FVA for Students with Multiple Disabilities A Collaborative

FVA for Students with Multiple Disabilities: A Collaborative Approach Across Disciplines Part I- Traditional FVA Perkins Webinar Rajiv K. Panikkar, MA, CLVT, COMS, TVI Joanne Szabo PT, DPT, MHA, PCS Arizona State School for the Deaf & Blind

OVERVIEW • Challenges in assessing students with multiple disabilities • Role of evaluator and Team

OVERVIEW • Building an FVA for a student with multiple disabilities • Apply collaborative strategies • Review case study

GIVE US YOUR INPUT What are the challenges associated with working with a student with multiple disabilities?

CHALLENGES: STUDENT Multiple Severe Impairments • Fine and gross motor • Speech and communication • Cognitive delays • Social interaction Severe Sensory Impairments • Tactile, • Visual • Auditory • Vestibular

CHALLENGES: STUDENT Biological Influences • Hunger • Tiredness • Comfort • Health and medications Behavioral Influences • Emotions • Interests • Environmental events May still be learning how to respond to people & objects!!

CHALLENGES FOR EVALUATORS • Lack of familiarity with student • Lack of familiarity with multiple disabilities • Student may not receive O & M • Student is reliant upon equipment and staff support • Optimal learning conditions are unknown • Student may not be able to help or take part in the assessment process

SOLUTION Team collaboration! This will help you: • Gather necessary information • Understand the student • Complete the FVA and additional assessments • Get the job done in a functional and meaningful way Your findings should relate to the concerns voiced by your educational Team!

COLLABORATION IS IMPORTANT Obtaining information through informal and unstructured activities in the student’s natural setting and during the student’s everyday activities is the primary purpose of the FVA. YOU CANNOT DO THIS ALONE! Erin & Topor 2010

FLOWCHART

USE THE ENTIRE TEAM • Communication • SLP, family, teacher • Social Interaction • teacher, SLP, family and all other members • Recreation and Leisure • PT, PE teacher, family, teacher • Use of Assistive Technology • Family, SLP, teacher, OT or other AT teacher Liefert 2003 • Orientation and Mobility • O & M or PT • Independent living skills • O & M, OT, PT, teacher, family • Visual efficiency skills • O & M, OT, PT, family and teacher • Career education • Family, OT and teacher

PREPARATION FOR TVI Gather information • Reports from eye care specialist • Not a complete picture of vision use • May be areas of uncertainty documented • Clinical low vision evaluation • Information not obtained via observation • Evaluator may not know child well • Family interview • Bring team concerns into focus

Multidisciplinary Team Interview Form • Develops a picture of the whole child: • Current participation at school • Physical abilities • Communication mode • How providers see student’s vision use • What modifications are being used • Issues that affect testing • Helps meet the team member’s needs • Areas of concern are documented • Questions about vision use are asked • Goals are identified

TEAM INTERVIEW FOR FVA • Note: Form is distributed electronically or in person to all Team members to include following information: • Student Name: • Name of Person Interviewed: • Relationship: • list: student, parent, teacher, TVI, O&M, PT, OT, Comm. , Residence Hall etc. ) • Date Interviewed:

TEAM INTERVIEW FOR FVA • Description of student's use of vision including working distances: • Any changes in vision: • Other conditions that might affect student's vision (physical limitations, cognitive differences, medications, etc. ) • Student's independent reading level: • Visual difficulties with school related tasks: • Hobbies and visual difficulties with these hobbies:

TEAM INTERVIEW FOR FVA • Adaptations/Accommodations/Low Vision Devices currently used: • Best lighting: • Sun protection: • Mobility Concerns: • Student's schedule: • Main Goals/Objectives for a Functional Vision Assessment (current/future):

WHAT YOU WILL GATHER FROM THE FORM • The tools you will need for the FVA • The environments you will need to include • Possible obstacles or behaviors • Who or what can help minimize them • Motivators • If pre-practice is necessary • If yes, give materials to staff • The staff you will need to assist you

IMPORTANT Hold questions for Collaborative FVA and children with CVI for Part II Offered Fall 2017

GIVE US YOUR INPUT What’s next- where do we go from here?

WHAT’S NEXT? ? ? • Observations

GENERAL QUESTIONS FOR THE TEAM • What size symbol can the student identify? • How much contrast is needed to see the symbol? • Are there limitations in color discrimination? • Where should materials be placed in the student’s visual field? • Does lighting need to be modified?

TEAM OBSERVATIONS Which factors influence use of vision • Observe in a variety of positions • Team can assist with positioning • Observe at different times of day • Observe on different days • Observe other factors • Lighting • Familiarity • Contrast • Motivation Erin & Topor 2010

COLLABORATION • Include student’s optimal learning environment to view strengths • Include daily activities: mealtime, playtime, traveling to class • Ask team to set up environment to get their questions answered • Use team to help you understand • • • Physical responses Eye movements Head turn to sound or arm to stimuli Breathing patterns or postural changes Vocalizing Signs of fatigue

REPORT CONTENTS SHOULD INCLUDE: • History • Assessment tools used • Acuities • Visual fields • Contrast sensitivity • Color vision • Lighting • Visual behaviors • Depth perception • Working distances • Distance • Near • Suggestions to improve visual efficiency

Case Study—JT Ocular Impairment

Case Study—JT Ocular Impairment 12 Year old boy Profound hearing loss Posterior brain abnormal Lagophthalmos (inability to close eyelids) • Bilateral corneal scarring • Corneal & conjunctival drying • Tarsorrhaphy (partial suturing of eyelids) • •

Case Study—JT Information from CLVE • Distance Acuity • 10/60 right eye • 10/60 left eye • Near Acuity • . 8 M at 6 inches (newspaper size print) • 1. 0 M at 6 inches for continuous text (magazine size print) • Fields • 20° centrally-right eye • 45°- left eye • Recommendations—no low vision devices but sun lens evaluation for glare control

GIVE US YOUR INPUT What’s next- where do we go from here?

STATIC VISUAL FIELD Student’s left Student’s right

EARLY WARNING FIELD (PERIPHERAL CONSTRICTION) Student’s left Student’s right

PREFERRED VISUAL FIELD

Lots of numbers!! BUT…what can I do to help his functional vision use when he is up walking with his walker? ?

PT Input on Form Description of student's use of vision • JT walks with a posterior walker. He occasionally needs reminders to look down and to the side if he hooks his walker on a corner. He does not always initiate freeing his walker. • Looking up high is difficult for JT, partly because his balance is poor. He needs cues to tilt his head back when trying to look up. He will disregard books in the library on higher shelves unless cued to look.

PT Questions on Form Main Goals/Objectives for a FVA • Best placement of objects for optimal viewing is where? • What type of training or modifications does he need to improve vision use when walking with walker? He goes to the library with class for reading. • How to address safety awareness if he is not looking up, down or to the sides as he moves through his environment?

LIBRARY • Physical therapy assisted with the FVA in the library environment. • Tested fields while actively walking with walker

LIBRARY • Determined that he was able to see small items in all of lower fields when walking • Determined that he was missing items in his upper left field when walking

QUESTIONS?

References Erin JN, Topor I. Functional vision assessment of children with low vision, including those with multiple disabilities. In: Corn AL and Erin JN, eds. Foundations of Low Vision: Clinical and Functional Perspectives. 2 nd ed. New York, NY: AFB Press; 2010: 339 -389. Liefert FK. Expanded core curriculum: Orientation and mobility. In: Goodman S and Wittenstein S, eds. Collaborative Assessment: Working with Students Who Are Blind or Visually Impaired, Including Those with Additional Disabilities. New York, NY: AFB Press; 2003: 264 -297.

Thank You!! And… Good luck collaboratively meeting the challenges of students with multiple disabilities!

CONTACTS • Rajiv K. Panikkar- Certified Low Vision Therapist® • VM: 520 -770 -3730 • Email: rajiv. panikkar@asdb. az. gov • Joanne Szabo—Physical Therapist • VM: 520 -770 -3909 • Email: joanne. szabo@asdb. az. gov