Main content

Alert message

Marina McCormick, M.Ed., Region 4 Regional Day School Program for the Deaf Coordinator

Originally published in the Spring 2015 edition of TX SenseAbilities.

Abstract: The author discusses ways local school districts can serve students with deafblindness. She emphasizes collaboration, putting the student first, rewarding outstanding staff, and including the student as part of the local community.

Keywords: deafblindness, administrators, collaboration, inclusion.

When most people encounter the word deafblindness, the first image that comes to mind is one of Helen Keller and her teacher, Anne Sullivan. Thanks in large part to Keller’s articulate and thoughtful nature, the groundbreaking duo challenged public perceptions regarding what was possible for people with multiple disabilities.

Although Keller’s life is an inspiration to many, the reality of deafblindness is more variable than originally understood by those outside the education arena. This variability within deafblindness comes from many factors. For example, children experience variations in their hearing and vision losses. One child with deafblindness may exhibit excellent use of his residual hearing and struggle with nearsighted vision while another may have better visual acuity but have profound hearing loss. Other factors that lend themselves to the diversity within deafblindness include the child’s cognition, sociological factors, communication modalities, social-emotional development, and technology skills. Children with deafblindness, through the very nature of their disability, require individualization to meet their needs.

It is the full realization of individualization, though, that many public school instructional teams struggle with when serving a student with deafblindness. An instructional team may encounter an individual with deafblindness for the first time and may grapple with how to provide that individual with access to the curriculum. From these tremendous efforts emerges a false belief that the student with deafblindness cannot be successful in the public school setting and should be sent elsewhere for his or her instructional needs. This notion can be countered, however, with a strong education administrator leading the team.

The following are five tips for administrators as they lead their teams to greatness for students with deafblindness.

1. Develop a deep understanding of the student’s needs.

In order to effectively lead the team that will provide services for the student with deafblindness, the administrator first must become highly knowledgeable regarding the student and the student’s academic and functional needs. Deafblindness is a disability that relates to access. How will the student access the curriculum, the environment, or the social network of the campus? Familiarize yourself with the student’s audiological and vision reports. Learn about how the student communicates and what accommodations and modifications the student requires. Become knowledgeable about the student’s daily living needs. The student’s multidisciplinary team (which could include teachers for the visually impaired and/or deaf, an orientation and mobility specialist, general education teachers, and others) or other campus personnel will, in most cases, contact the administrator first when questions arise related to the student’s services. Without possessing a thorough knowledge of the student’s disability and programming, an education administrator cannot sufficiently answer the question that underlies all other questions: Why are we doing this?

2. Know the team. Be the team. Lead the team.

Ronald Reagan once said: “The greatest leader is not necessarily the one who does the greatest things. He is the one that gets the people to do the greatest things” (Goodreads, 2015). Individualizing services for a student with deafblindness undoubtedly is one of the greatest things an education administrator will ever ask his or her team to do. Therefore, it is critical to identify the team that will serve the student. List every service and support the student requires and align the student’s needs with your current staff, categorizing staff members as core team members (frequent interaction with the student) or extended core team members (infrequent interaction with the student). Form a strong relationship with the student’s parents or guardians; they, too, are a part of the student’s core team. Identify the strengths of your team and those areas in which your team will need additional training. Establish regular meeting times for both the core team and the extended team. Be actively engaged in meeting and learning with the team.

3. Be student centered.

In the era of high-stakes testing, educators too often want quick solutions to their instructional problems. Effectively serving students with deafblindness is a marathon, not a sprint. The instruction for a student with deafblindness requires coordinated attention between the student and the teacher, both coexisting in the here and now. What this translates into for teachers is that lessons are not traditional and do not lend themselves to typical concepts of school time such as 45 minute class periods. For teachers who are unfamiliar with deafblindness, this can be a cause for concern because they may be unfamiliar with techniques related to differentiated instruction.

When considering programming, all team members will be involved with many e-mails, phone calls, and meetings. IEP meetings may be extremely long due to the number of services and service providers a student may need. The preparation and instruction for the student will be intensive for staff. Ongoing professional development will be needed. With all of this happening, it is essential to champion the purpose behind why the team is working so hard.

4. Reward outstanding staff contributions.

As your staff rises to your high expectations for high quality instructional services and support for the student with deafblindness, recognize and reward their achievements. These achievements do not need to be momentous occasions. Small wins such as collaborative efforts, instructional strategies, or consistency in providing excellent service and support are just as important. Have you noticed that your intervener and interpreter are working together to provide linguistic and conceptual support for a complex biology lesson? Did you observe the adaptive physical education teacher providing a superb accommodation for the student to walk around the track? Reward success often to encourage your team.

5. Remember the community’s trust in your school and in your district.

Often it is tempting for a team to want to focus on what it cannot provide, rather than what it can provide, for the student with deafblindness. Keep in mind this essential truth: The student and the student’s family are valued members of your community, and they have placed a great time-honored trust in you and your school’s abilities not only to meet, but to exceed, their expectations. According to Jay Gense, former director of the National Center on Deaf-Blindness, 95% of students with deafblindness nationwide are living at home with their families and attending school in their communities (Gense, 2015). Your team, in most cases, can fulfill the needs of a student with deafblindness through creative problem-solving and open lines of communication. It is up to you as the administrator to foster the belief of “Yes, we can!” rather than “No, we can’t.”

Concluding Thoughts

It is not often that a student with deafblindness crosses a school’s path, but when he or she does, the possibilities for learning for the student and the student’s team are endless. Students with deafblindness have an uncanny ability to stretch our professional understanding of what is educationally possible within the public school setting. They desire to achieve their goals and dreams as much as any other students, and even though we may not necessarily have a direct line in some cases as to what those aspirations are, these hopes exist nonetheless.

As Helen Keller said in The Story of My Life, “One can never consent to creep when one feels an impulse to soar” (Keller, 2002).


Texas SenseAbilities - a free newsletter provided by TSBVI and DARS-Division of Blind Services provides articles from parents, individuals with visual impairment and deafblindness, programming information and strategies, updates on resources and training in English, Spanish, braille and large print as well as electronic formats.

Deaf-Blind Perspectives - Deaf-Blind Perspectives is a free publication with articles, essays, and announcements about topics related to people who are deaf-blind. Published two times a year (Spring and Fall) by The Teaching Research Institute of Western Oregon University, its purpose is to provide information and serve as a forum for discussion and sharing ideas. The intended audience includes deaf-blind individuals, family members, teachers, and other service providers and professionals.

 By Jim Durkel, TSBVI Outreach Programs


A cue is a type of communication used by an adult to let a child know what is expected of him/her in a given situation. Cues are a type of receptive communication.

Designing and using a consistent routine is the beginning of teaching cues. Given time in this type of the routine, the child will first begin to anticipate his/her part in the routine. Given more experience with the routine, the child may begin to anticipate the routine from some part of the routine.

Touch cues are ways an adult can touch a child to communicate a desired action. For example, an adult may gently pull a child's arm upward with a grasp at the wrist to cue the child to lift arm during a dressing routine.

A sensory cues is some sensory input used to help a child anticipate an event: For example, a smell of lotion before it is applied to the child's arm or the sound of water splashing before placing the child in the bathtub.

Object cues are some concrete piece of a routine that is used to represent that routine. For example, a diaper may be an object cue for diaper changing.

When deciding what cues to use with a child, it is important to remember to select cues that the child can easily discriminate one from the other. Otherwise the cues may be confusing to the child.


Signals are movements the child uses to communicate needs, desires and feelings to adults. Signals are a form of expressive communication.

Signals may start as a behavior that the child is not intentionally using to communicate. But because an adult consistently responds to this behavior, the child begins to understand that producing this behavior causes a particular event to occur. For example, a child may inadvertently clap hands with an adult. If hand clapping is enjoyable for the child and the adult consistently responds by hand clapping with the child, the child may signal for more hand clapping by clapping the adults hand again. Signals are usually first seen within an already occurring activity. As the child becomes more sophisticated, he or she may produce the signal to initiate the activity.


Symbols are representations of an event, action, object, person, or place that can be used to communicate about the event, action, object, person, or place. Symbols can be used for both receptive and expressive communication. Objects, parts of objects, pictures, print, actions, gestures, signs, and speech can all be symbols. Symbols may start as cues and signals. If a child recognizes a cue out of context, that cue may be acting as a symbol. If a child uses a signal or an object cue to communicate about an event, action, object, person or place out of context, the child may be using that signal or cue as a symbol.

The more a symbol resembles what it represents, the more concrete that symbol is. The less a symbol resembles what it represents, the more abstract that symbol is. An example of a concrete symbol would be a spoon, used during mealtimes, to represent mealtime. A less concrete (or more abstract) symbol would be a small line drawing of a person eating. The spoken phrase "time to eat" would be the most abstract because those sounds don't look, smell, or feel like food or the action of eating. Concrete symbols are more easily associated with what they represent than are abstract symbols. When determining how closely a symbol resembles an event, action, object, person, or place it is important to consider how the child perceives that event, action, object, person, or place. For example, a symbol based on visual similarities may not be as concrete for a person with a visual impairment as it would be for an individual who is fully sighted. A symbol based on an action may be abstract for an individual with physical impairment such that he/she had never performed that action.

A hierarchy of visual symbols from concrete to abstract may be the following:

  • an object used as part of the activity it represents,
  • an object identical to the one used as part of an activity,
  • an object similar but not identical to the object used as part of an activity,
  • a part of an object,
  • a full-sized colored drawing of the object,
  • a full-sized black and white drawing of the object or a reduced-size colored drawing of an object,
  • a reduced-size black and white drawing of an object,
  • a printed word.

There is a similar hierarchy for movement with an object to sign:

  • movement with an object used as part of the activity it represents,
  • movement with an object identical to one used as part of an activity,
  • movement with an object similar to but not identical to the one used as part of an activity it represents,
  • movement without an object,
  • a sign that resembles the movement without the object,
  • a sign that does not resemble the movement without the object

J. C. Durkel, Texas School for the Blind & Visually Impaired, Austin, TX

(Originally published in the June 1995 edition of VISIONS)

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

Adapted from a presentation by Susan S. Simmons, Ph.D.

A number of years ago I began referring to myself as a "Developmental O&M Specialist." I choose this term because many O&M Specialists seem to come from one of two schools of thought when providing services for young children. Since most of us were trained from the adult model, if the person does not have a background in child development the tendency is to take adult skills and try to simplify them for children.

I was a child development specialist who became an O&M. When I went through my training I couldn't help but think of ways to implement some of the techniques in a very different manner with young children. Because of this difference in background, I think in terms of child development instead of O&M development.

In the past ten years or so many people have published articles, curricula, assessment tools, as well as ideas on how to effectively work with young children who are visually impaired. I have had the wonderful opportunity to speak at numerous conferences on this topic, and I have found that discussing O&M in the context of a child's development is very well received.

It is vital that we think about O&M differently when teaching young children as opposed to adults. We need to realize that everything we do with children under five years of age is related to their understanding of space or their ability to move through space. For that matter, sighted children at this age also focus on learning about where they are in space and how to make their body move through space.

The most important factor in developing a successful O&M program for preschool children is the philosophy that independence permeates everything you do.

So, what is O&M for preschool children?

Here are a few areas not usually associated with traditional O&M:

  1. O&M is our attitudes, and the attitudes of all who come in contact with this child.
  2. O&M is our commitment to that child's independence at whatever level she is capable.
  3. O&M is the language we all use with our children and how, even subconsciously, we encourage independence.
  4. O&M is valuing the child's skills. Our values often clearly indicate that anything short of being able to see the environment is a disappointment.

A few words about canes

It is absolutely normal for all young children to want to do things for themselves. We often brag about all the things that the sighted child can do independently. It is critical to develop the same expectations and opportunities for the child who is visually impaired. The child's self-image and the attitudes of those who work with her will be greatly influenced by the O&M Specialist's attitudes and expectations, especially as they relate to the use of canes.

I get very excited about teaching cane skills. A cane can be one of the simplest tools a child uses for independent travel skills. As the child develops, so will her cane skills. As she begins to have more body control, she will exhibit more cane control, and more complex techniques can then be introduced. These decisions are made based upon the child's environmental needs as well as her emotional readiness.

In my experience, families are either very interested in their child learning to use a cane or highly resistant to the introduction of the cane. It is very important for professionals to tune into the concerns of the family. Many families may feel that a cane will bring too much attention to their child. They may find it embarrassing if people stare, watch their child, or stop and ask questions. Some parents feel that if they hold the child's hand and lead them around, other people will not notice that the child is blind or visually impaired. Although these feelings are an understandable part of the acceptance process, it is vital to work through them with the family.

Suggestions for encouraging independence in the home and classroom

  • Mark children's chairs and "cubbies" with an indicator, such as a shape. Then a child will not only be able to distinguish her own chair or cubby, but can also identify other children's. This technique also helps children learn about sequencing.
  • Encourage independence, but make adaptations for safety. For example, a rug placed near a step or doorway can cue the child to slow down. For children with functional vision, you can use rugs with color contrasts to alert them visually.
  • Keep toys in categories and in specific places so children can go and get them without your assistance, e.g. keep all of the musical instruments in the big basket by the window, or keep the carpet squares for music on the bookshelf. This offers children the opportunity to go and get things they want for themselves.
  • Don't be afraid to rearrange the classroom or home environment (obviously you don't want to be rearranging the environments on a monthly basis). It is not a bad idea, however, to do it a couple of times per year depending upon the abilities of the children in your class. Reorient the children to the new arrangement, and make it an exciting experience to explore and look for favorite items. This reduces rigidity, and offers children the opportunity to learn a new arrangement in a familiar setting.
  • Avoid carrying kids as much as possible. They need to experience rolling, crawling, walking, trailing, and changes in textures. Whenever possible, let them travel to places on their own.
  • Use natural sounds available within the environment when establishing auditory cues. It is really easy to fall into the habit of tapping on walls and furniture. Instead, if the child is walking or crawling to the bathroom, turn the water on and off in the sink. Entice her to listen, e.g. turning a sound on and off makes it easier to localize.
  • Pay attention to your orientation when you want a child to follow your voice. If they are following a wall, you follow the wall and face the child. It can be really helpful to be down at the child's level, which makes your voice very easy to localize.
  • Encourage a child to trail or walk using sighted guide everywhere she goes! The more she practices these techniques in familiar environments, the more likely she'll be able to use them in unfamiliar environments. For example, to help her get into the habit of trailing in familiar environments, as you enter buildings ask, "Where's the wall?"
  • Talk about sequences of rooms, toys, etc. whenever possible. This will help the child learn to think sequentially, i.e. what comes next.
  • Make a habit of pointing out environmental changes, or ask the child to tell you about environmental changes. For example, the tile floor changes to carpet, sounds change, etc. These skills help build environmental awareness.
  • Encourage the child to use riding toys.
  • Give the child opportunities to climb on various structures and explore new environments.
  • Vary environments as much as possible; sandboxes, grass, trees, mud puddles, ice, snow, rain, etc. Looking for worms after a rain is a big thrill for very young children!
  • Help children be "detectives" as they investigate and identify sensory information. Instead of telling them what is in their lunch box, tell them, "Smell the sandwich," "Touch the fruit," etc. At snack time offer two or three kinds of juices, and ask what kind of juice is in the glass? The children can first smell, then taste their juice to identify it.
  • Use spatial and directional concepts as much as possible, e.g. right and left can be used in conjunction with "side" as in "The door will be on the right side of the wall," or "The door will be on my side to the left." When giving directions, use terms such as "in front of," "behind," "above," "below," and "next to" with children who can learn these concepts.
  • Make all activities functional. Walking to the front of the building may be meaningless to a young child, but going to the water fountain may be very interesting.
  • Try to incorporate a sense of adventure and excitement about everyday discoveries.
  • Help your students practice auditory discrimination skills in naturally occurring situations. For example, someone entering a classroom may say, "This is Susan." It is more natural for the classroom teacher to greet the person, e.g. "Hi Susan," or, once she speaks, to ask one of the children to name the visitor. Many kids are very good at identifying familiar people but do not have enough opportunities to practice the skill with people they don't know as well.
  • Use visual landmarks that have high color contrasts with children who have low vision.
  • Arrange furniture to limit the amount of open space. It is easier to navigate a room if landmarks, such as furniture, help break up the space. It is more difficult to remain oriented in a room with large amounts of open space. Put furniture in useful and reasonable places. Just keep in mind, the less open space the better.

Originally published in Texas SenseAbilities Fall 2008
Versión Español de este artículo (Spanish Version)

Lisa Ricketts, OTR, Texas School for the Blind and Visually Impaired

Abstract: This article discusses the impact of visual impairment on sensory integration, and how sensory integration disorder manifests in students with blindness and visual impairments.  Treatment approaches and educational interventions are also described.

Keywords: sensory integration, blindness, visual impairment, motor development, tactile skills.


As an Occupational Therapist at TSBVI, I am inspired to learn all I can about the theory of sensory integration by Dr. A. Jean Ayres. As a specialist for children with visual impairment and multiple disabilities, I am studying the impact of vision loss on the other senses and overall developmental progression. I also work at a sensory integration clinic here in Austin for the treatment of autism and sensory processing disorders.

I am lucky to be surrounded by expert teachers, therapists, school psychologists, and, most importantly, by my students, whom I learn from every day.  My purpose here is to share terminology, explanations, and problem solving ideas with students, parents, and teachers.

Sensory Integration and Motor Control

The author and initial researcher of the Sensory Integration Theory used in Occupational Therapy is Dr. A. Jean Ayers.  Her work presents an expansive theory describing how the brain and the body processes, organizes, and integrates the sensations received through sight, sound, touch, taste, smell, body position, and movement.

Students with visual impairment rely on hearing, touch, body position and movement sensations for everyday activities.  Normally these activities are directed by vision. Sensory Integration theory provides a framework to help emphasize and explain the role of all our sensory systems.


The tactile system processes touch experiences felt through the skin as light touch, firm touch or pressure, static touch, moving touch, temperature, pain, and comfort. There are two primary functions of the tactile system. One is protection and the other is discrimination.

The protective touch function is neurologically bound to the limbic system of the brain.  This system is described as the emotional control center with direct connections to the primal flight or fight responses. The protective function of the skin is reflexive and primarily unconscious with touch sensations automatically categorized into calming, soothing, familiar sensations, or into danger reactions.

The discrimination functions of the skin are conscious, cognitive tasks that are learned through experience.  These include touch localization, recognition, and stereognosis. Localization refers to knowing where on the body one is being touched. Tactile recognition is required to learn characteristics of objects such as size, shape, texture, and the weight of items.  Stereognosis is object recognition through touch.

Signs of tactile system imbalance:

  • Reacts negatively to touch, does not like being picked up or hugged.
  • Does not like being touched and may rub or press on his or her skin after being touched.
  • Startles easily.
  • Inability to feel touch immediately and responses are delayed.
  • Extraordinarily high or low tolerance for pain.
  • Does not like certain clothing or tags in clothes, and wears clothes for the wrong season.
  • Does not like band-aids or stickers on skin.
  • Uncomfortable wearing shoes or socks, or unwilling to walk barefoot.
  • Does not like brushing hair or teeth, or cleaning and trimming nails.
  • Avoids certain foods because of texture, or does not chew food well.
  • Rejects touching messy materials and will not handle clay, mud, shaving cream.
  • Washes or wipes hands often.
  • Uses fingertips instead of the entire hand.
  • Has a hard time sitting still.
  • Is poorly coordinated, is a heavy walker, or walks on toes.
  • Craves touch and may over-touch others or objects.
  • Doesn’t notice when hands or face are messy.
  • Doesn’t notice when clothes are twisted, or when feet are not well placed in shoes.


Body Position

Proprioception refers to body position sensation and is required to regulate movement and posture. This system allows us to feel the position of our limbs for motor control and to determine the amount of strength needed for specific actions, or graded force. It is an unconscious feedback system between the muscles & joints of the body and the brain. The receptor stimuli is the bending, straightening, pulling, and compressing of the body’s joints between the bones. Proprioception is neurologically connected to both the tactile and the vestibular systems.

Signs of proprioceptive system imbalance:

  • Has difficulty planning and executing motor tasks for gross or fine motor activities such as getting on or off a bike or riding toy, climbing on/off playground equipment, buttoning clothes, turning on/off a faucet, pouring, etc…
  • Has a high need for jumping.
  • Enjoys hanging by the arms.
  • Tends to lean on or hang on people or furniture.
  • Enjoys falling down.
  • Assumes odd body positions.
  • Is clumsy and plays roughly.
  • Breaks toys often.
  • Grips a pen or pencil too loosely or too tightly.
  • Has difficulty with fine motor skills for picking up small objects.
  • Did not crawl much during early development.
  • Difficulty grading muscle force—muscle exertion is either too much or too little to manipulate objects and perform tasks.
  • Puts non-food items in the mouth, chews on clothes, or grinds teeth.
  • May hit, pinch, or bite self or others.


Vestibular processing refers to movement and balance sensations.  These are the combined functions of the semicircular canals of the inner ear, basal ganglia, cerebellum and the cerebral motor cortex. This system regulates the feelings of motion such as balance, acceleration, deceleration, starts and stops, direction, rhythm, and creates and stores patterns of movement. The hair cells inside the semicircular canals are activated according to position and movement of the head in relation to gravity. Vestibular processing is likely to be impacted by auditory impairment.

Signs of vestibular system imbalance:

  • Difficulty maintaining balance and controlling the speed and direction of movement.
  • Poor balance reactions such as protective extension or righting responses.
  • Poor spatial orientation and is easily confused by directions.
  • Fears being upside down or tipped sideways.
  • Is anxious when feet are not touching the ground.
  • Is anxious about walking up or down inclines.
  • Is anxious walking up or down stairs.
  • Rejects unfamiliar movement activities and is afraid to move backwards.
  • Is afraid of movement, or is gravitationally insecure.
  • Gets motion sickness easily.
  • Is anxious about swimming.
  • Seeks out gross motor movement and may have a very high tolerance to spinning.
  • Possible extraneous or non-purposeful movements.
  • Can’t sit still—craves movement.
  • Likes to fall without regard of safety.
  • Difficulty with self regulation.
  • Needs to be moving but this may interfere with listening and interacting.
  • Needs to be moving in order to listen or be attentive.
  • Needs to jump or spin.
  • Likes inverted upside down position.
  • High or low muscle tone­—the vestibular system combines with the proprioceptive system to regulate muscle tone.


Impact of Sensory Integrative Dysfunction

Sensory integration is the organization of sensation for use.  Countless bits of sensory information enter our brain at every moment, not only from our eyes and ears, but also from every place in our body.  Sensations are food for the brain that provide energy and knowledge needed to direct our body and mind.  The greatest development of sensory integration occurs during an adapted response; this is a purposeful, goal directed response to a sensory experience.  In an adaptive response, we master a challenge and learn something new.  At the same time, the information of an adapted response helps the brain to develop and organize itself.  The first seven years of life our brain is a sensory processing machine nourished by having fun through play and movement.  The child who learns to organize play is more likely to organize activities of daily living.

If the brain does a poor job of integrating sensations, this will interfere with many things in life.  The brain is not processing or organizing the flow of sensory impulses in a manner that gives good, precise information about the body or the world.  Learning is difficult and a child often feels uncomfortable and cannot easily cope with demands and stress.  If a child is blind or visually impaired this difficulty is compounded when attempting to make sense of his or her world.

Complex medical problems associated with many syndromes at birth may result in delayed sensory integration development.  This delay may be due to either neurological disorders or medical issues creating limitations to sensory experiences that nourish the brain.  Symptoms of irregular sensory processing in the brain are different for each child.  There are three basic sensory systems that impact how a child learns and behaves in the environment. They are the tactile, vestibular, and proprioceptive systems.  The following outline is a brief description of symptoms observed in each of the three systems when dysfunction of sensory processing is present:


The Tactile System (Discriminative versus protective touch)

Dysfunction in the discriminative system may result in:

  • Difficulty with fine motor skills impacting daily living skills.
  • Problems articulating sounds due to inadequate information from touch receptors in and around the face and mouth.
  • Difficulty with accurate tactual perception and basic concepts.
  • Impaired awareness of body scheme.
  • Inefficiency in how one tactually explores an object or the environment in order to gain additional cues which give meaning about the object and about the environment
  • Contributes to somato dyspraxia – a specific disorder in motor planning

Dysfunction in the protective system may result in:

  • Interpreting ordinary contact as threatening
  • May be frequently in a state of Red Alert
  • May react with flight/fright/or fight, either physically or verbally.
  • Being labeled tactually defensive
  • Some children feel too much and feel too little.  Some may have a high tolerance for pain because they do not accurately feel what is happening to them.
  • They may not react to being too cold or too hot because they are unaware of temperature.

Proprioceptive System

The proprioceptive system is our unconscious awareness of muscles and joint positions that constantly send information to the brain to tell us our body position and posture.

Dysfunction in proprioception results in: Slower body movements.

  • Clumsier movements.
  • Movements involve more effort.
  • Difficulty grading muscle force—muscle exertion is either too much or not enough when manipulating objects or performing activities.
  • Difficulty feeling the weight of objects
  • Difficulty planning body movements while performing gross or fine motor activities (getting on or off a riding toy, buttoning clothes, turning on a faucet, etc.)

Vestibular System

The vestibular system responds to the position of the head in relation to gravity and accelerating or decelerating movement, and linear or rotary movement. Vestibular receptors are the most sensitive of all sense organs and are major organizers of sensations to all other sensory channels.

The location of the vestibular system is in the inner ear called the “labyrinth.”  Abnormalities of the ears and hearing loss are common features in many syndromes, the influence of this system plays a major role in the developmental milestones of sensory processing and gross and fine motor skills.

Influence of vestibular system on eye and neck muscles:

  • Ability to visually follow objects.
  • Ability to move eyes from one spot to another.
  • Ability to interpret—is it an object, our head, or our whole body that is moving?
  • Ability to interpret—is our head moving or tilted?
  • Ability to maintain a stable visual field.

Influence of vestibular system on muscles of the body:

  • Generates muscle tone.
  • Helps us to move smoothly, accurately, and with proper timing.

Influence of vestibular system on postural and equilibrium responses:

  • Maintains balance.
  • Controls spontaneous body adjustments.
  • Facilitates co-contraction of muscles.
  • Elicits protective extension and other balance reactions.

Other areas influenced by the vestibular system:

  • Reticular Interactions – responsible for arousal of nervous system (calming effects vs. arousal effects); the vestibular system keeps the levels of arousal balanced.
  • Relation to Space – perception of space; position and orientation within that space.
  • Auditory Processes – helps the brain process what is being heard; vestibular disorders slow down speech development.
  • Emotional Development / Behavior – for emotions to be balanced the limbic system, which generates emotionally based behavior, must receive well modulated input from the vestibular system.


Two types of vestibular disorders


Under-reactive vestibular system:

  • Child may tolerate an enormous amount of movement (merry-go-round, swinging, spinning) without getting dizzy or nauseous.
  • Has poor integration of the two sides of the body.
  • Is easily confused by directions or instructions.
  • Hands and feet do not work well together. Poor bilateral coordination and upper/lower body coordination.

Over-reactive vestibular system:

Child is hypersensitive to vestibular input resulting in:

  • Gravitational insecurity – a feeling of anxiety or stress when assuming a new position, or when someone else tries to control movement or body position; swings, merry-go-rounds, and other playthings that move the body in non-ordinary ways may feel terrifying.
  • Intolerance to movement – discomfort during rapid movement; the child is not necessarily threatened by movement, but it causes  uncomfortable, or possibly nauseous feelings.

Evaluation and Intervention

If there is suspicion that a child has dysfunction with sensory motor processing, an evaluation can be conducted by either an occupational therapist or physical therapist.  Evaluation consists of both standardized testing and structured observations of responses to sensory stimulation, posture, balance, coordination, and eye movements.  The therapist who conducts the testing may also informally observe spontaneous play, and may ask the parents to provide information about their child’s development and typical behavior patterns.  A report will follow the evaluation that provides test results and interpretation of what the results indicate.  The therapist will then make recommendations regarding the appropriateness of therapy using a sensory integrative approach.

Providing intervention based on the principles of sensory integration theory requires that the therapist be able to combine a working knowledge of sensory integration theory with an intuitive ability to gain a child’s trust and create the “just right” challenge.  Therapy will involve activities that provide vestibular, proprioceptive, and tactile stimulation, and are designed to meet a child’s specific needs for development.

Activities will also be designed to gradually increase the demands upon a child to make an organized, more mature response.  Emphasis is placed on automatic sensory processes in the course of a goal-directed activity, rather than instruction on how to respond.  Parent or teacher involvement is crucial to the success of a child’s development and improved sensory processing.  The therapist may make suggestions to the parent and teacher about how to help a child in the home and school environment.

Sensory Integration and Sensory Motor Activities

Tactile Play Activities

Try the following ideas for tactile stimulation. If your child or student will not touch materials with their hands and fingers, don’t push.  Try letting them touch with a spoon or fork or straw, or try wearing dish or other gloves to get started. Keep soft cloths and water ready for clean up.  Provide wash cloths for frequent hand wiping as needed. If touching bath foam or finger paint is too stressful, put a small amount into a zip lock bag and hold and squeeze the bag. Begin play with dry textures if wet, messy materials are too stressful.

  • Try water play outside of demanding situations such as bathing and tooth-brushing. Use various textures of washcloths, sponges, water toys, squirters, water guns. Water plants with a spray bottle.  Clean and wipe tables or floors with sponges and a bucket of water.  Play with cool and warm temperatures.  Help wash dishes in warm water and rinse in cool.
  • Fill large storage bins with dry beans or rice, encourage play in the bin with hands and feet.  Hide small toys for searching, use cups and coffee cans for pouring, stir with large spoons, play with funnels and other kitchen toys.  Pour beans or other textured material outside on the sidewalk and try to walk across.
  • Use lotion for firm touch massage.  Teach self massage.  Remember that firm, deep touch is calming and organizing.
  • Consult an OT or PT familiar with skin brushing and joint compressions.  This is a technique recommended to help reduce tactile defensiveness with frequent, structured tactile and propriooceptive input.
  • Art activities: finger paint, modeling clay, glue and glitter, glue and sand.  Make art with pasta and glue or string and glue.  Glue designs on paper.
  • Create feely boxes or bags with a variety of textured materials and various textured toys.  Fill with fabric swatches to discriminate, label or match.  Fill with items to identify and describe, like wooden puzzle shapes, beads, etc.
  • For hand fidgets, keep a fanny pack available with a variety of textured items inside.  For squeezing try stress balls, thera-band, thera-tube, and stretch toys.  Use noisy squeeze toys for play.
  • Cooking activities – mixing and stirring cookie dough, pushing cookie dough into cookie cutters.  Measuring and pouring ingredients.  Make pudding and jello. Sift flour.
  • Carefully introduce various textures for exploration and play.  Place materials on a cooking sheet or plastic placemat – shaving cream, bath foam, lotion, play dough, silly putty, toy slime (gak).  Introduce toys for ideas such as a “bath foam or shaving cream car wash.”  Drive toy car through shaving cream or draw shapes and write designs with fingers.
  • Play dough – use rolling pin, cut dough with safe/dull scissors, practice cutting with knife and fork, use cookie cutters and molds, hide items to search for (coins, marbles, pebbles, or small toys).
  • Sand play – use cookie sheet, cover table with plastic, or play outside.  Use clean dry sand and a spray bottle with water for added moisture.  Play with cookie cutters or toys, such as plastic dinosaurs or cars.  Write in sand, or build shapes or a sand castle.
  • Fabric and texture play – use carpet squares for walking on; space out squares to find with toes.  Use swatches of various types of fabric (corduroy, satin, velvet, fake fur).  Play and walk on egg crate foam; also use foam to roll up inside “taco or hot dog game”
  • Trace raised lines of tactile maps.
  • Any pushing through the hands will help.  Such as on the tummy over a yoga ball holding body weight through arms and hands.  This “prone weight bearing” is very helpful for tactile tolerance, general strength, postural control, and proprioceptive/vestibular input.
  • Theraputty is a resistive exercise material used by therapists.  Colors vary according to resistive strength.  Hide toys, coins, or buttons inside for tactile searching.  Keep in a sealed container and be careful not to get on clothes or carpet. (It will stain and stick!)
  • Try vibration with massagers or vibrating mats or toys, squiggly pens, or electric toothbrushes.

Proprioceptive Play Activities:

  • Move as much as possible!  Jump on a trampoline or a mini-tramp. Bounce on yoga balls. Outside play on all kinds of equipment for supervised climbing and up and down a slide.
  • Prone weight bearing – such as four-point crawling or on the stomach over a therapy ball holding weight through arms and upper body.  If strong enough, try “wheel barrel walking.”  (Prone weight bearing is very important for postural strength, upper body and arm/hand strengthening, and reflex inhibition).
  • Scooter board activities: for small size scooter boards sit cross-legged and propel with hands.  Ideally have long size scooter boards available for riding on the tummy to propel with arms.  Add wrist weights for increased proprioceptive and pressure sensation. Try all directions, forward backward turning full circles left to right.  Push off from a wall to propel backward.  Crash into cardboard brick walls or stacked boxes.  Ride scooter board down a ramp to crash into toy bowling pins or crash into a large pillow.  Ride a scooter board short distances to search for and pick up toys or bean bags and return.  Try prone on a scooter board with a large rope to pull forward for hand over hand reach.
  • Add weights to items for more feedback.  For example add weight to a cane or pre-cane to help keep it in the correct position and to provide greater pressure feedback.  Small size wrist and ankle weights are available – these can be worn for extra proprioceptive feedback and can also be added to other items.  Ask OT/PT if a weighted vest might be helpful.  Weighted blankets are available or try heavy quilts.  Neck and shoulder wraps are available in drug stores sometimes designed to go in the microwave for heat – these can be used without heating around the neck or held in the lap.  Weighted sweatshirts can be made easily by sewing seams shut after filling with dry beans or rice or sand.  Wear loosely over the shoulder and back or on the lap.
  • Hang from a trapeze bar or chin up bar – if this is too scary have a step stool to stand on and feel the pull through the arms and hands without having to support full weight.
  • Teach simple isometric exercises such as wall push-ups and chair push-ups.  Teach modified push-ups and sit-ups.
  • Practice pouring over the sink or outside from heavy containers – gallon and ½ gallon jugs.  Practice pouring with pitchers filled with sand or other dry materials.
  • Use squeeze horns such as a bike horn. Have a variety of stress balls—there are many different types and interesting toys for squeezing. Wring water from sponges and cloths.  Squeeze bottle glue and squeeze bottle puff paints for art. Use spray bottles to water plants or keep spray bottles at sinks or in tubs for play.
  • Zoomball game” is a toy with a plastic ball strung on two ropes.  The ropes have handles on both ends and the object is to pull arms apart quickly to send the ball to your partner.  Arms are spread quickly and closed quickly for a successful pass.
  • Try using tools with supervision – hammer, screwdriver, pliers, or sanding wood. Use dull/safe scissors to cut heavy paper or cardstock.
  • Pull with a partner for tug-o-war games.  Pull a friend in a wagon or push/pull a laundry cart.
  • Roll in foam pad or quilt for deep pressure games—“the hot dog”, the “burrito”, or the “enchilada.”  Use rhythmical touch with hands or roll over with a therapy ball.  Try weighted balls such as a medicine ball (weighted PE ball).
  • Climb and lie under large pillows, bean bags, mattresses, or cushions.  If other students are available have them try to crawl across and then take turns being underneath.
  • Throw balls against a wall.  Throw to the left and right sides, forward and backward and overhead.
  • Vestibular Play Activities:
  • Sit and bounce on yoga balls.  Try prone (on the tummy positions) and supine (lying on the back).  Give support to lie back and stretch the back and hang the head backward.
  • Stationary bike and treadmill exercise.  Ride tandem bikes.  Help a younger child ride tricycles and bikes with training wheels for left/right integration and reciprocal control.
  • Ride stand up scooters (with handle bars) and support. Roller skate with hand hold support or put a large belt around the body to hold on to.
  • Bouncy shoes or “moon shoes”—these are large toy shoes that fit over regular shoes to bounce, jump, and walk with.
  • Try as many types of swings as possible—standard playground swings, platform swings, bolster swings, pogo swings (a bouncy and rotational swing) and hammock swings.
  • Use rocker boards and spin boards. Both are low to the ground and the rocker board can be used in sitting or standing with support. Try four point position (crawling position) or tall kneel position with support. The spin board is only used in sitting!
  • Try a T-stool.  Try to keep balance while throwing a ball against the wall.
  • Rolling games or races; rolling down or up hills outside. (Rolling is terrific for tactile, proprioceptive, & vestibular input and reflex inhibition).
  • Practice balancing on one foot.  Hop with feet together and hop on one foot.  Jump one foot to the other.  Practice marching, running, or stomping in place.
  • Try very low balance beams or tandem walking in a straight line (heel toe, heel toe).  Use hand hold support, hold onto a hula hoop, or dowel – add a bean bag to balance on the head for greater challenge.  Place a ladder on the floor and try to step across separate rungs.
  • Use an inner tube to step or hop inside and walk around the edges for balance.
  • Balance in tall kneel position or half kneel.  Toss a ball against the wall while holding balance or keep a bean bag on the head.
  • For smaller feet, place feet in shoe boxes to slide along the floor.  Try walking with swim fins.
  • Directional movement practice – use a heavy wooden chair for sit/stand commands, in front/behind move to the left/right sides, circle the chair, three steps forward/backward from chair.  Add music, slow and fast movements.  Combine with Simon Says and Red Light Green Light games.  Practice directional controls for facing the front of the room, the back, & either wall.  Practice facing north, south, east, and west.  Try quick change games for moving from sitting to standing to four point to stand on one foot, etc.  Practice turning toward sound.
  • Parachute games for up/down arm movements and shaking.  If a group is available try having kids crawl under to the other side.  Add a light weight ball and bounce the parachute to toss the ball over the side.

Heavy Work Activities:

Heavy work tasks are any activities that require whole body movement and resistance such as carrying heavy objects or carrying large size boxes; pushing through heavy doors; pushing a grocery or work cart; pushing a laundry basket; pulling a friend in a wagon; helping to move furniture; vacuuming—any activity that requires resistance with movement.

Heavy work activities are thought to provide the longest sensory effect with combined benefits of proprioceptive and vestibular stimulation (heavy work routines potentially have a calming effect on the nervous system for 4-6 hours).


Tanni L. Anthony, Ed.S.
Colorado Department of Education,
201 E. Colfax, Denver, CO, 80203, USA


Over the past several decades, the profession of Orientation and Mobility (O&M) has revised its teaching strategies to focus upon the needs of young children. Within the past five to ten years, a particular emphasis has been placed on the early O&M skills specific to infants, toddlers, and preschoolers who are visually impaired.

With the inclusion of the birth through age five population, the field continues to refine both instructional philosophy and actual teaching techniques. Both have required careful steps; the process of merely "watering down" methodologies which are appropriate for older children has not always proven effective with very young children.

Research on the developmental route of the child with a sight loss has been helpful, but further research is still needed. Areas of specific challenge in each developmental domain have been documented. Based on this information, specific intervention methodologies have been devised, only to be revised with the contributions of new findings. It is fair to note that early intervention for children who are visually impaired is still within it's own toddlerhood of development.

A Proposed "Formula of Purposeful Movement"

Based on current research findings, it may be supposed that three primary areas emerge as important program domains within an early intervention O&M program. A "formula of purposeful movement" is offered for consideration which includes the following three components of program attention: physical readiness, cognitive connection, and motivation invitation.

Physical Readiness

Past research by Selma Fraiberg indicated that visual impairment did not have an effect on the order of gross motor milestone development. This may be changing, however, from the current longitudinal study in progress by Dr. Kay Ferrell and colleagues. Project PRISM (1994) is currently collecting information on the sequence of developmental milestones. Gross motor development maybe an area of noted unique skill acquisition order.

The rate of gross motor milestone development may be influenced by a visual impairment. There is evidence of delayed movement postures. This may be due in part to the possible presence of low postural tone, and the interdependent relationship of movement and the acquisition of true object permanence and/or auditory localization skills.

Physical readiness, however, far exceeds the mere acquisition of typical gross motor milestones of sitting, crawling, walking, and so on. It encompasses both quantity of skillacquisition and quality of movement. It is critical that motor milestones have qualitative excellence.

Quality of movement depicts the "underlying scaffolding" of both the static and dynamic postures of the child. It refers to the level of refinement of a particular gross motor skills. Without vision to confirm the infant's early body movements, the sense of proprioception may not develop to full maturity and low postural tone may be evident.

Brown and Bour (1986)report on one theory that the reason many babies who are visually impaired have low postural tone is because of a lack of experience in the prone position. Limited opportunities in this position ultimately deny the child the needed proprioceptive stimulation for neuro -motor development.

Low postural tone often will compromise the refinement integrity of motor skills involving balance and strength. Balance reactions, hunk rotations, and actual motor milestones may be influenced. For example, a child may be able to sit independently, but the actual sitting posture may be compromised. A rounded back with the legs situated far apart may be the only way the child can achieve independent sitting. Due to low trunk tone, the child may need to establish a wide base of support to maintain an upright sitting posture.

Compensatory patterns such as these may become habitual. If repeatedly used over time, the child is at risk for physiological change in her muscles; some may lengthen and some may shorten to accommodate for the compensatory posture. If left untreated, it is possible that an orthopedic deformity such as scoliosis may develop (Campbell, 1983).

It may be wise to consult with a physical and/or an occupational therapist to ensure that the child's motor skills are developing in a manner that reflects good quality of movement. Attention to positioning and special activities to strengthen the trunk muscles are two ways to address the influences of hypotonia. With consultation from a motor therapist, these activities can be easily incorporated into the child's daily care activities.

Cognitive Connection

Three stages in particular have great influence on the child's acquisition of early travel skills: (a) attainment of object permanence, (b) development of means-end, and (c) the early constructs of spatial relations. As each area is reviewed, it will become evident how one skill area is developmentally intertwined to other skill areas. It is impossible to fully isolate one from the other. For simplicity, however, they will be discussed as separate behaviors.

Object permanence in lay person's terms is simply "out of sight, “out of mind." During the first nine months of life, the infant does not have the memory capacity to search for an item completely removed from view, or in the case of a child with visual impairment, out of touch.

During this time period, however, the sighted infant demonstrates steady progress in the area of memory and search skills. At approximately four to six months of age, she will find an object that is touching her body (Johnson-Martin, Jens, and Attermeier, 1986). These authors further report that the sighted infant will briefly search for a newly dropped object and deliberately uncover a partially hidden object at six months of age.

By nine months, the infant learns that an object continues to exist even if it is covered from view. A favorite interaction game at this age is the classic Peek-a-boo.

Selma Fraiberg (1968) noted that sound is not a substitute for sight; between six and seven months of age, hearing and holding are two separate events for the child who is blind. Her research noted that the beginning of search behavior occurred between seven to nine months of age.

The child who is visually impaired may have a unique timetable as she acquires skills leading to object permanence and more sophisticated memory. Her individual level of functional vision will play an ongoing role in her ability to discern a world outside of immediate touch.

The ability to problem solve with an end result goal mind is called means-end. This indicates that a child is able to understand what means (actions) will result in a certain end (result). Over the course of the first two years, the child learns to construct a simple goal, then use the motor skills within her repertoire to achieve that end result.

The young infant, however, does not initially realize that her body movements knowing produce a certain sensory result. Body movements are not associated with reactions such as the visual movement of a swatted mobile or the chime bells of the kicked chime ball toy. During these early days, the infant is practicing newly acquired volitional movement as motor reflexes are fully integrated. Movement occurs for the sake of movement alone.

With repetition, however, the infant begins to discover that her body movements can make something happen. One of the first indications of intention occurs with deliberate hand watching behavior. With the discovery of her hands as a "working part" of her body, the four month old infant learns to reach for nearby objects.

Tactile cueing may be necessary to help initiate a reach of a desired object. As the child becomes more proficient with her understanding of a world beyond touch (expansion of object permanence), these touch cues will become less necessary.

Other means-end behaviors include early tool use. The child teams to pull a string to obtain the attached toy or use a stick to acquire a toy just out of reach. Clarke (1988) reports that tool use has great implications for a child's ability to successfully use a mobility device or long cane during the toddler and preschool years of development.

As the child expands her understanding of the space beyond her body and has the physical readiness to move out into space, the reach is extended from an isolated arm to a full body movement. This is the hallmark passage of purposeful movement; the child can begin to use self propelled ambulation for an end result. Her worldly travels have begun from a mobility perspective whether in the form of a roll from back to front or a long stretched reach while in a prone position that results in forward movement toward the object of interest.

Spatial relations development involves the concept formation of position, location, direction, and distance from one's own body (Morgan, 1992). Spatial constructs have three primary categories: (a) spatial awareness of one's body, (b) awareness both near and distance space as it relates to one's body, (c) awareness of the space dimensions between objects. All three of these areas have developmental beginnings in infancy.

Each area will be briefly discussed as to the associated developmental skills during the first two years of life.

The infant learns about her body as people touch and move her. Baby massage is an excellent means of proprioceptive input to the infant concerning the spatial dimensions of her body. Touching interaction games such as "I'm going to get you!" and a variety of body positions are also natural teaching methods of body image.

Dressing and undressing activities also play an important role in the internal mapping of the child's body. Dressing and bathing routines will further shape a child's labels of her body parts.

With maturation, the infant will master voluntary movements such as hand watching, midline hand play, and bringing her feet to her mouth. These movements give her even more information about the dimension and parts of her body as they are self regulated. As the infant reaches for her foot, she is participating in the discovery and confirmation of where her feet are located on her body.

Coinciding with spatial mapping of her body, the infant will begin to explore the immediate parameters of the world around her. Toys located on her body and next to her body will be the first ones explored. As she has repeated reinforcement for her random movements out into space, she will begin to actively search for "what is out there." Organized play areas with defined spatial boundaries and content will soon invite her visual and tactile search for people and toys.

Motivation Invitation

The human spirit needs both encouragement and reinforcement to work and to play. For the young child, it is important that the efforts associated with movement be met with inner delight of intrinsic reward.

A child who is engaged in the activity at hand, will be more willing to take a risk such as moving out into new space to continue an activity. In the beginning, it may be as simple as a slight weight shift from one side of the body to the next as a toy is offered in a slightly different location. Later, the child may independently navigate across an open space just to get a hug from her parent.

The goal is to determine what is motivating for the child. Two factors usually create a successful motivator; the child's cognitive development level and sensory preferences. It may be the thrill of reaching toward a colorful music toy for the infant with low vision or the satisfaction of walking across the room to the high chair for an afternoon snack for the toddler who is blind.


It is important for all children to be explorers of their world. The gift of self initiated quality movement in the early years is a priceless and lasting one. Early attention to the child's development from an OEM perspective can offer intervention at a critical time in the child's life.

Meeting the child at her developmental level will greatly assist 0&M practitioners when working with families and other team members. All three of the suggested components can be readily infused into the daily routine of the child. The result will hopefully be a supportive and involved family, a cohesive early intervention OEM program, and a child who moves out confidently and successfully into a world of new leamings.


Brown, C. and Bour, B. (1986) Movement Analysis Curriculum. Florida State Department of Education, Tallahassee, FL.

Campbell, P. H. (1983). Basic considerations in programming for students with movement difficulties. in M. Snell (Ed.) Systematic Instruction of the Moderately and Severely Handicapped (2nd ed.), Charles E. Merrill Publishing, New York, NY. .

Clarke, K. (1988) Barriers or enablers? mobility devices for visually impaired and multihandicapped infants and preschoolers. Education of the Visually Handicapped 2 0 (3), 115 -130.

Fraiberg, S. (1968). Parallel and divergent patterns in blind and sighted infants. Psychoanalytic Study of the Child, 23, pp. 264 - 300.

Johnson-Martin, N., Jens, K., and Attermeier, S. (1986). The Carolina Curriculum for Handicapped Infants and Infants at Risk. Paul Brookes Publishing, Baltimore, MD.

Morgan, B. (Ed.) (1992) Resource Manual for Early Intervention with Infants, Toddlers, and Preschoolers Who Are Visually Impaired and Their Families. SKI'HI Institute, Logan, UT.

Project PRISM (1994), an ongoing longitudinal study by Dr. Kay Ferrell and colleagues, University of Northern Colorado, Greeley, CO.

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

Banner Photo O&M Page

This page is a place to find resources and information related to Orientation and Mobility. The information and resources found here are intended for the whole Team: professionals, families, and students. This page is intended to provide access to a wide variety of information and resources related to students with visual impairments and deafblindness. Please send ideas for additional resources or features you would like included to Outreach Statewide Orientation and Mobility Consultant, Chris Tabb at .

Quick links for sections on this page:


Blogs, Listservs, and LiveBinders

Education Codes And Legal References

IDEA, Related Services (Sec. 300.34)

Texas Education Code (Specific to Children with Visual Impairments, Sec. 30.002)

Q&A: Expanded Core Curriculum Instruction and Orientation and Mobility Evaluations (Word Format)

Region 18 Legal Framework - summarizes federal and state law by topic

TEA Special Education Rules and Regulations - a resource for federal and state laws, rules, and regulations that covern the delivery of special education servcies in public schools. (As of April 4, 2014 has not been updated to reflect changes related to HB 590 or SB 39.)

Pedestrian Laws in Texas (Sec. 552.010 specific to Blind Pedestrians)Sec. 552.010 specific to Blind Pedestrians)

White Cane Definition and Service Animals in Texas (Sec. 121.002, Sec. 121.005, and Sec. 121.006)121.002, Sec. 121.005, and Sec. 121.006)


Teaching Age-Appropriate Purposeful Skills (TAPS) Texas School for the Blind and Visually Impaired (TSBVI) resource that is an Orientation and Mobility Curriculum for Students with Visual Impairments and includes activities and suggestions instruction, assessment, writing evaluations, street crossing details, working with students with ambulatory devices, the list goes on, and on, and on.

Orientation and Mobility Visual Impairment Scale of Service Intensity of Texas (O&M-VISSIT) The O&M VISSIT: Orientation & Mobility Visual Impairment Scale of Service Intensity of Texas is designed to guide orientation and mobility (O&M) specialists in determining the type and amount of itinerant O&M services to recommend for students on their caseload.

New Mexico School for the Blind Orientation and Mobilty Inventory Another option for ongoing evaluation of students' present levels of performance and a terrific tool for planning appropriate goals and objectives.

Guidelines and Standards for Educating Students with Visual Impairments - a "go-to" document for everything about serving students with visual impairments.

Benefits of O&M

General Orientation and Mobility Recommendations for Functional Programs

Michigan O&M Severity Rating Scale 2013 - two downloadable intensity of service scales from the Michigan Department of Education. One for students with visual impairments (OMSRS) and one for students with visual impairments and additional disabilities (OMSRS+).

T-TESS Texas Teacher Evaluation and Support System for COMS as a PDF document

Introduction to T-TESS for COMS document for COMS and Administrators PDF

Professional Development Assessment System (PDAS) Companion for VI Professionals: Certified Orientation and Mobility Specialists (COMS©)

VI and O&M Preparation in Texas

What Should I Charge for Contractual Services? (Word or PDF)

What is the Expanded Core Curriculum (ECC)?

Training Events

Southwest Orientation and Mobility Association (SWOMA) is a Southwest regional conference. SWOMA typically occurs annually in or near the beginning of November. Visit the SWOMA Conference Page for additional information.

For other training opportunities around the state and nation, please see the Statewide Calendar of Training Events.


TSBVI's Online Learning, Orientation and Mobility

International Orientation and Mobility Online Symposium (IOMOS), Recorded Sessions

Washington State School for the Blind, "Video Clips on Blindness Tips"

Guide Technique from Project IDEAL

How a Blind Person Uses a Cane from BreakingBlind

How To Offer Help To A Blind Person

O & M Video for Parents from Arkansas School for the Blind

Wheelchair Orientation and Mobility from Perkins

Lighthouse O&M Folding Cane Construction from East Texas Lighthouse for the Blind in Tyler

Lighthouse O&M Escalator Training from East Texas Lighthouse for the Blind in Tyler


Perkins E-Learning Webinars

Paths To Literacy (Collaborative between Perkins and TSBVI)

Paths to Technology

An Introduction to Orientation and Mobility Skills- Vision Aware

Perkins Scout Orientation and Mobility- Perkins School

Cane and Compass - Blog posts and lesson ideas for Orientation and Mobility



By Melvin Marx, COMS, Houston ISD, Houston, Texas

This article was originally published in the Summer of 2004 edition of See/Hear newsletter.

Abstract: This article provides a sampling of modifications in O&M techniques for use with deafblind students.

Key words: programming, orientation and mobility, O&M, deafblind, modifications, orientation and mobility techniques

Do you have indelible memories of your collegiate experience? As a graduate of Stephen F. Austin State University in the field of rehabilitation, majoring in orientation and mobility, I frequently think back on many positive memories. I fondly remember the orientation and mobility practicum lessons under blindfold in downtown Lufkin, the chaotic noise of twenty five Perkins Braillers hammering out inharmonious melodic lessons in the Braille 301 class, or waking up at 8:10 for Dr. Weber's 8:00 Rehab classes. Do these memories ring a bell? These may be a few of your favorites as well. For me, each memory holds a special place in the journey of what makes me who I am.

I believe that for all orientation and mobility professionals one memory that makes a lasting impression in the field of O&M is the study of the "Blue Book." The "Blue Book" is officially entitled Orientation and Mobility Techniques: A Guide for the Practitioner. Written by Purvis Ponder and the late Dr. Everett "Butch" Hill, the "Blue Book" is chock-full of precise technological application on every pre-cane and cane technique known to the O&M field. This book is a point of reference for every O&M who has reached out to teach and empower the life of a visually impaired or blind student. If the O&M profession had a bible, the "Blue Book" would be it.

Full of confidence and success in my "Blue Book" knowledge and teaching strategies, I continued along teaching fellow coworkers and students in the utilization of proper O&M techniques. I continued on my daily crusade of furthering my students' independence until one day when I received a phone call from my supervisor. She instructed me to go and evaluate a new student who was entering our program. This particular student was totally blind and profoundly deaf and yet cognitively on target with his age. As I began working with this student, I quickly came to a shocking reality. My method for teaching the "Blue Book" techniques to this student was functionally impossible.

Needless to say I did continue working with this student and eventually had many success stories in relation to developing his understanding of O&M concepts and the purpose for their use. I have also discovered that, as the years have gone by, I have evaluated and picked up more of these students for O&M service. Tragically, however, I have come to find out that this population of students is highly underserved. Probably the largest reason has to do with the lack of preparation and schooling in this specific population. When it comes to teaching students with dual sensory impairments of vision and hearing, we in the O&M field must be willing to step out of the box of standardized teaching. Modification of what we have learned from the "Blue Book" must become our mantra.

The information that follows is a sampling of a few modifications to the O&M "Blue Book" techniques. I hope you find this material helpful as you assist your deafblind students in achieving the highest level of independence that they deserve to reach.

  • In teaching sighted guide the traditional method can be taught having the student holding on to the guide's arm just above their elbow. For younger students the grip will have to be modified to holding the guide's index finger or wrist depending on height and strength needs.
  • For more receptive communication to assist the student's knowledge of what is coming up in his/her environment, move the student's sighted guide position to a hand under hand guidance. This method will allow the guide to wrap his/her thumb on top of the student's hand for more proprioceptive feedback. The examples listed below should be given to the student right before the requested movement takes place:
  • Left turns: hand movement goes twice towards the left.
  • Right turns: hand movement goes twice towards the right.
  • Ramps: Angle hand 45 degrees in a descending or ascending direction depending on how you are traveling on the ramp. Give an upward or downward hand motion, in the 45-degree position, twice to indicate the direction of the ramp.
  • Straight ahead: a forward surge of the hand given in intervals depending on the length of the straight travel.
  • Stop: hand moves from a 0 degree position to a 90 degree position. Pause in the stopped position to relate the requested action to the student.
  • Advanced directionality: This is for students who are emerging in their understanding of sign language. The directions left and right can be signed with an "L" or "R" in the student's hand to communicate which direction they are being requested to take.
  • Up: hand movement goes twice in an upward elevation.
  • Down: hand movement goes twice in a downward elevation.
  • If some students need more proprioceptive feedback to grasp the concepts of up and down, have the hand under hand guidance also establish contact at the guide's waist. This will give additional communication to the student to the length of the step up or drop off.
  • Touch cues have additional communication benefits for students who are utilizing adaptive mobility devices or for those who are engaged in trailing activities. These examples should be given to assist the student in understanding movement they are being requested to initiate.
  • Left turn: Using your index and middle fingers, make a sweeping motion down the student's left upper arm.
  • Right turn: Using your index and middle fingers, make a sweeping motion down the student's right upper arm.
  • Straight: While standing behind the student, make a sweeping motion across the student's shoulder with the side of your hand. Your pinky finger should be the only finger of contact on the student.
  • Stop: Place your hand firmly on the student's upper shoulder.
  • Squaring off: You will need to have good rapport with your student for this modification. The reason for this is because you will be physically maneuvering his/her body into a correct positioning initially. After using the stop touch cue, drag your index and middle fingers down the middle of the student's back to indicate squaring off. Position the student so that their shoulders and feet are touching the wall in the correct squaring off position. Then give the student a positive "good job" touch cue by patting them on the shoulder.

For all of these modifications the key is repetition. Remember, Rome was not built in a day. Your students will need these modifications routinely in order to gain understanding of their purpose and meaning. May these initial modifications assist you in teaching your children to develop to the fullness of their O&M potential.

Editor's Note: Melvin Marx graduated from SFASU in 1991. He has worked both in the rehabilitation and educational fields. He has received specialized training in the area of deaf-blindness from The Helen Keller National Center in Sandspoint, New York. For the past twelve years Melvin has been employed by Houston ISD. His specialty areas of training include the multiply impaired and deafblind populations. You may contact Melvin by email: 

Summer 2004 Table of Contents | Send E-Mail to SEE/HEAR|

Please complete the Comments! form or send comments and suggestions to Webmaster

Last Revision: September 1, 2010

By Cecelia Quintana, COMS

Orientation and Mobility is broadly defined as the ability to move safely and efficiently through any environment. At the adult level, this translates into the ability to independently cross streets, to use public transit systems, to go to work, to go shopping, etc. At the preschool level, students need to develop the concepts and skills which make the above mentioned goals attainable later in life.

Several areas of skill development should be included in a preschool O&M program. All individuals should incorporate these skills into the child's daily routine. This allows everyone to be actively involved in the child's growth and development. Parents, caregivers, teachers, related service personnel, as well as Certified Orientation and Mobility Specialists will be working on the same, common goal. The ultimate goal of the program is to develop a child into a skilled, age-appropriate traveler who understands basic concepts and can begin to apply learned skills to perform more complex tasks.

Below is a list of skill areas considered to be best practice. These areas should be incorporated into an early childhood O&M program.

  • Improve use of visual skills
  • Improve use of auditory skills
  • Improve use of tactile skills
  • Begin learning spatial concepts
  • Begin learning environmental concepts
  • Improve use of gross motor skills
  • Improve use of fine motor skills
  • Beginning use of clues and landmarks
  • Sighted guide techniques
  • Beginning cane techniques
  • Limited travel in residential areas

Only a Certified Orientation and Mobility Specialist should teach the last four items on the above list. Anyone who works with a child with visual impairment is encouraged to incorporate the rest of the skill areas into the child's routine. The following pages are a few games that encourage development of visual, auditory or tactile skills and/or introduce spatial, body, or environmental concepts. Please feel free to use these games as they are, or as a springboard for inventing games of your own. More games will be added as they are invented.

We're On The Move! 
O&M Games for the Very Young Child

Presented by

Linda Lyle, M.A.
Cecelia Quintana, M.A., COMS

 AER International Conference
July 14-19, 2000
Denver, CO

Download an RTF version of the games (for printing) - o&m.rtf (257k)


Skill(s) Targeted: Visual scanning

What you will need:

  •  Large squares of brightly colored material (approx. 10 X 10)
  • Index cards 

To set up: Determine what positional concepts will be targeted. In the following example we will use, "On" versus "Under". On the index cards write "Find my twin ________". In the blank write things like: "on the desk," "under the chair," "on the shelf", etc. In the door of the room place one piece of material. In the room place the material wherever specified on the card.

How to play the game: In the door of the room, the student will find the material, and the teacher will read the card to them. They will then visually search the room for the matching material and retrieve it.

Modifications: For more advanced students, place 2 pieces of the matching material in the room, only one of which is in the proper place. For example, place a piece of material both on and under the chair and they are supposed to determine which one they should take, and which one they should leave.

  • Find my twin 
    Under a chair
  • Find my twin 
    On a chair
  • Find my twin 
    On a desk
  • Find my twin 
    Under a desk
  • Find my twin 
    On a shelf
  • Find my twin 
    Under a window

All of Me

Concept(s) Targeted: Body Awareness, concept development of orientation words


Body part identification

  • Even while your child is very young, you can begin to help him/her become more aware of his/her own body. Children develop this skill in a specific order: his/her nose, another person's nose, a doll or stuffed animal's nose.
  • When naming body parts, put your child's name in front of the word. Sherri's nose.
  • Touch various parts of your child's body with different textured fabrics or a feather and name them as you do. Let your child do the same to you.
  • Play finger and toe games like "This Little Piggy", "Do Your Ears Hang Low" "Head, Shoulders, Knees and Toes".
  • Use a mirror to see your hair, your nose, your eyes, etc.
  • Adaptations:
    • For older child: place a sticker on a body part and let child name it as she pulls the sticker off.
    • Use hand puppets to find body parts.
    • As child master's body parts on a doll, you can increase the complexity of the task while still reinforcing the identification of body parts. You can ask your child to feed the baby and then wash her face. You can play silly games where you try to feed the baby by putting the bottle in her ear and letting your child correct you.

Positional words

  • Just as a child learns her own body parts first, a child first learns about positions (up, under, etc.) in relationship to her own body. It is not possible to give a child too much practice in this area.
  • Very young child: Use positional words frequently. "Let's put your sleeper on." "Let's take it off."
    • Early games:
      • peek-a-boo
      • Where's the _____? Name a toy in sight and let child reach for it. "Oh, it's beside your leg." or "It's on your shoe."
      • Where is Thumbkin?"
      • In/Out games: Give child a small container with several objects in it that can be removed. Child will move from dumping to removing one by one. Use out/in often so child will understand the concept.
      • Nesting toys; pots and pans; plastic storage containers all help a child begin to understand positional words relative to something other than his/her own body.
      • As child grows, toys can be hidden under, over, behind, etc. and a game of hide and seek established. Early successes will probably require that the child's body be the location for hiding under, etc. As the task becomes easy for the child, the toy can then be hidden under an object very close to the child and then, with success, further away.
  • The toddler: Once a child begins to crawl and walk, they enjoy putting their own bodies in relationship to other objects. They like to climb on, in, through, around, behind, etc. It is important to continue commenting on the positional relationships that occur between the child and his/her environment. "You're climbing in the box." "The box is around you." "I can't see you. You must be behind the box."
    • Games:
      • Hide and Seek
      • "Where's the Thimble" (revisited)
      • Looking for objects that have been hidden in the beans, inside play dough, picking chocolate chips or small pieces of candy out of cookie dough.
      • Peek-a-boo with a sheet/blanket that covers the whole body
  • Once a child is truly a confident walker, they are ready to start following simple instructions that require them to move throughout familiar areas.
  • A simple way to get practice in for a child with some useable vision, is to place preferred toys within sight but just out of reach. This helps strengthen distance vision as well as gives a child an opportunity to begin to use positional words him/herself.
    • Games:
      • You can send your child to get a diaper (in a familiar location) or send him/her for shoes that are "under Daddy's chair". This builds independence and continues to provide relevant experience for practicing positional concepts.
      • Obstacle courses
      • Swing set
      • Trampoline
      • Follow the String
      • Use hand puppets to tell stories filled with positional concepts. (ex: The puppet can hide behind the box and jump out to startle everyone.)
      • Ring around the Rosie
      • Simon Says
      • Big Ball Fun

from Linda Lyle ©

Balloon Bells

Skill(s) Targeted: Auditory Localization

What you will need: 

  • 10 - 12 medium-sized balloons
  • 5 - 6 small jingle bells
  • 10 - 12 pipe cleaners or long twist ties
  • String

To set up: In order to play this game, your ceiling must have some aspect that will allow you to hang the balloons from it. If you have the standard dropped ceiling with the metal runners and the foam-like tiles, the set-up will be easy. Take the pipe cleaners or twist ties and insert them between a tile and the runner, leaving a small loop that a string can fit through. I like to space them about 3-5 feet apart, and 2 balloons to a small room. Insert a small jingle bell in half of the balloons, and inflate all the balloons. Tie a long piece of string to all balloons, run the string through the ceiling loops and pull the string so that the balloon is hanging just below the ceiling. Make sure that one balloon of each pair has a bell, and the other does not have a bell. If there will be other people using the rooms before or between sessions, tape the strings up high on the nearest wall.

How to play the game: The object of this game is to have the student pull both strings at the same time and be able to tell you which balloon has the bell in it.

Modifications: If it is too difficult for the student to tell which one has the bell, then have them pull the strings one at a time.

from Cecelia Quintana ©

Find the Timer

Skill(s) Targeted: Auditory Localization

What you will need: 

  • One or two kitchen timers that make a ticking sound
  • A number of small toys (Optional)

 To set up: Place a number of small toys in various places around your building.

How to play the game: The object of this game is to have the student find the timer, and thus the accompanying toy. This works best if you have 2 timers, and several different rooms in which to work. Turn on the timer and place it on or next to the small toy. The student must listen for the ticking sound to find the timer and the toy. If you have 2 timers, you may hide the second timer while the child is distracted by looking for the first timer.

Modifications: If your building is too noisy for a timer to be heard, you may wish to try a metronome, a very small radio or some other sound source. You may also wish to try something such as a talking teddy, so that they have to call out to the teddy and it will echo back the child's voice (which it just recorded). Another option may be one of those gadgets that chirps or beeps when you clap your hands.

from Cecelia Quintana ©

Alligator Bridge

Concept(s) Targeted: Auditory localization

What you will need:  

  • Aluminum foil (18-inch-wide best) or other sound-making surface 
  • Blindfold
  • Sound source (such as a rattle, bells, whistle, etc.)

To set up: Place several pieces of the aluminum foil on the ground to make a path, which includes several changes of direction.

How to play the game: One child is chosen to be blindfolded. To set the scene, tell the child who is wearing the blindfold that s/he is returning home after dark, and their only flashlight just broke. Now s/he needs to follow the bridge that goes through the bog (the path of aluminum foil is the bridge) without being able to see it. Although many alligators live in the bog, they will only bother someone if they put one or more feet completely off the bridge. It is completely dark outside, and their only clue for making their way across the bridge is a sound source that leads them in the right direction. The person with the sound source should position himself about 3-4 feet ahead of the child with the blindfold and in such a position that walking directly toward that person will keep the child on the bridge. The teacher and/or the students then sing or chant the following words, which allows the sound-maker enough time to get to the correct position.

"The water's cold, so don't fall in, 'cause that is where the alligators swim."

After one recitation of the words, the child with the sound source makes a sound and the child with the blindfold walks forward directly toward the sound until he can touch it. The process is repeated until the child reaches the end of the "bridge".


More challenging - You may wish to use 2 sound sources, one which always indicates the proper direction, and one which is always a "decoy", (perhaps it's an alligator who's hungry and trying to drum up some dinner!)


This game works better with bare feet, so students can feel the foil as well as hear it.

To involve more students, plant "alligators" at various positions on both sides of the bridge to nip at (tickle) offending toes that may hang over the edge of the bridge.

from Cecelia Quintana ©

Squeaky Toy Tag

Skill(s) Targeted: Auditory Localization

What you will need:  

  • Large, adult-sized sock for each player
  • Squeaky toy for each player
  • Blindfold for each player

To set up: Find a large, open area with no furniture, and a level ground surface. If available, one or more large gym mats could be used for a playing surface.

How to play the game: Two students are blindfolded. Prior to putting on the blindfold the students each put on one of the large socks with a squeaky toy inside positioned directly underneath the foot, so that each time he takes a step, the toy makes a squeak. (You may wish to let your students practice walking around like this before beginning the game.) You will need to have a referee who will help set up the game, signal the start of the game, and watch out for safety during the play of the game. To begin this game the referee will silently position the players somewhere around the edge of the playing area, facing inward. The players may choose to move their squeaky toy for a moment, or the players may choose to crawl to the new location. The referee will say "Start, and the game then progresses as would a normal game of Tag, with one person who is "It" trying to tag the other person. A "Stop" command must be issued when either of the players comes close the edge of the play area. At the signal, the players will freeze, and the referee will reposition the players at the edge of the playing area once again.

Depending on the ability level of the players, you may wish to have a signal that has the players switch roles; so that the player who was "It" is no longer chasing, but being chased.

from Cecelia Quintana ©

The Penny/Nickel Can

Skill(s) Targeted: Auditory Discrimination/Localization

What you will need:  

  • A can and lid with a slit in the top
  • A street with light to moderate traffic from 2 directions.
  • A handful of pennies, and nickels
  • A folding chair for each player
  • 2 small containers such as margarine tubs

 To set up: Set up your chairs side-by-side on a sidewalk next to a street with light to moderate traffic. One player gets a small container with pennies and the other gets a small container with nickels.

How to play the game: The players listen (and watch, if appropriate) for traffic coming from a specific direction. For example, the player on the right will listen for cars coming from the right, and the player on the left will listen for cars coming from the left. (You may wish to start using the words "northbound traffic," "eastbound traffic", etc. so that your students begin to hear these directional terms.) Each time a car comes by, a coin is dropped into the can. For example, if the student on the right has the nickels and is listening for cars coming from the right, then he will drop a nickel in the can each time a car from that direction passes by. And, of course, the student on the left will do the same with a penny for each car that comes from the left. After a specified amount of time has passed, the players return inside and can then enjoy separating the coins into their respective groups, and then determine whether there were more cars from the left, or from the right (or northbound vs. southbound).

Modifications: To make this game a little more complex, you can set up at an intersection and target different concepts, such as: nickels on one street, pennies on the other; nickels for cars that stop, pennies for those that do not stop; nickels for cars that turn the corner, pennies for cars that go straight, etc. This game may also be done under blindfold, if the students are so inclined.

from Cecelia Quintana ©

Let's Get Movin' I

Concept(s) Targeted: Tactile Stimulation

What you will need

  • large blanket or quilt on which you have sewn a variety of textures

How to play the game: Remove baby's shoes and socks. Place baby on blanket so that arms and legs are able to come into contact with a variety of textures as baby moves.

  1. Let baby explore on her own.
  2. Occasionally comment, describing the texture she is exploring.
  3. Follow her lead. 


  1. Let baby explore while dressed only in a diaper.
  2. Use blanket when working with baby on rolling.
  3. Rub baby's body with different parts of the quilt, describing the activity with concept and comparison words (soft, rough, light).
  4. On warm days, move blanket out under the trees so baby can enjoy outdoor play on her blanket.

Comments/Suggestions: Blanket can be made in squares or strips that are sewn together. As baby grows, additional pieces can be sewn on to increase the blanket's size.

If baby shows a strong preference/dislike for certain textures, this can be reflected in the amount of texture on the blanket or in its pattern. For instance, a narrow piece of burlap can be sewn between two larger, more favored textures. In order to reach the preferred textures, baby must encounter the less preferred. The drive to reach a favored texture can be used to encourage touching a less favored one.

from Linda Lyle ©

Let's Get Movin' II

Concept(s) Targeted: Tactile stimulation; independent moving and exploration

What you will need

  • A box, slightly larger in length than your child
    (Parents report that plastic boxes designed to hold Christmas decorations work very well, are inexpensive, and last longer than cardboard.)

To set up: Fill the box about half full of uncooked pinto beans

How to play the game: Introduce beans to child slowly (ex: place her feet in them, or let her explore with her hands.) When she is comfortable, place the child on her back in the beans. Let her explore the way her body feels and the sounds that are made when she moves in this bean pool.

Like water, a child should never be left alone when playing in a bean pool.


  1. As the baby grows, small toys can be hidden in the beans; a child can learn to measure, pour, place things in and take out of containers while seated in the bean pool.
  2. Substitute rice, bird seed, plastic balls, leaves for the beans.

from Linda Lyle ©

Let's Get Movin' III

Concept(s) Targeted: Exploration, tactile stimulation

What you will need

  • A heavy piece of cloth (ribbon will do) 2-3 yards long and 1 inch wide (exact dimensions are not necessary;
  • Sew a variety of textures onto this strip of cloth (feathers, velvet, pom-poms, ric-rac, bells, etc.) Sew them on well!
  • Connect the textures so that there is a continuous flow of textured items along the strip.

To set up: Place your baby in a position where he/she is well supported and is able to freely use her arms (a highchair with a tray works well).

 How to play the game: Stretch the strip across the tray so that your baby can touch the strip in front of her. With her hands on the strip, gently pull so that the strip moves slowly under her hands. Comment occasionally on the textures that get a response from her. Move the strip over, under, around her arms and hands.

Adaptations: Vary the movement (sometimes pull, then stop and wait; see what she does with the fabric. Does she look for a favorite part? Does she reach for something on it that she wants? Do her fingers scratch, poke, etc.?)

Other long, narrow items can be used in the same way (ex: hose from the vacuum cleaner, belt, a piece of chain)

For children with some useable vision, consider the things they are able to see and incorporate them into the strip. Consider high contrasting colors (blue/yellow; black/white; red/yellow). For instance, sew red pom-poms onto a strip of bright yellow felt.

from Linda Lyle ©

Other Ways to Get Movin'

Concept(s) Targeted: Tactile discrimination, exploration


  • Mobiles: What to use/Where to hang them
    • Very young infants lay with their heads turned to the side and one arm out. At this age, a mobile can be hung to the side and very low so that the child can use her vision to see the movement of the mobile. The very young child with some vision may notice the high contrast of black/white or black/white/red mobiles.
    • Over the course of 2-4 months, the mobile can be moved so that it is more directly over the baby's head. Again, placing it very low in the crib encourages vision use and will encourage early swiping at the mobile (early arm/hand use and mid-line play).
    • Adaptations:
      • Consider using reflective balls or beads (from a Christmas tree); high contrasting colors.
      • If you notice your baby has a preference for a certain color, use that color (along with others) as a way to attract her visual attention.
      • Look for a mobile that can be wound up to make music. The music can attract her attention as well. If the music component is above the mobile, it can usually be separated from the mobile when she outgrows the toy and a different kind of mobile can be used.
      • Wind chimes make good mobiles.
      • Real objects that your child will need to learn about make excellent mobile toys (ex: measuring spoons, an infant spoon and cup, a pacifier, a favorite rattle).
      • If your child notices light, you can wind a string of Christmas tree lights around the mobile to attract her attention.
  • Jungle gym toys
    • Many of these are commercially available and are not expensive. Before purchasing one, it is helpful to consider whether you will be able to adapt the toy in order to get the toys close enough to your child for successful play.
    • If not, it may be easier to make a frame. To make a jungle gym, you can use a piece of PVC pipe, to make a frame. Instructions can be found on page
    • Some parents have reported success using a heavy cardboard box. They have hung toys from the ceiling of the box and the baby lays on her back in the box for play.
    • Lilli Nielsen has designed a box called a Little Room that provides this type of play space as well.
    • Toys can be hung using pieces of elastic. As your baby becomes more skilled at reaching, she can hold a toy and the elastic permits her to pull the toy toward her for more exploration. When she lets go, it returns to its place and she can find it again (early object permanence).
    • Adaptations:
      • It is a good idea to vary your child's position when playing with these toys. In addition to her back, she can lie on her side, sit in her car seat or another seating system, and even play with them while on her stomach.
  • Keeping things close!
    • Pin interesting textures such as pieces of ribbon, bells to your child's shirt in the center front. Her little hands can begin exploring at mid-line as she plays with these toys.
    • Bright colored socks with a bell sown on them can be used to encourage looking at feet as well as pulling legs up to reach with hands.
    • Hang a crib-safe mirror in your baby's crib and place her close enough to it that she can see herself.
  • Learning to like movement
    • Not all babies enjoy movement in the beginning. For some, the experience stresses their sensory system. For many, because of their low vision or blindness, they do not recognize the signs that they are about to be moved and are caught off-guard. This makes the experience frightening for them. For the baby who cries each time she is moved, the following may be helpful:
      • Give her information before any movement happens. Touch her body with your hands in the places where you touch her to pick her up. (Most babies appreciate a firm touch.) Tell her what you are going to do. Give her a few seconds to process the information. You will be surprised how quickly she learns that this touch means "up" and responds to it by shifting her body to say she is ready for the move.
      • Babies generally feel safer when moving in their parents' arms. Gentle rocking and swaying can be used in the early days to help her adjust to the feel of her body moving in space.
    • Other movement sources:
      • Baby swing
      • Vibrating baby seat
      • Water bed STYLE="text-decoration: underline">(Never leave a child unattended on a waterbed).
      • Baby hammock
      • Swinging in a blanket held by two adults (6 months or older)
      • A ride in the family car

from Linda Lyle ©

Tactile Signs

Skill(s) Targeted: 

  • Environmental awareness, signs
  • Tactile Skills,
  • Fine Motor Skills

What you will need:  

  • 4-5 rooms where a small activity can be set up
  • 4-5 small containers
  • 4-5 activities which have several parts
  • 4-5 materials of different texture
  • Blindfold for each player
  • Rubber cement or other removable adhesive

To set up: Cut each of your pieces of material into 2 pieces. Affix one piece of material to the right side of the doorjamb, where a sign would be placed, or at about shoulder level for the little guys. (I have found that rubber cement is quick, easy to use, effective, and is easily removed from most surfaces including painted walls, paneling, and metal.) Place one part of an activity in that room. Affix the matching piece of material to the lid of one container. In that container, place the matching parts of the activity in that room.

For example: 

  • In the room place a shape sorter--in the container, place the shape pieces.
  • In the room, there is a metal file cabinet--in the container, magnetic letters/numbers.

How to play the game: The student travels to the door with whatever mode of travel is appropriate for him, then independently locates the piece of material. He then scans the lids of the containers to find the matching material. He is then taken or directed to the area where the activity is set up, and completes the task.

from Cecelia Quintana ©

Follow the String

Concept(s) Targeted: Depth perception, positional concepts

What you will need

  • A long piece of string (5-10 yards); 
  • high contrast with the flooring if needed; 
  • a toy with wheels that can be pushed along the string; barriers (blocks, pillows, etc.)

To set up: Spread the string across the floor; place several barriers across the string.

How to play the game: Explain that the string is a road and we are going to drive our cars on the road. Follow the path of the string, going over or around the barriers. Use positional words related to the action taken around the barrier.


  • To increase difficulty:
    • Spread the string out in a way so that the child has to travel under, over, behind furniture in order to push the car along the string.
    • Together, create a path with building blocks and drive cars along the blocks. Barriers can be made with blocks as well.
    • Include a step or other changes in surface area when spreading string.
    • Use a raised surface like a balance beam.
    • Make a line in sand with your fingers and try to follow it.
    • Use the string to make wriggly lines.
  • For the child with depth perception problems:
    • Provide additional time to explore all changes in texture, surface area, etc.
    • Use solid barriers that cannot be moved (ex: the edge of a step, a couch leg) so that child can tactually experience and confirm the differences she is seeing.
    • Tape high contrast paper to the floor and let the child push a shopping cart along it. Let him/her crawl, pushing a ball along the paper.

from Linda Lyle ©

More Fun with String

Concept(s) Targeted: Object permanence, follow directions, memory

What you will need

  • A favorite toy or small treat, 
  • a long piece of string

To set up

  • Tie one end of the string to a favorite toy or small treat
  • Hide the toy out of sight
  • Weave the string around the furniture in a way that the child can follow it.

How to play the game: Give child the end of the string and have them follow it to find a surprise at the other end.


  • If child has language capacity, have them provide a running commentary of their actions, as if he/she were a news announcer on television. "Now I am going around the chair; I am climbing over the pillow, etc."
  • Have the child move in the direction the string is taking him/her and have them predict where they are going. "I think I am going to have to go to the chair next."

from Linda Lyle ©

Wall Pockets

Skill(s): Positional concepts

What you will need:  

  • Several pieces of scrap paper
  • Rubber cement
  • Several pictures and matching-sized blank paper, or
  • Several strips of Braille paper, some with Braille, some without Braille
  • Post-it notes

To set up: Use the rubber cement to affix sets of 2 pieces of scrap paper to the wall, one above the other. Only use the cement on 3 sides, leaving the top side open, so that you have a pocket. (You may wish to test your walls to see of the rubber cement will come off. In most cases, I believe it will.) In each pocket you will place a piece of paper with the top sticking out. For each set, one pocket will have a picture or Braille, and the other will have a blank piece of paper. Next to each set, leave yourself a Post-it note that says which pocket has the picture or Braille in it, either the top or the bottom.

How to play the game: The object of this game is for the student to find the picture on the first try, after the teacher tells them which pocket contains the picture or Braille, either the "top" pocket, or the "bottom" pocket. They get to take home the pictures or a small toy after the lesson.

Modifications: You may wish to change the positional concept to "left" and "right", or "high" and "low", or even "north" and "south" (with north being on the top, as it would be on a map). 

from Cecelia Quintana ©

Positional Racetrack Builders

Skill(s) Targeted:  

  • Positional concepts
  • Visual scanning

What you will need:  

  • Multiple pieces of a car or train track
  • A vehicle which can travel on that track
  • Index cards

 To set up: Determine which positional concepts will be targeted. In the following example we will use, "On" versus "Under". On the index cards write "We are resting ________". In the blank write things like: "on the desks," "under the chairs," "on the shelves", etc. Also include a number on the cards (a number between 1 and 5 works best). Place a card on the floor of the doorway of each room used for the game. Place the correct number of pieces of the racetrack in the rooms in the places specified by the card.

How to play the game: In the door of the room, the student will find the card, and the teacher will read it. The student will then use to clue given to find the pieces of racetrack hidden in the room.

Once all of the pieces have been collected, the student then gets to assemble them and play with the racetrack for a while.

Modifications: If the student prefers to build puzzles, the pieces of a puzzle may be hidden in the rooms. Or multiple pieces of a single game may be hidden in different rooms.

from Cecelia Quintana ©

Eastern Star, Western Sun

Skill(s): Cardinal directions, Matching

What you will need: 

  • A number of small toys
  • Envelopes
  • A large, simple picture of a star
  • A large, simple picture of a sun
  • Several sets of smaller matching pictures of the star and sun
  • 2 small boxes

To set up: Affix the picture of the star to one of the boxes and place the box on the eastern end of a large table or on the eastern side of the room. Place the picture of the sun on the other box and place it on the western end of a large table or on the western side of the room. Place a toy and one of the small pictures in each envelope.

How to play the game: The object of this game is for the student to identify the picture and place both the picture and the toy in the box with the matching picture. (At the end of the game, you may wish to let the student choose one toy from each box to take home.) The teacher's job is to reinforce the use of the words "Eastern" and "Western". Eventually, the pictures will be replaced with and "E" for East and a "W" for West.

Modifications: For the student with no vision, use textures or shapes, rather than the pictures.

from Cecelia Quintana ©

Boat Dock Shuttle

Skill(s) Targeted: Cardinal Directions

What you will need:  

  • A large bowl or small tub with water
  • A medium sized plastic lid that will float on water
  • A toy phone or real disconnected phone
  • A toy bus or car
  • A dozen or more small, light-weight toys
  • A small sign for each of the cardinal directions - "north", "south", "east", and "west"

 To set up: Set up your signs in the appropriate places, either around a large table, or in a moderate-sized uncluttered area. With each sign place an equal number of the toys. Fill the bowl or tub with water and place the lid so that it floats on the water. (This is the boat and the loading dock.) Place your phone and the bus or car (this is the shuttle) near the loading dock.

How to play the game: The student is the shuttle driver, and the teacher plays the role of the passengers. The teacher "calls" the student on the toy phone and asks to be picked up at one of the shuttle stations (north, south, east, or west). The student then takes his shuttle to the correct location, picks up one of the toys, and takes it to the boat dock, where he "loads the passenger" by placing the toy on the floating lid. This procedure is repeated until all of the passengers have been delivered to and loaded onto the boat.

Modifications - If the student is not yet ready for all of the directions, use only 2 or 3 stations. If this is still too difficult, place a different colored piece of cloth at each station. This way the teacher can ask, for example, to be picked up "at the north station with the pink parking lot" or the "west station with the striped parking lot".

from Cecelia Quintana ©

Directional Squares

Skill(s) Targeted: Cardinal directions

What you will need:  

  • 25 of any one of the following items: carpet squares, or chairs, or towels, or cafeteria trays or any other item that can clearly mark a small area.
  • 24 index cards, 3 copies of each of the following phrases:
    • Move 1 space north
    • Move 1 space south
    • Move 1 space east
    • Move 1 space west
    • Move 2 spaces north
    • Move 2 spaces south
    • Move 2 spaces east
    • Move 2 spaces west

To set up: Align the carpet squares (or whatever you are using) in a 5 X 5 grid pattern, (see the diagram below) with enough space between the squares to clearly separate them from one another, but close enough so that one can reach out and touch the surrounding squares.

Diagram:5x5 grid of squares  with equal space between squares

How to play: This is a gross motor adaptation of "Directional Checkers" fromSTYLE="text-decoration: underline">Simon Says Is Not the Only Game, page 31,(Leary & Schneden, American Foundation for the Blind, 1982). Each child begins in the exact center of the grid. Whoever has been selected to be the "caller" (the person who will be reading the cards) selects an index card from the top of the deck. The caller reads the card and the child moves the appropriate number of spaces in the correct direction. The first person that gets a card where the correct execution of the directions makes them move off of the grid is the winner.


More challenging - it is possible to separate the cards into 2 piles: the north-south pile and the east-west pile, and then have the caller draw 2 cards. This will result in secondary directions (such as northeast, southwest, etc.), thereby requiring the students to identify 2 directions and move in a diagonal direction.

from Cecelia Quintana ©

Sniff 'n' Turn

Skill(s) Targeted: Olfactory

What you will need: 

  • 2 distinctly different scents
  • Change of direction indicators (self-adhesive colored dots do well)
  • Route directions (for the teacher)

 To set up: Set-up and preparation for this game takes much longer than the actual playing time. The teacher must decide on a route and write out the directions as detailed below.

How to play the game: This game involves executing a route based upon scents provided. You may choose to use easily available scents such as spices and extracts. The extracts work well if you soak a cotton ball in the extract, and then wrap it in foil; the spices may be left in their original containers, with the label masked. Each scent indicates a change of direction. For example, oregano could mean "execute a left turn", and cinnamon "execute a right turn". (You could choose to use 3 scents. Then one of the scents indicates that the student should continue in the same direction. However, then you may be risking "sniffer burn-out")

The instructor will need to plan a route that includes several changes of direction. At each change of direction, some kind of marker will need to be placed on the floor (we will call this a Station). For particularly long stretches, you may wish to include a station where you continue on straight. Fluorescent Color Coding Labels which may be purchased at most grocery and/or "super" stores, are self-adhesive, easy to remove, and come in a variety of colors so that it will be fairly easy to find a color to contrast almost any floor color. The teacher should have a route card that indicates each change of direction. It may read something like this: "Station 1 - Lobby - right turn - cinnamon" The student will need a the teacher or another partner who will let him know when he has reached a station (if residual vision is not appropriate for the task) and present him with the appropriate scents. At each station, the partner presents the student with whichever scent is needed until the route has been completed.

Comments: While playing this game, I have found that after about 10-12 sniffs, the nose gets tired and it becomes more difficult to tell which scent is which. Also, I tried 3 different brands of plastic bags, and each had a residual smell which overrode the smell of the item placed inside.

from Cecelia Quintana ©

Winter 2000 Table of Contents
Versión Español de este artículo (Spanish Version)


By Diane Barnes, Certified Orientation & Mobility Specialist Region 13 Education Service Center, Austin, Texas


As part of the Functional Vision Evaluation / Learning Media Assessment, VI teachers are required to determine if an evaluation by a Certified Orientation and Mobility (O&M) Specialist is needed. Specific skill areas that may impact a child's present and/or future travel skills should be assessed. These skills relate to safe and efficient travel. Instruction in these areas may influence the child's developmental growth, which in turn may impact the level of travel skills he or she may develop. For example, will he develop skills that will allow him to travel only in familiar areas, with extensive orientation, or in very structured settings? Or can he be independent in both familiar and unfamiliar areas?

VI teachers focus on skills which impact the child's functioning in the home and school environment. These skill areas include, but are not limited to: visual efficiency, motor planning, concept development, environmental awareness, object identification and interest, and communication. They employ a variety of strategies to assess these vision skills with infants and young children such as presenting an object or toy at close range, from a specific side, or by moving it. They generally use toys or objects that are brightly colored, have auditory feedback and light sources, or which have been adapted with contrasts. This also helps to encourage optimum participation and interaction by the child during the assessment.

When considering the child's travel skills, the home environment is generally the most controllable environment. Once the child moves into the school environment, the environment can continue to be controlled to some extent. For instance a student might be given additional time to travel from place to place, curbs or steps can be painted brightly, highly contrasting colors used between walls and flooring, and so forth. However, beyond the home and school settings, the child's travel environment is less accommodating and more unpredictable. It is important to address travel skills in both familiar and unfamiliar environments or environments and situations that are less than ideal. On-going exposure to and guidance in handling these types of situations plays a significant role in helping the child acquire the skills needed for travel in both familiar and unfamiliar environments. In addition, instruction may also impact whether she will be able to travel without the use of a cane, needs to use a cane all the time or only in certain situations, knows when the cane is needed, and can interpret and properly respond to cane feedback.


Listed below are some O&M related activities that address these critical skill areas. These are also activities which can assist the VI teacher in determining the need for an O&M referral.

  • Place an item to the right of the child, and have her to reach for it with her left hand; reverse the process. Place item at midline and have child reach for it with alternating hands. This helps develop the ability to cross midline, extend the arm, reach for and contact an object; all of which are critical to success in using a cane.
  • Place pillows on the floor and have child sit and/or stand on them as she reaches for items placed on the couch. This works on coordination and balance necessary for negotiating steps, curbs, wheelchair ramps, or broken sidewalks.
  • Occasionally change the location of an object from where the child expects an item to be located. For example, a favorite toy changes from being stored on the left on the first shelf to being stored on the right or on the next shelf up. A toy basket moves from a spot by the bedroom door to the closet. These types of situations teach such skills as problem solving, route planning, visual searching, tolerance/patience, and soliciting aid. Learning these kinds of skills may allow a child to develop the ability to progress beyond being a "route traveler."
  • Start with completely covering/concealing a familiar item, and have the child to try to identify it as you reveal it little by little. This builds the ability to interpret part, whole, and "clutter." She will need this ability for example, so she can identify a newspaper stand partially obscured by a trash can from a distance. It also helps develop patience and tolerance, problem solving, vision efficiency, and the ability to identify landmarks.
  • Align floor mats, crumbled blankets and towels, and small rugs turned up on one corner in a path on the floor and have the child negotiate these items as she comes to you. This helps to develop a tolerance of terrain changes and works on motor planning and control.
  • Provide instructions to your child with music in the background, the window open, or the washing machine or vacuum cleaner going. This helps teach him not be startled by a trash can knocked over by a dog as he is preparing to cross the street or become distracted by kids opening and closing lockers as he walks down the hall.


If the child demonstrates difficulty at any point with any of these activities, it is probably an indication that the VI teacher needs to make a referral for an O&M assessment. In most instances the VI teacher can ask herself a simple question: Is the child visually impaired and moving (scooting, crawling, pulling up on furniture, walking, reaching)? If the answer to this question is "yes", then the VI teacher should give her O&M Instructor a call to discuss the need for a referral. Determining the O&M needs of children with visual impairments has to be an on-going assessment process. This requires a strong collaborative relationship between the vision teacher and a certified O&M Instructor. Through this collaborative process, the vision teacher should be able to determine when it is necessary for the O&M Instructor to provide direct intervention with the child.

Family members of children with visual impairments and deafblindness have a wealth of support and resources to help both the child and the family live a rich and productive life.  Here are just a few of the many resources you may want to explore.

Family Organizations

Disability Organizations

Texas State Agencies and Programs

Family Listserv, Blogs, and Distance Learning Connections


Videos and Web-based Informational Materials

TSBVI Parent Page

Training Events

  1. Name:
  2. Date:
  3. Information on My Etiology
  4. Access to Distance Tasks in School Settings
    1. Examples of tasks:
    2. Strategies and tools I use to accomplish these:
    3. My challenges:
  5. Access to Near and Medial Tasks in School Settings
    1. Examples of tasks:
    2. Strategies and tools I use to accomplish these:
    3. My challenges:
  6. Access to Distance Tasks in Community Settings
    1. Examples of tasks:
    2. Strategies and tools I use to accomplish these:
    3. My challenges:
  7. Access to Near and Medial Tasks in Community Settings
    1. Examples of tasks:
    2. Strategies and tools I used to accomplish these:
    3. My challenges:
  8. Access to Near and Medial Tasks at Home
    1. Examples of tasks:
    2. Strategies and tools I used to accomplish these:
    3. My challenges:

By David Wiley, Transition Specialist TSBVI, Texas Deafblind Outreach

Editor's note: While David's article is written about people with deafblindness, the ideas he discusses are relevant for a much wider population.

Helping a young person with deafblindness develop an active lifestyle is one of the important issues to consider when planning for the future. People with deafblindness, especially those with additional disabilities, may develop a routine of remaining passive and uninvolved with basic life activities around the home, and experience an unsatisfying use of free time. Families, educators, and any others who work with a young person, all have a role in planning and supporting a more active life at home.

Why an active life is important

It is important that kids develop the expectation of being actively involved in home life. Without this expectation, children are at risk of developing a "learned helplessness" that can continue throughout the adult years. Most people feel that being actively involved in everyday activities leads to a higher quality of life. A person who is actively involved in common daily activities, such as taking care of the home and personal care, has several advantages:

  1. Active participation allows a person to avoid boredom and inactivity.
  2. Active participation allows a person to gain a sense of competence and accomplishment.
  3. Active participation allows a person to have a greater sense of control over the circumstances of his or her life and more influence over the way things are done.
  4. Active participation allows a person to have more opportunities for making choices and expressing preferences.
  5. Active participation allows a person to have a better understanding of how everyday things happen (e.g. how long it takes for meals to be prepared, or how clean laundry gets back into drawers).
  6. Active participation supports communication development by providing a person with more topics to use in interactions with others.

Creating opportunities for more participation

When individuals are able to complete activities around the home independently or with minimal supervision, they should be given opportunities and support to do them. This may involve:

  1. Giving him or her responsibilities and chances to use current skills in regular household activities.
  2. Teaching new skills so he or she can take responsibility for regular household activities.
  3. Creating new household routines as opportunities for the person to use his or her skills (e.g. create a garden, get a fish tank, or start recycling).

Partial participation in activities is a way to encourage a more active life for individuals who are not very independent. Even when a person is not able to fully complete an activity, he or she should be given the opportunity to participate at a level in keeping with his or her capabilities. No one should be left out.

Partial participation can involve selecting those steps within an activity routine that a person is able to accomplish independently, and providing a chance for him or her to complete those steps while someone else completes the rest. Activity routines should be "task analyzed," by breaking them into small steps and identifying those steps the person can complete.

When steps cannot be completed independently, people should be allowed to participate in a wide variety of activities with the support of prompts or physical assistance from another person. Once a person is actively involved in a routine, the level of participation and independence can be increased over time, by reducing prompts, adding more steps, or fading the level of support.

Adapting materials and the environment can allow a greater level of participation. Adapted materials may include things such as tactile markers on appliance dials, a non-skid surface on a countertop, an electric razor, or a food processor to cut and stir. Adaptations to the environment include things such as storing materials in consistent locations, reducing clutter, and defining work spaces clearly.

Creating new expectations

It is not unusual for someone to initially protest when asked to join in new activities. Because daily routines are familiar, any person might become upset when these routines are disrupted. People may have a sense of uneasiness when they skip their morning coffee, miss the evening news, or alter some other routine activity. The difficulty of starting new routines is very evident to someone who attempts to change diets, stop smoking, or begin an exercise program.

Being accustomed to a routine of inactivity may cause a young person with deafblindness to initially resist more active participation. This is to be expected, even when the new activities are enjoyable, as would be the case if any routine is replaced by another. Once an individual becomes familiar and comfortable with new expectations and opportunities to be more active, however, the new routines will gradually take the place of inactivity. When that happens, the person will more easily grow to accept and enjoy new chances to participate.

Of course, if someone continues to resist a particular activity over a period of time, there comes a point when this must be accepted and honored as the communication of a preference. Before giving up, however, the person must have had enough opportunities to participate and fully understand the activity.

Free time can present a challenge

A significant portion of every person's time at home is spent with self-directed leisure. Leisure can be defined as unobligated time in which people perceive themselves to be free to choose activities they find meaningful, enjoyable, and intrinsically motivating. During free time, a person may be given the opportunity to "do anything he or she wants to do." But what does it mean to "do anything you want?" There are many steps that must be successfully completed before a person can initiate a leisure activity:

  1. The person must know how to do a number of activities from which he or she can choose.
  2. The person must understand the concept of free time, and know that it represents a time to choose for oneself.
  3. The person must know how to make a choice.
  4. The person must be able to think of, or have a reminder of, the activities he or she is able to do, and from which he or she is able to choose.
  5. The person must know when the free time will end, and how it fits in with other daily activities and events, as well as what activities are appropriate within that time frame.
  6. The person must be able to locate and get the materials needed to participate in an activity.

If any of these steps cause a problem, the person needs more support during free time, just as during self-care or other tasks. When given no support, many people with deafblindness may be unable to successfully initiate a leisure activity. This can be recognized when someone consistently chooses sleeping, sitting idly, or engaging in problem behaviors during free time.

How deafblindness affects the level of activity

Some problems experienced during leisure time are directly related to deafblindness. For example:

  1. People who are deafblind with multiple disabilities are often unable to enjoy many "old standbys" - simple, common leisure activities that people often fall back on (e.g. TV, music, books, conversation, sight-seeing and board games)
  2. Most people are motivated to try new activities they hear about or see others doing, and consequently build a repertOíre of leisure choices. People with deafblindness often receive less information through modeling and other sources in the environment. As a result, they may not have many leisure options from which to choose.
  3. People with deafblindness receive fewer natural environmental cues that prompt self-initiation and independent participation. Most people observe these cues and are reminded of the activities they might want to select when they have free time.
  4. People who are not strong communicators may be unaccustomed to making choices, and unable to easily communicate preferences. They may not be good self-advocates either.
  5. Sensory stimulation often takes on great importance. Activities that do not provide sensory stimulation may not be as motivating.

How to help someone have a more active life

Enhancing participation and increasing self-initiation is beneficial for a higher quality of life. These steps can help a young person become more active:

  1. Create and practice consistent routines that increase participation around the house.
  2. Develop and communicate a daily schedule, so the person will have expectations of what will happen. (Include both "chores" and leisure activities.)
  3. "Label" the concept of free time and support concrete choice-making.
  4. Support the person in learning about self-determination and self-advocacy.
  5. Arrange a system that reminds the person about possible leisure activities.
  6. Assess the person's interests, and plan new experiences for him or her to try.

Assessing and planning new experiences

In assessing interests and planning new experiences, consider the following:

  1. The person's past experiences.
  2. The person's preferences and attitudes.
  3. The expectations and interests of friends and family.
  4. Opportunities available in the person's home.

After gathering this information, support the person to become more active. Enjoyable and familiar preferred activities should be balanced with new things a person can learn more about. Honor the person's choices when possible. When it is not practical to accept a person's preference, because it is inappropriate for some situations, frustrating to the person, or potentially harmful, help the person by adapting these preferred activities to make them more appropriate. New skills should also be taught for specific activities, to increase the number of options the person has, and to provide a larger array of opportunities to choose from.

The Activity Planning Sheet can be used to "brainstorm" new activity ideas. By knowing the young person's preferences and abilities, and working together to encourage a more active life at home, everyone involved can help a young person with deafblindness have a more productive and satisfying lifestyle, now and in the future.

The Process of Planning and Supporting a More Active Home Life

Teacher's Role

  1. Talk to the family and work as a team to determine what routines might work well at home for the student.
  2. Work on similar routines at school, and communicate with the family to create as much consistency as possible.
  3. Make sure daily living and independent leisure activities are routinely discussed during IEP and ITP development.
  4. In order to plan effectively, find out about the activity level and typical support available to adults with deafblindness in their homes.
  5. Document both proficiency and preference, and make a list of activities the student has tried in the past. Documentation can be written and/or videotaped.
  6. Remember that the family has obligations in addition to supporting the student's active home life. Work, doctor appointments, other children, home maintenance, meal preparation and relaxation are only a few of the competing priorities families face.

Family's Role

  1. Make your child's active participation a regular and expected part of family life. Try to be as consistent as possible.
  2. Give your child chores, or find ways to include your child in household duties, even if only in a small way.
  3. Consider all the regular routines that involve your child, and discover some active role for your child in each.
  4. Use a calendar or other way to let your child know what is expected every day.
  5. Help your child make satisfying and productive choices during free time.
  6. Develop new ideas with your child's teacher or care providers, and be consistent across different settings.
  7. Remember your other family obligations, and find a way to support your child consistently without placing too much stress on other aspects of family life.

Other Caregiver's Role (Group Home Staff, Member, Respite Care Worker, etc.)

  1. Work with the individual and family as a team to determine what routines might work well at home.
  2. Make active participation a regular and expected part of the young person's life. Be consistent.
  3. Do things with, not for, the person you are supporting.
  4. During free time, help him/her make choices and participate in satisfying, productive activities.
  5. When necessary, schedule activities with or for the person. Keep in mind the appropriate level of support and his/her preferences.
  6. Use a calendar or other way to let him/her know and anticipate what to expect throughout the day.
  7. Document both proficiency and preference in making a list of activities the student has tried in the past. Documentation can be written and/or videotaped.

Activity Planning Sheet

Developing and Adapting Activities to Improve or Expand Options at Home

  1. What does the person currently enjoy doing or show an interest in?
  2. What might be motivating about this activity?
  3. Does this activity currently create such a problem that it needs to be changed? If not, skip ahead to Question 5.
  4. If so, answer the following three questions:
    • If this activity's location creates the problem, how could changing the setting make the activity better?
    • If the materials used in this activity create the problem, how could changing the materials make the activity better?
    • If the person's inability to finish this activity completely or correctly creates the problem, how could changing the expectations or level of support make the activity better?
  5. What are five new activities that could be motivating or interesting to the person, based on the qualities listed in Question 2?

Worksheet accompanying article "Planning & Supporting a More Active Life at Home" by David Wiley, Texas Deafblind Outreach

Hosted by Texas School for the Blind and Visually Impaired

National Agenda Logo

Guiding Principles:

Note: In the following position paper, the term "children with visual impairments" refers to all children who are blind or visually impaired, including students with multiple disabilities and students who are deafblind.It is also important to note that family-centered practices must always be used when providing services to children in the early childhood programs.For a job description of a teacher of students with visual impairments (TVI), an excellent resource may be found in Appendix F, "The Role and Function of the Teacher of Students with Visual Handicaps: CEC-DVI Position Statement" in the book Blind & Visually Impaired Students-Educational Service Guidelines, (Pugh & Erin, eds.), published by Hilton-Perkins in 1999.

Caseload analysis is a powerful tool for administrators to use in addressing both efficient use of monetary and human resources and quality issues related to student outcomes. The goal of caseload analysis is to provide consistent, quality, cost effective service to all students with visual impairments.Annual caseload analysis, resulting in a manageable number of students, is a critical component of quality services for students with visual impairments. The majority of students with visual impairments are educated in public schools where the itinerant service delivery model predominates. Itinerant teachers' caseloads must be determined analytically based on the needs of the individual students.

It is the position of AER Division 16, Itinerant Personnel, that a valid caseload analysis must encompass the following:

  1. Identification of a standard method that assesses the programs needs in relation to individual students.
  2. Training of Teachers of Students with Visual Impairments (TVIs) and supervisory staff in the use of the procedure.
  3. Annual analysis of caseload accomplished jointly by TVIs and supervisors
  4. Interpretation of results with recommended action
  5. Presentation of results to administration for action

The extreme low incidence of students with visual impairments, including those with multiple disabilities, requires that general and special education administrators, as well as legislators, receive background information relating to needs specific to this population. An appropriate caseload analysis includes these considerations:

  1. Children with visual impairments are an extremely heterogeneous group. They vary in age, degree of vision loss, cognitive ability educational needs and may have additional disabilities.
  2. Because of this heterogeneity, TVIs fulfill a variety of roles that differ widely from the typically roles of classroom teachers.
  3. Student instruction focuses on the acquisition of skills to allow access to the general curriculum, where appropriate, and to compensate for visual loss.
  4. Students require access to an expanded core curriculum of compensatory skills to meet their unique needs. Skills such as: independent living, study/organizational, and social interaction skills are addressed.
  5. Service is time intensive because of the variety of student and the typical one on one nature of instruction.
  6. Needs of individual students change over time; therefore caseload analysis must be done annually.
  7. The issues of student eligibility and need for specialized services should be considered annually.
  8. Service must be provided in a timely manner; access to instruction and materials must be provided to the student at the same time as sighted peers.
  9. Newly blind students or newly diagnosed blind infants and children must receive early and immediate intervention with a high degree of intensity.
  10. Service to students provided by TVIs may include instruction, collaborative consultation, material adaptation and production, instructional planning, assessment, case management, required meetings, and travel.
  11. Staff members trained in visual impairment are more effective and efficient in service delivery to this population than generically trained teachers.
  12. Equitable allocation of caseloads among itinerant staff can best be addressed through caseload analysis.
  13. The availability or non-availability of support staff to the itinerant teacher (e.g.: resources center, braillist, paraeducators) must be included in the analysis.
  14. Planning time varies for novice and experienced teachers depending on the demands of their caseloads. (e.g., new technology, advanced braille instruction, etc.)
  15. Sophisticated and constantly changing specialized software and hardware requires ongoing training, instruction and troubleshooting.

Conclusion: The over-arching goal of educating students with visual impairments is to allow each individual to become as independent and self-supporting as possible. A significant percentage of these students graduate from high school, go on to post secondary education, and/or enter the work force. Others may need some level of support throughout their lives, but can achieve a level of independence when given adequate educational programming and intervention. AER Division 16, Itinerant Personnel, supports quality services to students with visual impairments and caseload analysis as a strategy for achieving that goal.

Information and assistance in conducting caseload analyses can be obtained from AER, Division 16 Itinerant Personnel at:

Chrissy Cowan, TVI

Texas School for the Blind and Visually Impaired




  • Your VI teacher (TVI) should give you a copy of the Functional Vision Evaluation and Learning Media Assessment with detailed information about how your particular student uses his/her vision

  • Students with low vision should be encouraged to use their eyes to the maximum. Vision is not diminished by use

  • A student with albinism will be sensitive to the light and will sometimes require an adjustment period of about 10 minutes when he or she comes in from being in the sun

  • Allow the student to adjust his/her work to a position that he/she is most comfortable with

  • Do not use large print materials when regular print will suffice

  • Whenever an assignment refers to a picture (as in math workbooks) allow the student to look at the picture in a regular print book. The large print process distorts pictures

Reading the Board


  • Seat student near the board (within 3 to 5 feet) and in a central location, but within a group of students

  • Verbalize as you write on board

  • If possible, provide a copy of what you have written on the board to the student

  • Have another student with good handwriting copy off the board and make a copy of these notes.

  • Allow student to use a telescope supplied by the TVI (if this is done the student will probably need to be seated back away from the board to increase his/her visual field)

  • A clean board makes a better contrast and is easier to read

  • Avoid red/orange/yellow markers when writing on charts/white boards

Overhead Projectors/Video


  • Seat student close to the screen

  • Provide student with your overhead projector sheet or master copy so he or she can read and/or copy from it

  • Use a dark (preferably black) Vis-à-vis pen on the overhead sheet

  • Discuss movies thoroughly afterwards to make sure the student understands major concepts presented

  • A darkened room provides more contrast

  • Move the projector closer to the screen to produce a smaller, more distinct image

  • Make a good photo copy of your master

  • Do not use red ink

  • Record the assignment, provided that the student can function as well with a recording

  • Please be sure that your tests are completely legible. Ask the student to read parts of the test to you privately to be sure he or she can see all parts of the test

  • Give the student a little extra time

  • Avoid handing the student a paper and saying, “Do the best you can”. This only cheats the student out of the continuity of your lesson and can be frustrating



  • Light intensity can be regulated by adjusting distance from the window or light source

  • Artificial lights should be used whenever brightness levels become low in any part of the room.

  • Avoid glares on working surfaces (a piece of dark colored paper taped to the entire desk surface diminishes glare off the desk)



  • Avoid having students work in their own shadow or facing the light

  • Students may need to change their seats whenever they desire more or less light



  • White chalk offers more contrast on a clean chalkboard

  • Dry erase boards used with dark markers offer better contrast

  • Soft lead pencils and felt-tipped pens with black ink are recommended for use on unglazed light and tinted paper

  • Good contrast and white space between lines of print offer the best viewing comfort for lengthy reading assignments

  • Avoid using red/orange/yellow on Smartboards



  • Tests should be dark and clear

  • If there is a time element, please remember that a person with poor sight will frequently be a slower reader than a person with normal sight of the same intelligence. His or her eyes will tire much faster, so tests in the afternoon can be particularly difficult to read

  • On timed drills allow at least double the time for a student with low vision. Ideally they should be untimed

  • If the student is comfortable performing orally, tests could be given orally by another person who fills in the blanks. Please be careful here, as some people are not auditory performers, and it is a misconception that all blind and low vision students can perform better auditorily.

Physical Education/Recess


  • Check with TVI to see if there are any restrictions of activity or on visual fields

  • Ball Sports: practice catching, kicking, and batting with students to check whether or not he/she can see the ball in time to catch, kick, or bat

  • Use audible goals and/or balls (available from TVI) or use a radio as a goal locator (as in basketball)



  • Students with a visual impairment should be expected to participate in art. Consult with the TVI on adaptations for the art curriculum

Mobility and Orientation


  • Allow student to explore your room during the first week and whenever you make any major changes

  • Show student where his or her desk is, where materials are located, papers turned in, etc.

  • Point out the restrooms, water fountains, library, office, cafeteria, gym, and bus stops and ask that braille labels be placed outside each entry for blind students

  • Contact O&M specialist for detailed information


  • Your VI teacher (TVI) should give you a copy of the Functional Vision Evaluation and Learning Media Assessment with detailed information about how your particular student uses his/her vision
  • Students with low vision should be encouraged to use their eyes to the maximum. Vision is not diminished by use.
  • Allow the student to adjust his/her work to a position that he/she is most comfortable with
  • Do not use large print materials when regular print will suffice
  • Whenever an assignment refers to a picture (as in math workbooks) allow the student to look at the picture in a regular print book. The large print process distorts pictures

Reading the Chalkboard/Whiteboard

  • Seat student near the board (within 3 to 5 feet) and in a central location, but within a group of students
  • Verbalize as you write on board
  • If possible, provide a copy of what you have written on the board to the student
  • Have another student with good handwriting copy off the board (carbon or NCR paper can be used and the original can be given to the student with a visual impairment)
  • Allow student to use a telescope supplied by the TVI (if this is done the student will probably need to be seated back away from the board to increase his/her visual field)
  • A clean board makes a better contrast and is easier to read
  • Avoid using red, orange, or yellow markers as these are difficult to see

Projector Screen/Video

  • Seat student close to the screen
  • Provide student with your overhead projector sheet or master copy so he or she can read and/or copy from it
  • Use a dark (preferably black) Vis-à-vis pen on the overhead sheet
  • Discuss movies thoroughly afterwards to make sure the student understands major concepts presented
  • A darkened room provides more contrast
  • Move the projector closer to the screen to produce a smaller, more distinct image
  • Make a good photo copy of your master
  • Do not use red ink
  • Please be sure that your tests are completely legible. Ask the student to read parts of the test to you privately to be sure he or she can see all parts of the test
  • Give the student a little extra time if needed
  • Avoid handing the student a paper and saying, “Do the best you can”. This only cheats the student out of the continuity of your lesson and can be frustrating
  • Use an app, such as JoinMe, to connect the teacher’s computer screen and/or interactive white board with the student’s iPad


  • Light intensity can be regulated by adjusting distance from the window or light source
  • Artificial lights should be used whenever brightness levels become low in any part of the room.
  • Avoid glares on working surfaces (a piece of dark colored paper taped to the entire desk surface diminishes glare off the desk)
  • A student with albinism will be sensitive to the light and will sometimes require an adjustment period of about 10 minutes when he or she comes in from being in the sun


  • Avoid having students work in their own shadows or facing the light
  • Students may need to change their seats whenever they desire more or less light


  • Dry erase boards used with dark markers offer better contrast
  • Soft lead pencils and felt-tipped pens with black ink are recommended for use on unglazed light and tinted paper
  • Good contrast and white space between lines of print offer the best viewing comfort for lengthy reading assignments
  • Avoid using red/orange/yellow on interactive boards


  • Tests should be dark and clear
  • If there is a time element, please remember that a person with a visual impairment will frequently be a slower reader than a person with normal sight of the same intelligence. His or her eyes may tire much faster, so tests in the afternoon can be particularly difficult to read
  • On timed drills allow at least double the time for a student with a visual impairment. Ideally they should be untimed
  • If the student is comfortable performing orally, tests could be given orally by another person who fills in the blanks. Please be careful here, as some people are not auditory performers, and it is a misconception that all blind and low vision students can perform better auditorally.

Physical Education/Recess

  • Check with TVI to see if there are any restrictions of activity or on visual fields
  • Ball Sports: practice catching, kicking, and batting with students to check whether or not he/she can see the ball in time to catch, kick, or bat
  • Use audible goals and/or balls (available from TVI) or use a radio as a goal locator (as in basketball)

Orientation and Mobility

  • Allow student to explore your room during the first week and whenever you make any major changes
  • Show student where his or her desk is, where materials are located, papers turned in, etc.  
  • Point out the restrooms, water fountains, library, office, cafeteria, gym, and bus stops
  • Contact a certified O&M specialist for detailed information

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.

Hereditary/Chromosomal Syndromes and Disorders

101 Aicardi syndrome

102 Alport syndrome

103 Alstrom syndrome

104 Apert syndrome (Acrocephalosyndactyly, Type 1)

105 Bardet-Biedl syndrome (Laurence Moon-Biedl)

106 Batten disease

107 CHARGE association

108 Chromosome 18, Ring 18

109 Cockayne syndrome

110 Cogan Syndrome

111 Cornelia de Lange

112 Cri du chat syndrome (Chromosome 5p- syndrome)

113 Crigler-Najjar syndrome

114 Crouzon syndrome (Craniofacial Dysotosis)

115 Dandy Walker syndrome

116 Down syndrome (Trisomy 21 syndrome)

117 Goldenhar syndrome

118 Hand-Schuller-Christian (Histiocytosis X)

119 Hallgren syndrome

120 Herpes-Zoster (or Hunt)

121 Hunter Syndrome (MPS II)

122 Hurler syndrome (MPS I-H)

123 Kearns-Sayre syndrome

124 Klippel-Feil sequence

125 Klippel-Trenaunay-Weber syndrome

126 Kniest Dysplasia

127 Leber congenital amaurosis

128 Leigh Disease

129 Marfan syndrome

130 Marshall syndrome

131 Maroteaux-Lamy syndrome (MPS VI)

132 Moebius syndrome

133 Monosomy 10p

134 Morquio syndrome (MPS IV-B)

135 NF1 - Neurofibromatosis (von Recklinghausen disease)

136 NF2 - Bilateral Acoustic Neurofibromatosis

137 Norrie disease

138 Optico-Cochleo-Dentate Degeneration

139 Pfieffer syndrome

140 Prader-Willi

141 Pierre-Robin syndrome

142 Refsum syndrome

143 Scheie syndrome (MPS I-S)

144 Smith-Lemli-Opitz (SLO) syndrome

145 Stickler syndrome

146 Sturge-Weber syndrome

147 Treacher Collins syndrome

148 Trisomy 13 (Trisomy 13-15, Patau syndrome)

149 Trisomy 18 (Edwards syndrome)

150 Turner syndrome

151 Usher I syndrome

152 Usher II syndrome

153 Usher III syndrome

154 Vogt-Koyanagi-Harada syndrome

155 Waardenburg syndrome

156 Wildervanck syndrome

157 Wolf-Hirschhorn syndrome (Trisomy 4p)

199 Other __________________________

Pre-Natal/Congenital Complications

201 Congenital Rubella

202 Congenital Syphilis

203 Congenital Toxoplasmosis

204 Cytomegalovirus (CMV)

205 Fetal Alcohol syndrome

206 Hydrocephaly

207 Maternal Drug Use

208 Microcephaly

209 Neonatal Herpes Simplex (HSV)

299 Other_______________________

301 Asphyxia

302 Direct Trauma to the eye and/or ear

303 Encephalitis

304 Infections

305 Meningitis

306 Severe Head Injury

307 Stroke

308 Tumors

309 Chemically Induced

399 Other _______________________

Related to Prematurity

401 Complications of Prematurity


501 No Determination of Etiology