Blindness and Low Vision

Title, EditionISBN

© 2009 Pearson Education, Inc.All rights reserved.

Exceptional Children: An Introduction to Special Education, 9th EditionISBN 013514454X

© 2009 Pearson Education, Inc.All rights reserved.

Chapter 10Blindness and Low Vision

© 2009 Pearson Education, Inc.All Rights Reserved.2

Exceptional Children: An Introduction to Special Education, 9th EditionHewardISBN 013514454X


Focus QuestionsWhat are the instructional implications of the three general classifications of visual impairments that educators use?How do blindness and low vision affect learning, motor development, and social interaction?Why is it important that teachers know about the types of visual impairments affecting children in their classroom?How do the educational goals and instructional methods for children with low vision differ from those for children who are blind?How might the educational placement of a student with visual impairments affect her opportunities to learn the expanded core curriculum of nonacademic skills necessary for overall success in life?

KEY TERMS AND CONCEPTSDefinitions/Characteristics: Blindness, Low Vision, Legally Blind, Visual Acuity, Partially Sighted, Braille, Visual Impairment 20/20, 20/70/, 20/200(+) vision. Field of VisionWhat is in the core curriculum for student with visual impairmentsCongenital and Acquired Blindness – causes (macular degeneration, glaucoma, cataracts, diabetic retinopathy, etc.)Types and uses of optical devicesClassroom adaptations (light, paper, other)Orientation and Mobility Training, BrailleGuide dogs, assisting individuals with visual disability, canesPlacement in schools, characteristics of residential schools




Definitions of Visual ImpairmentLegal definition of blindness

The legal definition is based on visual acuity and field of vision

Visual Acuity- ability to clearly distinguish forms or discriminate among details

Ex. 20/20 vision means that at a distance of 20 feet, the eye can see what a normally seeing eye sees at 20 feet

Field of Vision- when gazing straight ahead, a normal eye can see objects within a range of approximately 160-170 degrees




Definitions of Visual Impairment

Legally Blind- A person whose visual acuity is 20/200 or less after the best possible correction with glasses or contact lenses

20/200 means that the person standing 20 feet away from an object, sees it as a normally sighted person would see it from 200 feet away

A person whose vision is restricted to an area of 20 degrees or less is considered legally blind




Definitions of Visual Impairment Low Vision- uses vision as primary

means of learning, but may supplement visual information with tactile and auditory input Ex. May use tactile vision sensory substitution-

use of touch to substitute visual information

Partially Sighted- Visual acuity is at best, 20/70, even after

correction (glasses, contacts)




Definitions of Visual ImpairmentEducational definitions of visual impairments

The IDEA definition emphasizes the relationship between vision and learning

Totally blind: Receives no useful information through the sense of vision and must use tactile and auditory senses for all learning

Functionally blind: Has so little vision that he/she learns primarily through the auditory and tactile senses; however he/she may be able to use their limited vision to supplement the information received from the other senses and to assist with certain tasks (ex. Moving about the classroom)

Low vision: Uses vision as a primary means of learning but may supplement by using tactile and auditory input




NJAC 6A:14 Definition "Visually impaired" corresponds to

"visually handicapped" and means an impairment in vision that, even with correction, adversely affects a student's educational performance. The term includes both partial sight and blindness. An assessment by a specialist qualified to determine visual disability is required. Students with visual impairments shall be reported to the Commission for the Blind and Visually Impaired.




Cognition and Language Child learns as they move through their environment (incidental

teaching) Learn concepts slowly through limited interactions with them in

their environment (Ex. What is a cat?- purrs, meows, scratches, paws, etc.)

Cognition Difficulties with comprehension, or relating different items of

information Visual deficits make it difficult to make connections between

experiences Incidental teaching makes learning “in pieces”

Language Difficult to learn simple language Trouble with analogies, abstract concepts, idiomatic

expressions Ex. Cats have tails, bananas are smooth




Motor Development and Mobility Delays in motor development

Absence in sight effects babies motivation to want to move- failed attempts are reaching for things

May move less often because movements in the past have resulted in painful contact with their environment

Parental concern for safety May begin to engage in self stimulating

behavior (flapping, rocking, poking) Poor balance, gross motor skills, cannot

perform motor tasks through imitation




Social Adjustment and Interaction Delays development in social skills; play and interact less during

free time Many cannot benefit from peers or adult role model because of

the low incidence of the disability Difficulty receiving and expressing affection- these behaviors

help with future development of social competence Struggle with social isolation- work harder to get and maintain

friendships Often not invited to participate in activities (games) Inability to see and respond to social signals (gestures, facial

expressions, body posture) reduces opportunities for reciprocal interactions

Stereotypic behaviors- engage in repetitive body movements or other behaviors which places them at a great social disadvantage

Many report the biggest difficulty socially is dealing with the attitudes and behavior of sighted people




Prevalence and Causes Fewer than 2 children in 1000 have visual impairments

Almost half of school age children with visual impairments also have another disability

Causes of visual impairments Refractive errors: Myopia (nearsightedness) and

hyperopia (farsightedness) Structural impairments: Cataracts, glaucoma,

nystagmus, strabismus Cortical visual impairments: Suspected damage to

parts of brain that interpret visual information




Common Causes-Acquired Diabetic Retinopathy

Most common cause of acquired blindness in adults

Impaired vision results of hemorrhages and growth of new blood vessels in the area of the retina, due to diabetes

Glaucoma Abnormally high pressure within the eye

caused by disturbances or blockages of the fluids that normally circulate within the eye

Central and peripheral vision are impaired or lost entirely when the increased pressure damages the optic nerve




Educational Approaches The age of onset has implications for how children with low

vision should be taught Visual impairment can be congenital (present at birth) or

adventitious (acquired)

Special adaptations for students who are blind Braille is a tactile system of reading and writing

composed of raised dots Tactile aids and manipulatives Technological Aids for Reading Print

Opticon - Optical-to-tactile converter Kurzweil 1000 - Optical character-recognition system Hardware/software that magnifies screen images Speech recognition software Software that converts text files to synthesized speech




Educational Approaches Lessons must be planned and carried out to

address activities that are Nonvisual Facilitate participation in active and practical

experiences Ex. Lesson on “birds”

Plan activities that have the student touch birds of various species

Manipulate objects- eggs, nests, feathers Assume responsibility of feeding a pet bird WOULD NOT- feel plastic models, read books

about birds, have student memorize vocabulary




Age of Onset Important for teacher to know age of onset

Congenital visual impairment Present at birth Most cases of visual impairment Has a background of learning through hearing and touch

only

Adventitious visual impairment Acquired after birth Child has a background of learning through visual, hearing

and touch Typically retains a visual memory of things, can be helpful

in education (colors, maps, printed letters) May need more emotional support to adjust to vision loss




Braille Primary means of literacy for the blind Tactile system of reading and writing in which

letters, words, numbers and other system are made from arrangements of raised dots

Similar to shorthand. It uses abbreviations Uses a set of 189 abbreviations called contractions

Helps save space and permits faster reading and writing Ex. When the letter “r” stands by itself it means “rather”

Reading Braille is usually slower than reading print, but faster than reading raised letters

100 words per minute for good Braille readers




Braille Typically introduced to Braille in the first

grade (recommend 1-2 hours of reading, writing instruction each day)

Learn to write Braille by using a brailler- six keyed mechanical device that resembles a typewriter

Older students use a slate and stylus- braille dots are punched out one at a time by hand from right to left- better for note taking because it is smaller and quieter




Braille Technological Aids Braille ‘n Speak

Battery powered, pocket sized device for note taking

Keyboard for braille entry and voice output Translates braille into synthesized speech or

print

The Mountbatten Pro Brailler Electronic brailler Easier to use than the mechanical one Print braille from digital text

Stylus and Slate

Braille ‘n Speak

Mountbatten Pro Brailler

Braille e-Reader




Tactile Aids and Manipulatives Math

Effective teaching tools in teaching beginning mathematics skills to elementary students

Ex. Cuisenaire rods- blocks consisting of small cubes (1), rods (10 cubes) and flats (100 cubes)

Belcastro has special ones that have tactile markings to identify each one Speech Plus talking calculator- more advanced math

Science and Social Studies Use of tactile and auditory sense for firsthand manipulation and discovery Ex. Embossed relief maps and diagrams, 3-D models MAVIS (Materials Adaptations for Students with Visual Impairments) and

SAVI (Science Activities for the Visually Impaired offer suggestions for modifications and adaptations

Reading Tactile experience books ( glue/staple/attach artifacts from actual events

experienced by the child to the pages of a simple and sturdy book Include braille or print related to the artifact




Technological Aides- for Reading Print Optacon (optical to tactile converter)

Small handheld electronic device that converts regular print to readable vibrating form

Does not convert print into braille but into a configuration of raised pins representing the letter the camera is viewing

Ex. Optacon camera is held over a letter “e”, the user will feel on the tip of one finger a vertical line and three horizontal lines

Training and practice is required Kurzweil

Computer based reading system that uses and optical-character-recognition system to scan and read printed or electronic text with synthetic speech

http://www.youtube.com/watch?v=TOwDzDnd9NY

http://www.youtube.com/watch?v=TOwDzDnd9NY




Computer Access Assistive technology that provides access to personal

computers- opportunities for education, employment, communication and leisure

Hardware/software that magnifies screen (Zoomtext) Speech recognition software that allows user to tell computer

what to do (Dragon Naturally Speaking) Software that converts text files to synthesized speech

(ReadOutLoud, WriteOutLoud) Keyboarding

Can facilitate communication between children who are blind and their sighted classmates

Handwriting is seldom taught to students who are totally blind

Only taught to sign name- bank account, register to vote, apply for job




Functional Vision/Visual Efficiency How well a person uses whatever vision he/she

has NOT measured by visual acuity or visual field

A student can have severe visual impairment, but function well

A student can have a minor visual impairment, but function poorly (behave as if blind)

Children must be taught systematically to make sense of what they “see” throughout daily schedule




Functional Vision/Visual Efficiency Vision is functional when one or more

visual-motor skills (fixation, scanning, tracking, gaze shift) achieve the following Essential step that the individual uses to

accurately and efficiently perform a task Promoted more independent performance

at home, school, vocation or community Enhances the degree of choice and

autonomy, enhancing quality of life




Visual Motor Skills Awareness- visually sensing the presence of objects or

movement

Fixation- active alignment of the line of sight in one or both eyes on a stationary object or person

Looking at a tube of toothpaste, while reaching to pick it up and apply it to the toothbrush

Scanning- visually searching for an object or person among a display of visual stimuli

Visually locating the appropriate bus or van at dismissal time.

Tracking- visually following a moving stimuli Watching what coins go where as they are sorted into

the appropriate location in a cash drawer




Visual Motor Skills Discriminating- visually determining

differences between and among stimuli

Visual Sequencing- detecting the sequence in which objects appear, leave or move in the visual field

Gaze Shift- shifting fixation in space from one location to another Fixating on one type of cutlery and then others

as the appropriate silverware for a particular meal is selected




Optical Device Determined by an ophthalmologist or

optometrist Ex. Glasses, contact lenses, small

handheld telescopes, magnifiers over print, monocular, closed-circuit television system, augmented reality system

May help perform better at reading print or seeing distant objects

Typically more specialized- dependent on student need and appropriateness

Closed Circuit Television

Augmented Reality System




Reading Print Students with low vision use three basic approaches

Approach magnification Reduce distance between the eye and print

Lenses Optical device

Large Print Print in 18-point font

Student should receive 1.5 to 2 times as much time for reading

Ensure sufficient time to study, and use auditory reading aids such as talking books or text-to-speech

Allow extra time on tests




Classroom Adaptations Proper lighting

Adjustable lamps Extra lighting on side of eye with less light

Desks with adjustable/tilting tops so can read/write at closer range and so that they get proper light

Increased print size Writing paper with a dull finish to reduce glare Avoid worksheets photocopied on colored paper Go over print on worksheet with a dark marker/pen Chairs with wheels- easily move around classroom

without having to get up (good light)




ReviewYou have a student with low vision who is starting in your class in September. His IEP states that you must assure proper lighting at all times. This may include:

A. using a standard desk close to the teacherB. using non-glare paperC. using a standard chair with tennis balls on the bottomD. using standard paper with a pencil grip




Expanded Curriculum Priorities Orientation and mobility training (O&M) (Orientation – where “you”

are. Mobility – how to get from one place to another) Cane skills – most frequent method. NOT TEMPORARY Guide dogs – working companions, not pets. Small % of people get

guide dogs. Sighted guides Electronic travel aids Should start as young as possible (no later than youngest grades of

elementary school) Listening skills Functional life skills

Cooking Personal hygiene Shopping Financial management Transportation Recreational activities




Orientation and Mobility Training Orientation- knowing where you are,

where you are going, and how to get there by interpreting information from the environment

Mobility- moving safely and efficiently from one point go another




Orientation and Mobility Training Considered a related service by IDEA Appears on IEP’s of virtually all students

with significant visual impairments Helps a person move safely from one

point to another, even in new environments

Taught from an early age (early as preschool) Learn own bodies (“knee bends”) Surroundings- walls, ceilings, doors, hallways




Orientation and Mobility Training Cane Skills

Used as a bumper to protect the body from obstacles- parking meters, doors

Tool for independent travel Probe to detect surface changes- grass to concrete,

rug to wood floors http://www.youtube.com/watch?v=MnxBnFyqMh0

Guided Dogs Used as working companions, not pets Trained to follow basic commands Provide basic protection against obstacles Ensure traveler’s safety Fewer than 2% with visual impairments travel with

the aid of a guide dog Young children need exposure to dogs and O&M skills

prior to working with a guide dog




Orientation and Mobility Training Sighted-Guides- simple method of helping a person with

visual impairments travel Speak in a normal tone of voice, ask directly “May I

help you?” Do not grab arm or body, permit him/her to take your

arm Should grab your arm above the elbow of sighted

person; young children may hold onto index finger or pinky

Sighted person walks normally, describing curbs or other obstacles, hesitating slightly before going up or down; never push or pull

Do not try to push or pull into a chair; hold the back of the chair, person will seat themselves

http://www.youtube.com/watch?v=YoRQiG_hlHk




Orientation and Mobility Training

Electronic Travel Aids Facilitate orientation and mobility Laser beam cane- converts infrared light

into sound as the light beam strikes objects in traveler’s path; different levels of vibration in the cane signal relative proximity to an obstacle

Mowat Sensor/SonicGuide- uses ultrasound technology

GPS




Listening Skills Systematic instruction of listening skills is an

important component of educational program Aware of sounds, discrimination, source of

sounds, attaching meaning to sounds Learning to Listen Activities

Sounds that are near and far, loud and soft, high pitched and low pitched, identifying important details with distracting background noise, differentiating between fact and opinion, responding to verbal analogies

Learn to use recorded materials (books, etc.)




Functional Life Skills Learn skills such as cooking, personal

hygiene and grooming, shopping, financial management, transportation and recreational activities that are requisites for independent and enjoyable adulthood




Expanded Core Curriculum Interpersonal Skills Direct instruction on how to deal with

strangers, interpret and explain their visual impairment to others, make socially acceptable gestures in conversation




Educational Placement Alternatives88% of children are educated in public schools62% are members of general education classrooms13% attend resource rooms for part of each day

Most students who are included in general education classrooms receive support from itinerant teacher-consultants

The most important factor to the successful inclusion of students with visual impairments is a skilled and supportive general education teacher

12% are served in separate classrooms6% attend special day schools4% attend residential schools (not always a permanent placement)




Itinerant Teacher-Consultants Help identify the child’s current level of performance, learning

goals and objectives, need for related services as a member of the IEP team

Collaborate with the general education classroom teacher on curricular and instructional modifications according to the child’s individual needs

Provide direct instruction on compensatory skills (Braille, listening, keyboarding)

Obtain or prepare specialized learning materials Adapt reading assignments and text based curriculum material

into Braille, large print or audio recorded form Make referrals for low-vision aids and services, train students to

use and care of low vision aids Provide information about the child’s visual impairment and

visual functioning to parents and other school personnel Initiate and maintain contact with various agencies and provide

services for children with visual impairments Consult with the child’s parents and other teachers




Teaching and Learning p 362-363

Helping the Student with Low Vision “Children with congenital low vision view themselves as whole. Although it

may be proper to speak of residual vision in reference to those who experience adventitious low vision, those with congenital low vision do not have a normal vision reference. They view the world with all of the vision they have ever had.

Children with low vision generally view the environment as stationary and clear. Although there are exceptions, it is a misconception that people with low vision live in an impressionistic world in which they are continuously wanting to clear the image.

Low vision offers a different aesthetic experience. Low vision may alter an aesthetic experience, but it does not necessarily produce a lesser one.

Using low vision is not always the most efficient or preferred method of functioning. For some tasks, the use of vision alone or in combination with other senses may reduce one’s ability to perform. For example, using vision may not be the most efficient method for determining how much salt has been poured on one’s food.

Those who have low vision may develop a sense of visual beauty, enjoy their visual abilities, and use vision to learn.”

For implementation strategies, see textbook




SOAPS p 368-369Self-Operating Audio Prompting Systems

“If the SOAPS will be used to help a student complete multistep activities ( e. g., making macaroni and cheese):

Create a task analysis of the activity.

2. Write a script of instructions for each step of the task analysis using language that the student understands.

3. Record the script, embedding a standard phrase or distinct tone between instructions to cue the student when to stop and start the playback device.

If the SOAPS will be used to help a student stay on task and be productive during an ongoing activity ( e. g., washing dishes):

Write a variety of simple statements that are likely to function for the student as prompts to keep working, encouragement and praise, and/ or cues to self- evaluate her performance.

2. Record the prompts, praise statement, and/ or cues to self- evaluate in a random sequence at irregular intervals.

3. If listening to music would be appropriate for the student while doing the activity, consider embedding the instructions or prompts within a recording of the student’s favorite singer or band.

For all SOAPS:

1. If necessary, teach the student how to operate the portable audio device before introducing the prerecorded instructions or prompts.

2. Observe and monitor the student’s initial use of the SOAPS to determine whether the length and complexity of the steps/ instructions are appropriate and efficient.

3. Ask the student whether any changes in the instructions or prompts would make the system more effective or enjoyable to use.”




Supporting A Student with Visual Impairments in the General Education Classroom p 370“Communicate with Clarity and Respect • Always state the name of the student you are speaking to in the classroom. The student with a visual impairment will not notice eye contact. • Indefinite pronouns such as ‘ this,’ ‘ that,’ and ‘ there’ can be confusing to students with visual impairments. It is better to name specific items, events, or people. • Individuals with visual impairments frequently make idiomatic references to sight, and it is okay for their teachers and peers to do so also: e. g., “ Do you see what I mean?” or “ Let’s take a look at this next sentence.” • Always give a verbal warning when you are about to hand something to a student with visual impairments. This avoids unnecessary surprises and helps the student respond efficiently. • Include specific spatial references when giving your student directions. For example, telling the student, “ The book is on your left,” or “ The desk is 10 feet in front of you,” is better than saying, “ It’s over there,” or “ It’s near the table.” • When writing or drawing on the board, describe your actions verbally in a manner useful for all students in the class. Be sure not to talk down to the student with a visual impairment. • Introduce yourself by name when meeting your student outside the classroom. Do not assume that he will recognize your voice, and do not ask, “ Guess who this is?”•When you are about to leave the student’s vicinity, tell him that you are going. • When you need to physically show your student how to do something, use the hand- under- hand technique. Have the student place her hands on top of yours so she can feel the movement of your hands. This is usually more effective than placing your hands over the student’s hands.”




Supporting A Student with Visual Impairments in the General Education Classroom continued“Expect and Enable Independence • If students are expected to perform jobs or responsibilities in your classroom, be sure also to assign a meaningful job to your students with visual impairments. • Allow students with visual impairments time to obtain and put away materials. If a student had to use glue and scissors for an activity, make sure she returns those items to their proper places. Although it is often much easier to get and put away materials for students with visual impairments, it is critical that they learn to become self- sufficient and pick up after themselves. • Peers are often the most effective and efficient teachers of social skills. Cooperative groups are a great way for students with visual impairments to learn important social skills. • Always make safety a priority, but do not overprotect students with visual impairments. Hands- on experiences are the best way for a student to learn new concepts. • Provide real- life experiences whenever possible. When on a school field trip, give the student with a visual impairment sufficient time to explore her environment. Source: Suggestions courtesy of Jeanna Mora Dowse, who worked for many years as an itinerant teacher of students with visual impairments in two school districts in Apache County, Arizona.”




Teacher Tips 372-373 Communication

Use student's name “When meeting with aides, teachers, or other professional,

give specific instructions – written, if possible – about what your student needs.”

Preparation “Be prepared with materials ahead of time so your students

are active participants” (This may mean meetings with other staff members to prepare materials, create student schedule, etc.)

“Self-Advocacy and the Right to Struggle a Bit” Give your students responsibilities and teach them how to

request help