique of coactive signing when learning new signs or speech cues?

Coactive signing is a technique that teaches expressive sign skills to students who are visually impaired and unable to see the instructor model the sign. When teaching a sign, the instructor takes the students hand(s) and helps the student form the sign correctly. This technique can also be used with students who have visual perceptual problems because these children may not be able to learn to produce signs just by watching others. This technique could also be used with speech cues. While coactive signing or cuing teaches the child to make signs and cues, he will still need to learn to read signs and cues when others produce them. Therefore, it is important to give the child an opportunity to see (or tactually read) you make the sign or cue if they are to learn them receptively.

9) Does the child initiate or benefit from (hand) tracking?

(Hand) tracking when used in reference to signing occurs when the person with deafblindness places his hand(s) on the wrist(s) area of the signer. This technique enables a person with a visual impairment to know where the signer's hand is moving so that he can direct his gaze accordingly. He may also get enough information from the plane or general location of the hand to recognize the sign without seeing it clearly. (Hand) tracking can also be used in conjunction with the other adaptations mentioned in question #1.

Some children initiate this technique on their own. This is usually an indication that they need more information than they are getting visually. Sometimes this can be a tip-off to a field loss. (Hand) tracking should be on this child's lists of strategies since there are some situations where the strategy of moving further from the speaker is impractical (e.g. sitting next to a friend on the bus when his optimum distance for viewing is 4 feet). The child should be allowed to shift to (hand) tracking when he chooses. In some instances, this technique will need to be taught to the child.

10) Does the child initiate or benefit from tactual signing?

Note: This is an abbreviated discussion of the important issues involved with tactual signing. Tactual signing, a receptive skill, should not be confused with coactive signing which is used to teach expressive signing.

Tactual signing is used by a person who understands sign language, but cannot visually read signs and fingerspelling. To receive information, "the deafblind person places one or both hands on the hand(s) of the signer in order to read signs and fingerspelling through the tactual sense. (It is) ...a direct adaptation of a communication system originally intended for vision...to the tactual sense." (Reed, et al 1995.) For students who learn sighs visually and then undergo a significant vision loss, there will be a process of relearning signs tactually. Signs feel different than they look. There may also be emotional issues to face in switching to tactual sign because it is an admission of vision loss. This is an extremely stressful change for a person who is hard of hearing or deaf.

In order to be a skilled reader of tactual signs a person must do more than just learn how the signs feel. He will need to learn how to place his hands to get the most information without interfering with the speaker's ability to sign. Typically, the student uses both hands in the beginning. As his skills increase or if he is very familiar with his partner, he may use only one hand. The student will need to "keep it light" in terms of how much weight he puts on the hands of the person who is signing to him. The partner can fatigue very quickly, and over time, injuries like Carpal Tunnel Syndrome can occur if adequate breaks are not allowed. The person with deafblindness may also become fatigued because holding his hands in place for long periods of time is tiring, and reading signs tactually takes a great deal of concentration.

Much of the information conveyed in sign language is expressed through facial expressions, eye gaze, a slight shrug, etc. With tactile signing, every attempt should be made to find alternate ways to convey the meaning tactually.

While tactual signing is most often used by individuals whose vision loss is total, it is also used by people who have vision but are not able to see the signs and fingerspelling clearly enough to understand them. If a student with low vision initiates this modification, it should be respected as an attempt to gain necessary information. The child should be given the opportunity to receive signs tactually. Some students may need to use tactual signing in some situations and not in others. For example, a student may need to rely on tactual signs in very dim light, but be able to get by without it under good lighting conditions.

In some instances, utilizing tactual signing can allow a child to follow a discussion with his hands while he uses his vision to regard the item or situation under discussion. He doesn't have to choose what to look at. When a child becomes more sophisticated in signing, having to read longer sentences, he may no longer be able to get by on his vision alone. He may move to tactual signing because of a change in the level of demand upon vision. In another student, self-initiation of tactual signing could indicate a problem with the child's vision.

11) Does the student need additional environmental information provided to him?

When conversing with or interpreting for a person who is deafblind, additional environmental information should be supplied along with the conversation or lecture. For example, who is in the room, a description of the furnishings, an unexpected noise, etc. Without this information some comments may not make sense if people are referring to things that the person with deafblindness cannot see or hear. Have each person say their name before making a comment and provide the interpreter with a seating chart that contains the names of the others in the group.

12) If a student will benefit from braille, are there English acquisition issues associated with students who are deaf or hard of hearing which should be addressed?

When determining whether print or braille should be used for a student who is deaf or hard of hearing, teachers will need to keep in mind that slow reading rates and problems with comprehension may be related to acquiring English rather than to a vision problem. In many ways, these students' learning needs are similar to those students who are learning English as a second language. A change in literacy medium from print to braille may not improve reading performance for students experiencing English acquisition issues.

The following item might be helpful to braille students acquiring English:

  • Modify the language level to match the child's ability to read and understand English.
  • Generate stories and text based on the child's actual experiences or interests will help them understand the English represented by the braille.
  • The ability to fingerspell has been useful in supporting the learning of the braille alphabet.

13) Are there instructional strategies, materials, and tools typically used with students who are deaf or hard of hearing that may present problems for the students with deafblindness?

  • Pointing, facial expressions, gestures, demonstrations, and modeling. These methods require shifting gaze from signs to some other reference.
  • Pictures of signs/fingerspelling used to teach signs or of faces to teach cues and speechig. If these are used it is important to determine the best presentation: color or black line drawings, high contrast, figure-ground clarification, perspective, etc.
  • When working on the floor, teachers frequently place pictures or objects on the floor and then sign at chest level or speak. Visual demands are being presented in two places and at two distances requiring gaze shifting and refocusing.
  • Holding two pictures or objects side by side and bobbing them up and down in a modification of the sign for "which". The child with a vision loss is faced with the problem of trying to interpret moving pictures.
  • Captioning. Subtitles are displayed on a screen so that a person who is deaf or hard of hearing can follow the sound track of a program. The size of print (the subtitles are about one half inch high on a nineteen inch screen) and rate of presentation may be problems for a student with a vision problem. There are versions of decoders that produce the information in braille.
  • Computer aided real time (CART). Students with vision problems may have difficulties with the size of print and rate of presentation.
  • TDD (telecommunications device for the deaf). May need adaptations to the keyboard such as larger and/or higher contrast labeling of the keys. Specially modified TDDs that come with an external large visual display are available. A device such as the Telebraille may be appropriate if the student is a braille user.
  • Alerting devices utilizing light or visual displays may need to be replaced with devices that are vibrotactile.

14) Are there modifications to standard interpreting arrangements or signed classroom instruction that need to be addressed?

Note: this is an abbreviated discussion of the important issues involved with appropriate interpreter services. Not all interpreter arrangements are discussed.

It is possible that a person with deafblindness may need a completely different interpreting arrangement than other hearing impaired students in the same classroom. Even in an environment where everyone is signing, you may need additional support. For example, at a recent conference we had four participants who requested sign language interpretation. One of the participants could see the platform interpreter who stood by the speaker. Two of the participants required a tactile interpreter. The fourth person used a close vision interpreter. Three different interpreting arrangements were needed simultaneously, in order to make the information accessible to all participants.

Adaptations about interpreter arrangements:

  • Platform interpreting. The interpreter is positioned near the speaker. They can be too close or too far away from the student with deafblindness.
  • Small group interpreting. The interpreter sits within two or three feet of a small group of students. This is an adaptation provided for those whose vision prohibits them from seeing a platform interpreter.
  • Close vision (1 on 1) interpreting. This type of interpreting is provided when an individual's vision loss requires specialized placement of the signed information. This is frequently the case when a person has restricted visual fields or other visual impairments that require signs to be delivered within a particular space or from a particular distance. This also occurs when a person needs to use tactual signing.
  • Visual descriptions. When interpreting for a person who is deafblind (or conversing with him), the interpreter includes descriptions of what he can't see or hear.
  • Tactual Interpreting (see question #11)
  • Feedback Interpreting. Used in situations where a presenter with deafblindness needs to know what is happening in the audience e.g. laughter, questions, remarks.
  • Oral Interpreting. Used by speechreaders, the interpreter mouths the words that are being said by the speaker at a distance where the deaf/hearing impaired person can read his/her lips.

15) Does the student have skills to advocate for the modifications he needs?

Many children, even at a very young age, will let you know when they cannot see what you are signing or saying. They may pull away from tasks or refuse to look. The older child may move your hands so they will be in his field of vision or become critical of your signing. He or she may comment that you are speaking too fast or that a mustache is reducing the visibility of the lips for speechreading. Note how well the child can assess his ability to see in any given situation and how well he can communicate visual difficulty to others. Ultimately, only the individual with deafblindness knows what really aids him in accessing communication and he must be able to advocate for these adaptations throughout his life.

Adaptations you might consider:

  • Work individually with the child to teach him to tell you what adjustments he needs.

Conclusion

Making the appropriate modifications and adaptations for a child with deafblindness is critical to their educational achievement. If his unique needs are not met, the child, no matter where he is placed, is in the most restrictive environment. He is cut off from any opportunity to learn. Unfortunately, these supports are not always easy or inexpensive to provide.

By conducting a thorough assessment of the child's visual functioning in accessing manual forms of communication, speechreading and cued speech, you can determine the supports that are necessary. This will help you and your team to develop the type of programming which has the most benefit for the child educationally and make that program accessible to him.

We would like to thank Millie Smith, Education Specialist, Texas School for the Blind and Visually Impaired Outreach Dept. for her assistance in writing this article.

References

Baker, Charlotte and Cokely, Dennis (1988). American Sign Language: a teacher's resource text on grammar and culture. Silver Springs, MD: T. J. Publishers.

Compton, Cynthia (1989). Assistive Devices: Doorways to Independence. Department of Audiology and Speech-Language Pathology, School of Communication, Gallaudet University.

Discover Cued Speech 2002.

Gustason, Gerilee and Zawolkow, Esther (1993). Signing Exact English. Los Alamitos, CA: Modern Signs Press, Inc.

Humphries, Tom; Padden, Carol; and O'Rourke, Terrence J. (1980). A Basic Course in American Sign Language. Silver Springs, MD: T. J. Publishers, Inc.

Kaplan, H. (1996). Speechreading. In M.J. Moseley and S. Baily (Eds.), Communication Therapy: An Integrated Approach to Aural Rehabilitation, 229-250. Washington, DC: Gallaudet University Press

Reed, Charlotte M.; Delhorne, Lorraine A.; and Durlach, Nathaniel I. (1995). A study of the tactual reception of sign language. Journal of Speech and Hearing Research, Vol. 38, 477-489, April 1995.

Watkins, Susan and Clark, Thomas P. (1991). A coactive sign system for children who are dual sensory impaired. American Annals of the Deaf, Vol. 136, No.4, pages 321-324.