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Milestone Sequence May Have Areas Of Unique Development.

Visual impairment may effect the specific sequence of gross motor milestone development. This is currently "under investigation" with Project PRISM.

As with all areas of development, the child with vision impairment should be regarded as an individual learner.

"On Schedule" Static Postures, Delayed Movement Postures

The rate of gross motor milestone development may be influenced by a visual impairment.

Milestone Comparison Chart **
 Number Of Months For Each Skill
Head lifted in prone 1 4
Elevates self on elbows in prone 4 8.75
Prone: forearm reaching for an object 3 - 5 9 - 12
Supine: rolls to prone 3 - 5 5 -9
Sits alone steadily 6 - 8 6 - 9
Raises from floor to sitting 8 11
Stands holding furniture 6 - 8 10 -16
Achieves four point crawling 9 - 11 13
Stands alone 11 13
Walks with one hand held 9 -11 16
Walks alone 12 -15 19
** - taken from literature, but should not be regarded as hard and fast data - most of this research has been done on children not receiving early intervention services that specifically target motor development from an NDT perspective.

Influence of low postural tone (hypotonia)

It has been theorized that the reason many babies who are visually impaired have low postural tone because of a lack of experience in the prone position which then denies them the needed proprioceptive stimulation for neuro-motor development. Another theory is that due to the lack of vision, the ability to utilize optical righting (righting head in alignment with visual horizon) is impaired. Without optical righting, . there is reduced motivation to move and turn the head. This dominos into a reduction of practice with head control which influences the muscles control development throughout the neck, shoulder girdle, and spine/trunk.

Reduced motivation to move out in space

  • vision is thought to be the primary incentive for movement
  • sound is not a pure substitute for the lure to move out in space
  • object permanency as it relates to the child who is visually impaired
  • child must have a concept of "the world out there" before s/he will know to move out into space
  • influence of the sequence of sound localization development – beginning at ear level, above ear level, below, and finally in front (use of stereo localization)
  • the process of sound localization is typically tutored by vision - which is not possible with the child who is blind
  • a poor base of support may reduce incentive to fight gravity and move out in space

Quality Of Posture And Movement Factors

Examples of poor quality of posture and movement include:

  • prone: head down (poor extension of the neck)
  • supine: poor flexion against gravity - legs abducted (frog leg appearance)
  • sitting: tipped pelvis (forward or backward), rounded back, elevated shoulders, lack of erect head position
  • standing: knees locked, elevated shoulders, wide base of support.
  • walking: wide base of support, flatfeet, shuffled walk, high guard arm position.

Influence of low postural tone

  • use of postural fixing due to lack of proximal support
  • this is especially evident in milestones involving trunk rotation

Reduced ability to monitor vertical postural adjustment

  • ear infections can contribute to balance problems

Reduced Ability To Learn By Visual Imitation - (depending on level of sight)

Need for deliberate teaching of activities within a purposeful context.

  • teaching should be done with real objects/furniture/situations
  • the child should be allowed to feel the movements of other people

Possible Fear Of Movement

  • Lack of postural stability - may reinforce insecurity of movement
  • Reduced ability to visually monitor the environment
    • sudden noises/movements/touches without warning or possible meaning
  • Overprotection - lack of varied (and praised) experience

Strategies to promote with families:

  • early experience with safe-but-fun rough and tumble floor play
  • exposure to new environments (with success)
  • confidence reinforcement - minimizing bumps and maximizing self challenges.
  • meeting with adults who are visually impaired to learn from their experiences

Compiled by Tanni L. Anthony, U.S.. June 1992

This document is a Resource for the Expanded Core Curriculum. Please visit the RECC.