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Anne Corn
Professor of Special Education
Vanderbilt University

The use of blindfolds in the teaching and training of all legally blind students has become a topic of discussion in the past few years. At a recent conference, Anne Corn and Phil Hatlen were invited to present their positions and opinions on education of legally blind students with remaining vision. They were members of a panel that took the position that many legally blind students will benefit most by utilizing remaining vision as their primary avenue of learning. Another panel took the position that every legally blind person needs to learn the skills of blindness, and should learn them while blindfolded.

When I was 18 a counselor told me I was denying my blindness because I refused to use a white cane. He was adamant that if I was legally blind I should use blindness methods for my academic, daily living, and mobility skills. I remember feeling inadequate at the time – trying to explain to this very nice man who was blind - why I did not need or want to use a cane. I felt comfortable with using combined visual and auditory methods for getting through heavy amounts of reading assignments, but simply put, I was not blind. I had no other way to rationalize my personal decision or convince him of my visual abilities to function in an efficient, safe, and comfortable manner.

More than thirty years later, I find myself, once again, trying to explain why someone who has low vision and who meets the legal criteria for blindness may not need or want to be blindfolded or employ the methods of blindness during the rehabilitative process or in daily life unless they are unequivocally more efficient and comfortable methods. Still, people with low vision, who are legally blind, based on individual needs, benefit from special education and rehabilitative services if they are to become efficient users of their low vision, learn non-visual methods when more efficient or comfortable, and become employed with jobs that allow for reasonable accommodations.

Let me begin with five premises that are at the heart of my personal convictions about blindfolding. First, a person who has low vision is not a blind person with just a little bit of vision. Second, a person with low vision is not a person trying to deny his or her blindness. Third, a large segment of the population includes persons who have stable conditions or will not lose all of their vision. Fourth, non-visual approaches may be taught with or without a blindfold in circumstances where vision is not an efficient modality. And fifth, a person with low vision is a person with low vision; they are neither blind nor are they fully sighted and should not be coerced into functioning in one way or another. I will speak to these premises and then raise questions about the scientific merits of using a blindfold during the rehabilitative processes.

I find that people who are functionally or totally blind, and those who have not developed visual efficiency for reading or for orienting and way-finding, often think that if people with low vision would only function more as people who are blind, their problems would go away. In effect, they are saying “you are blind” and your little bit of vision is just getting in the way. I believe they find it difficult to understand that people with low vision, especially those who have stable conditions, in the higher levels of legal blindness can and do see a great deal. Vision is, and always will be, the best gatherer of information beyond arm’s reach. Once a blindfold comes off, vision appears to become the dominant sense. To ask people with low vision to function as if they have no vision asks them to not use something that is precious and that will be present and available in their daily lives. I have never seen evidence that having low vision is a detriment in learning about the world by using vision or other senses. I have never seen evidence that people with low vision who have been blindfolded do function differently (better or worse) or have different levels of confidence (higher or lower) than they would if they did not undergo blindfolding for extensive periods of time.

It was in 1934 when the American Medical Association established the visual acuity and visual field criteria for legal blindness. This was before a time when a body of knowledge was developed about the functional use of low vision and before optical devices were available to enhance the use of low vision. At that time, blindness methods were probably appropriate for a vast majority of people who met the criteria for blindness set forth in the 1935 Social Security Act. Today, however, those who receive optical devices, appropriate instruction, and emotional support may obtain competitive levels of print or print and Braille literacy and employment; they function without blindness methods or they know how and when to use non-visual approaches as complementary or secondary methods. The same may be said of those who are functionally or totally blind who receive appropriate devices and technology, appropriate instruction and emotional support – they, too, reach competitive literacy levels and are employed. However, the visually efficient people with low vision are not the ones who are giving testimony about how a lack of Braille skills or blindness skills in their educational programs have held them back academically or emotionally.

While a person with 20/200 visual acuity may not be able to see print without a magnifier with or without glasses, he can see at great distances, using central, mid- and far periphery to complete tasks, sometimes using optical devices, and sometimes using special techniques to enhance visual efficiency. If I ask people who are congenitally totally blind and those who are congenitally sighted the distance at which they think those with 20/200 or 20/400 acuity can see objects, they are often surprised to learn that one may not see details but can see snowcaps on distant mountains or detect objects as small as 3/4 inches at 27 feet from the person or identify a coin on the ground at 7 feet. Why then, would they want to rely on auditory cues and a cane touching the ground only a few steps in front of their bodies, even if this may be a safe way to travel for those who do not use vision? Of course environmental conditions, level of vision, and prior experience in learning to use vision may have an impact on what is seen and how it is interpreted but these levels of vision are often far more efficient than non-visual methods. Also, even when there are fluctuations in vision, I believe people with low vision learn when to use and when not to rely on visual methods, and this may be taught without blindfolding. It is not as if the lights go out, new or different methods are employed based on different environmental conditions, and with vision when appropriate.

Young children with low vision often do “test” to see what it means to be “more blind” or “more sighted”. The world may look “normal” to them and they wonder why others speak about their poor vision. Gradually, they piece together what it means to have low vision and they learn that others are reading small print and identifying objects at much farther distances than they can. As they have no comparison, children with congenital low visual acuity do not see the world as “blurry” or “foggy”. Those with other types of low vision e.g., field restrictions, also put the pieces of the puzzle together and begin to understand how they see differently.

It is heart wrenching when we hear from people who, as children, should have learned Braille or other non-visual methods as primary or complementary methods along with their sight. I am pleased that educational services for students with visual impairments has moved forward in its thinking. With functional vision assessments, learning media assessments, and clinical low vision evaluations, Braille, print, or a dual media approach are appropriately available. Today, the challenge may not be so much as whether a child should learn Braille, print, or a combined approach but how many hours of instruction are delivered by a qualified teacher. Braille can be taught without blindfolding the person learning to read by touch.

Professionals sometimes marvel at the tasks people with low vision can accomplish and then say but the people coming to me have such poor vision that blindfolding is the only approach that makes sense. I wonder, if people weren’t blindfolded whether these same people might reach higher levels of visual efficiency, if this is their choice. Might the opposite approach, teaching enhancement of low vision throughout the day, show significant results.

Only after a functional vision assessment, a clinical low vision assessment, and an orientation and mobility assessment, can projections be made as to the extent to which a child or adult can learn to use their vision for literacy and for orientation and mobility, the extent to which they may become efficient, safe, comfortable, and confident. Without these assessments it is inappropriate to say that everyone needs any specific treatment to become rehabilitated. Blindfolding shouldn’t be the response when people receive no or poor quality low vision services.

Can we draw upon the experiences of people from other disability areas? We don’t place earmuffs on children who are hard of hearing to ask them to learn to sign and read lips. Although some people who are deaf may suggest holding back amplification, this is more of a cultural issue than one of teaching children with hearing impairments to improve their communication skills with the population that hears. The vast majority of professionals in hearing impairments, I believe consider the use of hearing aids and cochlear implants a positive approach rather than one that robs a child of his deafness.

I cannot fully understand the experience of blindness just as I do not believe someone who is blind and who has never seen or who has not become visually efficient can fully understand what the experience of low vision is all about. I would not presume to be the spokesperson to tell what is “best” for people who are blind and I hope that those who are functionally or totally blind would not assume they fully understand what is “best” for children or adults who have the potential to use their vision well. Fully sighted people also cannot fully understand people with low vision just as they cannot fully understand those who are blind. However, there are fully sighted people and blind people who through their professional and personal experiences with those with low vision who are highly respected and who bring much wisdom to this discussion.

Blindness methods work well and can surely be trusted by those who are functionally or totally blind. Educators have for many years believed that multi-sensory approaches work best in teaching skills such as reading. Why then should we assume that removing a sense results in better functioning with that sense?

Some people may say that results are sufficient. Anecdotal responses tell us that people who have been blindfolded are pleased and feel they have benefited from the experience. We know that a portion of people taking placebo drugs also believe they have benefited from taking them. We also have a self-selected sample of the visually impaired population, those who are willing to be blindfolded. This sample may not be able to speak to the benefits or adverse effects that may be derived from blindfolding. We also know that people respond positively to caring treatment. Can you imagine being thrust into blackness (not blindness since they see the inside of their sleep shades) and then have caring people give positive strokes because you have learned skills? I think satisfaction here would be high – but are the results effective?

To date, I know of no empirical research that speaks to whether there are benefits in the development of skills or self-confidence with the blindfold experience. Some research questions may include:

  1. Are there significant differences in outcomes for the two treatment options (with and without blindfolds) when people have:
    1. stable vs. progressive conditions?
    2. Higher or lower levels of visual functioning
    3. Low visual acuity and/or significant visual field restrictions
    4. Congenital vs. adventitious low vision
    5. Use blindfolds for different periods of time, e.g., 8 hours/day, 16 hours/day, or specific to task learning
    6. Total immersion or gradually add more time and/or more physical movements under blindfolds?
  2. Do people who have had blindfold experience use their low vision more or less efficiently with their other senses when they remove the blindfold than those who have received quality low vision services?
  3. Are there specific personality characteristics that should contraindicate use of sleep shades for rehabilitative processes?

I consider it irresponsible to blindfold for several hours at a time unless we know that there are no adverse effects, e.g., increased fears, or that the adverse effects are minimal or impact a very low percentage of the population. I also consider it irresponsible to blindfold without evidence that there are advantages to use of the blindfold that significantly outweigh receiving rehabilitative services without the blindfold.

I believe when any controversial methodology is used, as blindfolding is today, that clients must receive information about the best scientific knowledge to date along with professionals’ experience with clients with similar eye conditions. One without the other is not acceptable.? Saying, “I believe it works”, or “I hear from others that it has helped them” is simply not providing responsible information to clients. If I were to look into the effectiveness of blindfolding at my university, I would be required to have my methods undergo a review by our human subjects committee. If I were to use any “innovative treatment” at a Vanderbilt facility to aid a person, I would need an informed consent. This consent would need to include any potential adverse effects that are known. Without a method for documenting adverse effects, one cannot assure people undergoing that treatment that none exist.

Furthermore, adults learn to make good choices and problem solve when given opportunities to do so. To require a blindfold experience in order to receive rehabilitation services is taking away one of the most important decisions a person with low vision can make. It also placed them in a difficult position not faced by those who are blind. To accept the blindfold says I am blind and I should do as I am told – to refuse it makes one feel like an imposter, accepting services from a “commission for the blind” where only truly blind people should be recipients. If I were trying to make such a decision, two questions I might ask are, Will I receive visual efficiency training following the use of the blindfold or are you suggesting I just learn not to use my vision at all? How will I understand when my vision is and is not useful to me if I don’t have a chance to receive such feedback during rehabilitation? With research, it may show that the population of people who currently refuse services because of the practice of blindfolding may re-consider and accept services once there is hard data.

Another argument I’ve heard for blindfolding is that people with low vision have low self-esteem. I can assure you it is not because they have vision that they have low self-esteem. I believe some of the problems may be due to the fact that they are being pushed in two directions, to be more like those who are blind and then they feel like the imposter, or to be more like those who are sighted and then they are less capable. I hope to see the time when professionals consider it acceptable for people to just have low vision.

Are there circumstances under which I could envision blindfolding as an effective method? Yes, but I want to know more about the effects before I recommend this to adults who are undergoing rehabilitation. I could envision several appropriate uses for a blindfold including but not limited to: people for whom vision is so low that it is confusing to them under certain circumstances, people who experience night blindness, people who have low levels of vision with progressive conditions and when under the care of a psychologist or psychiatrist a person has such fears of blindness that under controlled circumstances, periods of blindfolding are recommended. I am not saying that low vision or blindness creates in and of themselves a need for mental health care. Rather, I am saying that there are people for whom the adjusting processes are so stressful that counseling should be a part of their rehabilitative services. When some of these conditions are evident and there is scientific evidence to the benefits, then a recommendation may be made that a client consider blindfolding.?

Finally, while our field has traditionally stayed away from the medical model, I see blindfolding as a treatment that can have benefits as well as detrimental effects when not used responsibly. Are we going to continue to carry these personal convictions without scientific review? Are you ready to take your pill – I hear it is good for you.


Developed by Chrissy Cowan, TVI

 

Magnifier Lesson 1: Orientation to a Handheld Magnifier

Procedure

  1. Have on display a variety of objects to investigate with a magnifier.  Examples include feathers, leaves, cloth, seeds, money, coral, paper wasp nest, and sticker burrs.  (a lamp may be needed if lighting is insufficient)
  2. Allow the student to investigate the materials without the magnifier.  Introduce a handheld magnifier in order to see the finer details of the objects on display.  Demonstrate how to hold the magnifier to get the clearest image.  Introduce the term “focal distance”, or the distance between the magnifier lens and the object being viewed. 
  3. Optional activities to stretch this activity:
  • Draw  pictures of what you see
  • Look up the object in a field guide
  • Go for a walk to investigate objects found outside

4.   Ask the student if there are things up close he would like to be able to see better.  Make a list.

Additional Activities:

 

Magnifier Lesson 2: Orientation to a Stand Magnifier

Procedure

  1. Explain the difference between a handheld and stand magnifier.  (refer to p. 170 in Looking to Learn) Be sure to mention the types of materials and situations in which you would use each kind of magnifier.
  2. Play a game using the stand magnifier to read fine print.  Examples of games include Monopoly (read the spaces on the board, the real estate cards, and the Chance/Community Chest cards); Trivial Pursuits; any board game that includes small cards to read.
  3. Look at photographs you and your student bring from home of family, pets, etc. 
  4. Compare finger prints.  

Additional Activities:

 

Magnifier Lesson 3: Positioning, Stabilizing Material, Stabilizing the Hand, Adjusting Head-to-Lens Distance

Procedure

  1. These skills are the “ergonomics” of using a magnifier.  They will enable the student to read for extended periods of time with less back, neck, and arm strain.  Use a 3-ring binder tilted toward the student on which to set (flat) material.  Both feet should be flat on the floor, the head to lens distance should be comfortably maintained, and the hand holding the magnifier should be stabilized.  There are slightly different techniques for the two different styles of magnifier (refer to pages 174-176 in Looking to Learn)
  2. Place materials to be viewed on the binder to practice with the magnifier.  Be sure to use materials which may be of interest to your student.  Examples include CD music case, lyrics of a song, jokes, magazines, Nintendo magazine, photo album.
  3. Practice moving smoothly across the material being viewed, keeping a comfortable posture and supporting the hand/arm holding the magnifier.  Ask the student to describe what he sees.

Additional Activities:

 

Magnifier Lesson 4: Reading on a Flat Surface / Reading a Variety of Formats

Procedure

  1. Examples of materials for this lesson include books, letters, workbooks, worksheets, newspapers, and magazines.  For this lesson, however, be sure the materials are spaced evenly (not single spaced, as this is too difficult just yet), and arranged in a systematic order on the page. 
  2. Encourage correct positioning of the body and materials (refer to the previous lesson).
  3. Demonstrate the correct scanning technique:  Start in the upper left corner.  Move across the top, then backtrack and move down.  Repeat to the bottom right corner.  Ask your student to tell you the format that was used on this page (columns, boxes, continuous text)
  4. Ask the student to read or describe the content of the page.
  5. Follow this lesson with examples of a variety of formats.  (refer to page 177-178 in Looking to Learn for ideas on more formats)  Be sure to include a sample of the student’s own handwriting.

Additional Activities:

 

Magnifier Lesson 5: Tracking at Reading Speed

Procedure

  1. Before starting this lesson, the student must be experienced at stabilizing materials and using positioning that enables him to read for longer periods of time.  This lesson also assumes that the student has some fluency in reading. 
  2. Two modifications which may help the student stay on the line include a ruler (to hold under the line being read when using a handheld magnifier) or placing a Post-It note along the middle of the bottom of the stand magnifier.
  3. Start by asking the student to smoothly track across each line of print, but don’t read just yet.  Use materials that are double spaced.
  4. The object is to track while staying on the line with the magnifier.  Reinforce smooth left to right, up to down movements  
  5. Ask the student to read out loud.  Ask one or two comprehension questions when he is finished. 
  6. As you continue with this type of lesson, introduce a stop watch for the student to time himself.  Keep a chart noting the date, # of words read in 5 minutes, the # of miscues (mistakes), and the percentage of comprehension questions he answered correctly.  Keep the time frame to 5 minutes until it is relatively easy for your student.  Gradually you will increase this time to up to 20 minutes.
  7. To perfect this skill, the student will need to practice at least 3 times a week for 5-15 minutes each time.  This will mean either assigning work to be done at home, or to be done in another setting at school.

Additional Activities:  (or ideas for reading materials)

 

 

Magnifier Lesson 6: Using the Magnifier for Classroom Assignments

Procedure

In order to use the magnifier successfully in class, your student will have to be proficient at positioning, tracking, and adjusting to different formats.  Start by selecting one class or subject area (or ask your student to select one) in which to integrate reading with the magnifier.  Discuss your objective with the classroom teacher, including a reinforcement system to be used.  Ultimately, the classroom teacher will have to encourage and reinforce usage of the magnifier in your absence.

Observe the class on a typical day to see the type of (near) reading required of your student (e.g. text book, worksheets, taking notes).  Select one reading task to reinforce (the shortest or easiest). 

  1. Discuss your objective with the student:  To use the magnifier to read in at least one class.  Review the reinforcement system you and his classroom teacher have decided upon. 
  2. Ask him to begin today (or tomorrow) in one class (or subject area).  Remind him that you will be observing during this class time next week.
  3. On the following week, step into the class to observe how the magnifier is being used, but avoid using this time to correct your student if this would be intrusive.
  4. At your next lesson, discuss your observations.  Give tips, if necessary, on techniques which may increase speed or stamina.
  5. Ask your student to select a second class in which to use the magnifier.  Continue to add classes.

Additional Activities:

 

Magnifier Lesson 7: Using the Magnifier for Life Skills

Procedure

Life skills reading with a magnifier includes the day to day reading that we all do outside of school.  This includes medicine bottles, menus, bills, inserts on CD’s, cans, maps, charts, recipes, oven dials….the list is endless. 

  1. Give your student a sheet of paper and ask him to list all the things in his house he sees people reading.  Or, he can ask each person in his house what they have read today. 
  2. When he brings this list back to school, review it with him.  Ask him to mark the things he can read well without magnification.  Ask him if there are any things not on the list that he would like to be able to see better (things using near vision).
  3. Collect as many of these items as you can for the next lesson.
  4. On the next lesson, practice reading these items.  They may require different types of magnifiers, so be prepared by having both stand and handheld magnifiers available.  As he is able to access each item, put a check next to it on the list.  Add the names of items he discovers he can read more easily with the magnifier.

Additional Activities:

  

 

Goals and Objectives For Magnifiers 

The following goals and objectives are purposely not written in measurable terms in order to enable the teacher of students who are visually impaired to customize them to individual students.

GOAL:  To demonstrate skills for magnifier maintenance

OBJECTIVES:  The student will be able to:

  1. Hold the magnifier properly
  2. Communicate the purpose of the magnifier
  3. Clean the magnifier appropriately
  4. Assume responsibility for the magnifier
  5. Store the magnifier in a convenient location for quick retrieval
  6. Initiate the use of the magnifier

GOAL:  To demonstrate skills for magnifier use

OBJECTIVES:  The student will be able to…

  1. Position self for optimal viewing
  2. Stabilize the reading material/object
  3. Stabilize the hand using the magnifier
  4. Adjust the head-to-lens distance
  5. Coordinate the hand, head, and eye movements specific to the type of magnifier
  6. Use the magnifier to read on a flat surfaces
  7. Read a variety of print formats
  8. Track at a speed which allows for reading commensurate with reading level
  9. Develop stamina for the duration of an age- or grade-appropriate assignment
  10. Select the appropriate magnifier for the task
  11. Use the magnifier for nonprint activities

(P.S. NEWS!, Vol. IV, No. 3, July 1991, pages 10-12.)

by Robbie Blaha, Teacher Trainer and Kate Moss (Hurst), Family Training Coordinator

En Espanol

There are few events in our day to day lives that do not become routines. Whether it is brushing our teeth, putting gas in our cars, or going bowling there exists in our minds a series of predictable steps and specific objects associated with those steps. Often we move through these familiar activities with little notice. However, there are aspects of these routine activities that deserve a second look. A well organized routine can have a powerful effect on a child with severe disabilities. Children with severe disabilities have been shown to benefit from learning through routines.

If you consider your child's day, you probably have already established a variety of routines. Think about changing a diaper, eating a meal, bath time, etc. These events happen daily and generally in a predictable or routine way. Here are some things that these routines are providing your child.

AN OPPORTUNITY TO COMMUNICATE

You may notice during these activities your child seems to communicate a great deal with you. His subtle or sometimes not so subtle responses during these events might "tell" you, "I'm not hungry," "I'm ready to get out of the tub," etc. You understand and respond to these communications by skipping to dessert or pulling the plug on the tub and wrapping the child in a towel.

EMOTIONAL SUPPORT IN LEARNING

Routines feel comfortable and the child uses his energy and attention more efficiently. When a person who is not familiar with your routine way of doing an activity, attempts to feed or bathe your child, the child might become anxious or uncooperative. Yet if you direct that person to do it your way the child will often calm and respond better. He's familiar with the routine. That helps him to better anticipate and participate in the activity.

A FRAMEWORK FOR LEARNING

Routines develop a sense of a beginning, middle and an end to an activity. They also help weave a cluster of people, actions, objects and locations into a meaningful whole. Routines make use of natural cues, i.e. one step acts as a cue for the next step. This type of cueing does not require another person to always prompt the child because the objects used in the activity serve as the prompts. In addition routines can help a child anticipate an end to an undesired activity or recognize the beginning of a desired activity.

A WAY TO BUILD PROCEDURAL MEMORY

Routines build a memory foundation for other learning. Paul Carreiro and Sue Townsend (Routines: Understanding Their Power) note that the development of a sophisticated memory is dependent on a core memory system referred to as "procedural memory." Procedural memory is defined as "the ability to retain a simple everyday 'low attentional' understanding of how things work." If a child does not have an organized experience he can not understand. If he can not understand an experience he will not learn from it.

A WAY TO HIGHLIGHT NEW INFORMATION

When a child has an internal picture of an activity he can recognize when something changes. He is alerted to attend and learn the new part. He can become aware of specific bits of information that impact him and is more likely to tune in to that particular concept. For example, if a child has a routine for making pudding, you can introduce a new flavor. The child will tune in to the flavor being different because everything else in the activity has stayed the same. The difference in flavor can be "spotlighted."

Using routines at home can reinforce learning, improve communication between the child and family, and reduce frustration for everyone. The information that follows will help you formalize your existing home routines. If you do not use routines, you might want to consider developing some. As you develop routines, share them with school personnel. If your school is not using routines currently with your child, you might encourage them to become familiar with the concept of using routines in learning.

CHOOSING THE ACTIVITIES

Before you set up your routines it is important to decide which of your child's daily activities you want to formalize into routines. The following tips will help you in this process:

1. Map out a typical week day and weekend day for your child. (Figure 1)

2. Begin by picking obvious activities where routines are likely to exist already such as eating, toileting. Give special consideration to those activities that will be most beneficial to the child's mental and physical health. Next look at those activities that adults must do for the child. Would these activities be made easier if your child could participate partially? For example, it would be helpful if the older child could anticipate when you need to slide a diaper under him and participate by raising his bottom rather than requiring you to have to lift him. Finally look at those activities that could be done as vocational activities.

Figure 1 - Mapping out a typical week day and weekend schedule helps to identify existing routines which can be formalized. It can also help to identify times when routines might be helpful to the child and family.
WEEK DAY SCHEDULEWEEKEND SCHEDULE
6:30 a.m. wake up 7:30 a.m. wake up
6:40 a.m. bathroom 7:40 a.m. bathroom
6:50 a.m. breakfast & medications 7:45 a.m. help dad cook pancakes
7:15 a.m. brush teeth 8:30 a.m. breakfast & medications
7:30 a.m. dress 9:00 a.m. brush teeth
8:00 a.m. catch bus 9:15 a.m. dress
AT SCHOOL 9:45 a.m. free time
10:45 a.m. family activity
3:30 p.m. return home 1:00 p.m. lunch time
3:45 p.m. bathroom 2:45 p.m. continue family activity
3:50 p.m. snack 4:00 p.m. snack
4:15 p.m. freetime 4:15 p.m. freetime
6:00 p.m. dinner 6:00 p.m. dinner
7:00 p.m. plays with dad 7:00 p.m. plays with dad
8:00 p.m. bath 8:00 p.m. bath
8:30 p.m. bedtime 8:30 p.m. bedtime

DEVELOPING THE ROUTINE

After you have identified activities for routines it will be helpful to write these routines out. List all the steps in the activity in the order in which they occur. The amount of detail in each step will depend on the expectations you have for your child. You might have the staff at your child's school review these routines and decide which specific IEP objectives could be worked on during the routine. These objectives could be written into your routine script. One objective might be included in several different routines. (Figure 2.)

MEAL TIME ROUTINE

  1. Walk to dining table (Trail wall from hall to dining room)
  2. Find chair and sit down
  3. Wait for mom/dad to put on bib
  4. Look for spoon when tapped on table and pick it up (Use visions to explore space and locate objects. Grasp object)
  5. Allow mom/dad to help scoop and carry spoon to mouth (hand over hand)
  6. Set down spoon and reach for cup when drink is offered, or set down cup and reach for dessert (Indicate choice by reaching for preferred item)
  7. Help move plate away when meal is finished
  8. Allow mom/dad to wipe off hands and face
  9. Drink medication from medicine cup
  10. Remove bib (Remove clothing independently)
  11. Get down from chair

Figure 2 - A mealtime routine might include steps in which IEP objectives can be imbedded. The objectives appear in italics.

You might enjoy tracking your child's success in carrying out the routine. A nice way to do that is by making periodic video tapes of the activity or keeping a log that you share with school. You may even come up with some other method to note the changes. It is important to remember that this type of information can and should be shared with the ARD committee when assessment data is being reviewed.

SETTING UP A SCHEDULE

Family life is subject to unexpected events and unplanned for crises. Given that, set up a schedule that is reasonable for you. Don't plan to take on too many new routines until you feel comfortable with the existing routines. When a routine becomes formalized, it may take longer to do especially if you expect your child to participate more in the activity. Allow for more time to complete the activity, or if that is not possible, opt to reduce the level of the child's expected participation. For example, family meal times may prove to be too hectic for encouraging the child to try emerging self feeding skills; however, snack time might be more relaxed. Instead of writing out a meal routine that includes using new self feeding skills, you might focus on these during the snack activity.

Once you have identified some routines that exist in your day write out a schedule. You may not be able to follow it exactly everyday, but if you have a schedule and everyone knows it, you will be more likely to follow it. Post the schedule on the refrigerator. Tape up the individual routines near the area where the activity will take place. Share this schedule and the routines with those individuals who may fill in for you such as grandparents, baby sitters, and siblings. It is especially important to share these routines with the educational staff who work with your child. This will help the staff to design their routines to be consistent with the routines that take place at home.

Editor's Notes: There is much more to learn about routines and their uses with children who are deaf-blind. Look for future P.S. NEWS !!! articles to cover this material. If you have questions about this article please contact Robbie at or Kate at . This article is based on two articles by Paul Carreiro and Sue Townsend who are communicative disorder consultants with Student Services in Edmonton Public Schools in Alberta, Canada. The articles are titled Routines: Understanding Their Power and Implementing the Routine Model.

by Robbie Blaha, Teacher Trainer and Kate Moss, Family Training Coordinator

Originally published in P.S. NEWS!, Vol. IV, No. 3, July 1991.

There are few events in our day to day lives that do not become routines. Whether it is brushing our teeth, putting gas in our cars, or going bowling there exists in our minds a series of predictable steps and specific objects associated with those steps. Often we move through these familiar activities with little notice. However, there are aspects of these routine activities that deserve a second look. A well organized routine can have a powerful effect on a child with severe disabilities. Children with severe disabilites have been shown to benefit from learning through routines.

If you consider your child's day, you probably have already established a variety of routines. Think about changing a diaper, eating a meal, bath time, etc. These events happen daily and generally in a predictable or routine way. Here are some things that these routines are providing your child.

AN OPPORTUNITY TO COMMUNICATE

You may notice during these activities your child seems to communicate a great deal with you. His subtle or sometimes not so subtle responses during these events might "tell" you, "I'm not hungry", "I'm ready to get out of the tub", etc. You understand and respond to these communications by skipping to dessert or pulling the plug on the tub and wrapping the child in a towel.

EMOTIONAL SUPPORT IN LEARNING

Routines feel comfortable and the child uses his energy and attention more efficiently. When a person who is not familiar with your routine way of doing an activity, attempts to feed or bathe your child, the child might become anxious or uncooperative. Yet if you direct that person to do it your way the child will often calm and respond better. He's familiar with the routine. That helps him to better anticipate and participate in the activity.

A FRAMEWORK FOR LEARNING

Routines develop a sense of a beginning, middle and an end to an activity. They also help weave a cluster of people, actions, objects and locations into a meaningful whole. Routines make use of natural cues, i.e. one step acts as a cue for the next step. This type of cueing does not require another person to always prompt the child because the objects used in the activity serve as the prompts. In addition routines can help a child anticipate an end to an undesired activity or recognize the beginning of a desired activity.

A WAY TO BUILD PROCEDURAL MEMORY

Routines build a memory foundation for other learning. Paul Carreiro and Sue Townsend (Routines: Understanding Their Power) note that the development of a sophisticated memory is dependent on a core memory system referred to as "procedural memory". Procedural memory is defined as "the ability to retain a simple everyday 'low attentional' understanding of how things work." If a child does not have an organized experience he can not understand. If he can not understand an experience he will not learn from it.

A WAY TO HIGHLIGHT NEW INFORMATION

When a child has an internal picture of an activity he can recognize when something changes. He is alerted to attend and learn the new part. He can become aware of specific bits of information that impact him and is more likely to tune in to that particular concept. For example, if a child has a routine for making pudding, you can introduce a new flavor. The child will tune in to the flavor being different because everything else in the activity has stayed the same. The difference in flavor can be "spotlighted".

Using routines at home can reinforce learning, improve communication between the child and family, and reduce frustration for everyone. The information that follows will help you formalize your existing home routines. If you do not use routines, you might want to consider developing some. As you develop routines, share them with school personnel. If your school is not using routines currently with your child, you might encourage them to become familiar with the concept of using routines in learning.

CHOOSING THE ACTIVITIES

Before you set up your routines it is important to decide which of your child's daily activites you want to formalize into routines. The following tips will help you in this process:

1. Map out a typical week day and weekend day for your child. (Figure 1)

2. Begin by picking obvious activities where routines are likely to exist already such as eating, toileting. Give special consideration to those activites that will be most beneficial to the child's mental and physical health. Next look at those activites that adults must do for the child. Would these activities be made easier if your child could participate partially? For example, it would be helpful if the older child could anticipate when you need to slide a diaper under him and participate by raising his bottom rather than requiring you to have to lift him. Finally look at those activites that could be done as vocational activites.

Figure 1 - Mapping out a typical week day and weekend schedule helps to identify existing routines which can be formalized. It can also help to identify times when routines might be helpful to the child and family.
WEEK DAY SCHEDULEWEEKEND SCHEDULE
6:30 a.m. wake up 7:30 a.m. wake up
6:40 a.m. bathroom 7:40 a.m. bathroom
6:50 a.m. breakfast & medications 7:45 a.m. help dad cook pancakes
7:15 a.m. brush teeth 8:30 a.m. breakfast & medications
7:30 a.m. dress 9:00 a.m. brush teeth
8:00 a.m. catch bus 9:15 a.m. dress
AT SCHOOL 9:45 a.m. free time
10:45 a.m. family activity
3:30 p.m. return home 1:00 p.m. lunch time
3:45 p.m. bathroom 2:45 p.m. continue family activity
3:50 p.m. snack 4:00 p.m. snack
4:15 p.m. freetime 4:15 p.m. freetime
6:00 p.m. dinner 6:00 p.m. dinner
7:00 p.m. plays with dad 7:00 p.m. plays with dad
8:00 p.m. bath 8:00 p.m. bath
8:30 p.m. bedtime 8:30 p.m. bedtime

DEVELOPING THE ROUTINE

After you have identified activities for routines it will be helpful to write these routines out. List all the steps in the activity in the order in which they occur. The amount of detail in each step will depend on the expectations you have for your child. You might have the staff at your child's school review these routines and decide which specific IEP objectives could be worked on during the routine. These objectives could be written into your routine script. One objective might be included in several different routines. (Figure 2.)

MEAL TIME ROUTINE

  1. Walk to dining table (Trail wall from hall to dining room)
  2. Find chair and sit down
  3. Wait for mom/dad to put on bib
  4. Look for spoon when tapped on table and pick it up (Use visions to explore space and locate objects. Grasp object.)
  5. Allow mom/dad to help scoop and carry spoon to mouth (hand over hand)
  6. Set down spoon and reach for cup when drink is offered, or set down cup and reach for dessert. (Indicate choice by reaching for preferred item.)
  7. Help move plate away when meal is finished
  8. Allow mom/dad to wipe off hands and face
  9. Drink medication from medicine cup
  10. Remove bib (Remove clothing independently.)
  11. Get down from chair

Figure 2 - A mealtime routine might include steps in which IEP objectives can be imbedded. The objectives appear in italics.

You might enjoy tracking your child's success in carrying out the routine. A nice way to do that is by making periodic video tapes of the activity or keeping a log that you share with school. You may even come up with some other method to note the changes. It is important to remember that this type of information can and should be shared with the ARD committee when assessment data is being reviewed.

SETTING UP A SCHEDULE

Family life is subject to unexpected events and unplanned for crises. Given that, set up a schedule that is reasonable for you. Don't plan to take on too many new routines until you feel comfortable with the existing routines. When a routine becomes formalized, it may take longer to do especially if you expect your child to participate more in the activity. Allow for more time to complete the activity, or if that is not possible, opt to reduce the level of the child's expected participation. For example, family meal times may prove to be too hectic for encouraging the child to try emerging self feeding skills; however, snack time might be more relaxed. Instead of writing out a meal routine that includes using new self feeding skills, you might focus on these during the snack activity.

Once you have identified some routines that exist in your day write out a schedule. You may not be able to follow it exactly everyday, but if you have a schedule and everyone knows it, you will be more likely to follow it. Post the schedule on the refrigerator. Tape up the individual routines near the area where the activity will take place. Share this schedule and the routines with those individuals who may fill in for you such as grandparents, baby sitters, and siblings. It is especially important to share these routines with the educational staff who work with your child. This will help the staff to design their routines to be consistent with the routines that take place at home.

Editor's Notes: There is much more to learn about routines and their uses with children who are deaf-blind. Look for future P.S. NEWS !!! articles to cover this material. If you have questions about this article please contact Robbie or Kate. This article is based on two articles by Paul Carreiro and Sue Townsend who are communicative disorder consultants with Student Services in Edmonton Public Schools in Alberta, Canada. The articles are titled "Routines: Understanding Their Power" and "Implementing the Routine Model."

For a complete listing of Strategies and Techniques to use with students with CVI, go to Diane Sheline's web site; www.strategytosee.com   
Or contact Diane Sheline at: 

Phase I

  • Yellow or red beeping ball (from APH, Sound Ball)
  • Red reflective self-adhesive covering (Con-Tact Brand, Red Glimmer)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Black gloves (From APH, Sensory Learning Kit)
  • Red Mylar Pom Pom (www.orientaltrading.com, Toys R Us, Hobby Lobby)
  • Yellow slinky, red slinky (www.orientaltrading.com, Toys R Us)
  • Super-Bright 100 LED Flashlight (www.amazon.com)
  • Invisiboard (from APH)
  • All-In-One Board (from APH)
  • Colorful, single colored targets with Velcro on back
  • Yellow ball, yellow bowl (from APH, TOAD Kit)
  • Children’s pop-up tent lined in Velcro compatible fabric
  • Red bike safety light (Extreme LED Safetylight, SX-6000 Extreme Mini-Pro, www.duravisionpro.com)
  • GE 100 Lights Super Sphere - red
  • Swirly Mat (from APH, in the TOAD Kit or order separately)
  • Gold mylar gift bag
  • Red spoon with mylar ribbon attach to it

Phase I, Clip 1

  • Invisiboard (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Large red ball (Celebrate It Christmas, Craft Ornament, from Michael’s, seasonal)
  • Red and Yellow slinky (www.orientaltrading.com, Toys R Us)
  • Red pom pom (www.orientaltrading.com, Toys R Us, Hobby Lobby
  • Yellow pom pom (from APH, Sensory Learning Kit))
  • Super-Bright 100 LED Flashlight (www.amazon.com)

Phase II

  • Purple pom pom (www.orientaltrading.com, Toys R Us)
  • Red beeping ball (from APH, Sound Ball)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Reading stand, black (from APH)
  • Mac switch (from APH, Sensory Learning Kit)
  • Power switch (from APH, Sensory Learning Kit)
  • GE 100 Lights Super Sphere - red
  • Lightbox (from APH)
  • Lightbox Materials, blocks and bowls (from APH)
  • Super-Bright 100 LED Flashlight (www.amazon.com)
  • Red Elmo doll (Toys R Us)
  • Red blinking cup (Walgreens, 2 for $5.00, seasonal)

Phase II, Clip 1

  • Invisiboard (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Flashlight and yellow ball cap (from APH, Sensory Learning Kit)
  • Ott Lite/standing floor light

Phase II, Clip 2

  • Invisiboard (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Blinking light toothbrush, in red or yellow, made by Crayola (purchase at any drugstore or grocery store in the toothbrush section)

Phase III

  • Yellow highlighter (Office Depot)
  • Yellow Highlighter Tape (Lee Products, ½” Removable Highlighter Tape)
  • Reading stand, black (from APH)
  • Yellow or Red Avery Self-Adhesive Coding dots (Office Depot)
  • Red (or yellow) reflective tape/strip (from hardware stores or www.findtape.com)
  • Black mat/frame (from hobby store or Michael’s)
  • Yellow glare reducer sheet (from APH, GlaReducer Sheets, 4 pack)
  • Black template, or “window”, cut from black construction paper 
  • Bright Line Marker (from APH)
  • Desk light (from APH, Lighting Guide Kit)
  • Red Elmo with red mylar ribbon “tie”
  • Children’s book with reflective, mylar-like pages
  • Large, black mat “frame” cut from black foam board

Phase III, Clip 1

  • All-In-One Board (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Red, plastic letters (Toys R Us or Teacher Supply store)
  • Desk light (from APH, Lighting Guide Kit) or Ott Lite

Phase III, Clip 2

  • Black “frame” cut from black foam board

For a complete listing of Strategies and Techniques to use with students with CVI, go to Diane Sheline's web site; www.strategytosee.com   
Or contact Diane at: 

 

National

Texas: General

Texas: Visual Impairment

Texas: Deaf & Hard of Hearing

Local Family Organizations

  • There are wonderful family organizations active in local communities all over Texas.  To learn more about them, please contact your local Division for Blind Services office, TSBVI Outreach or Texas Parent to Parent.

National

NAPVI Jewish GuildNational Association for Parents of Children with Visual Impairments

NAPVI is a national, non-profit, independent organization that enables parents to find information and resources for their children who are blind or visually impaired, including those with additional disabilities. NAPVI provides leadership, support, and training to assist parents in helping their children reach their full potential. NAPVI is dedicated to:

  • Giving emotional support
  • Parent education
  • Initiating outreach programs
  • Networking
  • Advocating for the educational needs and welfare of children who are blind or visually impaired

NAPVI, 15 West 65th Street, New York, NY  10023
Susan LaVenture, Executive Director
Phone:  212-769-7819
Toll free:  800-562-6265

Email: 

Website:  http://www.lighthouseguild.org/napvi

Family Connect Website:  http://www.familyconnect.org/parentsitehome.asp    

NFADB logoNational Family Association for Deaf-Blind

    The National Family Association for Deaf-Blind (NFADB) is a nonprofit 501(c) 3, volunteer-based organization that has served families since 1994. NFADB is the largest network of families focused on deaf-blindness. Originally started by and for families of individuals who are deaf-blind, our membership is now extended to any person or organization that desires to support individuals and families who are deafblind.  

We are all in this community together!

Visit us on the web at www.nfadb.org and on Facebook.

For questions, please call Lori at 1-800-255-0411 or   

PacerPACER Center

The mission of PACER Center (Parent Advocacy Coalition for Educational Rights) is to expand opportunities and enhance the quality of life of children and young adults with disabilities and their families, based on the concept of parents helping parents. http://www.pacer.org/parent/

Founded in 1977, PACER Center was created by parents of children and youth with disabilities to help other parents and families facing similar challenges. Today, PACER Center expands opportunities and enhances the quality of life of children and young adults with disabilities and their families. PACER is staffed primarily by parents of children with disabilities and works in coalition with 18 disability organizations.

With assistance to individual families, workshops, materials for parents and professionals, and leadership in securing a free and appropriate public education for all children, PACER's work affects and encourages families in Minnesota and across the nation.

Visit the PACER Center on the web at www.pacer.org or on Facebook  

Texas: General

Texas Partners ResourcesPartners Resource Network

Partners Resource Network (PRN) is a non-profit agency that operates the state wide network of federally funded Parent Training and Information Centers (PTIs) in Texas. The PTI Projects are:

PATH http://prntexas.org/path

PEN http://prntexas.org/pen

TEAM http://prntexas.org/team

The programs and services of PRN are based on the concept of parents helping parents. Our mission is to empower parents of children and youth with disabilities in their roles as parents, decision makers, and advocates for their children and to promote partnerships among parents and professionals.

Our web site is designed to provide timely information and to link the visitor with other resources in Texas and the nation. Our goal is to make a positive difference in the lives of infants, toddlers, children and young adults with disabilities and their families who live in the great State of Texas.

1090 Longfellow Drive, Suite B, Beaumont, TX 77706
Phone:  409-898-4684
Toll free TX Parents Only: 1-800-866-4726

Email: 

Website:  prntexas.org/

Family to Family Network

The mission of Family to Family Network is to help families of children with disabilities by providing information, training, referral and support

13150 FM 529, Suite 106 Houston, TX 77041
Phone:  713-466-6304
Email: 

Website:  www.familytofamilynetwork.org/

Texas Project First Website:  http://texasprojectfirst.org/index.html 

Texas Parent to Parent

Texas Parent to Parent is a state-wide non-profit organization that provides support to families of children with disabilities, chronic illnesses, and other special health care needs by empowering their families to be advocates for them through peer support, resource referral and public awareness.

3710 Cedar Street, Box 12, Austin, Texas  78705
Phone:  512- 458-8600
Toll free phone:  866-896-6001

Website:  www.txp2p.org

Texas: Visual Impairment  

Texas Association for Parents of Children with Visual Impairments

Texas Association for Parents of Children with Visual Impairments (TAPVI)

TAPVI is an affiliate of NAPVI. We are a non-profit organization that provides support to the families of children who have blindness or visual impairments, including those with additional disabilities. TAPVI enables families to find information and resources, as well as connect and network with one another. We offer leadership, support, and training to assist families in helping children reach their full potential in school and in the community.

View a video from TAPVI: https://www.youtube.com/watch?v=Fekev47SGr4

Visit the TAPVI Website: http://www.tapvi.com/

Visit TAPVI on Facebook: https://www.facebook.com/groups/TAPVI

TXPBCTexas Parents Of Blind Children

Texas Parents Of Blind Children (TPOBC) is the state chapter of the National Organization of Parents of Blind Children (NOPBC), a division of the NFB of Texas, a national membership organization of parents and friends of blind children.

Kim Cunningham, President, PO Box 125, Friendswood, TX 77549-0125
Phone:  713-501-9659
Email: 

Website:  www.tpobc.org/

Texas: Deafblind

DBMATDeaf-Blind Multihandicapped Association of Texas

  The mission of DBMAT is to promote and improve the quality of life for all Texans who are deaf-blind multi-handicapped, deaf multi-handicapped, and blind multi-handicapped. We support the establishment of educational, rehabilitative, vocational and independent living opportunities.  

Melanie Knapp, President
Phone:  (281) 302-5454
Email:   

Website:  www.dbmat-tx.org    

Texas Chargers, Inc.    

The Texas Chargers, Inc. is a group of Texas families, friends, and professionals who are dedicated to helping children and young adults who live with Charge Syndrome. The primary function of our organization is to support the emotional and educational needs of the people with Charge Syndrome and the families and professionals working with them, to provide them with a better quality of life.  

Kathi Barksdale, President
Phone:  325-286-4230
Email:   

Website:  www.texaschargers.org

Texas: Deaf & Hard of Hearing

TXHandVoicesTexas Hands and Voices

Texas Hands & Voices is a chapter of the nationwide non-profit organization dedicated to supporting families and their children who are deaf or hard of hearing, as well as the professionals who serve them. We are a parent-driven, parent/professional/community collaborative group that is unbiased towards communication modes and methods. Our diverse membership includes those who are deaf, hard of hearing, and hearing impaired and their families who communicate orally, with signs, cue, and/or combined methods. We exist to help our children reach their highest potential.  

PO Box 2208, Cypress, TX 77410
Phone:  936-463-8948
Email:   

Website:  www.txhandsandvoices.org

Guide By Your Side Website:  www.txgbys.org

TO: Classroom Teacher

FROM: Vision Itinerant Teacher

RE: Students Using a Monocular

A monocular is a small telescope which enables a visually impaired student to see print, pictures, diagrams, maps, faces and demonstrations when (s)he is seated at his/her desk. The following are some facts and adaptations which need to be considered if a monocular is being used:

  1. A monocular severely restricts the visual field. The student will be taught by the vision teacher to scan to pick up all visual information and increase their visual memory so they can copy more quickly and efficiently.
  2. A monocular is typically used for distance tasks only.
  3. Copying while using a monocular is laborious, and it will take the visually impaired child longer to copy from the board/charts, etc. You can adapt by modifying the length of the assignment. Some ways of doing this include:
    1. assigning even or odd numbers of problems
    2. allowing the student to write only the answers to questions rather than re-copy entire sentences, questions, and/or paragraphs
  4. When a student is using a monocular, walking up to the board/chart should be discouraged. This annoys other students and severely hinders speed, continuity of thought, and proficiency when reading or completing an assignment.
  5. Singling out a visually impaired student's desk (to place him/her closer to the board) is discouraged due to social reasons. A monocular will enable the child to sit within the group at all times.
  6. Monoculars break easily and should be worn around the neck when in use and stored in a case otherwise. Please encourage young children to keep their monoculars out of sight when the room is empty.
  7. Encourage the child to take the monocular to other school events, e.g. assemblies, film presentations.
  8. Do not allow other children to handle the monocular.
  9. Do not allow the monocular to be taken home with the child unless arrangements have been made with the vision itinerant teacher.
  10. A child who is using a monocular should be seated facing the boards/charts to allow straight-on viewing. This also enables the child to rest his/her elbow on the desk while he is looking through the monocular.

By Jenny Lace, Teacher Trainer, TSBVI, Texas Deafblind Outreach

Webster's dictionary defines minimal as "the least possible degree or quantity." Unfortunately this can imply that something is without consequence, insignificant, or requiring the least possible intervention. When it comes to vision and hearing losses this could not be further from the truth.

A dual sensory loss effects incidental learning. This is the learning that takes place just because you happened to see or hear something while you're hanging out, the way most of us learn most things. The problem with most incidental learning is that you can only learn what you can see or hear.

If you have a vision and hearing loss incidental learning is tremendously reduced. What happens when it is a peer's turn to read in a typical classroom, if you can't quite see him and you also can't quite hear him? You miss out on most of what he reads, comments he makes about what he read, and perhaps the feedback from the teacher and other students. When class discussions are out of sight and/or hearing range, the student with mild hearing and vision losses may spend more time daydreaming.

A common question that is asked is, " Won't the student let the teacher know if he can't hear or see clearly?" The answer is usually, "NO!" As Dr. Seuss might say:

You don't hear what you don't hear
And you don't know what you didn't hear….
You don't see what you don't see
And you don't know what you didn't see!

Do you know that a student can be on the deafblind census if he has documented hearing and visual losses that are minimal or mild? Even though these losses may not meet the requirements for auditory impairment or visual impairment if considered individually, if the combination of the losses adversely affects the student's education performance, they could be included on the deafblind census. When would that occur?

Problems occurring with a mild visual impairment

A mild visual impairment is not easy to quantify. We generally think of someone with a visual acuity of 20/60 _ 20/100 as mildly visually impaired. However, someone with Retinitis Pigmentosa might have 20/20 vision and better than 30 degrees of field vision and not qualify for vision services. This student would probably do fine visually. That is until the lights dimmed and the overhead went on or until they came inside from the bright sunlight into a dark hallway. Then they would experience visual impairment that was fairly significant for a time. Another scenario would be the student who had vision only in one eye. Normally that wouldn't be a problem, but if he also had a hearing loss in one ear on the same side as the vision loss, sound localization would be hard, and travel safety might be impacted. Making a call on the impact of the vision impairment has a lot to do with how the child functionally uses his vision to do educational tasks. If a child is experiencing educational difficulties that appear to be related to problems with his vision, he should be seen by an ophthalmologist and possibly referred to the vision teacher for a functional vision evaluation and learning media assessment. If the child has a hearing loss, even a minimal one, and is experiencing difficulty in school, we would encourage the school to complete a functional vision evaluation and learning media assessment. There may be a need to make some specific modifications in programming or materials, even if the child does not need direct vision services. Part of the reason we say this has to do with the impact of the hearing loss. Please read on.

Problems occurring from a minimal or Mild hearing loss

A minimal or mild hearing loss would fall into the range of 16-40 dB. Even without a vision loss, a slight hearing loss can cause a number of significant problems, especially in an educational setting:

  • Problems hearing faint or distant speech
  • Problems hearing subtle conversational cues
  • Problems tracking fast paced conversations
  • Problems hearing the word-sound distinctions

What kind of impact might this have on the mildly hearing impaired student who has a vision loss in a typical classroom?

Trouble hearing faint or distant speech

If a student has trouble hearing faint or distant speech, more than 25% of classroom instruction could be missed. (Flexer, 1997) Add a vision loss and imagine the percent of missed instruction that would likely occur. The child with a mild vision impairment and mild hearing loss probably relies on the information he can pick up from watching the speaker's lips to confirm what he thinks he is hearing. This is especially true if he is not using a hearing aid. Distance is his enemy for both his vision and his hearing.

Missing subtle conversational cues

Students with minimal or mild hearing losses often miss subtle conversational cues that cause them to respond inappropriately. They may appear immature and be more fatigued than peers with normal hearing because of the extra effort they make to hear. (Flexer, 1997) Students with mild vision and hearing loss miss out on this information, too. They also experience added stress and may appear socially immature. Not only can they miss auditory information; they may also miss additional conversational cues of a visual nature such as facial expression or gestures because of the vision problems. On top of that, their ability to use speechreading to support what they are hearing is impaired in many instances because of the vision problems.

Problems following classroom discussions

Another issue for the student with any type of vision and hearing loss is trying to follow a fast-paced conversation of a typical classroom discussion. About the time you locate the speaker and get focused auditorily and visually, he is no longer speaking and the girl behind you has the floor. You shift around to see her face, which you can actually see pretty well and you can also hear her pretty well. After about five seconds the teacher, who has moved to the window aisle, responds. She happens to be in front of the window with the sun coming in and beside the rattling air conditioner. After about twenty minutes of this activity imagine the impact on the student's attention and behavior. This also has great impact on his ability to participate in many types of social and extracurricular activities.

Misses morphological markers for plurality, tense, possessiveness

Try a little experiment. Put some earplugs in your ears. Have a friend stand across the room and in a quiet conversational voice say a series of words like, "hit, hitting, hits, rat, ram, dogs, dog's, dog, see, sees, seen." Did you hear all the different final sounds or did the words mostly sound the same? Now try it again, only this time, have a television or radio playing in the background. How did that work? Now do it without looking at his face. Next, add another friend across the room taking turns with the first speaker reciting a different series of words. What happens then? Chances are you could not tell exactly what words were being said with any accuracy. Imagine your entire day being like this. Do you think the student dealing with these conditions would be more fatigued and/or frustrated than the average hearing/sighted student? How would this impact his ability to get the information being presented?

Mild losses equal major problems in a typical classroom

Speech-to-noise ratio

The American Speech-Language-Hearing Association (ASHA) gives the following guidelines: ambient noise should be no louder than 30-35 dBA in an empty room; reverberation time should not exceed .4 seconds; Signal-to-Noise (S/N) ratios should be no lower than +15dB. Yet research has repeatedly found: the average unoccupied classroom (no children) noise levels are 41-50 dBA; the average reverberation times are .52 seconds; S/N ratios are only +4 dB, and may be worse than 0 dB. (Crandall and Smaldino, 1994)

Vision and hearing losses, even very mild ones, when combined can create some major problems. If you have a mild hearing loss you may not always function as if you have a mild hearing loss. How your hearing functions depends on the situation and the S/N ratio. We all have had the experience of being able to hear something without being able to understand what is being said. Think of the drive-thru at MacDonald's or Jack-in-the-Box, a busy gate at the airport, or a noisy restaurant. Your ability to hear has little to do with how loud something is said, but rather how loud it is compared to everything else is in the environment around you.

Adults with normal hearing sensitivity and language abilities don't need as high of a S/N ratio as children. Typical adults need speech to be twice the sound pressure level of the background noise. (Flexer, 1997) Typical children need better speech-to-noise ratio than an adult to hear and develop the crucial word/sound distinctions of language. (Flexer, 1994) Persons with any kind of hearing loss need an even more favorable S/N (even when wearing hearing aids). Speech needs to be at least 10 times the level of background noise for them. (Flexer, 1997) If you factor in noise, reverberation, and frequent changes in teacher and pupil locations in the average classroom, the typical speech to noise ratio is less than ideal even for the child with normal hearing.

While we are mentioning reverberation or echo, did you know that longer reverberation times reduce the signal-to-noise ratio? (Scott, 1997) Reverberation time increases with high ceilings, bare walls, and hard-surfaced, uncarpeted floors. Think about the design of most classrooms, especially in older buildings.

Busy visual environments

Although there is not an equivalent vision-clutter ratio, there is a similar phenomenon that occurs. You know it well, too. Think about the last time you were in an unfamiliar store trying to find a specific item or the last time you had to find a friend in a crowded room. Figuring out where and what to look at is tricky. If there is a lot going on visually and you can't see anything very clearly, do you find yourself getting frustrated or feeling overwhelmed? Now look at the typical classroom. Is it a busy place visually with lots of clutter and competing visual demands?

Let's move that child up front

A typical remedy for a child who does not hear very well and does not see very well is to move him up front, so he will be closer to the teacher. She is the learning signal we most want him to pick up, right? Well, not necessarily, not in a group discussion. This solution also assumes that the teacher is nailed to the floor in front of the child. How many teachers do you know who teach that way? Besides all of that, you are required to periodically look at your book, a handout, and the overhead or map. Preferential seating is a less-than-perfect solution for this child.

Problems and Solutions

Helping the child with combined mild or minimal hearing and vision loss

There are several things that should be considered for this child. First of all, has appropriate assessment been done to determine the impact of the vision and hearing loss on education? Even if the ophthalmological and otological evaluations from the doctors do not qualify them as visually impaired or hearing impaired under SBOE definitions, education may still be impacted. A functional vision evaluation should be done. Specific hearing assessment related to listening in differing environments may also be helpful in evaluating hearing functioning for educational purposes.

Making simple and appropriate modifications to the classroom can also make a huge difference. Acoustic modifications can be as simple as:

  • installing carpet;
  • putting rubber tips or tennis balls on desk/table/chair legs;
  • installing curtains;
  • installing acoustical ceiling tiles;
  • maintaining ventilation systems, doors, lighting, and windows.

Additionally, a Sound-Field FM System allows for the control of the acoustic environment facilitating accessibility of teacher instruction for ALL children in the classroom. An assistive listening device may also be appropriate. Those students who do not qualify for special education due to a minimal hearing loss or because they have not failed enough may be able to qualify for S/N ratio enhancing technology through Section 504 of IDEA using "Acoustic Accessibility."

In addressing mild visual impairments there are also some simple modifications:

  • Additional time with "hands on" exploration in order to internalize what others grasp incidentally;
  • Reduced visual clutter;
  • Low vision devices;
  • Eccentric and varied viewing positions and seating positions;
  • Improved lighting and glare control;
  • Reduced use of overheads and chalkboards unless the student has the information on paper in front of him;
  • Additional staff to assist with accessing information in group settings;
  • Use of strategies such as a talking stick or raised hands to control the pace of group discussions and to provide more clues to who is speaking.

Conclusion

The needs of the child with minimal or mild combined vision and hearing loss can be major. Too often, these children must fail to have the support and modifications they need in educational settings. Many of the things we can do to improve the classroom for these children will also improve the classroom for the other students as well. It is important not to let these children fall through the cracks and miss out on the education they need. They are just too valuable to our future to overlook their needs.

REFERENCES

  • Biehl, Jane: I Am Hard of Hearing, But I Can See Fine… Coping with Hearing and Vision Loss. Hearing Loss, July/August, 1996.
  • Crandell, Carl: Classroom Acoustics: A Failing Grade. Hearing Health, September/October 1998.
  • Crandall, C. C. and Smaldino, J.J. 1994. An Update of Classroom Acoustics for Children with Hearing Impairment, The Volta Review, Vol. 96, Issue 4, page 291.
  • Dancer, Jess: Effects of Unilateral Hearing Loss on Teacher Responses to the SIFTER. American Annals of the Deaf, Volume 140, No. 3.
  • Flexer, Carol: Classroom Management of Children with Minimal Hearing Loss. The Hearing Journal, September 1995; Volume 48, No. 9.
  • Flexer, Carol: Commonly~Asked Questions about Children with Minimal Hearing Loss in the Classroom. Hearing Loss January/February 1997.
  • Flexer, Carol: Facilitating Hearing and Listening in Young Children. Singular Publishing Group, Inc. San Diego, CA, 1994.
  • Hilt, Gary: Testing for Hearing Loss in Children. Exceptional Parent, May 1998.
  • Oyler, Robert, Oyler, Anne, Matkin, Noel: Unilateral Hearing Loss: Demographic and Educational Impact. American Speech-Language Hearing Association, 1988.
  • Scott, Abigail: Sound Solutions in the Classroom. ADVANCE for Speech-Language Pathologists and Audiologists, December 1997.
  • Swift, Billie: Scott Haug Foundation Helps Amplify Austin Classrooms. The Hearing Review, October 1998.

 

7/99

_____ Annual ARID within last year (to include VI ARD/IEP or IFSP Supplement)

_____VI IEP

_____*Parent's Explanation of Safeguards

_____*Parent's Release of Confidential Information

_____ Parent's Resource Sheet each year

_____*Parent's Permission to Test

_____ Parent's Release for information to Texas Education Agency, etc.

_____*Notice of ARID

______Ophthalmologist Report (with CIA Eligibility Report, Part A attached)

    1. indication of no vision or serious vision loss
    2. visual field
    3. visual acuity
    4. prognosis

_____ Functional Vision and Learning Media Assessment (with CIA Eligibility Report, Part B: Functional Vision Report attached)

    1. an evaluation of performance of tasks in variety of environments using near and far vision
    2. recommendation concerning low vision evaluation
    3. recommendation concerning need of O & M evaluation

_____Learning Media includes:

    1. appropriate learning media
    2. statement of need for ongoing assessment to determine learning media
    3. determination if student is "functionally blind"
    4. if student is "functionally blind", documentation of strengths/ weaknesses in braille skills.

_____ARD summary addresses (when appropriate)

    1. low vision evaluation (every 3 years)
    2. orientation and mobility evaluation (every 3 years)
    3. assistive technology

_____*Modification sheet/ coordinate with IEP

______Orientation and Mobility Report (if applicable)

    1. learning competencies which identify the need for the related service
    2. documentation that the service will enable the student to benefit from instruction
    3. a recommendation for the specific service(s) to be offered

_____"Statement of Need for Transition Services" (on or before age 14)

_____*'Individual Transition Plan (16 years or older)

_____*Vocational Testing (14 years or older)

_____*Graduation Plan

* = General District Requirements (not VI specific)

For Further Clarification: Visual Impairment

  • On the eye report if exact measures could be not be obtained, an eye specialist must so state and give best estimates.
  • On the eye report "Prognosis when possible" refers to the doctor's ability to determine a prognosis. If the doctor is unable to report a prognosis then that inability should be noted. No information about the prognosis constitutes a discrepancy.
  • Documentation should ensure that the functional vision evaluation reflects visual functioning in the environments in which the student functions. These may include, but not be limited to, the classroom, cafeteria, gym, hallway, school grounds, job site, and home. Although the FVE should include data from the medical reports, that information alone is not sufficient. The FVE should include information which can be used as the basis for educational decisions.

    There should be a variety of recommendations including modifications to the environment, supplemental aids and equipment, adaptive technology, teaching strategies, physical education, vision related services, assessment strategies, testing strategies, and areas of needed instruction in compensatory skills areas. (These recommendations can be combined with those from the Learning Media Assessment.)

    An FVE which (a) does not clearly indicate the student's visual functioning in a variety of environments, or (b) is a restatement of the medical information, or (c) otherwise does not include information designed to assist in educational decisions is out of compliance.

     

    If a clinical low vision evaluation and/or an orientation and mobility (O&M) evaluation was recommended, there should be documentation that the evaluation occurred within a reasonable time frame. Reports should be included in the student's eligibility folder.

  • In the LIVIA, a statement of need for ongoing assessment to determine appropriate learning media is necessary in this report only if the evaluator is unable to determine a learning media. Typically this occurs when evaluating a very young child, a child with severe and profound disabilities, or when there is a borderline vision determination.
  • A learning media assessment evaluates:
    • the efficiency with which the student gathers information through the use o vision, touch, and hearing.
    • the appropriate learning media and the variety of methods and materials the student uses to accomplish learning tasks
    • the primary literacy medium the students will use for reading and writing (such as print, large print, Braille, and/or auditory tapes.)

    There should be a variety of recommendations including what the learning media should be, modification to the environment, supplemental aids and equipment, adaptive technology, teaching strategies, physical education, vision related services, assessment strategies, testing strategies, and areas of needed instruction in compensatory skill areas.

    The LMA may be combined with the functional vision. evaluation. However, the LMA should be labeled as such. Only a teacher holding a valid certificate to teach students with a visual impairment is qualified to perform a learning media assessment.

  • For Functionally Blind, "Braille skills" include pre-Braille and/or Braille readiness activities which develop the skills required for Braille reading and writing. These skills may include tactual exploration and discrimination, fine motor coordination, and hand strength. Pre-Braille and/or Braille readiness activities may be appropriate for:
    • infants and preschoolers
    • students with multiple disabilities
    • students who are blind and in the primary grades
    • older students who are learning Braille due to trauma, deteriorating vision, and/or severely limited visual efficiency.

Grasp

Palmar

  • squeezing toys
  • squeezing playdough/clay
  • taking objects out of containers
  • drawing
  • picking up jacks
  • sanding
  • using a cookie cutter
  • using a hole puncher
  • putting pop beads together

With thumb and fingers

  • stringing beads
  • holding paper for cutting
  • using crayons/pencil/paintbrush
  • using glue sticks for art projects
  • pinching playdough/clay
  • using pegboards
  • building towers with blocks
  • picking up jacks
  • painting with paintbrush
  • turning pages of a book
  • picking up small beads/objects with tweezers (may be too visual)
  • paper weaving
  • putting shapes into a shape sorter
  • sorting paper clips, red hots, goldfish crackers
  • buttoning, zipping and snapping - on own body

Pincer

  • popping bubble wrap
  • picking up small objects
  • tying bows
  • using pushpins
  • sewing cards
  • stringing beads
  • putting pegs in pegboards
  • using geoboards
  • putting clothespins on edges of cans or jars
  • using an eyedropper
  • turning knobs on a wind-up toy
  • putting coins through a small slot

Release

  • giving an object on request
  • stacking activities - cans, blocks, nesting cups
  • sorting activities
  • placing objects in containers
  • the release that is necessary to complete the activities in the "grasp" section

Rotary Motion

(takes place from wrist with stable arm)

  • assembling nuts and bolts
  • using twist ties
  • turning volume knobs on radio & TV
  • manipulating lids on and off of jars/tubes
  • mixing food in bowl
  • turning knobs on water fountains or sinks
  • using wind-up toys, busy boxes, music boxes
  • turning doorknobs
  • scooping sand, gravel, dried beans
  • finger painting
  • finding objects hidden in sand, dried beans
  • unwrapping individually wrapped candy
  • pouring from one container to another

Finger Isolation

  • making fingerprints in playdough/clay
  • pushing buttons on tape recorder
  • pushing buttons on blender and other appliances
  • playing musical instruments
  • turn dial on toy phone
  • pushing push-pins into cork
  • tracing around stencils with fingertip

Bilateral Hand Use

(almost all of these activities involve stabilizing with one hand and manipulating with the other hand, which is hard for VI kids)

  • stringing beads
  • pulling tape off roll
  • tearing paper
  • twisting lids on and off
  • cutting paper
  • using a hole puncher
  • sanding
  • using a ruler to make lines
  • holding container with one hand/placing object in with other
  • stabilizing toy with one hand/using other to play with toy
  • pushing together and pulling apart pop-beads
  • finger painting
  • rolling "snakes" and "balls" with playdough/clay
  • attaching paper clips to paper
  • tracing around an object/stencil
  • holding paper with one hand and stapling with other
  • stabilizing bowl while stirring

Hand And Finger Strength

  • crumpling paper
  • placing clothespins on edges of cans or jars
  • stretching rubber bands
  • manipulating playdough
  • squeezing glue bottles
  • using stapler held in hand
  • using stapler by pushing
  • using rolling pin
  • using a hole puncher
  • hammering
  • pushing together and pulling apart pop-beads
  • pushing together and pulling apart bristle blocks
  • squeezing nerf balls
  • sponge painting

Proper Finger Position

  • each finger has a "job" - lead finger, detective fingers
  • curve fingers over the edge of pencil or ruler

Light Touch

  • work on whole body relaxation - if your body is tense, your fingers will be unable to touch lightly
  • place checkers inside the squares of braille graph paper and have the student move his fingers across them so lightly that he does not move them outside the squares
  • place cotton balls beneath the childs fingers and have him move them across the page
  • learn to "tickle" the dots

Tracking

  • tracking across lines of yarn, popsicle sticks, etc.
  • tracking across pipe cleaners/straws glued to paper
  • Mangold Developmental Program of Tactile Perception and Braille Letter Recognition (first eight lessons)
    • tracking from left to right across like symbols which follow closely without a space
    • tracking from left to right across unlike symbols which follow closely without a space
    • tracking from left to right across like symbols which have one or two spaces between them
    • tracking from left to right across unlike symbols which have one or two spaces between them
    • tracking from top to bottom over like symbols with follow closely without a space
    • tracking from top to bottom over unlike symbols which follow closely without a space
    • tracking from top to bottom over like symbols which have one blank space between them
    • tracking from top to bottom over unlike symbols which have one blank space between them

 

Wendy Drezek, Ph.D., NEISD, San Antonio, Texas

Overview and background

Braille literacy is the tool that allows the braille reader to seek and share information and affect the world through Symbols. Readiness for braille literacy develops in the whole child as that child ventures into life; it is concerned with using the body, particularly the hands effectively, with meaning that comes from risking, exploring and experiencing the world, and investing in interaction, communication and problem solving.

Emergent braille literacy includes establishing the experiential base for meaning, discovering the communication potential of Symbol and book, and acquiring the perceptual-motor Skills for reading and writing. The braille reader needs motor Skills to find and replace books, maintain posture that permits accurate tracking movements, and search for reading materials. The reader requires hands that can locate and synthesize tactile information and coordinate to use a braille writer, stylus or keyboard. The motivation for literacy resides in interest, confidence and curiosity about the world, and the ability to gain information through Symbols. All these prerequisites grow from the totality of the child's actions and encounters with the world to optimize both the production and consumption of text. Parents and teachers can assist the young emergent braille reader by creating a braille literate environment, including braille labels, specialized braille books, braille materials in the community, prebraille preprimers, and adapted print books, that affirms braille communication.

These sample units and references demonstrate some of the many ways that print books can be adapted to support braille readiness. Books can be enhanced by emphasizing sounds, singing refrains or adding actions. Meaning can be supported with story boxes, sensory boxes, real activities and play. Tactual Skills can be reinforced by adding textures and outlines. Move, Touch, Read is an informal collection of sample units and unit outlines that provide simple techniques for adapting print books, to accompany the weekly units in the APH curriculum Move Touch Do! (Drezek, 1995). The 44 units in Move Touch Do! establish the experience base for 44 basic content areas encompassing the Concepts and Vocabulary included in most preschool and kindergarten classrooms.

Each unit moves from tolerating, experiencing and participating in activity with real objects, through perceptual exploration, learning related Skills, matching and identifying, to Symbolic play and recognizing varied two and three dimensional representations including toys, models, pictures, photos and Symbols; the activities in each literacy unit parallel this sequence of experiencing the content through whole body actions, tactual exploration and a variety of progressively more Symbolic, less concrete adaptations.

Examples of explorations, adaptations and activities are:

  • Drummer Hoff--sounds and rhyme,
  • The Very Hungry Caterpillar--actions,
  • My Five Senses--sensory box,
  • The Wheels on the Bus--songs and fingerplays,
  • Just Me in the Tub--story box,
  • All Through the Year--object calendar,
  • Pumpkin, Pumpkin--real activity,
  • The First Thanksgiving--cooking and art,
  • Santa's Beard Is Soft and Warm--texture book,
  • Valentine's Cats--puppets,
  • Caps for Sale--play,
  • My First Counting Book--one-to-one correspondence,
  • The Carrot Seed--story pillows.

The units encourage children to experience a wide range of adaptations and to develop the skill to learn from the unadapted materials they are sure to encounter in life.

Sample Literacy Unit Outline-Story Box

Title

Mayer, M. & Mayer, G. Just Me in the Tub. (1994). Racine Wisconsin: Western Publishing Company, Inc.

Introduction

This is a simple story about an every day activity--bathing. Since this is a familiar activity for all children, the content and meaning are, to some extent, known. When we move from tactile books and books with funny sounds, we want to make sure that the child's first exposure to books that do not have an inherent sensory component, is with content that has been consistently and repeatedly experienced.

Vocabulary

This book uses familiar words--bath, water, tub, towel, washcloth, pajamas, clothes, wash.

Concepts

The Concepts of body parts, on and off, warm and cold, and clean and dirty can be reinforced.

Skills

The book includes the Skills of dressing and undressing, cleaning up, putting things away, and bathing.

Symbol

A washcloth makes an easily identifiable tangible Symbol for this book.

Move

Introduce the book by taking the child through a bathing routine and using the language in the book in conjunction with each step. For instance, you might say , "It's time to take your bath--there are lots of things to do," paralleling the language of the book. Work through the steps-- run water, get a towel and washcloth, get clean pajamas. Try to use a linking phrase to the book, "I start with my face...then I wash my hair." Spend time on the "fun" activities--splashing, making a storm.

Touch

Make your story box, basket or bag. Gather together objects to go with each set of pages--one per set. These objects could include a towel, pajama bottoms, brush, toy and sponge. A laundry basket makes an appropriate container for the objects. Take time to explore each object, talking about how it feels, smells and looks and what it can do.

Read

The braille text can be prepared using a braille writer, slate and stylus or computer. The easiest permanent method of inserting braille text is to braille directly onto paper and attach the braille to each page.

When you begin to read the book, hand the child the Symbol first, so that the young reader will later be able to choose stories using Symbols even before words are available. As you read each page hand the child the pertinent object and demonstrate the use. As the story becomes familiar you can read the story without the objects. Later the story box can be used for acting out the story and dramatic play.

As you read the book, lightly guide the child's hand over the braille text. With very young children, you will want to let them explore each page first, to get comfortable with feel on their own. Later you can help them follow with hands, as you read. As soon as they are enjoying reading, you want to begin modeling good book handling and scan and detect behaviors. Positive feedback, such as "gentle fingers" can be used to reinforce constructive book behavior.

Enrichment

This book has a frog in each picture. You can buy a set of tiny plastic frogs in a craft store and glue one on each page or use glue or textured paint to outline the frog for the older child to find on each page. Challenge the child to think of other games besides pirate ships to play in the water!

Literacy Units

School

Mayer, G. & Mayer, M. ( 1992). A Very Special Critter. Racine, WI: Western Publishing Co, Inc. This book is best used in conjunction with everyday schoolroom activities. Vocabulary includes bump, ramp, pouch, book, high, ball, hide-and-seek, car. An enrichment activity includes making a car costume.

Wheels on the Bus. (1988). New York : Crown Publishers. This is an excellent book to use with the familiar song. It lends itself to doing the actions which accompany the text.

Me

Aliki. (1962). My Five Senses. New York : Harper & Row Publishers. This book lends itself to a sensory box including things to smell, hear, taste, feel and look at. Make sure the visual stimuli are optimally interesting to the very low vision child, and include a drum, soap, cookies, milk carton, balloon, and ball mentioned in the text.

Kates, B. J. ( 1992). We're Different, We're the Same. New York : Random House. This book is good for exploring and finding body parts.

Franco, G. (1992). Baby's Book of Dressing. New York: Zokeisha Publications Ltd. make a story basket from a laundry basket and find examples of the different clothes to put in the basket. Take out each item to explore, as you read the book.

Fall

Franco, B. (1994). Fresh Fall Leaves. New York: Scholastic, Inc. This book is adapted best with an activity--go outside and do all the actions--watch, collect, crunch, run,rake, jump,make a fort, have battle, cover, leap and throw. Then repeat the activities inside. Finally, read the book acting out each action on the page.

Muldrow, D. (1997). We Love Fall. New York : Scholastic Inc. Act out the actions depicted in the book and put a sweater, rake, kite, nuts, apples, pumpkins, and pie pan in the story box.

Mask/Bag/Candy

Appleby, E. (1990). A Merry Scarey Halloween. New York: Simon & Schuster Inc. This book is ideal for a story bag in a large trick-or-treat bag. Include a plastic spider and bat, and monster, cat and vampire masks for the children to wear, candy, a small bag, and a witch hat. For the low vision child, point out the visual images of each character and the child dressed as the character.

Hat

Dudko, M. A. & Larsen, M. (1993). Barney's Hats. Allen, TX: Barney Publishing. Use this book with dress up play. You can have a hat and object for each page and act out the different roles.

Speirs, J. (1995). Hats, Hats, Hats. Racine, WI: Western Publishing Company, Inc. This book has an action component of finding the face and changing the hat. It can be reinforced with a dress-up box of hats, acting out each role--clown, king, firefighter, farmer, cowboy, sailor, pirate--and then encouraging dramatic play with the hats.

Pumpkin

Pumpkin, Pumpkin. (See sample units.)

Hall, Z. (1994). It's Pumpkin Time! New York: Scholastic, Inc. This book can be used with a story bushel basket. Place seeds, a shovel, a pumpkin, a watering can and candles in the basket. Cut a pumpkin to make a jack-o-lantern and make a costume from a large paper grocery bag.

Corn/Potato/Apple/Cranberry/Turkey

Child, L. M. (1974). Over the River and Through the Woods. New York: Scholastic. This book is based on the well known song. The content is taught in the Thanksgiving units. Sing the song as you read the book. The low vision child can find the color pictures of the outdoor verses and the black and white pictures of the indoor verses.

Prelutsky, J. (19982). It's Thanksgiving. New York: Scholastic. This book has short poems about the familiar activities and history of Thanksgiving. Use speed, intonation and rhythm to reinforce the content. Choose an object for each poem, e.g. a spoon for the first, dried corn for the second and let the child choose which poem to hear by choosing an object. Place all the objects in a cornucopia.

My First Thanksgiving. (See sample units.)

Cookie/Present/Winter Holiday

Santa's Beard Is Soft and Warm. (See sample units).

Ricklen, N. (1991). Baby's Christmas. New York : Simon & Schuster Children's Publishing Division. In a large gift wrapped box place a tiny tree, ornament, card, popcorn, light, stocking, candy cane, wreath, bell, cookie, present, train, and toy snowman, Santa Claus and reindeer. Use the story box objects to explore along with the text.

Bridwell N. (1994). Clifford's First Christmas. New York : Scholastic, Inc. This book is a good activity book--decorate a tree, wrap a present and stuff a stocking.

Marzullo, J. (1997). Christmas Cats. New York: Scholastic. Make cat puppets (See Valentine Cats model unit.). Use the cats with the objects in the story--e.g. broom, rolling pin, popcorn chain--to act out the story. The puppets provide the scaffold to transition to imaginary characters.

Miller, J. P. Little Rabbit's Merry Christmas. This is a "sniff" book. Collect a real object for each odor--piece of pine tree, gingerbread cookie, hot cocoa, apple, candy cane and cinnamon cookie--in a gift wrapped box. Explore each object by smelling, feeling, looking and tasting as you read the story the first few times. When the objects are consumed, replace them with models such as play dough cookies, a plastic apple. This creates the connection among the sniff samples, real object and models.

Fruit/Vegetable/Bread/Drinks/Snacks/Dessert

Baby's Special Food. (1968). Pawtucket, RI: Playskool. Make sure you taste and feel all the foods and compare them to the tactile foods in the book. Let the child do all the actions with the foods in the book.

Franco, G. (1992). Baby's Book of Eating. New York : Zokeisha Publications, Ltd. Take a large paper grocery bag and put a banana, sandwich, spaghetti, watermelon slice wrapped in foil, apple, plum, orange, corn muffin, ice cream cone, carrot, wrapped cupcake, can of peas, wrapped cookie, cup and bottle in it. Use the bag with the book, eating one food each day, the most perishable first. The foods can be paired with plastic foods from a toy kitchen or craft store, and the plastic foods substituted after 3 weeks. Use this storybag with the book.

Wilkes, A. (1989). My First Cook Book. New York : Alfred Knopf. You can use the cookie, potato, cake, bread and fruit recipes with the cooking units. The photos are colorful, realistic and life size. Find each of the implements in your kitchen and prepare the recipe. Then read the section on that recipe. Let the child choose favorites to repeat. Encourage the child to retell the sequence of steps in the recipe.

The Very Hungry Caterpillar. (See sample units.)

Shapes

Ziefort, H. & Baum, S. (1996). Play Shapes. New York : DK Publishing, Inc. Let the child assist in punching out the shapes and matching them to the book. You can outline the shapes in the book with puff pen.

Disney's Pop-Up Book of Shapes. (1991). Los Angeles, CA: Walt Disney Company. The shapes in this book pop up. Get containers of each shape, e.g. a plate for the circle, a box for the square and find household items of that shape to put in the box.

Valentine

Valentine Cats. (See sample units.)

Spring

The Carrot Seed. (See sample units.)

Egg

Scarry, R. (1967) Egg in the Hole Book. Racine, Wisconsin: Golden Books. This is an action book; let the child find the hole on each page. Make the path raised with puff pen markings. Find a plastic Easter egg that fits in the hole and let the child put it in each hole.

Animals

Hillert, M. (1981). The Baby Bunny. Chicago: Follett. Act out run, jump, play, eat go up and down. When you read the book make the actions with the story.

Grooming

Just Me In the Tub. (See sample elaborated unit.)

Kitchen/Household

Cushman, J. (1959). We Help Mommy. New York: Golden Press. Put pajamas, sock, shoe, toaster, sheet, mop, dust cloth, doll clothes, soap, clothespins, cereal box, raisin box, knife, place mat, fork, bowl, rolling pin and block in a storybox decorated like a house with window and door. Use the storybox to accompany the text. Take out each item, use it and discuss what we do with it.

Tools

Honey Bear. (1997). Twist It. New York: Modern Publications. This book is shaped like a pliers and can be used with screws and pliers to put together and take apart pieces of Styrofoam.

Sukus, J. (1977). My Tool Box. Racine, WI: Golden Press. Put a hammer, screwdriver, saw, pliers, measuring tape, wrench, flashlight, oilcan, drill bit, paintbrush and paint in a toolbox. Take out each relevant item as the story unfolds and explore it.

Music

Baer, G. (1989). Thump, Thump, Rat-a-Tat-Tat. New York: The Trumpet Club. Make a box or pan drum. Drum loudly as the story gets louder and softly as it gets softer. Point out to the low vision child how the band gets larger and smaller as it approaches and departs. Make homemade band instruments to create a homemade band.

Toys

Rockwell , A. (1986). In the Morning. New York: T. Y. Crowell. This book has familiar activities. Let the child do an action with each page--get out, eat, push, hug, roll, walk. When you do the routines, e.g. eating, relate each to the book and the picture in the book.

Mayer, M. (1988). Just My Friend and Me. Racine, WI: Golden Books. Use this book to begin to transfer to models from real objects. Glue a small car, ball, plastic apple, piece of rope, small book and band aid on the appropriate pages.

Rogers, M. (1988). Playtime. England: Brimax Books Ltd. This book adaptation is to transfer from real objects to toys. Tape a ball, toy elephant, doll, truck, bucket and spade on the pages.

Art

We Go To School. (See sample units.)

Books

Williams, G. (1959). Baby's First Book. Racine, WI: Western Publishing Company. Take the child through the routines in the book, finding each object and using the phrases in the text, for example, "I hang up my pajamas." Note: The resource section includes references for making a variety of adapted books for this unit.

Touch

Pat the Bunny. (See sample units.)

Witte, P. & Witte, E. The Touch Me Book. Western Publishing Company. Feel a real table, doll, sponge, sand, glass, rubber band and sticky tape. Compare the real object to the touch objects in the book. Touch books are not necessarily meaningful without adaptation. Teach the child the relationship between the model, piece of object or texture in a touch book and the real object, before the book is read.

Size

Pienkowski, J. (1990). Sizes. New York: Little Simon. Put all the big objects in a big box. Put all the little objects in a little box. Use the story boxes to accompany the big and little object on each page.

Demi. (1984). Watch Harry Grow. New York: Random House. Let the child feel the yarn that let Harry get bigger on each page. Find big and little shoes, hats, socks, pans and plates in the house. To make the transition to a character (Harry) that may not be able to be experienced "hands-on", make a sock puppet that can "grow" (See The Very Hungry Caterpillar).

Space/Time

Hoban, T. (1979). One Little Kitten. New York: Scholastic Book Services. After experiencing a real kitten, make a kitten puppet from a paper bag (See Valentine Cats.) and let the child place the puppet in each relationship, e.g. behind the broom.

What's In the Box?(1995). New York: Convent Garden Books. Open and close the flaps. Glue something interesting to feel under each flap. Save a duplicate to put in a box. Open and close the box and find what's in it.

Color

Albee, S. (1996). Allegra's Colors! New York: Simon & Schuster. Visit a grocery store and find each item and note the color. Make matching color cards for each color.

Numbers

Vasilak, S. (1991). Numbers. New York: Modern Publishing. This book is good for relating the numerals and sets which are clearly represented. You can also use it to relate models to objects by gluing model or toy nuts, pine cones, mushrooms etc to correspond with each picture.

Moore, L. (1957). My First Counting Book. Racine, WI: Western Publishing Company. These books are good for one-to-one correspondence. put an adhesive velcro tab on each object. Make a set of counters with complementary tabs. On each page the child can put a counter on each tab.

Letters

Abc. (1994). New York: Random House. This book has one clear color photo per page. Find and explore as many of these objects as possible in the house. Glue the braille letter and word on each page. Make a set of matching braille letter cards for matching.

Community Helpers/Vehicles

Younger, J. (1982). The Fire Engine Book. Racine, WI: Western Publishing Co. This book experience should be built around a trip to the fire station. Find each object on the equipment page when you visit the fire station. If possible, let the child explore the station, trucks and clothing hands-on. Bring the book to the station to link each real object to the picture and language in the text. If the child has a toy fire station or fire engine, encourage representational play with these toys.

Miryam. (1950). The Happy Man and His Dump Truck. Racine, WI: Western Publishing Company. This is another action book that can be adapted using toys and model animals. Let the child dump the animals in the truck at each dumping episode in the story. Notice if the child anticipates the dumping after repeated exposure.

Community Activities

Reiser, L. (1995). Good Morning, Farm. Grand Haven, MI: School Zone Publishing. This book has clear colorful pictures and simple text. It can be used with the Fisher-Price farm set. This book can be used first with a field trip to a petting zoo farm and then with the toy to develop Symbolic play.

Toys

May be less meaningful to children with visual impairment, since many toys feel alike. Representational and dramatic play are crucial social, cognitive and linguistic prerequisites to understanding meaning and storylines. This book links the world to the toy and text.

Krasilovsky, P. (1962). The Very Little Boy. New York: Doubleday. This story brings together Concepts and Vocabulary from previous units. Try reading it with only the braille. Ask the child to tell you ways the child is big and little.

Summer

Anglund, J. W. (1992). A Child's Year. Racine, WI: Western Publishing Company Take a one page calendar and glue each item on the month--knit cap, valentine, kite, umbrella, flower, veil, flag, shovel, slate, pumpkin, plate and candy cane--forming an object calendar. Use this calendar through the year to develop the concept of the annual cycle of time and activity. Make sure each item is explored through activity and then connected to the page in the book and the calendar.

Weather

Hill, E. (1989). Spot Looks at the Weather. London: Ventura Publishing Ltd. Make a story box with the different objects--kite, umbrella, cup, knit cap. Feel each object as the page is read.

Literacy Units

1) Literacy Unit - Relating a book to a familiar activity with a story bag

Title

We Go to School by E. Hathon, (1992), Random House.

Introduction

The purpose of this book activity is to help the child make the connection between familiar activities in life and stories in books using a story bag with real objects as a link between the activity and the book.

Vocabulary

play, sing paint, clean up, roll sleeves, snack, story coats

Concepts

predicting order in the environment

Skills

tolerate "reading" braille text

Symbol

school bag

Move

Make sure you always do the real activity and explore the real objects before you explore your storybag object. Build with blocks, strum guitar, paint, wash hands, eat cupcake, dig sand, read book, shake sheet and put on jacket.

Touch

Then explore each of the items for your bag, remembering to relate them to the real objects--lego, airplane, juice box, lunch box, bucket and mattress.

Read

After you have done all the activities and felt all the objects, place a block, paint brush, soap, cupcake, cup shovel, book pillowcase, jacket, juice box and plane in a school bag. As you read each page take out the related object to feel. Braille a key word on each page and glue it on the pages. Let the child "read" the words as you read the story.

Enrichment

Make an object clock by taping small objects for your daily routine on a cardboard circle.

2) Literacy Unit --Using a touch book with a story box

Title

Pat the Bunny by D. Kunhardt, (no date), New York, Golden Press

Introduction

The purpose of this unit is to introduce books. Even a touch book needs to be reinforced with the real object. This kind of unit teaches the child to understand the relationship between real objects and activities and the tactual representation in books.

Vocabulary

pat, bunny, peekaboo, smell, flower, mirror, feel scratchy, face, look, read, book finger, ring, bye bye

Concepts

smell, feel, look, read

Skills

pat, play peek-a-boo, finger extension, wave

Symbol

toy bunny

Move

First do the activities related to each page. Then assemble a story box with bunny, scarf, plastic flower, perfume sample, mirror, sand paper, book and ring--practice playing peek-a-boo, smelling real flowers, looking in mirror, feeling cheek, reading book, putting on ring and waving.

Touch

Explore each object in the storybox and book and talk about how it feels (soft, furry, thin, bumpy, smooth, scratchy, round, hole). Compare each to the real object.

Read

As you read each page take out the related objects and do the related action; place all the items in the box and wave bye bye. Let the child "read" the braille on each page of text.

Enrichment

Visit a pet store and feel a real bunny. Compare this bunny to the toy bunny.

3) Literacy Unit--Relating a book to the activity by adapting the pages with objects from a story bag

Title

Pumpkin, Pumpkin by J. Titherington, (1986), New York, Mulberry Press

Introduction

The purpose of this unit is to read about an activity we do in class or at home and transition from a story bag to representational objects on a page. Children with visual impairment cannot be assumed to understand spontaneously the relationship between an object acted upon and each level of representation--another object attached to a page, a model or toy object, a portion of an object, a texture or outline representing an object. Each relationship should be taught explicitly. The adult provides a carefully and systematically constructed scaffold of meaning and relationship that teaches the child simultaneously how to analyze and construct and interpret representation.

Vocabulary

pumpkin seed, plant, scoop, pulp, face, window

Concepts

plant, grow

Skills

touch something messy

Symbol

pumpkin trick-or-treat carrier

Move

Shop for a pumpkin, carve the pumpkin and plant the seeds. As you do each activity, use the language of the text and show the related pictures.

Touch

In the store feel different sized pumpkins (big, bigger, biggest), feel parts of pumpkins. If you have access to a garden feel the parts of plants and how they grow from the soil. Explore all the parts of the shovel, watering can, pumpkin and knife, pointing out key features like the spout, handle, blade, stem, pulp.

Read

Place a packet of pumpkin seeds, plastic plant, mini pumpkin and plastic knife in the carrier. Let the child feel each object as you read the story. Then tape each object into the book.

Enrichment

Relate the face parts on the jack-o-lantern to the child's face. Make a jack-o-lantern mask.

4) Literacy Unit--Relating activities to an adapted book

Title

My First Thanksgiving by T. dePaola, (1972), New York, G. P. Putnam Sons

Introduction

The purpose of this unit is to relate activities to a historical event and move from story boxes to pages adapted with objects that are not necessarily identical to the complete real object. This unit adaptation includes objects, model or toy objects and portions of objects.

Vocabulary

food, hands, turkey, kitchen, stuffing, cranberry sauce, sweet potatoes, pumpkin pie, mince pie, thank you

Concepts

thanking, feast

Skills

trace hands, assist cooking, self feeding

Symbol

tray

Move

As always, first do the real activities, pairing them with the text and pictures--carry food on the tray, make hand print turkeys, cook.

Touch

Go shopping for the Thanksgiving meal. Find some of the foods and feel them. How do they look, feel and smell in the store? Compare how Thanksgiving foods are the same and different in the store, packaged, uncooked and cooked.

Read

Tape on the appropriate pages a stuffing wrapper, mini Indian corn, crayon, spoon, mini pie pan, napkin. Put a duplicate set of objects on the tray. As you read, find the object on each page and match it to the objects on the tray.

Enrichment

Visit a petting zoo or feed store and feel a real turkey. Let your child help shop for, prepare, serve and eat the Thanksgiving meal.

5) Literacy Unit - Enhancing a touch book with real objects

Title

Santa's Beard Is Soft and Warm by B. Ottum and J. Wood, (1974), Racine, Wisconsin, Western Publishing Company

Introduction

The purpose of this unit is to move from a story box to an adapted touch book and adaptation with textures and parts of objects. Touch books can be very abstract with models, parts of objects, textures or sniff dots. The child must be taught systematically to understand each of these stimuli in relationship to the complete real object and activity.

Vocabulary

pine tree, round, smooth, bright, package, paper, ribbon, blanket, basket, bear, fuzzy, snap, stocking, candy, card

Concepts

puffy, fluffy, pointy, bright, smooth, fuzzy

Skills

lift blanket, snap elastic, open card

Symbol

cotton ball

Move

Visit a mall and feel trees and ornaments and presents under a tree. Find a toy store and feel stuffed animals; experience puppies in a pet store. Visit Santa and feel his beard and suspenders. Buy a small gift and wrap and tie it, then put it in a stocking and hang the stocking up. Play peekaboo with a blanket.

Touch

Feel a wad of cotton, an artificial tree, ornaments, wrapping paper, garland, yarn, ribbon, sock, elastic band, candy, fur and card. Let the child match each touch object to the tactual representation in the book - place the touch objects in a box decorated with Christmas wrap and ribbon or in a large stocking. Let the child help you tape the objects in the book next to their representations. For instance, tape a twig of artificial twig next to the tree and a tiny bow next to the present.

Read

After you have taped the piece of tree, ornament ball, ribbon, candy and card on the appropriate pages, glue a braille word under each object. Feel the objects and textures on the pages and "read" the braille.

Enrichment

Take out the touch stocking and see if your child can match the textures to the objects

6) Literacy Unit --Relating activities to puppet play and text

Title

Valentine Cats by J. Marzello, (1996), New York, Scholastic

Introduction

The purpose of this unit is to relate activities and puppets to a story and objects. Not all characters and experiences are subject to "hands-on" exploration, yet the world of literacy contains wonderful materials with imaginary content. Puppets provide one bridge between accessible real actions and the fictional content.

Vocabulary

card, word, write, catch, fall, paper, glue, glitter, paint, heart, cup scrap, mailbox, sign, bag, march, door

Concepts

valentine, giving

Skills

scribble, catch, glue, paint, cut, write, fill, march

Symbol

valentine box

Move

Do the activities--look up a word in a dictionary, write a sign, toss and catch scraps, make valentines with glitter and glue, cut paper, fill bag with valentines and mail to classmates, march to the door. Emphasize the actions that are fun--stomp to the door, scatter the scraps and valentines, snap the scissors open and closed.

Touch

Explore the paper, foil, envelope, marker, glue, glitter, paint, scissors, mailbox and door. Remember to point out the key feature--foil is shiny, a doily has holes, an envelope has a flap.

Read

Act out the entire story taking time to feel the real objects; then place the objects in the valentine box. Repeat the story without the objects stressing the rhythm and rhyme.

Enrichment

Make three cat puppets from paper lunch bags drawing eyes, nose and whiskers on the flap and adding two pointed ears at the top and paper strip arms at the sides--writer cat has a marker, painter cat has a paint brush and mailing cat has an envelope. Act out the story with the puppets.

7) Literacy Unit --Making a story pillow

Title

The Carrot Seed by R. Krauss, (1945), New York, Harper & Row

Introduction

The purpose of this unit is to encourage narration by making a story pillow. A story pillow allows the child to transition between actually doing activities and representing doing activities--a prerequisite for understanding narrative content.

Vocabulary

mother, father, brother, water, seed, carrot, wheelbarrow, weed

Concepts

planting and growing, believing in oneself

Skills

dig, water, pull up

Symbol

packet of seeds

Move

Plant, water, and weed carrots at home or in class. Push a wheelbarrow.

Touch

Buy a bunch of carrots. Explore the tops and carrots. Out of felt, cut out figures for the family, a watering can, a seed, a tiny and huge carrot. Put a piece of furry velcro on the boy figure's hand. Relate each felt figure to the real object--it has a spout and a handle like the real watering can, it is long and thin and pointy at the bottom like the carrot. Attach velcro hook tabs to the back of each piece. Sew two felt squares stuffed with old socks together. Attach a piece of furry velcro two-thirds of the way down one side. Let the child find the velcro and practice putting each figure on and making it stick using the hooked velcro on the back. It will be easier if the child first practices finding and pulling off each piece. It is important for the child to begin to realize that there are two dimensional representations of graphics--these occur frequently in school--this kind of activity is the scaffold for working with graphic representation.

Read

When you read the story use a deep voice for the father, a high voice for the mother and a taunting intonation for the brother. At first act out the actions such as planting, watering and pulling weeds. Make the story sound dramatic. Then demonstrate how to act it out using the story pillow. Each time let the child retell the story with the pillow and figures, while you extend the child's actions and utterances to enrich meaning. Let the child make up new stories, too.

Enrichment

Once you have made and learned to use your story pillow you can make figures from other stories that have a narrative line, such as Caps for Sale, The Three Little Kittens or The Three Bears.

8) Literacy Unit --Enjoying sounds and rhymes

Title

Drummer Hoff by B. Emberly, (1967), Englewood Cliffs, New Jersey, Prentice-Hall, Inc.

Introduction

The purpose of this unit is to give the child experience with a book in which the content is, to some extent, not subject to direct experience and to engage the child in the enjoyment of the sound and rhythm of text. In life and school, there will be many books used for which the child cannot have hands-on experience. It is important that each child be able to listen and enjoy and even learn from such books. Learning to appreciate the rhythm and sound of language is a normal developmental step towards complex language and later narratives, literature and poetry.

Vocabulary

carriage, barrel, powder, rammer, shot, order, fired it off

Concepts

sequence, assembling a whole

Skills

listening to the sound of text, recalling sequence

Symbol

toy cannon

Move

Many towns have a cannon or statue depicting a cannon, either on a military installation or museum or at a memorial, that can be explored. If either is available, explore it thoroughly finding the various parts and their relations in space.

Touch

If a life size cannon is not available, find a toy cannon for the child to explore.

Read

When you read, emphasize the rhythm and rhyme, and order. Once you have read it several times to establish expectation, introduce slight variations in pacing to develop suspense about what is coming next. Ask the child what comes next. Read the second half progressively faster to complete each page in one breath--make a game of it!

Enrichment

Make story pillow figures for each soldier and each part so the child can have each character bring the correct part and add it on.

9) Literacy Unit--Acting out a story and encouraging Symbolic play

Title

Corduroy by D. Freeman, (1968), New York, Viking Press

Introduction

The purpose of this kind of unit is to expose the child to classic books which may not be wholly available for life experience, and to facilitate understanding, and generalization to acting out a story and Symbolic play. Children with visual impairments need to be prepared to engage and be successful with a range of material and content. Not every book can be based completely on hands-on or familiar experience. Symbolic and peer play are often difficult and may require scaffolding by adults to develop.

Vocabulary

Corduroy, bear, toy department, store, shoppers, overalls, girl/Lisa, Mommy, button, shoulder strap, lost/find, shelf, climb down, floor, escalator/mountain, furniture/palace, mattress/bed, small, round, pull up, pop. bang, lamp, fell down, watchman. hiding, ear, cover, home, broken/fixed, friend, hug

Concepts

sequence, causation, home, friend, comparing Concepts, real/make believe

Skills

understanding cause/effect and sequence

Symbol

button

Move

Visit a department store. Ride the escalator up and down comparing it to a mountain or hill; make sure the child gets to walk up and down hill in the familiar neighborhood. Find the toy department and explore the shelves, dolls and stuffed animals, especially any teddy bears; make sure you point out the clothes and buttons. Find the furniture department and explore the mattresses, beds, lamps, sofas, tables and chairs; explain what a palace is and find the buttons on the mattress.

Touch

When you explore each object, make sure you start at the floor to establish a reference in space and systematically work up feeling every part and noting the spatial relationship to the other parts--for example, the legs are under the table top, the shade is at the top of the lamp. Spatial language is more difficult for children with visual impairments, since the tactual sense is sequential and partial compared to normal vision.

Read

Use different voices for each character. Corduroy's voice should sound full of wonder and the watchman should sound angry. Lisa and Corduroy sound sad at the beginning of the story and happy at the end. Assemble a toy bear, doll clothes overalls, flashlight, lamp, mattress and sheet. As you read the story, act it out with the real objects. Leave the real objects in the play area, after you have read the story several times, and encourage the child to

act out the story.

Enrichment

You can make a storypillow set for Corduroy to encourage more story telling and more Symbolic play. Discuss the order of events in the story. Ask the child why Corduroy searches for the button, why everything falls over. Practice divergent thinking; where else can Corduroy search. Discuss the feelings and emotions of the characters. Compare the escalator to a mountain, the store to a palace. Discuss what it means to be fixed and broken, and the Concepts of having a friend and home.

10) Literacy Unit - Making the transition to a book without adaptation

Title

Whistle for Willieby E. J. Keats, (1964), New York, Viking Press

Introduction

The purpose of this unit is to make the transition to the book without adaptation--the most frequent real life situation the child will encounter. The child's literate and social world would be impoverished indeed if limited to content that can be touched and experienced directly and formats that are specially adapted for visual impairment. An emergent literacy program must facilitate Skills to deal with the everyday world of unadapted books dealing with the full range of content. This transition, like the preceding ones, must be addressed with explicit training.

Vocabulary

whistle, whirl, faster, down, up, turn, around, carton, Peter, Willie, chalk, pocket, draw, line, door, blew, hat, mirror, mother, father, walk, crack, sidewalk, run, shadow, jump, corner, shout, stand

Concepts

faster, up/down, together, in, under

Skills

whistle, draw, jump

Symbol

toy whistle

Move

Take the child through the actions--spin faster, draw a line, get in and under the carton, walk, run, jump, shout, stand, try to whistle or blow; use the toy whistle to whistle.

Touch

Feel the sidewalk and cracks, a pocket with chalk inside and a hat and mirror.

Read

Read the story doing an action for each set of pages; some actions will be pretend such as drawing a line. After reading the story several times with the actions, try reading it without the actions. The goal is for the child, eventually, to be able to hear a new story, without advance preparation, and listen, engage, and learn.

Enrichment

Try reading a book which blends familiar and unfamiliar content, such as Bedtime for Frances, without preparation. Be sure to enrich reading with divergent and convergent thinking activities--what happened first, what happened at the end, why do you think Frances didn't fall asleep, what did she learn, what other things can you imagine scaring Frances?

11) Literacy Unit - Using an action book and puppet to enhance the story

Title

The Very Hungry Caterpillar by E. Carle, (1969), New York, Philomel

Introduction

The purpose of this unit is to relate a puppet to an action book. This book has real content, but it is content that is unlikely to be subject to hands-on exploration. It is important for the child to begin to relate what is knowable through hands-on experience (eating) to what is unavailable (caterpillar transformation) since much of later social studies and science will fall into this category.

Vocabulary

caterpillar, leaf, apple, pear, plum, strawberry, orange, cake, ice cream, pickle, cheese, salami, lollipop, pie, sausage, cupcake, watermelon, butterfly

Concepts

transformation

Skills

find hole in page

Symbol

fabric butterfly

Move

Find the 15 foods listed above in the store and feel, smell and examine them. Act out being a caterpillar crawling on the floor, spinning a cocoon, and flying away as a butterfly.

Touch

Feel those matching foods you have on hand finding the key parts, such as cylinder shaped sausage, pits on the orange, cone on the ice cream cone, holes in the cheese or stick on the lollipop, and relating the food to the picture in the book.

Read

Make a caterpillar puppet by coloring a white sock with marker to look like the caterpillar in the book; make sure it has big eyes and a long green body. Cut out huge colorful wings out of cloth or paper. Attach strips of furry velcro to the puppet and hooked velcro to the wings. Make a cocoon from a piece of old hose or brown sock. Act out the story with the puppet and find each hole on the pages with holes. When the puppet eats, stuff as many as possible foods in the sock puppet to make the caterpillar get fat! Put the puppet in the cocoon and attach the wings so that the butterfly can fly away! Ask questions about how and why the caterpillar changes.

Enrichment

You can enrich this experience by making colored poster board cutouts of the foods so the child can practice making one-to-one correspondences between the cutouts and pages;use puff pens to emphasize the key differences. Use furry velcro tabs on the pages and hooked velcro tabs on the matching pieces as markers. Point out the relationship of the pieces to the real objects.

References and Resources

Anderson, E. S., Dunlea, A. & Kekelis, L. S. (1993). The Impact of input: Language acquisition in the visually impaired. First Language, 13, 23-49.

Drezek, W. (1995). Move Touch Do! Louisville, KY: American Printing House for the Blind.

Evans, J. & Moore, J. E. (1991). How to Make Books with Children. Monterey, CA: Evan-Moor Corporation.

King-DeBaum, P. (1990). Storytime: Stories, Symbols and Emergent Literacy Activities for Young, Special Needs Children. Solana Beach, CA: Mayer and Johnson.

Koenig, A. J. & Farrenkopf, C. (1996). Essential experiences to undergird the early development of literacy. Journal of Visual Impairment and Blindness. 91, 14-23.

Miller, D. (1985). Reading comes naturally: A mother and her blind child's experiences. Journal of Visual Impairment and Blindness, 79, 1-4.

Moore, J. E., Evans, J. & Morgan, K. (1990). Making Seasonal Big Books with Children. Monterey, CA: Evan-Moor Corporation

Recchia, S. L. (1997). Play and concept development in infants and young children with severe visual impairments: A constructivist view. Journal of Visual Impairment and Blindness, 91, 401-406.

Rettig, M. ( 1994). The play of young children with visual impairments: characteristics and interventions. Journal of Visual Impairment and Blindness, 88, 410-120.

Sacks, S. Z., Kekelis, L.S. & Gaylord-Ross, R. J. (1992). The Development of Social Skills by Blind and Visually Impaired Students: Exploratory Studies and Strategies. New York, NY: American Foundation for the Blind.

Sewell, D. & Durkel, J. (1997). Emerging Literacy for Braille Readers. Paper presented at the Texas AER conference, El Paso, Texas.

Stratton, J. M. (1996). Emergent literacy: A new perspective. Journal of Visual Impairment and Blindness, 90, 177-183.

Strickling, C. (1997, January). INSITE Training: Motor. Paper presented at the INSITE training workshop, San Antonio, Texas.

Self-Determination Units and Lessons

Use with How Does My Vision Affect My Access to Information? Self-Determination Lessons 9, 10, & 11

  1. List 3 personal goals you have.
    • 1.
    • 2.
    • 3.
  2. Will your vision make it difficult for you to accomplish any of these goals independently?
    • Yes
    • No
  3. What steps would you have to start taking now to achieve these goals?
    • Step 1:
    • Step 2:
    • Step 3:
  4. Who could you use as a support or resource to complete the steps you listed in #3?

Self-Determination Units and Lessons

Use with Strategies for Communicating with Others about Access Lessons 9 & 10: Personal Preferences for Access to Visual Media

Visual TaskMagnifier or TelescopeBrailleiOS DeviceDesk-top Video MagnifierScreen MagnifierScreen ReaderDesk CopyAudible MaterialsPartner with StudentNone Needed
Read print in textbooks                    
Read small print such as math symbols, tables, charts, graphs                    
Read information on the chalkboard or whiteboard                    
Read information on an interactive board (e.g., Smartboard)                    
Read things projected on a screen (such as a PowerPoint)                    
Watch a speaker in class, at an assembly, or large lecture hall                    
Use audio books along with print books for classwork                    
Complete art projects                    

KHSelf-Determination Units and Lessons

 Use with Strategies for Communicating with Others about Access Lesson 1:  Personal Preferences for Access to Visual Media

Visual Task Magnifier or Telescope Braille iOS Device Desk-top Video Magnifier Screen Magnifier Screen Reader Desk Copy Audible Materials Partner with Student None Needed
Read print in textbooks                    
Read small print such as math symbols, tables, charts, graphs                    
Read information on the chalkboard or whiteboard                    
Read information on an interactive board (e.g., Smartboard)                    
Read things projected on a screen (such as a PowerPoint)                    
Watch a speaker in class, at an assembly, or large lecture hall                    
Use audio books along with print books for classwork                    
Complete art projects                    

Originally published in See/Hear Newsletter, Summer 2007
Versión Español de este artículo (Spanish Version)seis

Chris Montgomery, TSBVI Outreach, Deafblind Education Consultant

Abstract: A former classroom teacher, now Outreach deafblind consultant, shares the observations and educational intervention strategies he compiled when working with one student a few years ago. Natasha had cortical visual impairment, central auditory processing disorder, seizure disorder, and additional sensory integration problems.

Keywords: visually impaired, cortical visual impairment, central auditory processing disorder, deafblind.

Natasha is a seven-year-old girl who has been labeled deafblind. She has a severe bilateral hearing loss, a cortical visual impairment, and a long history of severe seizure disorder that began at four months of age. To restrict and lateralize her seizures, by age three she needed a corpus callosotomy to separate the anterior two-thirds of the corpus callosum. After surgery Natasha made significant improvements in her general health, sleep, growth, development, midline control, and sustained visual gaze. Her seizures continued, and at age six she received a Vagus Nerve Stimulator (VNS). The VNS is a device that sends an electric signal to the Vagus nerve at consistent intervals so regular brain waves can be established, thus minimizing seizure activity.

It has been approximately three years since Natasha's neural surgery. Research suggests that the first three to four years of a child's life is the most critical for the development of neural pathways. Early identification of Natasha's neurological conditions, including CVI provide the best opportunity to take advantage of the brain's plasticity. I feel we are just in time in this regard, and I am noticing improvement in her use of vision weekly.

Observations

In Natasha's case, her CVI had a more profound effect on her vision before her corpus callosotomy. According to her mother her depth perception problems have improved. Her ability to stay on task and recognize people and calendar symbols is also improving. Natasha still exhibits a strong preference for bright primary colors, and usually attends better when her environment is kept visually uncluttered. She does not demonstrate fluctuations in her vision.

Natasha is starting to respond to my voice during familiar activities such as eating breakfast. She will lean her ear toward my mouth to listen to familiar phrases that I say to her. I try to keep these vocalizations as consistent as possible during the routines so they will in effect be paired with the routine we are doing. I am hoping the next step will be her hearing these vocalizations from a further distance, and associating my vocalizations with the particular activity by signal or gesture when we are away from the activity. Natasha is motivated by her near senses including:

  • Vestibular: swinging, being flipped, rocking, swaying, and extreme extension in a inverted position.
  • Oral/Tactile: oral exploration, smelling, tasting, textures (e.g. pegboard, carpet, familiar blanket), water, vibration.
  • Touch/Proprioceptive: deep pressure, physical rough house play, tapping, stomping feet.

Cortical Visual Impairment

Cortical visual impairment (CVI) is a temporary or permanent visual impairment caused by the disturbance of the posterior visual pathways and/or the occipital lobes of the brain. The degree of neurological damage and visual impairment varies with the time of the onset, as well as the location and intensity of the injury. It is a condition in which the visual systems of the brain do not consistently understand or interpret what the eyes see. CVI can have wide-ranging effects. Individuals can have multiple disabilities, and other cognitive disorders, as well as motor impairments that compound their CVI.

The major causes of CVI are asphyxia, developmental brain defects, head injury, hydrocephalus, and infections to the central nervous system, such as meningitis and encephalitis. (Jan & Groenveld, 1993) The damage may be localized to a

specific area of the brain or generalized to different cerebral regions. Additionally the severity of the visual impairment is related to both the gestational age at the time of insult and neonatal seizures. Other causes for cortical visual impairment include toxoplasmosis, cytomegalovirus, and such cerebral degenerative conditions as Tay-Sachs disease, and galactosemia. (Cogan, 1966) Similar injuries to an adult's nervous system may have very different outcomes than those effecting children.

Individuals with CVI may exhibit any of the following characteristics:

  • Their visual acuities may range from light perception to print reading ability.
  • There is almost always a field deficit present.
  • Nystagmus is absent unless there is an additional ocular disorder.
  • The eyes show no apparent abnormality.
  • A high percentage demonstrate light gazing, even though about the same percentage are light sensitive.
  • Visual functioning fluctuates.
  • Color perception is generally intact and many students seem to perceive red or yellow more easily.
  • Difficulties with depth perception are frequently present, particularly with foreground/background perception.
  • Suppressing unnecessary visual information may be difficult. Close viewing may be preferred even though visual acuities are normal.
  • Perception of objects is difficult when they are spaced close together.
  • Avoiding obstacles during travel is easier than using vision for close work. (Smith & Levack, 1997)

While Natasha uses the distance senses of vision and audition, these senses are less reliable. The information gained through them seems to be more difficult for her to process. Natasha sometimes exhibits signs of auditory overload. She may have a difficult time filtering out environmental noises. Sensitivity reactions observed in the past have included withdrawal, covering her ears, vocalizations indicating stress, and shut-down behavior. Extraneous objects in the environment tend to distract her if they are brightly colored or if they have a desirable texture for touching or mouthing. People walking past or about the room also distract Natasha.

Central Auditory Processing Disorder and Auditory Neuropathy

Central auditory processing disorder (CAPD) is a term that refers to some type of problem in the auditory system, which occurs neurologically instead of in the ear itself. A person may have one or more auditory processing problems for a variety of reasons. Differences in auditory nerve (auditory neuropathy) might cause some of these problems, however there is more to the neurology of the auditory system than the auditory nerve.

As the nerve fibers enter the brainstem at the base of the skull they split and cross (similar to the optic nerve at the optic chiasm). Then the fibers go to various parts of the cortex of the brain. Most of the fibers go to the temporal lobe. Differences in neurology, anywhere along the line, might result in the symptoms of CAPD. (Durkel, 2001)

CAPD is similar to CVI in that it results from neurological causes instead of damage to the sensory system itself. Children with cortical visual impairments are at a greater risk of having CAPD, because the damage to their neurological systems which caused the visual impairment may also have caused damage to the auditory system.

CAPD is defined as a disorder with problems in one or more of the following six areas:

  • Sound localization and lateralization (knowing where in space a sound is located).
  • Auditory discrimination (usually with reference to speech, but the ability to tell one sound is different from another).
  • Auditory pattern recognition (musical rhythms are one example of an auditory pattern).
  • Temporal aspects of audition (auditory processing relies on making fine discriminations of timing changes in auditory input, especially in differences in the way the input comes through one ear as opposed to the other).
  • Auditory performance decrements with competing signals (listening in noise).
  • Auditory performance decrements with degraded acoustic signals (listening to sounds that are muffled, missing information or for some reason are unclear, e.g. trying to listen to speech from the other side of a wall. The wall filters or blocks out certain parts of speech, but a typical listener can often understand the conversations.).

Both at home and at school Natasha associates specific locations with specific actions. She travels to various locations in the classroom to perform these actions, leaving and returning to a given activity repeatedly. Natasha seems to process information by interacting with a person or object for several minutes then withdrawing to a calming activity for several minutes. She has recently begun to associate her calming activities with familiar people, and is attaching her calming activities to places or objects in the room with less and less frequency.

Natasha shows significant signs of sensory disorganization. It is not easy for her to attach meaning to what she sees, hears, or how her body feels within a movement or activity. This means it requires a lot of effort on her part to combine her skills. Natasha's sensory processing skills vary throughout the day, and from day to day. There are occasions when it appears she is using her vision to actively explore and search within her environment. There are other situations in which she is less actively attending to her vision, but seems more aware of her own body through movement, sound, or oral/tactile involvement. The appropriate educational strategies and methods are modified according to her responses.

Body position is a strong contributor to functional use of vision. Natasha is able to hold her head steady to scan the environment and make visual contact with adults. However, there are long periods of time in which her head position is constantly changing and the ability for her to combine her vision and midline control is limited. Movements that promote controlled head and neck extension are helpful.

Epilepsy Surgery and Corpus Callosotomy

Most seizures can be controlled with medicine. When medications are unable to eliminate seizures, other therapies are considered, including surgery. When a part of the brain can be identified as the source of seizures, surgical removal of that source will often eliminate the seizures all together. Several different types of surgery can be offered. The temporal lobe is the most common part of the brain involved in seizures and these patients undergo lobectomy. Extratemporal lobectomy, hemispherotomy, and corpus callosotomy are also used in patients with seizure sources in different parts of the brain. In patients who are not candidates for brain surgery, the Vagus nerve stimulator can be used to reduce seizure frequency.

The surgical procedure corpus callosotomy is resection of the anterior two thirds of the corpus callosum. In many cases, limiting the resection provides significant seizure reduction and may avoid some of the cognitive complications that may arise from complete corpus callosotomy. Anterior corpus callosotomy is less likely to lead to significant cognitive difficulties, so-called split-brain phenomenon, than larger resections. More extensive corpus callosum resections can disrupt the cross-hemispheric communication of visual information and may lead to more noticeable neuropsychological problems. All divisions likely cause some deficit and acute, transient problems are common, especially in total resections.

Nevertheless, when anterior corpus callosotomy fails to provide significant seizure reduction, some patients may benefit from a secondary procedure to resect the remaining posterior one third of the corpus callosum.

The goal of these procedures is seizure reduction, not cure. Accordingly, reduction in seizures to a certain percentage is used as a measure of success. Overall outcome has been reported as 8% seizure free, 61% improved, and 31% not improved. In children who undergo corpus callosotomy, quality of life measures improved with seizure reduction, even in the absence of seizure-free status. (Beach, 1998)

A Vagus Nerve Stimulator is used with patients who have medically intractable epilepsy, and are not candidates for resective surgery. The stimulator is placed on the left Vagus nerve, in the neck. A battery is placed under the skin in the chest, like a pacemaker. By using the stimulator, a significant reduction in seizure frequency can be achieved. Although complete seizure freedom is unlikely, the effect of the stimulator seems to improve with continued use. Seizure reduction is greater the longer the device is used.

Learning Implications

In order to address Natasha's unique learning style, the educational team has adopted the following educational strategies.

  • Provide opportunities for a variety of vestibular and tactile stimuli. Allow Natasha to swing for at least 20 minutes prior to a structured activity. This type of vestibular input has great impact on increasing her eye contact and focus on objects and people. Vibration and deep touch are also calming to her nervous system.
  • For sensory motor participation and play, Natasha should direct her own movements as much as possible. Sensory motor play is a chance for Natasha to experience comfort within her own body. The caregiver's role should be to establish trust, offer options, and make themselves available for interaction.
  • Use the near senses (tactile, oral, vestibular, proprioceptive) to gain Natasha's attention and motivate her to attend to visual and auditory information.
  • To promote self-initiation, provide opportunities for Natasha to build a sense of anticipation. The layout and organization of the classroom and calendar systems must be predictable. A quiet uncluttered environment with a limited number of people will help her focus. Combining object symbols, voice, and gesture (e.g. pointing, gestural sign) will help to direct Natasha's attention. Adding rhythmic sounds and singing while Natasha is engaged in an activity helps her to focus her attention as well.

Conclusion

Research indicates that the ear and the eyes neurologically function and develop in much the same way. I feel Natasha still has time to establish neuro-pathways that will facilitate her use of both vision and hearing in meaningful ways. Through the use of consistent activities and communication strategies we are already seeing Natasha make more sense of her world and use her vision and hearing in more functional ways. I feel the future is very bright for Natasha.

Bibliography

Beach, S. (1998). Washington University Neurosurgery (retrieved 2001) (neurosurgery.wustl.edu).

Cogan, D. (1966). "Neurology of the visual system". Springfield, Ill: C.C. Thomas.

Durkel, J. (2001). "Central Auditory Processing Disorder and Auditory Neuropathy." See/Hear, 6 (1).

Jan, J., & Groenveld, M. (1993). Visual behaviors and adaptations associated with cortical and ocular impairment in children. Journal of visual impairment and blindness (JVIB), 87, 101-105.

Jan J., Wong P., Groenwell M., Flodmark O., & Hoyt CS. (1986) Travel vision Collicular visual system? Pediatr. Neurol. 2 (6) 359-62.

Morse, M. (1990). Cortical visual impairment in young children with multiple disabilities. Journal of Visual Impairment & Blindness, 84, 200-203.

Smith and Levack, (1997). Teaching students with visual and multiple impairments. Austin, TX: Texas School for the Blind and Visually Impaired.

We are so glad that you will be joining us for a webinar on Adobe Connect.  If you are using a screen reader to access this webinar it can be a little tricky the first time around.  Here are a few tips to make the experience less frustrating. 

When you register, you will be sent a link to the webinar "room" which you will use to join the webinar.  You will sign in as a guest using at least your first name.  It is best to arrive at least 15 minutes prior to the start time to make sure you are up and running when the webinar begins.  Because most of our webinars are recorded for archiving to the web, you will also be given a phone number to call to be able to access the audio portion of the webinar.

When you enter the room, take some time to navigate to various "pods" or areas where information is shared. Your presenter should give you some basic information about the location of each pod at the start of the webinar, but the more time you have to become familiar with the layout the better your experience will be.  

Pods

Pods are areas on your screen that contain different types of information and presented in a variety of ways such as text, links to downloadable files and websites, captions, interactive polls and more.  The presenter should orient you to the room at the start of the webinar, but you may want to enter the room a little early to find your way around before the presentation starts.

Use Control-F6 to move clockwise between pods, Shift-Control-F6 to move in reverse through pods, Control-F8 open Settings Menu for a particular pod. Pod titles are announced when focused.

Chat pod

A chat pod is where participants can make comments or ask questions by typing in text.  A chat text can be shared with everyone, only with presenters and hosts, or with individual attendees.  Typically, someone on the presenter side monitors these chats, and if anything is pertinent to the presentation, then  the presentation is interrupted and the chat message read. Individual attendees can get to the chat pod to type a comment. Default focus is the new message field. Shift-tab to read messages is the chat window.  The messages will automatically be read from oldest to newest which can be clumsy.  You may want to use the directions below so that you read the newest message typed in the chat first.

Note: Important setting - Read the latest message first (steps below)

  • focus the chat pod,
  • hit Control-F8.
  • Arrow to "reverse order of messages."
  • Hit Enter.

Files pod

The files pod is a listing of downloadable files which might include handouts, sign-in roster, or other documents you should have for the webinar. Typically we send these out in advance to all registered participants, but they will always be in the files pod if you did not have a chance to download them before you joined the webinar. File pod is readable and operable from the keyboard.

  • Users can download all files
    • hit Control-F8 for the menu
    • arrow down to "Download All"
    • hit Enter
    • A new window opens
    • Use TAB key until you hear "Click to Download," hit enter
    • Users can download one file.
      • Focus the Files pod,
      • TAB to list box which will read first file name and size (and tell you how many files there are),
      • Down arrow to the file you want,
      • hit SPACE BAR.
      • A new window opens.
      • Use TAB key until you hear "Click to Download",
      • hit enter.

Caption pod

The caption pod provides a real-time caption of everything that is said during the webinar.  This can be very helpful if your hearing is impaired or if you are not getting good audio reception.  

 

Polls pod

Poll pods are used to get feedback from attendees related to their participation in the webinar.  Some polls require you to select a single answer and others require you to select multiple answers from a list.  Polls may also ask that you type in an answer.  Your response is shared with everyone attending the webinar most of the time, though the presenter has the option of making your votes anonymous.  In most cases the poll and answer options will be included in your handout.

  • Pod pops up, alerts the user (beeps), and moves focus moves to the pod.
  • The question is read. (the only way to reread the question is to unfocus and refocus the pod (Control-F6 move focus to another pod, Shift-Control-F6 move focus back to Poll pod)
  • The user is placed on the first item.
  • Tabbing cycles through all of the answers.
  • There is no indication of the number of items, presenter must provide.
  • User can tab between items, use the enter key to select radio button or checkbox(s) to vote on an item.
  • When a short answer (edit field) is presented the question is asked, the user is already in the edit box (but no indication of being in the edit box is presented.)
    • type the answer,
    • tab to the submit button,
    • hit space to submit answer.
    • Tab again to read all of the results. There is no navigation within the results, they just read in one chunk.
    • When presenter closes the poll pod it will go away.

Discussion notes pod

The discussion notes pod is a way for someone to take notes live.  This is typically only used in meetings or when a group of people are collaborating on a project. This pod can only be read in one chunk from top to bottom. Usually discussion notes are emailed to all participants after the presentation.

Weblinks pod

This pod contains links to pertinent websites that may be accessed during the presentation.  To access the links:

  • Tab into list box of web links,
  • arrow to select a web link to browse,
  • tab to "browse to" button,
  • space bar activates link and opens in a new browser window.

Raise hand

Another feature attendees might want to use is "raise hand".  This allows you to let the presenter know that you have a question or comment and would like them to call on you.  You don't have to use this feature since you can either speak to the presenter or post something in a chat.  To raise your hand:

  • Control-space jump to menu
  • tab 2 times to "Set status button dropdown"
  • SPACEBAR raises hand.
  • SPACEBAR again lowers hand and announces "lower raised hand dropdown"
  • Or
  • CTRL+E will jump to the Set Status Button and raise hand CTRL+E will lower hand but no announcement of either condition is made.

Resources

Adobe Connect Captioning Pod http://www.adobe.com/products/adobeconnect/feature-details/closed-captioning.html)

Keyboard shortcuts (mostly for presenters)http://help.adobe.com/en_US/connect/9.0/using/WS5ae85155c1a0214d1172e081227b89777b-8000.html

Texas Closed Captions http://www.texascaption.com

Adobe Connect Troubleshooting page https://<your room>.adobeconnect.com/common/help/en/support/meeting_test.htm

By Sam Morgan, Education Specialist

Fact Sheet reprinted with permission from California Deafblind Services

Neurological Visual Impairment (NVI) is now the preferred name for a type of vision impairment that has been and is still referred to as Cortical Visual Impairment or Cortical Blindness. NVI is now divided into three categories: Cortical Visual Impairment, Delayed Visual Maturation, and Cortical Blindness. These divisions are made according to what area of the brain has been effected.

A variety of studies indicate that the percentage of children with vision impairments who have NVI is between 3.6 and 21%, making it the major cause of vision impairment in children who are deaf-blind. NVI occurs when the part of the brain that is responsible for seeing is damaged. In other words the eye itself is normal, but the brain does not process the information properly. NVI has a variety of causes, including, but not limited to, lack of oxygen before, during, and after birth, viral or bacterial illness such as meningitis and cytomegalovirus, or traumatic brain injury. These children can but do not always have additional disabilities. Other types of vision impairments such as optic atrophy (defect of the optic nerve resulting in the inability of the nerve to conduct images to the brain) and optic nerve hypoplasia (a vision impairment caused by a congenital defect of the optic disk) are more common in children with NVI.

NVI effects vision in a variety of ways and causes vision loss that can be from mild to severe, temporary or permanent. There is no way to predict what a young child's vision will be like as they mature but many children with NVI experience improvement in their vision. Fluctuating vision is common. This is most pronounced in children with seizure disorders or in those on certain medications such as Dilantin, Tegretol, or Phenobarbital. A child may be able to see an object one day and be unable to the next. These children may also have better peripheral than central vision and thus look at objects out of the side of their eye. They may have visual field losses that are not symmetrical (one eye may be worse than the other). This uneven loss does not necessarily correspond to hand function. If the left eye is better than the right, the left hand is not necessarily stronger than the right.

Children with NVI experience problems with specific types of visual tasks. They have difficulty with figure-ground (seeing an object instead of the background), and with complex visual displays such as cluttered pictures (a picture of five different animals instead of two). Spatial confusion is common; for example being unable to locate their chair even though they can see it. They may also be visually inattentive, not wanting to look at objects, and may prefer their sense of touch. It is common to see a child turn his/her head away as they explore an object with their hands. Seeing with NVI can be compared with trying to listen to one voice in a noisy room or to speaking a foreign language.

Vision stimulation is proven to help most children with vision impairments improve the way they use their vision; this is especially true of children with NVI. For vision stimulation to be effective it needs to happen in everyday real life situations, not only in therapy sessions. Identifying colors in an activity, visually tracking their classmate as they move across the room, and identifying the shape of every day objects are examples.

Suggested Instructional Strategies for Children with NVI

  1. Materials, such as pictures, should be simple in form, high contrast (the colors of a picture or object should be different such as a yellow toy against a black background instead of an orange one), and presented one at a time.
  2. Bright lighting can help a child see and attend to visual materials more consistently. Adjust the light both natural and artificial to determine what is best. Controlled incandescent lighting may be better than fluorescent lighting.
  3. Give the child time to respond to the materials that are being presented.
  4. Color vision is usually intact, and color can be used effectively. Yellow and red are possibly easier to see and can be used to outline numbers, letters, or pictures, to color code, or to attract attention to something you want the child to look at.
  5. It is also important to keep the color of materials constant to avoid confusion. This also applies to visual cues in general which should also be consistent over time and location. If the child uses a red bowl at home and this is how he knows it is time to eat then the same should be done at school. Watch to see if the child has a preference for size or color.
  6. Use a multisensory approach such as pairing an object that you want them to see with a sound.
  7. Touch should be considered as a major sense for learning. Children with NVI appear to learn effectively through this sense.
  8. Repetition and routines can help the child understand their visual environment. If changes are needed make them slowly to allow time to adjust.
  9. Fluctuations in visual performance can be limited by reducing fatigue. Try working in short spurts, or divide a long task into shorter periods.
  10. Reduce outside noise and other environmental stimulation that may distract the child.
  11. Objects can be more easily seen when they are moving. This is especially true when they are in the peripheral fields.
  12. Positioning is also important. The more energy being expended on holding yourself up the less can be used for seeing.
  13. Language helps a child to understand a visual situation by adding meaning to it. Be consistent in the language you use.

References

Groenveld, M, Jan, J.E, & Leader, P. (1990). Observations on the Habilitation of Children with Cortical Visual Impairment. Journal of Visual Impairment and Blindness, 84, 11-15.

Levack, N. (1991). Low Vision: A Resource Guide with Adaptations for Students with Visual Impairments. Austin: Texas School for the Blind.

Morse, M.T. (1990). Cortical Visual Impairment in Young Children with Multiple Disabilities, Journal of Visual Impairment and Blindness, 84, 200-203.

Takeshita, B. (1996, March). Neurological Visual Impairment. Paper presented at the annual conference of the California Transcribers and Educators of the Visually Handicapped.

Fact sheets from California Deaf-Blind Services are to be used by both families and professionals serving individuals with dual sensory impairments. The information applies to students 0-22 years of age. The purpose of the fact sheet is to give general information on a specific topic. More specific information for an individual student can be provided through individualized technical assistance available from California Deafblind Services. The fact sheet is a starting point for further information.

Ann Rash and Nancy Toelle, TSBVI Outreach

The most important tool in the TVI's toolbox when working with MIVI students is collaborative consultation regarding activity routines. A well-written routine will incorporate aspects relating to all disciplines working with the child: occupational therapist, physical therapist, speech therapist, teacher of the visually impaired, teacher of the auditorially impaired, classroom teacher, parent. Remember the overriding purpose of activity routines is to provide the child with a pleasurable experience that they will want to participate in, will anticipate, and communicate about. Also keep in mind that the very first step to implementing routines is to build a relationship with the classroom teacher and assistants so that they will be open to trying this approach.

Though we feel strongly that activity routines are appropriate for all MIVI students, we recommend that for your first trial you select a student who: attends school regularly, has a teacher who is willing to try new techniques, has demonstrable likes and dislikes and has periods of alertness during the school day.

Steps for incorporating Activity Routines into your practice:

1. Informal assessment of the student:

  • Appetite and aversion inventory. Make a list of the student's likes and dislikes. For example: water play, singing, being held closely, vigorous movement, cuddling, food. This information should come from those most familiar with the child, including parents. The key to this step is to use the activities liked by the child and avoid the dislikes.
  • Biobehavioral states. When is the child awake and alert for learning? Ask classroom staff and parents to make note of the child's most alert times of day. Learning cannot occur if the child is distressed, hungry, or asleep.
  • Orienting reflexes. Determine what calms and/or alerts the child to be ready to learn.

2. Writing the routine:

  • Develop a trial routine based on the child's likes as found in the informal assessment information.
  • The TVI, classroom teacher, and other related staff available draft a script of the steps for a sample routine, including: positioning, spoken language/sign to be used, location and materials.
  • The group agrees on an activity that is highly pleasurable, simple to do, brief, and fits easily into the classroom schedule, and is well within the child's current range of abilities. Once an initial routine is learned, steps can be incorporated to increase the level of challenge.
  • A routine is developed with a note taker being responsible to produce copies for all (frequently the TVI).
  • Once a copy is in hand, circulate it to any member of the team who was absent to make sure issues relating to their discipline are addressed properly (positioning, language, etc).
  • Set a date to give the routine a try and see how all the steps work and make revisions, as needed.
  • Produce a final, revised routine.

3. Implementing the routine:

  • The routine will need to be done at least once daily (or as frequently as the child is in school) at the time that it fits in the schedule; can be done exactly as scripted, always in the same location, and with the same materials. Remember, the goal is to build memory and anticipation!
  • The final routine should be demonstrated and practiced with whomever will implement it.
  • Pick a date to begin that is not before a holiday or when student will be absent for a prolonged period.
  • Start the routine and pay attention to the child's responses to each step: both of you should be enjoying it. Look for: anticipation, participation, pleasurable response, and effort to communicate a desire to continue.
  • Keep in mind that you will be establishing a baseline for this child's ability to learn a new routine and that we simply don't know how long that will take. Be prepared to stick with it; don't give up.

Once this routine is firmly established, develop another pleasurable routine, following all the guidelines presented above. This sets the stage for choice making and incorporating these activities into a calendar or schedule of meaningful activities for the child. Eventually, you will be able to sandwich a not-so-pleasurable routine (tooth brushing, face washing) in between highly pleasurable ones.

Sample activity routine:

Rocking with a young child (consult with speech therapist regarding the signs for "more" and "finished"):

  1. Start by going up to the child with pillow, blanket or other object prompt and say, "Let's rock!" and help them make a rocking movement with their hands/arms.
  2. Take the child to the rocker (plain chair or place on the floor where you can rock slightly if no rocker is available).
  3. Say, "Let's sit in the rocker (chair/floor)," and seat yourself and the child with the pillow or blanket touching the child.
  4. Start rocking and sing a rocking song, such as "Rock, Rock, Rocking with Amy". Sing the line three times before saying, "STOP!"
  5. Stop and wait for 15 seconds to see if the child indicates in any way that he/she wants to continue.
  6. Ask "Do you want more?" You may help the child make the sign for more.
  7. Repeat the rocking, singing, and the STOP several times, as long as the child is enjoying it and is engaged.
  8. Look for anticipation, participation, communication, and enjoyment on the part of the child.
  9. When ready to end, say "We're finished (or all done)," help the child make the finished sign, and get up from the chair immediately.

Suggestions for other simple routines:

  • Cuddling - object prompt could be a blanket or stuffed animal
  • Water play - object prompt a water toy or bottle of liquid detergent to make bubbles
  • Hand lotion - object prompt a pump lotion bottle
  • Brushing - object prompt a soft therapy brush (check with OT before implementing)
  • Bouncing - object prompt therapy ball
  • Music - object prompt switch to turn music on
  • Play with vibrating toy - object prompt is toy

Sample IEP Objectives to support the use of activity routines:

These objectives could be implemented by the OT, PT, SP, AI, O&M, TVI, and classroom staff

  • Will demonstrate anticipation in the use of 10 familiar objects used in daily routines by appropriate associated actions.
  • Will demonstrate anticipation of the next step in specified daily activity routines.
  • Will actively participate in specified daily activity routines by movement, communication, use of vision and hearing. (Massage, brushing, switch use, diapering, position change, feeding, and play.)

Resources for more detailed information: