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A Publication about Visual Impairments and Deafblindness for Families and Professionals

Excerpts from the website: National Center on Deaf-Blindness https://nationaldb.org/

This framework offers state deaf-blind projects a collection of online resources that they can use to provide customized training and technical assistance to early intervention providers as well as to project staff and families. It focuses on the identification of children with combined vision and hearing loss, key instructional strategies, and the developmental domains used by early interventionists.

https://nationaldb.org/products/ei-framework

Megan Rech, Research Coordinator, Baylor College of Medicine

Abstract: Ms. Rech shares an overview of the BBSOAS Family Conference that was held in Houston in April.

Keywords: Boonstra-Schaaf Optic Atrophy Syndrome, BBSOAS, cortical visual impairment, optic atrophy, visual impairment, Texas School for the Blind and Visually Impaired Outreach (TSBVI)

Photograph of Dr. Christian Schaaf.The inaugural Bosch-Boonstra-Schaaf Optic Atrophy Syndrome (BBSOAS) Family Conference was held in Houston, Texas on April 27th and 28th. BBSOAS is a rare neurological disorder caused by a disruption in the NR2F1 gene on chromosome 5. The syndrome is characterized by a wide array of clinical features, but the most common are developmental delay, intellectual disability, low muscle tone (hypotonia) at birth, and vision impairment caused by a small and pale optic nerve and/or cortical visual impairment (CVI). There are currently about 55 known cases of BBSOAS worldwide. Though there is presently no cure for BBSOAS, with early intervention and proper management, much can be done to improve the quality of life of those affected.

The purpose of the conference was not only to provide education through presentations from leading researchers and medical professionals, but also to promote community-building by facilitating opportunities for families to get to know and learn from each other.

The conference was hosted by the lab of Dr. Christian Schaaf, a Professor for Clinical Genomics and the Medical Director of Clinical Genetics at the University of Cologne in Germany and Visiting Professor at Baylor College of Medicine and the Jan and Dan Duncan Neurological Research Institute in Houston. In addition to Dr. Schaaf, several other collaborators and experts shared their knowledge with families.

Photograph of Dr. Danielle BoschDr. Danielle Bosch (UMC Utrecht, photo right), together with Dr. Schaaf, presented on the clinical features of BBSOAS, while Dr. Fred Pereira (Baylor College of Medicine) spoke about the molecular aspects of the syndrome.

The conference also highlighted vision research, with a presentation from TSBVI Outreach Consultants Sara Kitchen and Lynne McAlister on supporting children with CVI, and a talk from Dr. Jane Edmond on the causes of visual impairment in the syndrome. Dr. Edmond is the Director of the Mitchel and Shannon Wong Eye Institute and Professor and Inaugural Chair of the Department of Ophthalmology at the Dell Medical School at the University of Texas at Austin, and she is also an Adjunct Professor in the Department of Ophthalmology at Baylor College of Medicine. In addition, special guest Dr. Ana Treviño-Godfrey (Director of Prelude Music Classes for Children) facilitated a music activity for the group.

As part of the event, families also had an opportunity to be examined by Dr. Edmond or Dr. Veeral Shah, a pediatric neuro-ophthalmologist at Texas Children’s Hospital, as well as to meet one-on-one with Dr. Schaaf. While the focus of these visits was to answer families’ questions, the hope is that findings from these visits will lead to a more comprehensive characterization of the syndrome.

All in all, 27 families, or about 100 people, traveled to Houston for the conference.

To learn more about BBSOAS, please visit https://www.bcm.edu/research/labs/christian-schaaf/nr2f1.

Veronica Lewis, Writer/blogger at Veronica with Four Eyes, Excerpts from https://veroniiiica.com

Abstract: Ms. Lewis reviews 5 websites that provides information and resources that shares information about vision impairments with children.

Keywords: blind, visual impairment, braille, low vision,
https://veroniiiica.com/2018/01/19/five-websites-that-teach-kids-about-vision-impairments/

As more and more students are diagnosed with vision impairments, kids naturally become curious about what vision impairments are and how people live with them (read more about how I answer questions children ask about my low vision here: https://veroniiiica.com/2017/08/28/answering-strangers-questions-children-edition/). Luckily, there are many kid-friendly resources online that teach about Braille, blindness, low vision, and more. In honor of National Braille month, here are five websites that teach kids about vision impairments, including blindness and low vision. These websites are targeted at sighted kids but are also great for curious kids with vision impairment.

  • You’ve Got Braille
    You’ve Got Braille is a resource on PBS Kids that teaches young children about Braille using characters from the show Arthur. A character named Marina has a page where she talks about life with blindness and educates readers on basic adaptations such as listening to books (read more about listening to books on Amazon Alexa here), reading large print (read more about Bookshare, an accessible library here), and using screen readers. There’s also a Braille translator. I love that this website is inclusive of low vision and has current information too. Check out the website for You’ve Got Braille here (http://pbskids.org/arthur/print/braille/).
  • Braille Bug
    Braille Bug is an interactive resource created by the American Foundation for the Blind. On the website, kids learn about color contrast (read my post on colored backgrounds here), Louis Braille, Helen Keller, different types of Braille including music (read more about how to make music accessible for low vision here), and also has games and activities. I had a lot of fun exploring the website, especially the Louis Braille virtual museum. Check out the website for Braille Bug here (http://braillebug.afb.org/).
  • SeeNow Vision Simulator
    SeeNow Vision Simulator was developed to teach people about navigating with a vision impairment by seeing what locations look like through the eyes of someone with uncorrectable vision loss. I used it to explain to someone why I find it difficult to navigate an area near my college and show them how it looked to me- read more about navigating college campuses here. There is also an app available, but I have not tested it. Check out the website for SeeNow Vision Simulator here (https://simulator.seenow.org/).
  • Kids Quest: Vision Impairment
    Kids Quest: Vision Impairment is a resource developed by the Center for Disease Control. The website challenges assumptions kids may have about vision impairment and teaches them about assistive technology (read five myths about assistive technology here) as well as encourages them to research information on outside websites. There’s even a section on famous people with vision loss- read my post on Buddy Holly and how he helped make glasses cool here. This website can answer most questions someone could have about vision loss. I recommend it for older kids, age 10 and above. Check out the website for Kids Quest: Vision Impairment here (https://www.cdc.gov/ncbddd/kids/vision.html).
  • WonderBaby
    While this website isn’t technically directed at kids, WonderBaby is a website curated by Perkins School for the Blind about raising children that have vision impairments and multiple disabilities. There's a lot of great projects, information and tips featured, and my mom has said she wished this website existed when I was younger because it would have been really useful. Check out the website for WonderBaby at (http://www.wonderbaby.org/).

By encouraging kids to learn more about living with vision impairment, inclusive and accessible spaces can be created and flourish. After all, kids with blindness and low vision aren’t much different than other kids, which I mention in my myths about IEP students post here (https://veroniiiica.com/2017/10/30/seven-myths-about-iep-students/) – they just see things a little differently.

Kevin Markel, Program Specialist for Pre-ETS, Texas Workforce Commission

Abstract: In this article, Mr. Markel discusses work-based learning and the impact it can have on the post-secondary education and business success of an individual with a disability.

Keywords: Vocational Rehabilitation, disability, Texas Workforce Commission, Workforce Innovation and Opportunity Act, pre-employment transition services, work-based learning, Summer Earn and Learn, WACO, SWEEP, SWEAT, WALIC.

For students with disabilities and their families, achieving meaningful, long-term employment is one of the primary goals for post-school life. This goal is also shared by the education and vocational rehabilitation professionals who partner with them.

The Workforce Innovation and Opportunity Act (WIOA) requires vocational rehabilitation programs, such as the Texas Workforce Commission Vocational Rehabilitation program (TWC-VR), to provide pre-employment transition services (Pre-ETS) to students with disabilities to better prepare them for a successful transition from secondary education to postsecondary education and employment. Pre-ETS activities include five services: work-based learning, counseling on post-secondary education, career exploration, workplace readiness and self-advocacy. This article will focus on work-based learning. Future articles will provide additional information on each of the other Pre-ETS required areas.

While all of the required Pre-ETS areas are important and instrumental for transitioning students with disabilities, there is an additional emphasis on the provision of work-based learning opportunities. There are numerous studies, including longitudinal studies, that point to the positive relationship between work-based learning experiences during secondary education and successful post-school employment.

Work-based learning is an instructional approach that uses the workplace or real work experiences to provide students with the knowledge and skills that will help them connect school experiences to real-life work activities and future career opportunities. It is essential that direct employer or community involvement, within an integrative setting, be a component of the experience to ensure student engagement and assist in the learning process. Work-based learning experiences vary and are tailored to the student’s needs. These activities include:

  • Job Shadowing
  • Career Mentorship
  • Informational Interviews
  • Service Learning
  • Simulated Workplace Experience
  • Paid and Non-Paid Work Experience
  • Volunteering, and
  • Internship or pre-apprenticeship experiences

In January 2017, TWC approved the Pathways to Careers Initiative to expand opportunities for Texas students with disabilities to receive Pre-ETS. This initiative compliments and advances the Tri-Agency initiative by TWC, the Texas Higher Education Coordinating Board and the Texas Education Agency (TEA), which emphasizes the importance of applied learning opportunities. These opportunities may be through internships and work experiences, ensuring that students have better information about career pathways to promote informed choices and increase the number of Texas students who complete a postsecondary degree or credential. One of these TWC work-based learning initiatives is called Summer Earn and Learn (SEAL), which is conducted in partnership with Local Workforce Development Boards (Boards) and their employer partners. SEAL combines essential employability skills training and paid work experience for students with disabilities. SEAL is offered across the state in each Board area during the summer months, for at least five weeks, when students are typically out of school. Through this program, students experience a real work environment, receive a paycheck, and learn valuable interpersonal and transferable skills that prepare them for their future success.

In its inaugural summer of 2017, the SEAL program assisted more than 1,500 students with disabilities with employability skills training and paid work experiences with a variety of Texas employers. TWC anticipates at least 2,500 students with disabilities will participate in SEAL in 2018.

Other summer work-based learning opportunities that have historically been available for students who are blind or visually impaired will also continue this summer. Those activities include SWEEP in Lubbock, the WACO Project at Texas A&M, and the SWEAT / WALIC programs at Texas School for the Blind and Visually Impaired (TSBVI).

On a personal note, as an individual who is visually impaired, I can point to the positive impact and integral role that summer jobs played in my readiness to face the world of work. Through these summer opportunities in high school and college, I had the opportunity to practice self-disclosure about my disability, understand how self-disclosure impacts my functioning, and determine which assistive devices and aids allowed me to complete certain tasks best. These opportunities also afforded me the chance to gain invaluable information on the type of work that I enjoyed and the type of work I did not enjoy, so I could make better informed career decisions during and after post-secondary training. For these reasons, and many others, we encourage students and their families to discuss the possibilities of work-based learning opportunities with their respective TWC-VR counselor.

Keisha Rowe, Director, Office of Independence Services Health and Human Services Commission

Abstract: This article outlines the program services provided by the Rehabilitative and Independence Services section of HHSC.

Keywords: HHSC, services, disabilities

The Blind Children’s Program is part of the Texas Health and Human Services system, which is dedicated to helping millions of people each year. For people who need medical care, food for their children, dignified care in a nursing home or an assisted living facility, or independent living resources – HHS is ready to help.

More than 3.4 million Texans have a disability. HHS programs offer an array of services to meet the needs of people with disabilities, including providing guidance and referral expertise to a family whose child was just diagnosed with a disability; helping people find and secure independent housing; working with community partners to create jobs; and locating service providers who provide in-home care in order to help keep people out of institutions.

HHS’s Health, Developmental and Independence Services programs offer information and support in the following areas:

  • Acquired brain injury
  • Autism
  • Blindness and visual impairment
  • Comprehensive rehabilitation services
  • Deaf and hard of hearing services
  • Early childhood intervention
  • Employment services
  • How to pay for services
  • Intellectual or developmental disabilities– long-term care
  • Medical or physical disabilities
  • Person-centered planning
  • Service coordination

HDIS’s Rehabilitative and Independence Services is home to numerous programs to Texans with disabilities.

Blind Children’s Program

The Blind Children’s Vocational Discovery and Development Program helps people 22 and younger who are blind or severely visually impaired learn the skills required for personal independence, potential employment and integration into their community. BCP’s comprehensive habilitative services enhance children’s ability to develop skills comparable to those of their sighted peers. It also helps children achieve financial self-sufficiency as adults. Blind Children Program’s specialists serve a dual role as case managers and direct service providers.

Blindness Education, Screening and Treatment Program

Blindness Education, Screening and Treatment services reduce the incidence of blindness throughout Texas. The program encourages people to protect their eyesight by seeking professional care if they are at risk for potentially serious eye conditions. The program provides medical treatment to people without health insurance, helping to prevent blindness. The BEST program contracts with the agency Prevent Blindness for screening services and collaborates with ophthalmologists for treatment services.

Comprehensive Rehabilitation Services

The Comprehensive Rehabilitation Services program fills a service gap for intensive rehabilitation services for people who have sustained a traumatic brain injury, traumatic spinal cord injury or both. The program helps people live independently in their homes and communities. It focuses on three main areas that affect both function and quality of life:

  • Mobility 
  • Self-care
  • Communication skills

Services are provided in the consumer’s home, a hospital, a residential facility, an outpatient clinic or in a combination of settings to encourage the maximum flexibility in service and independence. Depending on the person’s needs, different program services are available, such as in-patient comprehensive medical rehabilitation services, post-acute rehabilitation services -- both residential and non-residential -- and outpatient therapies and supports.

Deaf and Hard of Hearing Services

Deaf and Hard of Hearing Services oversees and manages 11 programs that advance opportunities for people who are deaf and hard of hearing. These programs reduce societal and communication barriers to ensure full and equal opportunity to participate in public life. The program also raises public awareness of the needs of people who are deaf or hard of hearing, as well as the development and coordination of programs, policies and regulations.

Guardianship Services Program

The Guardianship Services Program serves adults with diminished capacity who are substantially unable to provide for themselves and have been referred by the Department of Family and Protective Services. It also serves youth moving out of DFPS conservatorship. HHSC is appointed guardian of people affected by abuse, neglect, self-neglect and/or exploitation.

For adults to be referred by DFPS for guardianship, they must either have a disability or be 65 or older and have been abused, neglected or exploited. For youth moving out of conservatorship, they must be in CPS conservatorship and appear to meet the adult definition of incapacity.

Independent Living Services

The Independent Living Services program enhances the quality of life of people with significant disabilities, including those who are blind or visually impaired. It promotes independence in the home and community and provides access to rehabilitative services and supports. The program places special emphasis on helping people accomplish daily tasks independently; participate in their favorite activities; improve communication and transportation access and mobility; gain a better understanding of their disability; and increase their self-confidence, access to the community and participation in society.

Surrogate Decision-making Program

The Surrogate Decision-making Program authorizes family members and surrogate consent committees to provide written informed consent for people who receive community-based services, lack the capacity to make treatment decisions for themselves and have no legal guardian. This consent applies to the areas of major medical treatment, major dental treatment, use of psychoactive medication and use of highly-restrictive procedures. Volunteers make decisions for people who are living in community-based intermediate care facilities for people with intellectual disabilities or related conditions.

To learn more about these and other programs offered at HHSC, please visit the HHSC website at: https://hhs.texas.gov/

William Daugherty, Superintendent TSBVI

Abstract: In this article Superintendent Daugherty discusses the new pilot program TSBVI is developing with local Independent School Districts (ISDs) and Educational Service Centers (ESC) designed to support and foster early literacy in the braille medium.

Keywords: TSBVI, braille, blind, visually impaired, Educational Service Centers (ESC), early literacy

It is widely recognized that many young children who are likely to become braille readers do not have early literacy-developing experiences similar to those of typically sighted children. Typically sighted children are surrounded by the printed word as soon as they can see, and begin to develop literacy through incidental learning and through more direct avenues such as being read to by family members. Young children with severe visual impairment often do not have sufficient, similar experiences, and may not begin to develop reading skills until formal instruction begins as they enter school. By the same age, the majority of typically sighted students have achieved a much higher level of literacy independence and are using their reading and writing skills to access the broader curriculum. The child with the visual impairment can easily fall behind.

There are certainly examples across the state where children under the age of 5 are getting an excellent early start on developing literacy in the braille medium. A commonality among these examples is a teacher who can devote sufficient time to supporting the child and their family in an organized sequence of activities in the home that build the necessary concepts and skills. For a variety of reasons, not all children have access to this type of consistent, organized instruction that finds its way into daily life routines around the home.

To try and improve this situation, TSBVI has begun creating a pilot program in collaboration with ESC 14. The target is to create a model program for students who are probable braille readers to develop braille literacy skills earlier with on-going support by educators and by family members. The age group of the children for the program will be three to five years old, with the discretion to expand that range as appropriate. This first pilot site will develop a program that we hope can then be replicated by interested regional programs and local schools. The program will consist of assessment tools, curricular materials, activities for home and a design for on-going supports utilizing families, educators and volunteers. TSBVI wants to create an early braille literacy initiative that is both effective and sustainable. We are flexible in how the program is structured and have begun working with ESC 14 on a school year model. So far, we know we will need:

  • A motivated and engaged local school administrator and/or teachers of students with visual impairments who have a strong interest in literacy
  • Support for the program from the regional Education Service Center consultant
  • The availability of local volunteers who are braille readers and are willing to mentor families and their children
  • A package of activities, materials and supports for families that is fun, stress-free, and tailored to each child’s learning needs
  • Data collection and analysis leading to program improvement and justification

While the Region 14 Education Service Center in Abilene has been selected as the first pilot site, we know that several other ESCs have expressed interest and we may be able to expand our partnerships as we move forward. The goal of this first round is to figure out what approaches work best overall, with full awareness that each pilot site will likely need to be tailored to local realities. Broader goals of this initiative are to start a statewide conversation about early braille literacy needs, and to identify partners with similar interests. The desired outcome is for students entering the school system to be reading braille at their highest potential. We are excited to be part of this collaborative effort.

Scott Baltisberger, Education Specialist TSBVI Outreach, with photos by Kristine Seljenes, Adaptive PE, TSBVI Comprehensive Programs

Dragon Boat team logo; a Wildcat and the words TSBVI Dragonboat  Dragon Boat team in 'paddles up' position to start the race.
TSBVI’s Dragon Boat team logo (left) and TSBVI’s Dragon Boat Team in “Paddles up" position - Ready to begin racing! (right)

Keywords: Dragon Boat Festival, Team Sports, Community, Race, TSBVI, Texas School for the Blind and Visually Impaired

On April 30th the TSBVI Wildcats dragon boat team took first place in Division C of the community/corporate category at the 20th annual Austin Dragon Boat Festival, racing in three 300 meter races to capture the title. This victory was the result of regular twice-monthly training sessions which began in September of 2017, during which team members learned independent skills and aspects of teamwork that resulted in their triumph. In this endeavor, they were supported and coached by both school, residential and recreational staff as well as community volunteers.

Team members lining up to board the boat.Team members in the boat getting ready to launch.
Team members lining up to board the boat (left) and team members in the boat, ready to launch for our first race of the day (right).

Dragon boat racing is a 2000-year old sport that is currently having a world-wide surge in popularity. TSBVI’s participation in the Austin race was a chance not only for us to mingle with the crowd and take part in the thrill of competition but also for the public at large to experience first-hand the ability, drive and goodwill of our students. Maintaining an active and engaged lifestyle can have many benefits, including physical fitness, engagement with the community and stress management and we look forward to providing another group with this opportunity during the next school year!

Dragon Boat team photo
TSBVI’s Dragon Boat Team with banner.


Gold! The Wildcats took first place in Division C.

Katherine Trimm, TVI in Houston, TX

Abstract: Kathy Trimm describes the after-school art program she has begun with students who are blind and visually impaired, “Creating With Blind Abandon,” and the group’s participation in the Houston Art Car Parade.

Keywords: Community, Creating with Wild Abandon, Blind, Visually Impaired, Artist, Art, Houston, Tactile and Visual Art.

We were so excited to have participated in the Houston Art Car Parade this year! It was not a planned experience - we sort of fell into it. Read on to find out how!

In my experience as a teacher of students with visual impairments, I have found that so many of my blind and visually impaired students love art! Like many sighted people, I was surprised by this. I have encountered some very talented blind and visually impaired student artists over the years. One of the major inspirations for our art program was a student named Zack, who has very low vision, and whose art later became our group logo. More important to him than sheer talent is the real joy he finds in drawing and creating art! His interest in art inspired me to seek out art for him to experience tactually.

    Photograph of a person holding a round cartoon drawing of a face in front of their face.

Above: Two of Zack's art works: (left) Logo for Creating with Blind Abandon and a round face (right) he created for the parade.

Living in Houston, I assumed I would find accessible art venues that my students could enjoy. I worked with Linda Brown, Braillist, to try to find sources of art for Zack and other students. Much to our dismay, all we found were dead ends. Every museum and art exhibit we could find was strictly hands-off. We knew there had to be something more for our students! That is when we got the idea for Creating with Blind Abandon –a tactile art program for students with visual impairments. With the help of some fantastic volunteers, we solicited students from multiple school districts to join our program and began meeting monthly at the local library.

During my continued quest for tactile art exhibits for my students, I came across an internet article about a local artist, Bonnie Blue, who has an art car and participates in the Houston Art Car Parade. I learned from the article that prior to the actual parade, the art cars go into the communities in the “Main Street Drag,” and that Bonnie loves to be on the route that goes through the Houston Lighthouse for the Blind so she can give the patrons who are visually impaired the chance to TOUCH her car! I immediately contacted her and asked how our kids could get in on the fun. This lovely woman took us under her wing and guided us through the process of creating our own “ARTomobile” for the parade.

 Photograph of Bonnie Blue and three children standing in front of her art car.

Above: Bonnie Blue came to visit our group and let our kids tactually explore her art car.

One of our parents, Jason Thompson, offered to let us use his truck and trailer for the parade. Students worked diligently to produce a great deal of art for our trailer in a very short period of time. We had donations of broken as well as unused musical instruments that the student artists turned into works of art including guitars, a trumpet, drum heads, and a bongo. We also had vinyl records that became art pieces. The truck was decorated to look like a guide dog, complete with Mario on the roof holding the harness! The local news, ABC Channel 13, filmed and interviewed our group in preparation for the parade.

Our entry’s theme was Helen Keller’s quote, “Life is either a daring adventure or nothing!” It was a mobile depiction of the "can do" spirit! This entry description explained our mission:

“Although the art community is generally closed off to those who use their hands as their eyes, we are daring to bend those rules and show the world that art can be touchable! Although art is generally considered to be a visual experience, we are daring to show that it takes more than sight to have artistic vision! Although blindness and visual impairments are considered to be limiting, we are daring to create with blind abandon!”

One of the students, Madi Hayes, wanted to do something special for Bonnie Blue for helping us. We decided to decorate an album with bottle caps and rocks to make the words, “Bonnie rocks” in Braille. She presented this to Bonnie at the parade site.

Photograph of Bonnie Blue in a purple wig standing by Madi, who is smiling and holding her cane.
Above: Madi presenting her “Thank You” to Bonnie Blue at the parade.

Photograph of a student, Caylen, sitting at a table.  On the table in front of them is a trumpet and various art supplies such as corks, pom-poms, glue, etc.The students had a great time participating in the parade! One of the students, a second grader named Caylen, said that she thought “it was really cool and fun!” She said that she would do it again because she liked “being on a trailer and having fun with [her] friends!” As for the art program itself, she liked getting to meet new people and painting and stringing beads.

We are excited about Creating with Blind Abandon for the opportunities it gives these kids. They are forming friendships and experiencing art in a way that is all about them. They have real-life practice in multiple areas of the Expanded Core Curriculum, all while having fun in a way that makes sense to them!

Right: Caylen turning a trumpet into a work of art.

Emily Morlandt, Education Specialist: Low Incidence Disabilities, Assistive Technology, Related Services, Education Service Center, Region 20

Abstract: Ms. Morlandt shares her experience with using Active Learning for a student during and after a two-year pilot entitled “Developing District Capacity in Active Learning.”

Keywords: Active Learning, Education Service Center Region 20 (ESC-20), Texas School for the Blind and Visually Impaired Outreach (TSBVI), HOPSA dress, Functional Scheme.

I began my Active Learning journey backwards. I had been an Educational Specialist serving teachers of students with Low Incidence Disabilities for two years after teaching students from the same population for several years prior. I attended a conference with Ms. Patty Obrzut at Texas School for the Blind and Visually Impaired (TSBVI) to build my knowledge base about Active Learning, which had been introduced to me at the time by my partner at the Education Service Center.

I felt like a door had opened to reveal possibilities for students just like those that I had served in the classroom years ago that I had been at a loss with how to reach at the time. I had done the best that I could with what I knew at the time, and I’m proud to say that some of what my team and I had done were on the right track—but it could have been so much better. I began to wonder how I could use this invaluable information in my current role as a provider of professional development and training for teachers serving students with these significant challenges. How could I help these teachers to have this information so that they would be empowered to build instructional programs for their students who needed this approach?

I brought my thoughts forward to other stakeholders who serve the same population, and through our conversations the Developing District Capacity in Active Learning (DDCAL) Pilot was born. It was developed as a collaborative effort between the Low Incidence Disabilities Statewide Network (LID or LISN) and TSBVI. Four regions from around the state would support a district team around one student that met the criteria as a learner who would benefit from the Active Learning approach. Each team would complete the Functional Scheme assessment developed by Dr. Lilli Nielsen and submit baseline videos. The team members would receive training through participation in ongoing consultation visits with the ESC lead and TSBVI Outreach staff and/or support to attend the 2-day Active Learning Conference. Then each district would have access to a minimum of $1000 from the LID to help them purchase materials or equipment needed for implementing Active Learning for the student.

The Pilot proposed to add 4-5 additional regions each year, with the intention for all 20 Education Service Centers to participate within four years. I volunteered to represent Education Service Center, Region 20 (ESC-20) as one of the pilot teams, and along with four other teams of my esteemed colleagues from around the state we began this two-year project.

Fast forward a few months—the first ESC-20 DDCAL team was selected and ready to go. None of us knew what to expect but all were dedicated to the idea of getting Active Learning incorporated in the school day for our student, Voozeki. At the time, Voozeki was in Kindergarten attending Maverick Elementary School in San Antonio Independent School District (ISD). Sara Kitchen, our support from TSBVI, guided the team to complete the Functional Scheme, which is the assessment tool that guides how Active Learning is implemented.

Can I say how extremely fortunate I have been to work alongside such dedicated, hard-working people? Voozeki’s team took in all of the information Sara and I shared like a sponge and immediately began incorporating it into Voozeki’s day. He has the most conscientious (not to mention the coolest) parents who have been there every step of the way. They shared the activity boards and other materials that they were using at home. They created these activities for Voozeki after they attended Active Learning training with Patty Obrzut and tweaked these learning environments with the data we gathered through completing the Functional Scheme assessment! They even invited representatives from Team Ability, which is a non-profit organization in San Antonio where Voozeki attends therapy sessions, to participate. Team Ability also utilizes the Active Learning approach. This collaboration and information sharing between school, home and this facility was incredibly helpful. Team Ability not only shared information with the school team about his progress during therapy at their facility, they also allowed for our team members to visit and watch Voozeki in action. Voozeki in the HOPSA dress examining rocks in a baking pan with his bare feet.

By the end of year one, the original team had done so much—the Functional Scheme had been completed initially then was updated. The team had worked together to build equipment and gathered materials based on his preferences and what the data indicated he might need. Thanks to DDCAL support, the team was able to purchase some equipment and materials to help build on what we had begun. This included a portable tripod designed to support a hammock chair (Hammaka Tripod Hanging Chair Stand found on amazon.com), which we used to support a HOPSA (Holding Up for Standing Activities) dress so that Voozeki could explore items from a standing position.

Year Two brought a new set of opportunities and challenges. Voozeki, now a first grader, transitioned to a new school, which meant there were new team members to train about Active Learning as well as all of the other considerations when a student joins a new classroom and team. And again, the new team rose to the challenge. Voozeki’s new team members jumped right in.

One of his teachers at his new campus, Crockett Elementary, has a unique classroom called the Sensory Optimal Learning Environment (S.O.L.E.), which is designed based on the Active Learning approach and philosophy. Voozeki has been able to spend part of his school day in this setting, and his S.O.L.E. teacher, Claire Heins, graciously assumed the leadership role to assist his other teachers with implementing Active Learning strategies in their classrooms. To continue moving forward, the team used an amazing and thorough online resource, Active Learning Space (www.activelearningspace.org), to provide support for new team members as well as to build his program. This website has been developed through collaboration between Penrickton Center for Blind Children, Perkins School for the Blind and Texas School for the Blind and Visually Impaired. Whenever a team member needed additional support on a particular component of Active Learning, such as the 5 Phases of Educational Treatment, they were able to visit the website to view videos that describe each phase as well as examples of implementation with students.

From year one to year two, Voozeki made progress in these skill areas: communication, fine movement, perception of objects, and spatial perception. Voozeki showed this progress through developing new skills such as purposeful acceptance or rejection of options using auditory scanning of consistent verbal labels for familiar activities. This was generalized to use either when presented by a speech output device or by a person. He showed rejection by turning away, and acceptance by turning toward a person and vocalizing. He has been vocalizing more during play and his vocalizations have become more differentiated. He also has developed specific preferences and is very clear of what he wants at various times of the day. He has grown more confident in his own ability to make choices and get information, and spends more time engaged in activities and less time taking processing breaks. He is now able to spend more time looking at his own activity with objects. He is currently experimenting with graded force of his own action, and no longer only uses large back muscles to activate arm movement. He keeps his hands in midline more often and is able to isolate the pointer finger of his right hand to spin a favored toy. Voozeki remembers where items are in familiar learning environments and returns to favored items to compare their qualities or repeat an activity with an item.Voozeki at the zoo touching a chime.

We are now approaching the end of Year Two. In a few days we will meet as a team for the final time to discuss this project: How has it benefited Voozeki, the team, what the data shows, and where we go from here? I have to say that I have no doubt about his future success. I have had the honor and privilege to work alongside these dedicated educators and family members for two years now and it reminds me of why I decided to make special education my profession years ago. I am truly grateful for the opportunity to have learned from and grown with each person on the team.

I plan on taking what I have learned from this experience and sharing it throughout Region 20 by creating workshops that will help other teams build a similar program to serve their students. TSBVI has graciously agreed to continue to support me and my partner at ESC-20, Dana Frankland, with building these new training opportunities and I couldn’t be more appreciative. One new training tool is the online self-paced course, Active Learning Principles. TSBVI plans to develop 5-6 additional online modules about various aspects of utilizing Active Learning during the 2018-2019 school-year.

My ultimate goal is to share as much information as I can with school teams so that they are empowered to build meaningful instructional programs for the students in their classrooms that access the general curriculum in a very different way. My participation in the DDCAL project has provided me with the information and support to do just that. I’m very excited to see how this will grow to serve more teachers, therapists, families, and (most importantly) students.

Dr. Kitra Gray in collaboration with Region 11 ESC and TSBVI, January 2018

Abstract: Dr. Gray examines issues regarding vision therapy.

Keywords: vision therapy, controversy, vision training, visual training, developmental vision therapy, orthoptics, behavioral vision therapy, visual attention, binocular vision, optometric vision therapy, learning disabilities, dyslexia, related service, Local Education Agency, LEA.

If you have ever tried to find definitive answers regarding vision therapy, you might have been met with:

  • Vague responses
  • Inconsistent responses, depending on the source
  • Emotional responses regarding whether vision therapy is a viable educational option or
  • Conflicting responses regarding research and benefits of vision therapy.

As we know, programming for children with disabilities must be addressed individually based on their own set of needs and criteria. This article will explore the controversies surrounding vision therapy and provide information so that when the topic of vision therapy arises in regards to a child, you will be knowledgeable enough to know what questions to ask, and how to interpret the answers.

Definition of Vision Therapy

The first area of controversy is understanding what is meant by the term vision therapy. Vision therapy is known by several names, including visual training, vision training, and developmental vision therapy. Some optometrists divide vision therapy into two categories. The first is orthoptics, which focuses on binocular vision including disorders such as strabismus and diplopia, also known as double vision. The second area is behavioral vision therapy, which addresses problems such as “visual attention and concentration which may manifest as an inability to sustain focus or to shift focus from one area of space to another” (Allegheny Intermediate Unit. n.d., para 3). The College of Optometrists in Vision Development (COVD, 2008), a non-profit, international membership association of eye care professionals including optometrists, optometry students, and vision therapists, does not differentiate between orthoptics and behavioral vision therapy, but simply addresses the practice as Optometric Vision Therapy. Thus, you may be confronted with any of these identifiers when someone refers to vision therapy.

No matter what identifiers are used, the overall definition of vision therapy is fairly consistent. Optometric Vision Therapy is an individualized, supervised, medically necessary treatment program that is prescribed by an optometrist using neurological and neuromuscular conditioning over time to address visual dysfunctions, prevent the development of visual problems, or enhance visual performance to meet the patient’s identified needs. (Hatton, D., n.d.; COVD, 2008, p. 1) “Vision therapy trains the entire visual system which includes eyes, brain and body” (Optometrist Network, 1996-2007).

What deficits does vision therapy treat?

The second area of controversy, or confusion, is what deficits can be appropriately addressed by using vision therapy treatments. The only treatment area that appears to have wide reaching consensus among optometrists, as well as ophthalmologists, is convergence-insufficiency which includes symptoms such as double vision and eye fatigue. The following citations substantiate that vision therapy can be beneficial in treating convergence-insufficiency:

  • According to Dr. Jose, a well-respected Texas optometrist in the area of low vision, “symptomatic convergence insufficiency can be treated with near-point exercises, prism-convergence exercises, or computer-based convergence exercises (Jose, Rosner, & Cowan, 2012 p. 17).
  • A study published in the Archives of Ophthalmology “found that a 12-week program of supervised, in-office vision therapy plus orthoptics produced a functional cure of convergence insufficiency in over half…the children with CI who received this treatment” (Heiting, G., 2017, para. 34).
  • The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) states that “orthoptic eye exercises as prescribed by pediatric ophthalmologists, orthoptists, and optometrists can be beneficial in the treatment of symptomatic convergence insufficiency” (AAPOS, 2016). 

“Other than for strabismus and convergence insufficiency, the consensus among Ophthalmologists and Pediatricians is that visual training lacks documented evidence of effectiveness” (Allegheny Intermediate Unit, n.d., para.3). The website of the AAPOS (2016) states that:

  • Behavioral vision therapy is considered to be scientifically unproven.
  • There is no evidence that vision therapy delays the progression or leads to correction of myopia.

Yet, the COVD’s “white paper” indicates that optometric vision therapy can significantly improve the following functional vision problems:

  • Ocular motility dysfunction – eye movement disorders
  • Vergence dysfunction – inefficiency in using both eyes together
  • Strabismus – misalignment of the eyes
  • Amblyopia – lazy eye
  • Accommodative disorders – focusing problems
  • Visual information processing disorders
  • Visual sensory and motor integration
  • Visual rehabilitation after traumatic brain injury which results in inefficient visual information processing (e.g., stroke). (COVD, 2008, para. 2).

Other deficit areas of discussion are whether vision therapy can treat learning disabilities or dyslexia. Dr. Jose indicates that through a number of studies, it has been determined that “readers with dyslexia have linguistic deficiencies rather than visual or perceptual disorders...Research has shown that most reading disabilities are not caused by altered visual function.” Therefore “...the evidence does not support the concept that vision therapy or tinted lenses or filters are effective, directly or indirectly, in the treatment of learning disabilities. Thus, the claim that vision therapy improves visual efficiency cannot be substantiated” (Jose, Rosner, & Cowan, 2012, pps. 12,13,19). This is further corroborated by the AAPOS (2016) which notes that, “The scientific evidence does not support the use of eye exercises or behavioral/perceptual vision therapy in improving the long-term educational performance in children with learning disabilities.”

In addition, Dr. Takeshita (2013), a pediatric optometrist in California who set up a foundation to assist children who are visually impaired after he lost his own sight, states that “Vision Therapy Does NOT:

  • Cure medical conditions such as autism, attention deficit disorder or learning disabilities
  • Strengthen eye muscles. Vision therapy increases the neuro-muscular innervation between the brain and the muscles of the eyes
  • Eliminate the need for glasses” (p. 13).

While these sources concur that vision therapy cannot address learning disabilities, confusion persists for educators and parents, because other literature such as the COVD “white paper” indicates that:

“According to the American Optometric Association, 35% of all children with learning disabilities have visual problems. Specifically, at least 20% of individuals with learning disabilities have been found to have prominent visual information processing problems, and 15-20% of them have problems with visual efficiency skills (COVD, 2008, para. 8).”

The source used by the American Optometric Association is not specified and this information was written in 2008; whereas, Dr. Jose’s and Dr. Takeshita’s information is from 2012 and 2013 and the AAPOS statement is dated 2016. Nonetheless, you are probably beginning to see why there are very few definitive answers regarding vision therapy and why parents and educators may be confused as to the efficacy of this treatment method.

Is vision therapy a related service?

One factor that appears to be consistent in the literature regarding vision therapy is that it is a partnership between doctor, parent(s) and student. It is a prescribed treatment plan by an optometrist, or sometimes an ophthalmologist. As indicated by the COVD (2008), “Optometric vision therapy plans typically involve a programmed combination of office treatment and home therapy….As with most therapeutic treatments, the extent of the success is also linked to the patient compliance” (para. 5). Dr. Heiting (2017) states, “this therapeutic process…depends on the active engagement of the prescribing doctor, the vision therapist, the patient (and in the case of children) the child’s parents” (para. 8).

According to IDEA “medical services” that are eligible “related services” are those specific “services provided by a licensed physician to determine a child’s medically related disability that results in the child’s need for special education and other related services.” 34 CFR 300.34 (c)(5)” (Special Education and Disability Rights Blog, 1970, para. 1). Since vision therapy is not necessary for diagnostic purposes, according to this definition it is not a related service under IDEA.

Furthermore, “the Supreme Court has adopted a bright line rule…, finding that medical services that can only be delivered by a physician are not related services and that health care support services, which can be administered by a person other than a physician are related services under the IDEA and therefore the responsibility of the school district See Irving Independent School District v. Tatro, 555 IDELR 511 (1984)” (Special Education and Disability Rights Blog, 2009, para. 2).

Therefore, as vision therapy is a service that has to be delivered by a qualified eye medical specialist, it does not appear to meet the definition of a related service.

What is the role of a Vision Therapist versus the role of VI Education Professionals?

Occasionally parents request that the teacher of students with visual impairments (TVI) or the orientation and mobility specialist (COMS) provide vision therapy without understanding that these education VI professionals are not qualified or certified to provide this medical therapy. Vision therapy is provided by Optometrists (most frequently), Ophthalmologists and certified para-optometric technicians. These eye care professionals “gain training (e.g. medical/optometric courses, clinical practicum, internship, residency, etc.) in optometric vision therapy” (Lawson, Lueck, Moon, & Topor, 2017, p. 5). They are trained to provide “medical treatment that involves neurosensory and neuromuscular activities” (Lawson et al., 2017, p. 4).

The VI education professionals are NOT vision therapists. They are education specialists trained to evaluate and provide services to IDEA eligible students with visual impairments in the school setting, not in a clinical setting. Sometimes parents, and even school personnel, mistakenly refer to the teacher of students with visual impairment as a vision therapist, but this is incorrect. They are teachers who have attended “an accredited university program, typically within a college of education” (Lawson et al., 2017, p. 2).

The role of the TVI as well as the role of the COMS are defined in the 2017 Guidelines and Standards for Educating Students with Visual Impairments in Texas. This document can be found on the Texas Education Agency (TEA) website at: http://www.tsbvi.edu/attachments/EducatingStudentswithVIGuidelinesStandards.pdf. According to these guidelines, some of the roles of Certified Teachers of Students with Visual Impairments (TVIs) and Orientation and Mobility Specialist (COMS) include:

  • Assessment and Evaluation [regarding special education eligibility and educational programing]
  • Direct Instruction in the Expanded Core Curriculum
  • Supporting Educational Teams
  • Administrative/Record Keeping Duties (Texas Action Committee for the Education of Students with Visual Impairments. (2017, p. 23-24).

In addition, a position paper regarding vision therapy, written by the Association For Education and Rehabilitation of the Blind and Visually Impaired (AER), Low Vision Division, explains that TVIs “are not trained to provide vision therapy services nor does vision therapy fall within the scope of the [TVIs’] professional responsibilities” (Lawson et al., 2017, p. 1). This statement is also true for Orientation and Mobility Specialist (COMS).

What is the Role of the LEA?

Of course, a child should be evaluated in all areas of suspected disabilities. The educational committee must consider evaluation information from a variety of sources (34 CFR§300.306(c)(i)) and not rely on a single source to determine eligibility. More information on eligibility for services as a student with a visual impairment in Texas is available in the Guidelines cited above, and the TEC 30.002.

Nevertheless, it is important to note that a recommendation for vision therapy by an eye medical professional does not automatically mean the student warrants an evaluation, or if evaluated, will meet IDEA eligibility criteria. An LEA should consider each case individually to determine the necessary steps to address a parent concern regarding vision therapy.

Summary

Most likely, vision therapy will continue to be controversial, or at the very least confusing to parents and educators alike because:

  • there are no consistent identifiers
  • the medical profession does not agree on which deficits can be addressed appropriately and
  • people sometimes mistakenly refer to VI educational professionals as vision therapist without understanding the difference in focus and training.

However, the one thing that is not controversial is that since VI education professionals, TVIs and COMS, are not trained in optometric vision therapy methods, they do not play a role in the delivery of vision therapy. Their role is to evaluate and provide services for IDEA eligible students with visual impairments in accordance with the IEP.

References