TETN # 30910

Visually Impaired Students with Vestibular

Issues

Presented by Kate Hurst and Jim Durkel

TSBVI OutreachKateHurst@tsbvi.eduJimDurkel@tsbvi.edu With Special Guest

David BrownCalifornia Deaf-Blind Services

Workshops and ConferencesWorkshops and Conferences

June 5-7 Appropriate Communication

Assessment for Babies with Deafblindness

HAS BEEN CANCELED

June 25-26 ECI Conference @ Embassy

Suites in San Marcos

June 26-27 5th Annual Statewide Texas

Parent to Parent Conference@ Omni Austin

Hotel at Southpark in Austin

Roll CallRoll Call

How many How many participating?participating?

Remote sites?Remote sites? Taping or Taping or

streaming?streaming?

Visually Impaired Students with Vestibular Issues

Presented by

Kate Hurst, Statewide Staff Development Coordinator, TSBVI Outreach with

Jim Durkel, Audiologist/Speech-Language Pathologist and APH, VI Registry, & Deafblind Census Coordinator, TSBVI Outreach and

David Brown, Education Consultant, California Deaf-Blind Services

Our Special Guest . . .

David Brown Formerly of SENSE,

UK Currently with

California Deaf-Blind Services

World-traveler Funny guy

How do we achieve balance?

Three separate components make up “Equilibrium Triad”

Input from the eyes (vision) Input form the muscles and joints

(proprioception) Input from the vestibular organs (balance)

A Good Place to Start

Pediatric Resource - Vestibular Disorders

Association

(

http://www.vestibular.org/vestibular-disorders/specific-disorders/pediatric-vest.-disorders.php)

Causes Pediatric Vestibular Disorders

Head/neck trauma Chronic ear infections Maternal drug/alcohol abuse CMV Immune-deficiency disorders Meningitis Migraine Metabolic disorders (e.g., diabetes) Ototoxic drugs

Causes Pediatric Vestibular Disorders

Neurological disorders (CP, Hydrocephelus)

Genetic syndromes (e.g., Wallenberg, Usher,

CHARGE)

Posterior brain tumor

Family history of hearing loss/vestibular issues

Cochlear implants

Lack of use - movement issues, fear, ill health

Some data . . .

VI Registry - 84 or 14%

CP - .3% CHARGE - 7.7% CMV - 2.7% Hydrocephaly - 1% Meningitis - .5% Shaken Baby - .5% Usher 1 - 1.7%

Deafblind Census - 147 or 19.9%

CHARGE - 9.7% CMV - 4.8% Hydrocephaly - 1.9% Usher 1 - 1.2%

So how does the vestibular system work?

Vestibular organs Located in the bony

chambers of the skull in the inner ear

3 semi-circular canals positioned in different planes for rotational movements

Otoliths (Utricle and Saccule) for linear accelerations

Semicircular Canals Bulge at base of canals -

ampulla Ampulla contain sensory

receptors for each canal Canals filled with endolymphatic

fluid and surrounded by perilymphatic fluid

Detect heads rotation Demonstration on

The Physiology of the Senses Transformations for Perception and Action, Tutis Vilis, University of Western Ontario, Canada

Otolith Organs Utricle Saccule Demonstration on

SenseWeb

Vision and Balance

Vestibular Occular Reflex

Normal head rotation: eyes move in opposite direction of head to stabilize retinal image (VOR)

Conflicting sensory information from visual and vestibular senses is a problem

The cerebellum repairs “slippage” Demonstration

What Part Does Proprioception Play?

Sensation experienced by muscle and joint receptors

Requires a normal range of muscle tone to work properly

Feeds information to the brain that allows for awareness of where body parts are in space, movement, speed and direction of movement

A Redundancy for Balance

Brain and Spine Foundation Online

When one of the three parts of the Equilibrium Triade do not work or work well, the other two can compensate.

Moving Platform Posturography

QuickTime™ and a decompressor

are needed to see this picture.

From Jean Ayers Sensory Integration and the Child

“The vestibular system is the unifying system. It forms the basic relationship of a person to gravity and the physical world. All other types of sensation are processed in reference to this basic vestibular information.”

From Jane AyersSensory Integration and the Child

“The activity in the vestibular system provides a “framework” for the other aspects of our experience. Vestibular input seems to “prime” the entire nervous system.”

From Jane AyersSensory Integration and the Child

“When the vestibular system does not function in a consistent and accurate way, the interpretation of other sensations will be inconsistent and inaccurate, and the nervous system will have trouble ‘getting started.’”

From Carol Stock KranowitzThe Out-of-Sync Child

“Gravitational insecurity is manifested by abnormal distress and anxiety in reaction to falling or the possibility of falling. It is a primal fear.”

From Carol Stock KranowitzThe Out-of-Sync Child

“Indeed, our need to know where we are in relation to the earth is more compelling than our need for food, for tactile comfort, or even for a mother-child bond.”

References on Vestibular Issues

David Brown, California Deaf-Blind Services

o “The Vestibular Sense”, DbI Review, June, 2007

o “Educational and Behavioral Implications of Missing

Balance Sense in CHARGE Sydrome”, reSources,

Spring 2003.

Effects of vestibular problems

Organization of ALL sensory information

Postural security/muscle tone

Use of residual vision Perception/processing

sound Remembering auditory

sequencing

Memory development Speech/Language

development Behavioral challenges Bilateral coordination Breathing, feeding,

digestion, nutrition Sociability

What do we do?

ASSESS

Vestibular Dysfunction Checklist in Out-of-Sync Child

Sensory Learning Kit Vestibular assessment by

Audiologist OT/PT Evaluation Sensory Integration Evaluation

Various testing deviceshttp://www.tchain.com/otoneurology/testing/engrot.html

QuickTime™ and a decompressor

are needed to see this picture.

QuickTime™ and a decompressor

are needed to see this picture.

QuickTime™ and a decompressor

are needed to see this picture.

QuickTime™ and a decompressor

are needed to see this picture.

What do we do?

TEAM

With OT knowledgeable about SI to develop menu of interventions

To plan flexible schedule related to fatigue and need for breaks

To select / train staff to respect individual differences in behavior, performance, pacing

With family to gain insight to home challenges, child preferences and for support

What do we do?

MODIFY

Seating to address postural concerns Positioning for visual and auditory tasks Materials and learning environment

(isolate lines of text, reduce distractions) Activities to incorporate SI approaches Pacing Schedule (general / day-to-day) Staffing patterns

What do we do?

RESPECT

Student challenges in learning Family struggle to address

challenges / knowledge of the child Staff challenges to adapt

programming and the expertise each has to offer

To Learn More . . .

Brown, David, 2007. “The Vestibular Sense”, pp. 17-22. Dbl Review, January-June 2007, Deaf-Blind International.

Brown, David, 2003. “Educational and Behavioral Implications of Missing Balance Sense in CHARGE Syndrome”, pp. 1-4. re:Sources, Spring, 2003. California Deaf-Blind Services, San Francisco, CA. http://www.sfsu.edu/~cadbs/Spring03.pdf

To Learn More . . . Brown, David, 2008. “The Sensory

Integration Perspective and What It Offers Us in the Field of Deafblindness”, pp. 22-26. DbI Review, July-December, 2008. Deaf-Blind International.

Brown, David, 2008. “The Forgotten Sense - Proprioception”, pp. 20-24. DbI Review, July-December, 2006. Deaf-Blind International.

To Learn More . . .

Kranowitz, Carol Stock, 1998. The Out-of-Sync Child. The Berkley Publishing Group, 375 Hudson Street, New York, NY 10014.

Kranowitz, Carol Stock, 2003. The Out-of-Sync Child Has Fun. The Berkley Publishing Group, 375 Hudson Street, New York, NY 10014.

To Learn More . . .

Vestibular Disorders Association www.vestibular.org

Brain and Spine Foundation - Dizziness and balance problems http://www.brainandspine.org.uk/information/publications/brain_and_spine_booklets/dizziness_and_balance_problems/how_does_the.html

Tutis Vilis - SenseWeb http://www.physpharm.fmd.uwo.ca/undergrad/sensesweb/L10Balance/L10Balance.swf