University of Edinburgh
 

Early Support Developmental Journal for Babies and Children with Visual Impairment

presented on Friday 7 December 2007

Promoting visual development and use of vision: introducing the visual materials of the Developmental Journal

Alison Salt

The impact of Visual Impairment on Vision

Vision in a child with VI

  • may develop more slowly and be constrained more than need be
  • fail to achieve full visual potential

a catastrophe in a VI child

Development of visual brain

  • Poor visual input leads to impairment in development of neuronal connections centrally
  • with potentially cumulative and ultimately permanent effect on neuronal templates

Hypothesis

Vision development is not a passive process in response to visual input but needs to be of sufficient quantity

  • to arouse and sustain cognitive interest in 'looking'
  • in many VI babies is isn't
    (Patricia Sonksen)

Vision Section of Developmental Journal
designed by Patricia Sonksen

  • developmentally based programme to promote visual development
  • functional visual assessment (4 visual levels)
    - monitor visual progress
    - foundation of optimal use of vision for learning; visual promotion strategies

Stages of PVD

  • alert baby's interest in 'looking'
  • visual interest
    - for smaller items
    - at greater distances
  • visuo-motor control - following, pursuit, tracking
  • looking for find detail at increasing distances, eg; faces and pictures

Note

  • programme follows sighted visual development
  • with stages introduced in sequence or in parallel as appropriate

Early introduction

  • ensure a higher quality of vision is available earlier
    - for all aspects of development / learning
  • foster ongoing development of the visual nervous system during era of greatest pliancy
  • maximise opportunity to achieve full visual potential

Vision Sections of Developmental Journal

  • Optimal use of vision for learning
    - The visual environment and visual materials for development and learning
    - description of vision levels (I-IV)
    - signposted on Activity Cards
  • Promotion of vision
    - Record of Developing Vision
    - Developing Vision Activity cards - visual promotion

The Visual Environment and visual materials cards

  • Vision provices a child with information they need for every aspect of development
  • Need to use child's current vision to best support every aspect of their development
  • Ensure that developmental activities are carried out
    - in the best visual surroundings
    - using toys or objects for the current level of vision

Standard observation of functional vision

Vision Levels

Simple method for standard observation of vision. These levels are used to guide advice on Activity cards about the visual environmnt and toys used to support learning.

Vision levels and examples of lures

V1 - no response to glowing light source in a dark room

V2 - large tinsel ball or mirror or light within 30 cm

V3 - large (12 cm or less but not V4) dangling ball

V4 - 1.2 cm (chocolate button or raisin) or smaller on a contrasting background

The Visual Environment and visual materials cards

  • Card 2, 3 and 4 make suggestions for the visual characteristics of materials and surroundings - size, luminance, colour, contrasts etc for each level of vision
  • all Activity cards have a reminder on the footer to check the Visual environment and visual materials cards for ideas about how to adapt visual materials
  • these two sets of cards are designed to be used together

Activity: using the visual environment and visual materials cards - adapting visual materials

  • What type of visual adaptations would you make to the toys or environment to help this child learn?
  • ideas on the visual environment and visual materials cars for childre at level V2

[from Journal]

In a darkened room, use:

  • glowing light sources and make them flash on and off in one place. Look around - there's lots to choose from in the shops
  • an 'oogly' on a pen torch
  • glowing toys or night lights
  • illuminated sparkling tubes or spheres
  • wands or table lights with fronds and tips that glow in a cascade of colours
  • a ball of mini christmas tree lights
  • a light that shines on your own face when bending low over your baby and if you normally wear glasses, keep them on, as they reflect light

Don't shine a light directly at your child's eyes - it may be unpleasantly bright and lack the three-dimensional qualities that are important for arousing visual interest.

In a room lit by daylight or ceiling lights

For vision activities use:

  • pom-pom balls at least 12 cm in size made of gold or silver tinsel dangling on a string
  • christmas tree balls or decorations at least 12 cm in size and dangling

To encourage your child's postural control choose a room with:

  • shiny uprights and verticals that reflect light, eg; metal window / door frames, mirrors, metal picture frames

To encourage your child's saving reactions and concept of the floor as a solid base:

  • choose a play mat with reflective (shiny) surfaces

[from Journal] Optional Activity: Movement and mobility
Card 4 Sittin and saving
- adapting visual materials

Sitting and saving

  • Encourage pulling to a sitting position by holding your baby's shoulders and gently raising them from the floor, saying 'up you come!' gradually lessen the amount of support, by moving from shoulders to elbows, to hands as you pull to a sitting position. Reduce the amount of pulling provided by encouraging your baby to pull more and more. This can be done regularly after nappy changing or dressing.
  • Place your baby in a sitting position on a firm surface, propped up with pillows to show them how to support themself using their hands and arms as props on the floor in front of them.
  • Sit on the floor with your baby between your legs. Rock them from side to side (singing a 'seesaw' game) taking their hands to the floor to the side and showing how to save themself.

Vision Section of Developmental Journal

  • Optimal use of vision for learning
    - The visual environment and visual materials for development and learning - including description of vision levels (I-IV)
    - Signposted on Activity Cards
  • Promotion of vision
    - Record of Developing Vision
    - Developing Vision Activity cards - visual promotion

Programme to promote visual development

Evaluation

Randomised Control Trial - highly significant differences in visual outcome
(Sonksen et al)

Visual record

  • Visual awareness
    - near
    - distance
  • Visual interest for looking at / activity
  • Eye movements (near / distance)
    - directing gaze
    - following
    - convergence
    - tracking

Visual assessment 1

Identify

  • visual target that baby can definitely see within arm's reach
  • vary colour, size, luminance

Note

  • Characteristics of target

Guidance 1

What would you advise to promote development of vision?

If light (emitting or reflecting) or larger than 6.25 cm in diameter

  • guide baby's hand to it
  • thus confirming by touch that the target has substance and is worth looking at!

Visual assessment 2

Tracking a target moving across a surface

Observe:

  • ability to track ball (6.25 cm or larger as necessary)
  • on table top or on floor (3 people)
  • vary speed and distance

Note:

  • size, speed and distance at which definite

Guidance 2

At home*

  • start with size of ball at distance and speed of roll noted
  • gradually decrease size of ball and increase speed of roll and distance in tune with baby's performance

*on floor - requires 3 people

Vision Section: Developmental Journal

  • maximise opportunity to achieve full visual potential
  • ensure a higher quality of vision is available as soon as possible for all aspects of development / learning