Scottish Sensory Centre

Teamwork with children with cerebral palsy and
visual impairment: Towards a common language

Presented in November 2000

Identifying Thresholds for Education (Draft)

(with acknowledgements to Professor GN Dutton and Lea Hyvärinen, MD)

Introduction

In his paper "Impaired vision due to brain damage: designing educational strategies" (Dutton, 2000) Gordon says that "all educational material needs to be presented so that it is well inside the thresholds for rapid, clear and simple
perception." He then lists the thresholds as follows:

A Basic thresholds of visual function
B The threshold for visual complexity (of both foreground and background)
C Temporal thresholds for presentation of information
D The proximity threshold for facial expression
E Specific thresholds matched to the focal brain disorder of the child.

In the search for a common language for thresholds for education, I will be addressing the main educator of the child. This person or persons, will change according to age and stage of child/pupil, (eg; parent, home visiting teacher, nursery teacher and staff, class teacher and her colleagues: classroom assistant, teacher of the VI). I am starting from the 'end' of the process. In other words, I am going to presume that certain 'team' assessments of vision have been done and that the main educator has access to the information from the assessment.

I have taken into account Gordon's five main thresholds, with their subdivisions.The thresholds are contained in suggestions addressed to the 'main' educator.

They are intended to enable that person to take account of the information from the team assessments to provide 'thresholds' for learning based on both the child's identified abilities and limitations.Rather than base these thresholds on curricular areas or skills, I will use Lea Hyvärinen's four main functional areas where vision plays an important role:

1 communication, both person to person, group and distance communication;
2 orientation and mobility
3 activities and tasks of everyday life (ADL);
4 sustained near vision tasks, like reading and writing.

I will address the suggestions first of all to those working with infants and preschoolers. Then to those involved with school age pupils. Some suggestions will overlap the stages. From the suggestions made, team members should be able to identify which assessments have been done.My interpretation and approach to 'Identifying thresholds for education' is proposed as a first draft to be developed, adapted or totally replaced as a result of today's discussions.

Infants and Pre-school children

Communication

• Be near enough for the child to 'see' your face;
  
• Take into account whether the child child has central vision and will have the possibility of 'eye contact' or whether the child uses an area of vision outside thecentral field to look straight ahead, and seems to look past when looking at a
  person's face;
  
• Ask the medical team if the child needs correction for near vision if there seems to be problems with focussing or long sightedness (common in children with cerebral palsy);glasses can be prescribed from 3-4 months or earlier;
  
• Speak slowly and if child doesn't have vision to see lip movements, take the little hands to your mouth and throat;
  
• The child may not be able to recognise features, though at this stage it may be too early to be able to verify this, so remember to emphasise your voice, scent and other familiar physical or cosmetic characteristics (beard, glasses, earrings).
  
• Let all other relatives, staff and children (brothers and sisters or children in the nursery) know how to communicate with the child;
  
• Remember to tell everyone not to startle the child by sudden touching or picking up without gentle prior warning and using the child's name.

Movement (Orientation and Mobility)

• To encourage the child to explore near and eventually more distant space, usetoys which reward the child through touch and sound as well as being as visually attractive as possible;
  
• Use different sizes of toys and objects;
  
• Use information on the child's contrast sensitivity to ensure appropriate contrast of toys and people against the background;
  
• Use safe, tried and tested methods such as the 'Little Room' and 'Resonance Board' for letting the child independently explore the toys and the environment;
  
• Make sure the child's physio- and occupational therapists are involved for advice on positioning and movement.

Activities and tasks of everyday life (ADL)

• Always speak slowly and clearly and make sure the child understand what you are saying on every occasion;
  
• Make the child familiar, with steps, kerbs, slopes, through practice, and by highlighting edges;
  
• Let everyone concerned know if the child has difficulty accommodating to lower light levels; make sure lighting is good where the child has to go or has an adult companion; as the child gets older he/she may be able to use a torch;
  
• Make sure that the child has always something by which to recognise his/her parent or accompanying adult when in a crowd;
  
• Make sure the child feels safe and is looked after if going into a new place

Near Vision Tasks

• Always speak slowly and clearly and make sure the child understand what you are saying on every occasion;
  
• Help the child develop tactile skills if difficulties with directions of line and eye-hand co-ordination have been detected;
  
• Matching colours and shapes can be practised with a view to using these skills in assessing visual acuity;
  
• Matching colours can be done without 'naming' the colours; if there are problems with naming colours, associations can be learnt from a young age, eg; sky blue, lemon yellow, grassy green;
  
• Adapt activities the child finds difficult to be more attractive and fun:
  
  • simplify pictures;
    
  • encourage use of play do' and plasticene to strengthen fingers;
    
  • play colouring -in games;
    
• Always let the child sit close enough at circle time to see what is being discussed;
  
• Find videos and TV programmes which have slow and repetitive actions, words and songs; use the slow down control on your video-replay.

Children at School

Communication

• Always speak slowly and clearly until you are sure the child understands what you are saying on every occasion;
  
• Always use the child's name when speaking to them in the class or playground;
  
• Let all the other children know that they should do this, too;
  
• Say who you are to the child who is blind or who does not recognise people's faces;
  
• Explain this to the other children;Draft/SSC/Course 6:23.11.00Marianna Buultjens
  If asking the children to work in groups, make sure they get into the habit of identifying themselves at the start eg "It's Keith here, and I've got a blue jersey on today."
  
• Learn with the rest of the class not to point and say things like: "Look over there!" Fun language lessons could involve practising how to be explicit in what we say instead of the usual vagueness;
  
• Facial expressions and body language can be explored as a class lesson so that all the children begin to recognise how we express ourselves without words; make sure the pupil with visual impairment can see close up and maybe in slow motion (video the actions?) what is going on.
  
• For a blind child, make sure the actions can be felt and learnt and the sounds, eg; in-take of breath before speaking, can be heard

Orientation and Mobility

• Always speak slowly and clearly and make sure the pupil understands what you are saying on every occasion;
  
• Remember that the pupil will only learn to use information for orientation if he/she is responsible for the decisions and actively involved in the movement; although a pupil might have been pushed in a wheelchair over the same route for
  years, it does not mean he/she 'knows' the route; whenever possible give the pupil the independence necessary to learn, by assisted walking or using an electric or 'smart' wheelchair;
  
• Make the pupil familiar with steps, kerbs, slopes through practice and by highlighting edges;
  
• Let everyone concerned know if the pupil has difficulty accommodating to lower light levels; make sure lighting is good where the pupil has to go or has an adult companion; give the pupil a torch;
  
• Make sure that the pupil has always something by which to recognise his/her parent, friends or accompanying adult when in a crowd;
  
• Help the pupil to identify landmarks in school and playground;
  • colour coding: the orange stickers show the route to the canteen;
  • language: learn the route as a poem or song;
    specialist advice should be got from the teacher of the visually impaired and a mobility specialist;
    
• Make sure the pupil feels safe and is looked after if going into a new place;
  
• Help the pupil identify ways of coping despite loss of or inattention to a visual field;
  
• Remember that vision for movement is often preserved in the 'inactive' visual field; use movement to get attention/awareness of activity on the impaired side;
  
• When asking what a 3D object is or how big it is in comparison to another object, let the pupil feel the object if there seems to be a problem in identifying through sight alone;
• 2D diagrams and maps can also be made clearer for some pupils if they are made 'tactile'.

Activities and tasks of everyday life (ADL)

• Discussions during topics relating to personal and social development and also the daily diary or discussing weekends and holidays may identify areas for attention in school;
  
• Self-help and independence skills related to cooking, cleaning, washing and hygiene can be addressed during home economics;
  
• Social skills, dancing and other hobbies through PE or clubs;
  
• Ensuring that the pupil has access to the same ICT equipment at home as in school will enable use of the internet as well as the possibility to do homework efficiently.

Near Vision Tasks

Early school years:

• Always speak slowly and clearly and make sure the child understand what you are saying on every occasion;
  
• Help the child develop tactile skills if difficulties with directions of line and eye-hand co-ordination have been detected;
  
• Matching skills for colours and shapes can be practised with a view to using these skills in assessing visual acuity;
  
• Matching colours can be done without 'naming' the colours; if there are problems with naming colours, associations can be learnt from a young ag, eg; sky blue, lemon yellow, grassy green;
  
• Make activities the child finds difficult more attractive and fun:
  
  • simplify pictures;
    
  • encourage use of play do and plasticene to strengthen fingers;
    
  • play colouring-in games;
    
• Always let the child sit close enough at circle time to see what is being discussed;
  
• Find videos and TV programmes which have slow and repetitive actions, words and songs; use the slow down control on your video-replay

All stages of school:

• Always speak slowly and clearly and make sure the pupil understands what you are saying on every occasion;
  Use of print for reading: make sure that the best size and style of print has been identified for the pupil, having taken into account:
  
• scotomas ('holes' in vision) and
  
• limitations in the visual field which might affect reading saccades (the measured jumps made by the eyes from one word to the next);
• print much larger than that of the smallest print which the pupil can read, often helps overcome the problems;
  
• If the pupil has a loss to the right visual field, reading may be helped by teaching the pupil to tilt the book; or a pupil may hold the book upside down and read from right to left;
  
• If the pupil has a loss to the left visual field, using a marker or finger at the start of the next line can help the pupil find it and read fluently;
  
• Use of ICT: setting parameters for background/foreground, mouse size, print size, style eg full page, or columns, or presentation of one word at a time are all possible and can be set up to suit the pupil; find out from the teacher of the visually impaired about this and the following
  
• Specialist software for enlarging and reading out text may be supplied for some pupils if identified as appropriate.

The above approach to 'Identifying thresholds for education' is proposed as a first draft to be developed, adapted or totally replaced as a result of today's discussions.

Marianna Buultjens

• Teamwork