Visual Impairment

Kimberly M. HeimerJuly 24, 2008ECE 505.01

Federal Definition of Visual Impairment:

•“Visual impairment including blindness is defined as an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial, slight, and blindness” (p. 346).

Bartlett, L.D., Weisenstein, G.R., & Etscheidt, S. (2002). Successful inclusion for educational leaders. Upper Saddle River, NJ: Pearson Education, Inc.

•Visually Impaired can “refer to people who have never had any visual functioning, as well as those who became gradually or suddenly partially or totally blind” (p.176).

Paasche, C.L., Gorrill, L., & Strom, B. (2004). Children with special needs in early childhood settings identification intervention inclusion. Canada: Delmar Learning.

What does it mean to be visually impaired?

• For the purpose of this presentation we will focus on visual impairments in children.

Importance of early detection:

•According to research the first three months of a child’s life are the most critical to the development of the visual system.

•Low vision, fluctuating vision, and blindness “can severely impede the development of independence, communication, and social interactions” (p.140).

McLean, M., Wolery, M., & Bailey Jr., D.B. (2004). Assessing infants and preschoolers with special needs. Upper Saddle River, NJ: Pearson Education, Inc.

•“A lack of vision or reduced vision may result in delays or deficits in motor, linguistic, cognitive, and social-behavioral development” (p. 346).

Bartlett, L.D., Weisenstein, G.R., & Etscheidt, S. (2002). Successful inclusion for educational leaders. Upper Saddle River, NJ: Pearson Education, Inc.

•As a result early detection of any visual impairment is crucial in helping to minimize the negative impact on a young child's development as they move through life.

What to look for:

Paasche, C.L., Gorrill, L., & Strom, B. (2004). Children with special needs in early childhood settings identification

intervention inclusion. Canada: Delmar Learning.

Physical CharacteristicsThe child’s eyes may

1.) be inflamed or watery.

2.) have reoccurring styes or infections.

3.) be red-rimmed, encrusted, and or have swollen eyelids.

4.) have different sized pupils.

5.) have drooping eyelids.

6.) be sensitive to light.

7.) see well one day and not the next.

8.) be crossed.

9.) be semi closed or squinted.

10.) appear to be focusing in different directions.

What to look for cont…

Behavioral Characteristics

The child may

1.) close or cover one eye.

2.) squint eyes or frown.

3.) complain that things are blurry or hard to see.

4.) have trouble reading or doing other close-up work, and holds objects close to eyes to see.

5.) blink more than usual.

6.) be cranky when doing close-up work (looking at books).

Vision Loss Fact Sheet, http://www.cdc.gov/ncbddd/autism/actearly/pdf/parents_pdfs/VisionLossFactSheet.pdf

When should a child’s vision be checked?

A child’s vision should be checked by an ophthalmologist, pediatrician, or other trained specialist at:

•Newborn-3 months

•6 months- 1 year

•About 3 years

•About 5 years

•This is especially important if someone in the family has vision problems as research suggests that certain visual impairments may be genetic.

Vision Loss Fact Sheet, http://www.cdc.gov/ncbddd/autism/actearly/pdf/parents_pdfs/VisionLossFactSheet.pdf

What causes visual impairment in children?•There are many causes of visual impairments. “Any defect in the eye itself; in the optic nerve, which carries visual messages to the brain; or in the vision center in the brain may result in a visual impairment” (p. 80).

Source: http://www.crowrivereyecare.com/articles/anatomy_a1.htm

More specifically vision loss can result from…

•Damage from injury

•Accidents

•Illness to any part of the visual system

•Genetic disorders

•Congenital (present at birth) abnormalities

•Premature birth

Pueschel, S.M., Scola, P.S., Weidenman, L.E., & Bernier, J.C. (1995). The special child: A source book for children with developmental disabilities second edition. Baltimore, MD: Paul H. Brookes Publishing Co.

Don’t know much about the human eye? You’re not alone! Follow this link http://www.nei.nih.gov/health/eyediagram/ to an interactive diagram of the human eye.

Prevalence:

•Childhood blindness and severe visual impairment occurs in approximately 2 to 10 per 10,000 births.

•Acquired visual impairment during childhood is 1/5 as prevalent.

•Approximately ½ of congenital (present at birth) and later onset blindness is the result of genetics.

•Research also suggests that children living with visual impairments were found to have developmental delays and one or more other disabilities.

Some common disabilities associated with visual impairments are:

-Down Syndrome

-Seizure Disorders

-Autism

McLean, M., Wolery, M., & Bailey Jr., D.B. (2004). Assessing infants and preschoolers with special needs. Upper Saddle River, NJ: Pearson Education, Inc.

Common Childhood Visual Conditions:

Visual Condition Nature of Condition

Effects on Vision

Albinism At birth, absence of eye pigment.

Loss of central vision, poor depth.

Amblyopia Reduced vision due to lack of eye alignment.

“Lazy eye”, if uncorrected brain turns off vision in weaker eye. Depth and acuity effected.

Congenital Amaurosis of Leber (CAL)

Degeneration beginning in utero, present at birth.

Profound vision loss at birth.

Color Blindness Dysfunction of the cones, present at birth.

Difficulty differentiating colors.

Congenital Glaucoma

Caused by increased pressure in eye.

Cause early onset blindness.

McLean, M., Wolery, M., & Bailey Jr., D.B. (2004). Assessing infants and preschoolers with special needs. Upper Saddle River, NJ: Pearson Education, Inc.

Visual Condition Nature of Condition

Effects on Vision

Cortical Visual Impairment

Lack of visual attention and awareness.

Aware of flashing lights, movement and bright colors, vision changes over time.

Nystagmus Present at birth or acquired condition.

Diminished acuity, turn head to compensate.

Optic Atrophy Degeneration of the optic nerve. Congenital or acquired as a result of eye infection.

Slowed pupil responses, visual field deficits, color vision loss.

Optic Nerve Hypoplasia

Nonprogressive, congenital disorder of the optic nerve.

Minimal vision impairment-total blindness.

Retinopathy of Prematurity

Congenital condition associated with premature births.

Minimal-high vision loss.

McLean, M., Wolery, M., & Bailey Jr., D.B. (2004). Assessing infants and preschoolers with special needs. Upper Saddle River, NJ: Pearson Education, Inc.

Follow this link http://www.nei.nih.gov/health/ to learn more about eye conditions that can effect vision.

Adaptations and Augmentative Communication:Curriculum-

•Reading and writing through the use of Braille (check out this website http://www.afb.org/braillebug/ ).

•Listening skills.

•Personal-social and daily living skills.

•Instruction in the use of special aids, equipment, and alternative learning materials.

• Educators should be familiar with media materials designed to teach skills and concepts that are normally acquired through vision.

Orientation and Mobility Related Services-

•Service provided to blind or visually impaired students by qualified personnel to help these students attain a systematic orientation to their school environment which allows them to move within this environment safely.

•Use of information such as sound, temperature, vibrations etc…to determine location ex. the vibration the water fountain makes.

•Use of a long cane as a tool to safely negotiate their environment.

Assistive Technology-

•Braille.

•Talking devices (clocks, spelling aids, speech calculators).

•Computers with speech recognition, magnification capabilities, and scan and read synthesizers allowing children to put books onto the computer which will then help them read it.

•Magnifiers, mini telescopes, large print materials and tape recorded materials. (p. 347)Bartlett, L.D., Weisenstein, G.R., & Etscheidt, S. (2002). Successful inclusion for educational leaders. Upper Saddle River, NJ: Pearson Education, Inc.

Classroom Implications:•In addition to assistive technology teachers working with children who are visually impaired must be especially sensitive to a child’s emotional needs.

•“An estimated 85% of the information people receive is transmitted through the visual sense” (p. 130).

Kemple, K.M. (2004). Let's be friends: Peer competence and social inclusion in early childhood programs. New York, NY: Teachers College Press.

•Think about how much information you send out and receive visually through:* Facial expression* Gestures* Eye contact* Body language

•Not being able to sense other peoples emotions, feelings, and or intentions can significantly impact a child’s ability to acquire appropriate social skills.

•As a result it may be difficult for a child who is visually impaired to engage in the same meaningful social opportunities as his/her peers.

•Thus it is important for classroom teachers to provide all children in their classroom with appropriate opportunities for desirable peer interaction. Since children who are visually impaired can not rely on visual cues to gain their peers attention it is important to

* have size restricted play spaces.* help them learn all of their classmates names and identify them by the

sounds of their voices (name games, and circle time songs help ex. who stole the cookie from the cookie jar?) (p. 131).

Classroom Adaptations:•Physical environment (clear traffic patterns).

•Seating.

•Reduced glare to help children with some vision see better.

•Provide auditory supplement to visual information (reading information from board or overhead projector—which could subsequently assist other non-visually impaired students who are auditory learners.

•Enhance visual information in the classroom (large and dark print, dry-erase boards).

•Collaborate with support personnel (vision specialist) providing support through

-Supplemental instruction.

-Translate material into Braille.

-Serve as a consultant to the general education teacher.

(May also receive services from physical therapist, occupational therapist, or school nurse if physical disabilities accompany the students visual impairment.)

•“Advances in technology and a variety of related services have facilitated the inclusion of students with visual impairments in general education classrooms. The U.S. Department of Education (1998) estimated that 48% of school-aged students with visual impairments are in regular classes, 21% receive services in resource rooms, and 17% are educated in separate classrooms” (p. 348).

•Please note that statistic is reported from 1998, I’m wondering if the number of visually impaired children educated in regular education classrooms is significantly higher than that today?Bartlett, L.D., Weisenstein, G.R., & Etscheidt, S. (2002). Successful inclusion for educational leaders. Upper Saddle River, NJ: Pearson Education, Inc.

Family Involvement:•“According to current research “professionals agree that providing support to families and helping them become more involved in the lives of their visually impaired children are important components of providing effective services to individuals with various types of impairments” (Neibaur Day, J., & Kleinschmidt, J., 2005, p. 775).

I believe it is our job as teachers to provide extended support to the families of the children in our classrooms. Helping families of children who are visually impaired build strong community ties allows for an increased awareness of and accessibility to available resources. Which inturn is an extremely important factor in leading a fulfilling lifestyle for all involved

•National Dissemination Center for Children with Disabilities is a useful website providing information for children living with various disabilities including vision loss including a focus on high quality education for children with disabilities.

http://www.nichcy.org/

•Board of Education and Service for the Blind in CT (BESB) is a state agency that is “committed to providing high quality educational and rehabilitative services to people who are legally blind, deaf-blind, and children who are visually impaired at no cost to clients or families.

http://vvv.besb.state.ct.us/

•The Bureau of Rehabilitative Services (BRS) is a division of the CT State Department of Social Services. This agency works to create opportunities that allow individuals to live and work independently.

http://www.brs.state.ct.us/

•Family Connect is an informative website designed to provide support to families raising children who are visually impaired.

http://www.familyconnect.org/parentsitehome.asp

•National Eye Institute is a website which offers extensive resources on subjects related to vision loss.

http://www.nei.nih.gov/index.asp

•Advisor-Assisting the Development of Visually Impaired Students through Online Resources is another great website full of useful links for parents and teachers working with children who are visually impaired or for anyone interested in learning about visual impairments.

www.e-advisor.us/

•Dots for Families-Ongoing Literacy for Families of Children with Visual Impairments is a website that highlights different resources available to families of children with visual impairments.http://uacoe.arizona.edu/viliteracy/

Other Useful Resources:

•American Foundation for the Blind (AFB) is an organization that works to expand possibilities for people living with vision impairment. This website is full of informative links for families and children who are impacted by visual impairment.

http://www.afb.org/

•National Federation of the Blind Voices of the Nation’s Blind (NFB) is an organization that works to promote equality for the blind through advocacy, education, research, technology, and various programs encouraging independence and self-confidence. This website is full of many great links.

http://www.nfb.org

References

Bartlett, L.D., Weisenstein, G.R., & Etscheidt, S. (2002). Successful inclusion for educational leaders. Upper Saddle River, NJ: Pearson Education, Inc.

Disability Info: Visual Impairments Fact Sheet (FS13), http://www.nichcy.org/pubs/factshe/fs13txt.htm

Kemple, K.M. (2004). Let's be friends: Peer competence and social inclusion in early childhood programs. New York, NY: Teachers College Press.

McLean, M., Wolery, M., & Bailey Jr., D.B. (2004). Assessing infants and preschoolers with special needs. Upper Saddle River, NJ: Pearson Education, Inc.

Neibaur Day, J., & Kleinschmidt, J. (2005). The efficacy of family camp experience for families who have children with visual impairments. Journal of Visual Impairment & Blindness. 99 (12), 775-779.

Paasche, C.L., Gorrill, L., & Strom, B. (2004). Children with special needs in early childhood settings identification intervention inclusion. Canada: Delmar Learning.

Pueschel, S.M., Scola, P.S., Weidenman, L.E., & Bernier, J.C. (1995). The special child: A source book for children with developmental disabilities second edition. Baltimore, MD: Paul H. Brookes Publishing Co.

The National Eye Institue, http://www.nei.nih.gov/index.asp

Vision Loss Fact Sheet, http://www.cdc.gov/ncbddd/autism/actearly/pdf/parents_pdfs/VisionLossFactSheet.pdf.