Trust Through Touch: Creating Positive Interactions

Authors: Dr. Audra Bishop, COMS, Fort Worth ISD, Kelley Nicholson, COMS, Fort Worth ISD, and Stephan Slawson, TSVI/COMS, VIST Coordinator-Texas Valley Coastal Bend VA

Keywords: touch, tactile skills, tactually defensive, tactually selective, collaboration, hand-under-hand, building trust, prompting and cueing, orientation and mobility, TSVI, COMS

Touch is the first sense that is developed and is fundamental to all aspects of early development (Blackwell, 2000). The sense of touch is always active, and physical contact is necessary for development. When an individual has a visual impairment, the sense of touch is an integral means of obtaining information, communication, interaction with others, and the development of concepts. Although professionals in visual impairment are acutely aware of the importance of touch for a child with a visual impairment, these children are often perceived as tactually defensive when they are not immediately willing to explore a variety of objects and textures. 

To address the unique tactile needs of children with visual impairments, it is important to first actively seek to change the narrative from the negative connotation of defensive to the more positive terminology selective. Tactile selectiveness implies that an individual has a choice and a voice in exploring their environment. When professionals select and use tactile strategies with children who have visual impairments, thoughtful consideration and planning is necessary (Chen and Downing, 2006). All children with visual impairments need multiple opportunities for tactile exploration and experiences to create an understanding of tactile information. Because it is not possible for an individual to completely avoid objects, textures, or temperatures they do not like, it is important to provide a safe and supportive environment for students to explore a multitude of items and identify their likes and dislikes (Silvia, Shimano & Lopez, 2021).

Why Might a Student with a Visual Impairment Not Want to Touch Items?

There are many reasons why a student with a visual impairment may be averse to touching and exploring objects around them. One of the most common reasons is that they have been forced to touch items in the past with no preparation (McLinden & McCall, 2002). When a student’s likes/dislikes are not respected, they are less likely to be willing to explore items in the future. In addition, many children with visual impairments have experienced little control over being touched and who/what touches them. They may be touched and handled regularly with little warning.

Dorm Manager Jenelle places fruit into a handheld blender during a smoothie routine and waits for Kolby to engage his hands.

Building Trust

The first step in building a trusting relationship is not forcing a student to touch items, especially those which they have rejected in the past. It is important to remember that touch may occur with various body parts such as the feet, mouth, or elbows, and not just with the hands and fingers. Some methods to build a trusting relationship include:

• Repetition: use the same language and same routines across service providers
• Provide the narrative: give the student the necessary vocabulary to understand and name or describe objects
• Work side-by-side: work next to the student with the same items and describe the items as you touch them, allowing the individual to participate when they are ready
• Hand-under-hand: use hand-under-hand strategies for exploration while describing items/textures to the student
• Wait time: provide wait time for the individual to process information and respond
• Observe responses and reactions: closely observe the student’s body language and vocalizations to identify their likes and dislikes
• Identify preferences: identify the likes/dislikes of the student and use those to plan future lessons; use items the individual likes to introduce new items or less preferred items (you could use a sensory tray that holds several preferred items or textures and one non-preferred item, allowing the student to explore a new item or texture in the comfort of a known/preferred one)

Ways to Incorporate Prompts and Cues

Prompts and cues, both verbal and physical, are helpful when introducing new objects or textures to a student with a visual impairment. Activities should occur in a meaningful context to facilitate learning and concept development. There are many ways to prompt or cue, and they may also be used in combination.

• Natural cue: use something that is routine or part of the day
• Verbal cue: use speech or tactile sign
• Auditory cue: use auditory signals such as tapping a spoon on the table
• Visual cue: hold up a toy, point to a toy, spotlight a toy
• Tactile modeling: have the student feel another student’s (or adult’s) hands as that student/adult makes a choice
• Tactile prompt: touch the object to the student’s hand (or elbow, foot, etc.)
• Physical prompt: touch the student’s hand, wrist, or elbow to gain attention
• Physical guidance: use hand-under-hand technique

Collaboration: TSVI, COMS, and Other Members of a Student’s Educational Team

Collaboration is an essential component in the development of tactile skills and concepts. Students with visual impairments need to have a safe and trusting relationship with all who work with them. The team should work together to provide the following:

• Verbalization of activities and items the student needs to explore before interacting with them. Use consistent language.
• Encouragement of movement and exploration of objects in the environment
• Opportunities for exploration: e.g., exploring objects, smells, tastes, and sounds in the environment
• Development of spatial awareness: understanding location, distance, and personal space
• Concept development: building a vocabulary based on tactile experiences and moving from concrete to abstract concepts
• Allowing students to take ownership (e.g., experience books, braille stories)
• Assisting the student to understand sensory information as a basis for independent travel skills
• Communicating with each other about observations of a student’s level of participation and engagement in certain activities

It is important for a TSVI or COMS to remember that other educational team members may need continued support in understanding the tactile needs and limitations of a particular student.

Residential Instructor Danielle uses hand-under-hand to help Melina reach out during a yoga routine on the dorm.

Students with Tactile Challenges

It is possible to encounter students with tactile challenges such as neuropathy or other conditions that impact sensation in their extremities. This can result in their touch sensations not matching what a teacher is describing, resulting in confusion (Chen & Downing, 2006). Strategies that can address tactile challenges include:

• Asking the individual to explain/describe what they feel 
• Having the professional put on gloves to impede their own tactile sensations in order to better understand and describe textures, temperatures, and objects to the student

Students Who Are Deafblind

For individuals who have dual sensory loss (deafblind), touch becomes even more important as it serves as both their eyes and ears for understanding the environment (Chen & Downing, 2006). Special consideration when introducing tactile objects, textures, and temperatures should be given for students with dual sensory impairment, including:

• Determining when to use which sense: students may have varying levels of vision and hearing loss, so it is important to identify when it is best to use each sense
• Wait time may need to be extended: in order to allow sufficient time for processing, it may be necessary to increase wait time for a student’s responses, especially when introducing new information 
• Meaningful and consistent prompts/cues across environments: ensure the same language, prompts, and cues are used across providers to increase understanding
• Acceptance and understanding of touch may require significant repetition

Important Reminders

Do Not:

• Force a student to touch something without warning 
• Force a student to touch something for your entertainment
• Touch a student without warning

Do:

• Tell the student what is happening/what will happen.
• Describe the item/object/texture you want them to experience.
• Ask the student before initiating physical contact and respect the student’s reaction.
• Have fun as you explore together!

This article was based on presentations at TAER 2022 and SWOMA 2022.

References

Blackwell, P. L. (2000). The influence of touch on child development: Implications for intervention. Infants and Young Children, 13(1), 25-39. 

Chen, D.  (2014). Essential elements in early intervention: Visual impairment and multiple disabilities. AFB Press.

Chen, D., & Downing, J. E.  (2006). Tactile strategies for children who have visual impairments and multiple disabilities: Promoting communication and learning skills.  AFB Press.

McLinden, M., & McCall, S.  (2002). Learning through touch: Supporting children with visual impairment and additional difficulties. London: David Fulton Publishers.

Nicholas, J. T., Johannessen, A. M., & van Nunen, T.  (2019). Tactile working memory scale. Nordic Welfare Centre.

Silva, M. B., Shimano, S. G. N., & Lopes de Oliveira, N. M.  (2021). Effects of a physical therapy intervention to improve the quality of life of visually impaired people:  

Development of an audio-tactile exercise protocol. Journal of Visual Impairment & Blindness, 115(4), 329-341. https://doi.org/10.1177/0145482X211027491