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Curriculum for pupils with Profound and Multiple Learning Difficulties
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Contents
2. Introduction
3. The Principles of the PMLD Curriculum
6. Assessment
7. Examples of the Curriculum in Practice
8. Body Awareness
9. Communication
10. Health and Safety and The Resonance Board
11. Sherborne Movement
12. Health and Safety for Adults
14. Pupil Education Profile
16. Potential Learning Outcomes
17. Touch Profile
18. Overview of Activity Cards
23. ICT Fact Sheet
24. Peter – Touch Profile
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Introduction
In 2010 we at The Bridge School, decided to research the curriculum offer for pupils with PMLD in a large variety of schools. This research took the form of ordering curriculum documents for sale from other schools, and visiting a number of schools to find out what they were doing and why. This information was shared with and was discussed between a core group of staff concerned with the education of PMLD pupils. These discussions resulted in our first attempt at defining a Bridge PMLD curriculum. We have since revisited our earlier thinking and revised it, particularly following our experiences of implementing the curriculum for pupils with ambulant PMLD. This document provides an overview of our revised PMLD curriculum.
This curriculum overview recognises that children and young people with Profound and Multiple Learning Difficulties have unique abilities and ways of learning. Pupils who are described as PMLD are likely to remain within developmentally early intellectual parameters for the whole of their school lives and the curriculum needs to be approached in a different way than for those who have higher cognitive ability. Additionally many assessment models do not recognise all the progress and development that we know that those with PMLD can make.
This curriculum overview gives ideas, not instructions. It is up to the individual pupils’ educators to decide what is or is not appropriate and write this into the learning plans for each individual. The child/ young person must be at the centre of the educational process. It is not the responsibility of the child to change to meet the demands of the curriculum; it is the responsibility of those providing the curriculum to ensure that it is flexible enough and adaptable enough to meet the needs of each child/ young person. Adults are the facilitators of the children and young person’s learning and it is key that all agencies (for example nursing, speech and language therapy, occupation therapy, physiotherapy) work together in an integrated way to maximise the learning opportunities.
At The Bridge we believe that how we are (as adults and essential facilitators in learning) directly affects how our pupils are and how well they learn. We must therefore all take individual responsibility for being and remaining positive with our learners at all times.
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THE PRINCIPLES OF THE PMLD CURRICULUM
There are five key principles to this curriculum 1. Students learn through interaction2. All subjects happen at the same time3. Teaching is led by the pupil4. The pupil determines the activities5. The curriculum promotes independence
1. Students learn through interaction
• Our curriculum is based on the understanding of what the individual pupilneeds. Comfort, security, stimulation and motivation have to be accountedfor in any situation.
• Having a good relationship with staff members is paramount to the students’learning experience. Through interaction pupils can learn to trust the adultsand the adults can learn about the pupils’ abilities, interests and preferredcommunication approaches, their feelings and their discomfort.
• Once a relationship is established we can understand what the pupils’interests are. If the students have not yet built up a repertoire of interests wecan then find objects and activities of interest through the safe and secure‘friendship’ that has developed through the interaction sessions. When thesehave been established, they can be used to motivate the student s tocommunicate and develop independence.
• A pupil with PMLD will spend a large proportion of the day maintaining andconsolidating what has already learnt so as not to lose skills andunderstanding. New concepts and skills will be taught, when appropriate, inthe framework of a familiar and structured session or activity.
• Our Curriculum starting point is not the core areas or specific objectives butthe social interaction of the students within the activities. Everything ishappening at once, and the chances for students to learn are multipleprovided that some basic elements are present, i.e. the right communicationapproach, the repetition of the routines, motivation, comfort, an appropriatephysical environment, enough time, etc.
2. All subjects happen at the same time
• The most basic curriculum structure consists of three main areas: Cognitivedevelopment; Emotional, social and communicative development andPhysical, Motor and Sensory development. The areas are interrelated anddependent of each other.
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• Our students’ curriculum is naturally an integrated curriculum that eachstudent accesses through the adult: there is communication involved inpractically everything, they observe and explore (what others call Science), itcan involve shapes and quantities (Maths), it tends to involve at least twopeople (Social and Emotional skills), etc.
• This curriculum does not provide the contents of the identified three mainareas so that teachers are not constrained. These decisions are made withthe students’ needs, motivation, etc. in mind.
• We do not consider that the traditional subject boundaries matter.
• These core strands will be supported through Activities. There is not adefinitive list of such Activities, and apart from Intensive Interaction, teachersare free to choose which activities they want to use. We wish to encourageinnovation from all our staff.
2. Teaching led by the pupil
• Learning is taken as a whole rather than through teaching to specificindividualised targets. The student decides where the learning process willgo; and therefor the student will decide pace and direction of teaching.
• Individual progression is often best recognised in retrospect, at the end ofeach session, week, half-‐term, term and/or year. This retrospective targetsetting is legitimated by the tendency of objectives based teaching to narrowthe learning opportunities.
• Recording and reporting on progress is absolutely vital and we stronglyrecommend that each teaching session looks for opportunities to celebratesuccess, record specific pupil progress, pick up areas of concern, and informthe next lesson. At this vital time, the teaching team reflects on what theyhave seen and heard, taking the lesson as a whole but more importantly,each individual learner one at a time.
• Skills Based Learning recognises that certain skills need to be acquired bymuch practice and this will also be used when appropriate.
3. The pupil determines the activities
• The teacher is the one setting up a social situation where the child and theadult are together on a task. The adult decides what to do based on what thechild can do and it is interested in. The teacher’s role is to provide routines,to enable the students to make decisions and to allow variation by them.
• Our aim is to put the students in control by giving them an environment thatthey can understand and that will keep changing in order to encourage
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development. Once the students know how a simple routine works, they can introduce variations, and once they are doing that, they are in control. They develop the routine and it becomes more complex.
• We have to listen to the student’s requests and choices. Allowing requestshelps to develop the student’s autonomy. When they state a preference andthey get it, they are empowered. They decided, they tried to affect the worldand were successful.
• Spontaneity comes out of the children knowing the structure of the routinesand when they are empowered.
• We have to create learning opportunities. The best way to do that is toembed broad enough demands in easy enough language or ways ofcommunicating and easy enough routines to engage the students. Those arethe principles, they don’t change, but how we translate them into practicewill vary according to the students. Any technique that does not allow themfreedom, any technique that does not give them a structure, any techniquethat does not create certain cognitive demands, any technique that createstoo great cognitive demands, are not supportive of the pupil’s learning. Weshould aim to set up situations that are both challenging and enabling.
6. The curriculum promotes independence
• Within activities pupils may reach, hold, explore sensory items/stimuli anduse switches. It is imperative the students are able to explore the physicalworld as independently as possible (in terms of touch from an adult). This willlead to a clearer and more concrete understanding of the subject beingexplored. When physical support is required strategies such as hand-‐under-‐hand and hand-‐under-‐ elbow ensure the student is not being dominated byadult touch and the student is still able to focus on the activity. (See touchprofile)
• Supporting the students to be as independent as possible means differentthings in different educational situations, for example personal care andmanual handling includes changing, eating and drinking, travelling around thebuilding/community and hoisting. These activities/routines occur every dayand possibly many times a day. It is important to prompt the student beforethe activity happens and throughout each stage of the routine to enablethem to process what is about to happen and give them the opportunity tohelp. For example ‘we are going to roll you onto your side’ -‐ including a touchprompt and then a count ‘1, 2, 3’. This gives the students the opportunity tohelp roll/move themselves. Mediation strategies can be added to each ofthese activities to help inform the students of the different stages involved.
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ASSESSMENT
Assessment, at regular intervals and in the most rigorous forms possible, is an absolute necessity if we are to be certain about providing an appropriate and individualised curriculum to each learner. It is certainly not optional. Fortunately, we have at our disposal Routes for Learning (RfL) a copy of which is available from your head of site. Written by a number of Welsh (PMLD) teachers and academics under the guidance of Jean Ware and published in 2006 by the Welsh Qualification and Curriculum Group, RfL notes 43 possible milestones which learners may or may not pass through in their educational and developmental journey through life. These milestones are broadly divided into cognitive and communicative, though a number (naturally) meet in the middle. Of the 43, there are seven which are key, these being 1) Notices stimuli; 9) Responds consistently to one stimulus; 23) Contingencyresponding; 26) Contingency awareness; 34) Object permanence; 36) Selects fromtwo or more items; 43) Initiates actions to achieve desired result (exerting autonomyin variety of contexts). The numbers allocated indicate where they appear in thewhole map.
A rigorous and accurate assessment procedure informs teaching, drives the recording of progress and is key to the successful education of our learners.
© The Bridge School 2013
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EXAMPLES OF THE CURRICULUM IN PRACTICE
On the following pages examples are provided of the pupil profiles which set the learning intentions for individual pupils, touch profiles which explain in detail the support each student requires to access learning opportunities and activity cards which demonstrate activities with differentiation for each individual. These are provided to give a real life feel to our curriculum and show how it works in practice.
PUPIL EDUCATIONAL PROFILE
Name: xxx Date of Birth: xx/xx/xxxx Class: xxx Language/s spoken at home: xxx Religion: xxxx Physiotherapist: xxxx OT: xxxx SLT: xxxxx Pupil Educational Profile updated the xx of xx 2011
Routes for learning 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 14, 16, 17, 18, 19, 20, 21, 23 (example) (Only numbers here of achieved outcomes).
Physical and Sensory
Where she/he is at the moment: If the student has a physical impairment or condition, how is this affecting her/his physical day to day and Sensory development? Sensory. Information about preferred and not preferred learning environment and sensory input. Also note any recent significant change in responses to sensory input. Physiotherapy and body Posture. Description of specialised equipment (standing frame, work chair, side layer, AFOs, etc.) that the student is using and what activities she/he takes part to develop motor skills, body posture and body positioning. We could note here how the student reacts to the equipment, stretches, etc. Potential learning outcomes: Physiotherapists and OTs can assist you in this point if there is any specific objective.
Social and Emotional
Where she is at the moment: Patterns of learning. Physical and vocal clues of communication (when motivated and when not). Preferred teaching style and grouping. Preferred style of interaction.
Potential learning outcomes: Process based and skills based learning. Refer to Routes for Learning and, if developing a particular communication system (skills based), the next steps of that system. We have to think laterally and horizontally when considering the potential learning outcomes.
Cognitive Development
Where she is at the moment: From Routes from Learning. Preferred leisure activities. Also switch level if using switches.
Potential learning outcomes: Process based and skills based learning. Refer to Routes for Learning and, if developing a particular system such as switch work (skills based), the next steps of that system.
Other information
Does the student eat orally? Is she/he allowed to be photographed? Etc.
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Communication
Potential Learning Outcomes • Specific for A., C., J.:
- Awareness: demonstrating any kind of awareness of thesounds of the activity.- Turn-taking: participating, in any way, in the turn-takingstructure of the activity.- Showing self: demonstrating a 'this is me' behaviour' to gainsomeone else's attention, by smiling, vocalising, eye-contact etc.- Seeking physical proximity: moving or turning towards anotherperson to indicate intention to communicate.
• D.- Turn-taking: participating, in any way, in the turn-takingstructure of the activity.- Anticipation: demonstrating anticipation of a word, phrase orsound effect.-To show contingency awareness on the resonance board.
• E., L. and A.- Gaze alternation: looking from person to person.- Turn-taking: participating, in any way, in the turn-takingstructure of the activity.-To show contingency awareness on resonance board.-Persevering by repeating actions-Early problem solving.
Description:
Activity Description Focus Hello -La la la la la la, hello, hello to
everybody and then using individualnames.
-Beginning-Becoming alert, aware-Gaining eye contact, attention.
Names - Tap tap ssh ssh tap tap X- Name chants- Various names at once
-Establish who is in the group-Recognition of name-Responding to own name.
Shake hands
-Lift arms slowly while raising voicewait for looking/vocalising then downwith a bang.-Shake hands-Swing up, Swing down
-Visual tracking of hands-Listening,-Anticipating-May indicate ‘more’
Stop, start, listen
-Tapping and chanting quietly thengetting louder.-slowly/quickly-getting faster-getting quiet
-Listening,-Anticipating-May indicate ‘more’
Hide and find
-Using fabric lift and lower. Tap totune e.g. drunken sailor-Someone is hiding
-Indicate up, down, more, again
Finishing -Goodbye chanting and tappinggently-Finish
-Calming, relaxing-Anticipating ending-Preparation for end of activity
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Health and Safety and the Resonance Board
• Check the boards for splinters each time that they are used.
• Wipe the boards after use with soapy water only.
• Place the boards so that there are no gaps in which fingers could be trapped.
• Use non-lip matting underneath the boards if necessary.
• Provide PE mats or cushions around the board so that pupils and staff are comfortable.
• When lying pupils on the boards make sure that they are not looking directly into the light including natural light.
• When lying pupils on the board make sure that they do not have their head or spine over a join.
• Keep heads and feet away from each other. Either heads in the middle, or feet in the middle.
• Ponytail bobbles and hair bands can be uncomfortable. They should be removed before the pupil lies on the board.
• Be aware that sounds created on the board can be very loud and intimidating
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Sherborne Movement
Potential Learning Outcomes • Specific for A., C., J.:
-‐ Awareness: demonstrating any kind of awareness of the sounds of the activity. -‐ Turn-‐taking: participating, in any way, in the turn-‐taking structure of the activity. -‐ Showing self: demonstrating a 'this is me' behaviour' to gain someone else's attention, by smiling, vocalising, eye-‐contact etc. -‐ Seeking physical proximity: moving or turning towards another person to indicate intention to communicate.
• D.-‐ Turn-‐taking: participating, in any way, in the turn-‐taking structure of the activity. -‐ Anticipation: demonstrating anticipation of a word, phrase or sound effect. -‐To show contingency awareness on the resonance board.
• E. , L. and A.-‐ Gaze alternation: looking from person to person. -‐ Turn-‐taking: participating, in any way, in the turn-‐taking structure of the activity. -‐To show contingency awareness on resonance board. -‐Persevering by repeating actions -‐Early problem solving.
Description:
Activity Description Focus Hello Introduction to the session -‐Beginning
-‐Becoming alert, aware -‐Gaining eye contact, attention.
Bacon and eggs
students on parachute -‐Visual tracking of faces and parachute -‐Listening, -‐Anticipating -‐May indicate ‘more’
Sausage roll Rolling students on blanket -‐Visual tracking of blanket -‐Listening, -‐Anticipating -‐May indicate ‘more’
Rocking Rocking students side to side to the tune of row your boat. Then rock forwards and back,
-‐Listening, -‐Anticipating -‐May indicate ‘more’
Body surfing -‐Listening, -‐Anticipating -‐Indicate up, down, more, again
Crawling -‐Listening, -‐Anticipating -‐May indicate ‘more’
Stroll on blankets
-‐May indicate ‘more’
Finishing -‐Goodbye gently with parachute -‐Finish
-‐Calming, relaxing -‐Anticipating ending -‐Preparation for end of activity
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Health and Safety for adults For swinging activities
• Use slow and smooth movements. Hurried, jerky movements can strain the muscles in your back.
• Keep your body facing the object/student while you lift it. Twisting while lifting can hurt you back.
• Keep the load close to your body. Having to reach out to lift and carry an object may hurt your back.
• “Lifting with your legs” should be done only when you can straddle the load. To lift with your legs, bend your knees,not your back, to pick up the load. Keep your back straight.
• Consider how many staff can lift child safely.
• One person takes the lead and count “1,2,3 lift”.
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Health and Safety for adults For carrying children on backs
• Warm up. Stretch your legs and your back before lifting anything.
• Don’t overdo it. Don’t try to lift something to heave for you. If you have to strain to carry the load, it’s too heavy.
• The strongest place is across back on hips.
For rocking
• You are using your stomach muscles. If you don’t hold them in you could hurt your back.
15 Cognitive Development Where she is at present
Sxxx is an inquisitive person who is aware of the daily routines of school. Sxxx is able to use actions to make changes in her environment and she responds to interesting events around her. She is making progress in her use of switches/vocas and can use them to get attention. Sxxx is aware of sequences in her immediate environment and is using this knowledge to anticipate, to take turns and to look at objects or people that she wants. She also tries to interact with her immediate environment.
Potential Learning Outcomes
• To use eye-‐pointing to make choices for preferred activities, clothes, etc.To modify her action when repeating action does not work.
• Sxxx lives with her mum, dad and sister.• She has epilepsy but rarely has seizures. If you see her have a seizure, please
inform a member of the class team or a nurse immediately.• Sxxx has had a gastrostomy, which means she eats through a tube in her
tummy. She has tasters of blended food and has thickened drinks.• Sxxx is dependent on others for all her care needs such as feeding, drinking,
going to the toilet, washing, dressing and undressing, etc.Sxxx has permission to be photographed/ videoed for inside and outside of school.
18 Overview of Activity Cards
Key:
Awareness Sept 2012 Sept 2013
1. Recognise an obvious change happening very close toself
Practising a skill Practising a skill
2. Recognise when a stimulus starts and stops Practising a skill Practising a skill
3. Accept stimuli for an increasing amount of time Practising a skill Practising a skill
4. Respond to a widening range of stimuli Practising a skill Practising a skill
5. Anticipate stimuli that occur over and over again Learning a new skill Practising a skill
6. Respond to a range of stimuli that are quieter / lessobvious
Learning a new skill Practising a skill
6a Read a book with a partner Learning a new skill Learning a new skill
7. Transfer attention from one stimuli to another Learning a new skill Learning a new skill
8. Locate a specific stimulus against a busy background Extending a new skill Extending a new skill
Control Sept 2012 Sept 2013
1. Make things move deliberately with gross (big)movements
Practising a skill Practising a skill
2. Make things move deliberately with finer (small)movements
Practising a skill Practising a skill
3. Persist in making simple toys do something Learning a new skill Practising a skill
4. Operate a toy that requires a single action Learning a new skill Practising a skill
5. Activate toys deliberately, using different movementsfor different toys
Extending a new skill Learning a new skill
6. Shift attention between different objects / actions Extending a new skill Extending a new skill
7. Manipulate objects purposefully
8. Push buttons to make a toy work
9. Look for favourite item when hidden
Practising a skill
Learning a new skill
Extending a new skill
September 2013
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10. Look for favourite objects in a box of similar items (notdeliberately hidden)
11. Open containers to find objects
Exploration Sept 2012 Sept 2013
1. Use their senses to register interesting events aroundthem
Practising a skill Practising a skill
2. Locate a moving stimuli Practising a skill Practising a skill
3. Turn to objects and sounds that are activated but in oneplace
Practising a skill Practising a skill
4. Make things happen when they move randomly Practising a skill Practising a skill
5. Activate toys that provide an interesting effectrandomly and without connecting the cause to theeffect
Practising a skill Practising a skill
Sequence & Pattern Sept 2012 Sept 2013
1. Take turns in repetitive games where the adult stopsfor a response
Practising a skill Practising a skill
1. A. Intensive Interaction Practising a skill Practising a skill
2. Take turns actively Learning a new skill Practising a skill
3. Choose between two or more motivating items Learning a new skill Learning a new skill
4. Operate toys that require more than one action tocomplete
Extending a new skill Learning a new skill
5. Operate toys that need to be pulled apart and puttogether
6. Follow objects that move within the toy
7. Put objects into a container one at a time
8. Select preferred item from a mixture of objects in a box
9. Look at the bottom of a sliding / tumbling toy for theobject to appear when it can’t be seen travelling down
10. Use objects that require two or more actions tocomplete
11. Use early problem solving for a familiar event
20 12. Solve simple problems where understanding the
pattern in importantLll
Routines 1. Sept 2012 Sept 2013
2. Attend to stimuli in a busy classroom Practising a skill Practising a skill
3. Attend to stimuli further away Learning a new skill Practising a skill
4. Anticipate routine events Learning a new skill Practising a skill
5. Recognise familiar places Learning a new skill Learning a new skill
6. Explore objects that are used in familiar routines Extending a new skill Learning a new skill
7. Respond to object cue Extending a new skill Extending a new skill
8. Select appropriate resources for a familiar routine
9. Assist in putting away resources used in a familiarroutine
10. Use objects and materials according to their function
21 Awareness 8
Students should be given opportunities to:
Locate a specific stimulus against a busy background
Activity
1 find favourite toy in a box of several toys 2 turn to name in a noisy room
Resources
Light box, sound box, tactile box, messy play box, music box, and the anticipation box.
What to look for 1.f When hiding a favourite item in a box of several items
• Eye pointing• smiling
2. When calling the student’s name look for:• a change in activity level or facial expression• movement of eyes, lips, tongue• vocalisation• tensing/relaxing• movement of arms/legs/fingers
Who can do the activity
Additional guidance
Pupil Education Profile Tactile profiles
22 Control 1
Students should be given opportunities to:
Make things move deliberately with gross (big) movements
Activity Arrange items so that students can cause a change by using arms or leg movements
eg: knock mobile, kick bells, swish water push a balloon
Resources
Light box, sound box, tactile box, messy play box, music box, and the anticipation box.
You can use the washing line to attach tactile objects for the students to use.
What to look for
Arm/ hand movements The student looking at the item and their hands Smiling at the effect of the action
Who can do the activity
Additional guidance
Pupil Education Profile Tactile profiles
23 ICT fact sheet
Switches and position
Peter uses touch cues on his switches to help cue him into the activity.
Black felt cover – Connected to something to make it work Bubble wrap cover – Connected to something to make it work Fur cover – Not connected to anything, this switch always does nothing.
If Peter is using 1 switch it should be placed in the middle of his beanbag tray. If the tray is not available it can be placed on his lap as in photo column 1, but the best position is shown in both photo column 2 and 3.
Switches that can be used Jelly bean switch Big mac
Computer programmes that can be used
Big Bang – colour change SENSwitcher – press 1 Jelly bean attached to the lights and switch toys
Supporting the student
Peter needs verbal prompting when using his switch. Peter may need some physical prompting this is done by using hand over hand strategies (see touch profile)
Photo column 1 Photo column 2 Photo column 3
24 Peter -‐ Touch profile
Please support me to explore items INDEPENDENTLY – Use minimal physical prompting!
I can independently explore sensory items as shown opposite
Support and preferences…
I need more verbal support to explore wet, small and sticky items….
TOUCH CUES!! Touch the back of my head lightly with my neck brace and I will bring my head forward.
When taking off my top/coat, make sure the arms holes are accessible so I can pull my own arm through
When putting my top on make sure I can push my own arms through the arm hole with minimal support.
When supporting me to explore wet and sticky items, talk to me!
It is best to support me with one hand under my elbow and one under my wrist, leaving my hands free to explore…
