CHILDREN WITH SENSORY IMPAIRMENTS

Chapter 10

STUDENTS WITH VISUAL IMPAIRMENTS

LEGAL DEFINITIONS1. Legal blindness: 20/200 (central

vision acuity) with correction. This means that what a person who is legally blind can see from 20 feet a person with normal sight can see from 200 feet. Or if the individuals visual field is 20 degrees or less (tunnel vision).

2. Low vision: CVA between 20/70 and 20/200 with correction. Visual field of 20-40 degrees). These students still use vision as a primary means of learning using optical and non-optical devices.

3. Prevalence: 0.5% of students served under IDEA. ½ to 2/3 of students with developmental disabilities have a visual impairment.

EDUCATIONALLY MEANINGFUL (FUNCTIONAL) DEFINITIONS

1. Blind: used to refer to students who are totally blind.

2. Visual impairment: used to describe all children with a visual loss (including blind).

3. Congenital loss of vision: Born with a visual impairment, or become visually impaired before visual memory is established.

4. Adventitious loss of vision: Lose vision after visual memory is established (around age 5). They have an established visual memory to use while acquiring new information.

5. Visual efficiency: degree to which an individual can perform specific visual tasks with relative ease. Varies student to student. Depends on the learning style.

PROFESSIONALS

Ophthalmologist: physician that specializes in diagnosing and treating the eye (surgery, medication, corrective lenses)

Optometrist: Licensed eye care provider treating refractive errors (glasses, contact lenses)

Optician: makes and fits lenses for wearerClinical Low Vision Specialist:

Ophthalmologist or Optometrist specializing in low vision

EDUCATION/REHABILITATION PROFESSIONALS

Teacher of Students with Visual Impairments: certified teacher with skills in educating students with low vision and blindness. (usually earn a certification in this content area)

Orientation and Mobility Specialist: help visually impaired students orient themselves and maneuver safely and efficiently.

Rehabilitation Teacher: Specializes in helping visually impaired students gain confidence in carrying out daily activities.

Low Vision Therapist: provide instruction in the functional use of vision and help select appropriate devices as well as train in the use of the device.

IMPACT OF VISUAL IMPAIRMENT AND MULTIPLE DISABILITIES ON DEVELOPMENT AND LEARNING

Range and Variety of Experiences: have to rely on touch to understand the properties of something, which is not always possible

Mobility: not free to explore their environments alone. Mobility instruction is essential.

Control of the Environment and the Self in Relations to It: cannot observe stimuli visually so do not imitate behaviors, do not have access to facial/gestural expressions. Learn at slower rates and need more time to acquire skills when there is a multiple disability, than if there were just a visual disability.

OTHER AREAS OF IMPACT

Motor Development: delay of gross motor skills and fine motor skills. Lack motivation due to insufficient opportunities for movement.

Social Interactions: cannot respond to social signals. Respond to isolation by using self-stimulatory behaviors to alleviate boredom.

Communication Skills

FUNCTIONAL VISION ASSESSMENT

Used to determine student’s visual performance in a variety of environments.

Help determine appropriate strategies to help engage students

Should be done in different environments by different collaborative team members, over a period of time.

Considerations of an FVA: student needs to understand how to respond to activities before assessment, sensory functioning (using one or more senses), appropriate pacing, using child’s mode of communication

COMPONENTS OF AN FVA

Background medical informationFixation: ability to establish/maintain eye

contact on an object.Tracking: ability to visually follow a moving

target.Shift of Gaze: ability of eyes to stop looking at

one thing and move to another.Scanning: ability to use eyes to search for

and find a target.

LEARNING MEDIA ASSESSMENT

Evaluate student’s efficiency in visual, tactile, and auditory sensory channels to assess potential for and use of literacy skills.

1. Consider all literacy options2. Each student has unique needs and abilities3. Determine individual literacy goal.

ENVIRONMENTAL CONSIDERATIONS

Lighting: use observation during different settings

Color and Contrast: increase visual efficiency by using contrast in colors.

GlareVisual Clutter: causes confusion and lowers

visual efficiency.Size and DistanceAmbient Noise: some student’s will need a

quiet environment to perform efficiently

ASSISTIVE DEVICES

Optical/Non-Optical: magnifiers, scopes, book stands, wide tipped pens/markers, large print books, etc…

Assistive Technology: braillewriter, closed-circuit tv, computers (voice output, braille translation software)

CLASSROOM ADAPTATIONS

Safety: keep cabinet doors closed, things under desks and out of the way

Orientation to the physical arrangement Avoid standing with backs to windows (glare) Use commonly used words such as see and look (they can do this

with their hands), State your name when approaching a student who is blind. Use verbal cues Use verbal phrases for praise with a pat on the back (they do not

see your smile) Encourage good posture and eye contact Teach modified behaviors that are more appropriate when student

uses behaviors to self stimulate Use three dimensional concrete objects during demonstration for

the student to touch

EXPANDED CORE CURRICULUM

Functional Academic Skills/Communication ModesOrientation/Mobility: help them become as independent as

possible in the environmentSocial Interaction Skills: provide opportunities for positive

interaction and teach appropriate skills necessary for communication.

Independent Living Skills: avoid learned helplessness!Recreation and Leisure: age-appropriate activities based on

student and family preferences.Career EducationAssistive TechnologyVisual Efficiency: enhance and embed visual behaviors

throughout the day.

DEAF/HARD OF HEARING WITH ADDITIONAL DISABILITIES

Deaf: significant hearing loss that impedes processing of linguistic information even with the use of a hearing aid.

Hard of Hearing: able to process linguistic information with hearing aids.

Prevalence: 6 out of every 1000 children. 25% have an additional disability.

PROFESSIONALS SERVING DEAF AND HARD OF HEARING

Teacher of the Deaf or Hard of Hearing: classroom teacher or consultant responsible for planning/delivering curriculum and providing instruction in communication, speech, and listening skills.

Classroom Teacher: provide curriculum as well as hear aid and cochlear implant management. (may require assistance and support from specialists)

Otologist: physician specializing in the ear/diseases of the ear.Audiologist: perform auditory assessment, make medical

referrals, fit hearing aids, provide auditory training, teach speech reading, give guidance for families.

Speech and Language Pathologist: support the development of communication and language.

Sign Language Interpreter

ASSISTIVE DEVICES

Hearing Aids: amplify soundFM SystemCochlear Implant: supports the individual to

perceive sound.Tactile Communication Devices: covert

sounds into vibrations felt on the skin.

IMPACT OF HEARING LOSS AND ADDITIONAL DISABILITIES

Communication and Language DevelopmentIncidental Learning: learning through

hearing conversationsSocial Cues: expressions through voice,

volume, and intonation.

TEACHING APPROACHES/STRATEGIES

Auditory Training: support the child to improve use of hearing. 1. Detection: knowing when sound is present2. Attention: focus on a sound3. Localization: ID location of sound4. Tracking: movement of sound5. Discrimination: differences in sound6. Identification: recognize a stimulus7. Comprehension: attach specific meaning to a sound

TEACHING APPROACHES/STRATEGIES

Language Approaches: encourage development of communication and language. Auditory-oral: uses speech reading and contextual

cues Auditory-aural: emphasizes reliance on hearing Manual approach: sign language TC approach: incorporates all approaches and

encourages anything and everything that supports communication.

FOUR ASPECTS OF COMMUNICATION

1. Form: method used to communicate2. Function: purpose of communication3. Content: the message4. Context: physical arrangement of

environment, child characteristics, routines, etc…

One person speaks at a time Speak within 3-4 feet of student Establish eye contact Avoid exaggerating movements of speech Avoid speaking more loudly or slowly

THE ROLE OF TECHNOLOGY

TT: text telephonesComputer aided speech to text translationClosed captioningAlerting devices (flashing lights to indicate

things)

STUDENTS WITH DEAFBLINDNESS

Team Members Unique to Deafblindness Interpreters for the Deafblind: convey visual

information, act as a guide. Intervenors: provide one-to-one service. Deafblind Specialists: support the team by providing

instructional suggestions

IMPACT OF DEAFBLINDNESS ON DEVELOPMENT AND LEARNING

Attachment: sensory impairments interfere with interaction, trust, security.

Motor Skills: without intervention their world is limited to what is within reach.

Communication Access to Sensory Information: unable to receive

complete/accurate information from other senses causing a distorted concept of the world.

Isolation and Limitations in Experiences: without the distant senses, the world is very limited

Lack of Incidental Learning: through visual and auditory observation

Concept Development: object permanence, categorization skills Progressive Sensory Losses: will need ample support to maintain

socialization

INTERVENTIONS/STRATEGIES

Hand-under-hand Touch (teacher’s hand under the hand of the student): Primarily learn through touch Hands are their eyes Adverse to having their hands held (hand-over-hand) Hand-under-hand is noncontrolling

STRATEGIES: THE VAN DIJK APPROACH

Resonance: develop turn-taking within an activity. Familiar movements are used to help the child respond to the environment.

Co-active movement: partner follows the child’s movement and the child is encouraged to follow the partner’s movement.

Objects of reference: object is used as a common frame of reference so that the child knows the subject of the conversation without words or signs.(water wings = swimming)

Characterization: a symbol is chosen based on what is most meaningful to the child about that activity (piece of a mat to represent physical therapy)

Sequential memory strategies: objects/symbols lined up to represent activities or schedule of events. Memory books.

Drawing: child creates drawings of experiences. They are two-dimensional/textured and can be used a communication symbols

Anticipatory Strategies: familiar routines so child can predict what the next step will be.

Symbolic communication strategies: gradually move from invented symbols to true symbolic communication

ASSISTIVE TECHNOLOGY

Vibrotactile Devices: translate sounds into vibrations

Telebraille: turns messages into printed braille messages

Text telephones: used with those who have some functional vision. Large screens with maximum contrast.

Braillephone: notebook, calendar, calculator. Works with screen-reading software.

PLACEMENT

Regular classroom with support servicesSelf-contained classroomSpecial school with residential option