Working with infants toddlers and developmentally young blind

Working with infants, toddlers, and developmentally young blind and visually impaired children Sue Douglass. M. S. Vision Impairment Specialist, Blind Babies Foundation Presented at CTEBVI April 24, 2010

Problems in the Construction of Reality in Congenitally Blind Children Sylvia Santin M. A. and Joyce Nesker Simmons, M. Ed. Originally published in Journal of Visual Impairment and Blindness, 1977

• Better communication • Better handling • More information about what he likes and doesn’t like • More communication between home and school • More involvement in the activities of his classroom • The ability to know what to expect • Good materials to look at and play with

Communication Assessment The Communication Matrix, by Charity Rowland, Ph. D Available at www. communicationmatrix. org

The Communication Matrix assesses seven levels of communicative competence Level I: Preintentional Behaviors Level II: Intentional Behaviors Level III: Unconventional Communication Level IV: Conventional communication – using gestures and vocalizations Level V: Concrete symbols – includes use of tangible objects Level VI: Abstract symbols – such as Bliss symbols Level VII: Language – used conventionally Available in both hardcopy and on-line versions

Assessments v For fine and gross motor assessment: Functional Scheme, by Lilli Nielsen, available from Lilli. Works Active Learning Foundation, 2517 Blanding Ave. , Suite 110, Alameda, CA 94501. (510) 814 -9111, Fax: (510) 814 -3941. www. lilliworks. com. A vendor here at CTEBVI. No longer available through Vision Associates. v For cognitive assessment: Home Inventory of Problem Solving Skills, by Charity Rowland Philip Schweigert. v 3. For communication assessment: The Communication Matrix, by Rowland Schweigert. v 4. To help teachers design learning opportunities: Design to Learn, an environmental inventory, by Rowland Schweigert. All three available from Design to Learn, www. designtolearn. com or call 1 -888909 -4030.

How to handle CJ’s hands: hand-under-hand technique www. wsdsonline. org/deafblind/huh-overview. html

A child and helper explore a teddy bear using the hand-under-hand technique from Barbara Miles “Talking the Language of the Hands to the Hands” www. nationaldb. org/NCDBProducts. php? prod. ID=47

Object cues Give C. J. the very same spoon he will eat with. This specific spoon says, “You are about to eat, C. J. ”

Anticipation calendar Uses objects and dissimilar containers 1. Now and Finished: Two containers. Take the object out of the Now container, use it, then put it in the Finished container NOW FINISHED

Now, Next, and Finished: Three containers. Take the object out of the Next container and move it to the Now container. NOW NEXT Take the object out of the Now container, use it, then put it in the Finished container. NOW NEXT FINISHED

Activity Calendar An example: making chocolate milk Steps: 1. Pour milk in blender. 2. Pour chocolate syrup in blender. 3. Put lid on blender. 4. Blend for ten seconds. 5. Pour milk in glass. Symbol: Milk carton. Syrup bottle. Blender lid. Switch. Glass.

When is an event a routine? There is a clear signal to the student that the activity is starting. • The steps of the activity occur in the same sequence. • Each step is done in the same way each time (same materials, same person, same place). • Assistance is given the same way each time until the student is ready for a lower level of prompt. • The pacing of instruction is precisely maintained until the activity is finished (no side conversations, going off to get something you forgot, or spontaneously adding new or different steps that won't happen the next time the activity is done). • There is a clear signal to the student that the activity is finished. Millie Smith, Routines, www. tsbvi. edu/Education/vmi/routines. htm

Routines • build a positively bonded relationship between the learner and the partner provide social experiences that facilitate access to sensory information stimulate the learner’s curiosity motivate the learner’s interaction maximize the learner’s social availability increase the learner’s quality of life Millie Smith, 1 -14 -10

Routines Develop “agency” skills: v. Cognitive skills v. Communication skills v. Motor skills Millie Smith, 1 -14 -10 “Agency skills: ” skills that give individuals the ability to act independently and to make their own free choices

Going to bed 1. Child is put in crib. 2. Cover is pulled up over him. 3. Child is invited to reach for favorite squeaky ball and takes it. 4. Mother kisses child good-night. 5. Mother turns out the light and leaves. You can see this routine for yourself at www. wsdsonline. org/deafblind/routines/video. html #video_3

Introducing a new object 1. Touch the object to a less sensitive part of a child’s body (e. g. , upper arm) 2. Touch the object to a part of the body closer to your eventual “destination” (e. g. lower arm) 3. Move it closer (e. g. back of the hand) 4. Move it to your final destination (e. g. , palm of hand)

Millie Smith’s three stages of interacting with objects 1. Paying attention: increase the length of time and the number of things the child will focus on 2. What does thing do? The child is a physicist. Does it fit in my mouth? Make a noise? Come apart? What happens when I bang it, bite it, throw it? 3. What is thing for? Does it have wheels so I can roll it? Can I pretend to feed it? Can you read it to me?

CVI definition Cortical Visual Impairment (CVI) is a temporary or permanent visual impairment caused by the disturbance of the posterior visual pathways and/or the occipital lobes of the brain. From the Blind Babies Pediatric Visual Diagnosis sheet on Cortical Visual Impairment www. blindbabies. org

Some characteristics children with CVI may demonstrate Eyes look normal, but children do not appear to see well History of interrupted oxygen to the brain or brain bleed May not have full visual fields. May prefer objects of some colors over objects of a different color Seem to see familiar objects better than new ones Take awhile to “focus in on” an object

More characteristics children with CVI may demonstrate Prefer plain backgrounds and objects with one or two colors over objects with many colors and much detail Look at an object, then turn away from it before reaching for it Appear to look at faces but do not really seem to see them – recognize people by their voices, etc. See better if an object is moving or they are moving (as in a swing) Either avoid light or stare at them, especially overhead lights, in preference to looking at other things

Phase I: Building Visual Behavior § Ranges 0 -3 § Discover what child will look at § Develop child’s ability to use vision more frequently to look at what he or she will look at § Child only looks at a small repertoire of objects usually having similar characteristics (may be specific color, have reflective properties, be moving objects, shown against a particular background, and visible in a particular part of child’s visual field)

Phase II: Integrating vision with function Ranges 4 -6 Child now uses vision enough that he or she can use vision to explore objects and do activities Child can use vision in choice-making, self-help routines, fine motor tasks, cognitive tasks Still needs a controlled environment to maximize use of vision Light Box a good tool for children who look at lights Usually able to look at faces and respond to facial expressions

Phase III: Resolving remaining CVI characteristics Range 7 -10 Child may not appear to casual observer to have vision difficulties Still may have reduced visual fields, or be unable to see at great distances Still may have difficulty seeing when there are lots of objects to look at combined with a “busy” background May have trouble recognizing photographs or drawings of objects he or she can see May still have some O & M issues

Long-range planning Keep in mind: How will the activities you are doing now make a difference in the child’s Control over her or his life? Ability to do things independently? Connection with others? Access to the world? v In one year? v In five or ten years? v In 20 -40 years?

Long-range planning Was this activity planned together with the child’s family? Is this activity something the child can do at home with the family?

IEP goals and objectives By (date goal will be measured), (conditions under which goal will be measured), (child’s name) will (do something observable and recordable) in (number of) opportunities on (range of) days as measured by (how achievement or non-achievement will be measured). By (June, 2010), (while seated in his Tumbleform feeder seat), (Asher) will (look at an APH yellow pompon for 10 seconds) in (4 of 5) opportunities on (4 of 5) days as measured by (teacher record on teachermade chart).

IEP goals and objectives By (June, 2010), (when seated in her high chair at the dinner table, and given her spoon), (Melania) will (open her mouth in anticipation of being fed with the spoon) in (5 of 5) opportunities on (4 of 5) days as measured by (parent record). By (June, 2010), (when seated in his Rifton chair at school) (Isaac) will (reach for a red Mylar-covered switch to turn on his tape player when the music stops playing) on (4 of 5) opportunities on (4 of 5) days as measured by (teacher record on teacher-made chart).

So long, farewell, auf Wiedersehn, adieu. Good luck, and have fun! Sue Douglass vipreteach@msn. com