Prematurity and Vision

Friday 3 March 2006

Linda Bain
Royal Blind School

Getting Around

Ref: Understanding Low Vision, Edited by Randall T Jose, American Foundation for the Blind 1997 reprint (© 1983).
Range of severity - "minimal ocular damage with no visual impairment to complete retinal detachment and scarring that causes total blindness"
Persons with RLF "generally have no usable vision or have extremely low levels of visual acuity".

Ref: Disorders of Vision in Children, A Guide for Teachers and Carers, R Bowman, R Bowman & G Dutton, RNIB, 2001.
Other associations:
"Because these children are usually born prematurely there is a relatively high incidence of associated brain damage, which may cause learning difficulties and cerebral palsy."

Ref: Paediatric Visual Diagnosis Fact Sheet
www.blindbabies.org/factsheet_rop.htm

Visual and Behavioural Characteristics

"Many of the behaviors of children with ROP may be related to prematurity and not necessarily to vision loss. Learning difficulties associated with neurological disorders may accompany prematurity."
These may show up in areas of:

"The way a premie with ROP understands his position in space, or the manner he uses to walk (gait) may also be different than that of a child who has a different visual diagnosis."

"Getting Around" . . . and ME "GETTING ON A BIT!"

ROP

One common characteristic

Considerable difficulty learning and remembering routes . . . even familiar, frequently travelled ones.

CASE STUDY: Fraser


First started working with him in April 1993 (aged 9)

The incident!

Anxiety about new life and leaving all that he was familiar with.

Cumulative effect of pressures, big "push" on as part of transition.

Lack of realisation on the part of the sighted adult.

Summary of Routes travelled (from end of school day until bedtime)

Total number of journeys undertaken = 13 (not counting the extra mobility session in the middle of the evening!)

Fraser’s difficulties?

Got lost going from bedroom to Duty room because, as he left his bedroom, Fraser was carrying a couple of items of dirty washing in his right hand. He therefore turned left into the corridor, as it was his left hand with which he was trailing and he simply followed this hand.

When the shout went up that it was time for tea, Fraser immediately stood up but only moved forwards to make his way out of the TV room when he was specifically told to do so.

Fraser has no difficulty recognising most, if not all, the signifiers in school and will freely say what they are on finding them. However, he does not fully understand how they can be used to help establish where he is or where he should be going next; where one room is in relation to another; to follow a route etc.

(Excerpts from Handout for Care Staff) WAYS TO HELP FRASER:

Say his name so that it is clear to him when he is expected to do something.

Speak to him in a quiet, calm and measured voice (he is acutely aware when you are unhappy with him, when he is "failing" etc).

Before he sets off from any room, take the time to sort out where he is and where he is going next. "Thinking Head On" is a phase he likes and responds well to and he also likes the choice of needing help. Ask him if he needs help or is able to "find his own way" or "do it on his own" so that he has choice and control.

When leaving a room, encourage him to use his hands to check for any clues, features, signifiers etc. that may be displayed on the wall either side of the doorway.

When trailing, he has a tendency to let go and drift away from the shoreline he is following. Remind him to "stay with" or "follow" the rail, wall, whatever.

Fraser is quite clearly frightened of walking through open spaces and crossing doorways. He has started closing any open doors he is passing (did this with the Duty room door a few times and also shut the two single bedroom doors next to the wooden steps). Ensuring doors, where possible/appropriate, are kept closed would make it easier for Fraser.

Fraser has no concept of a corridor that is; that it has ends and sides and different rooms along either side of it. He also has difficulty understanding many directional concepts such as in front of; behind; opposite, next to etc. When asked to move to the "other side" of the corridor, he doesn't understand what to do or where to go.

And the other young people with ROP? Do they experience the same difficulties?

WHAT WE CAN DO TO HELP?

Ref: Paediatric Visual Diagnosis Fact Sheet TEACHING STRATEGIES

Beware of the dangers of this! Must back this up with practical, "hands-on", direct learning experiences.

TEACHING STRATEGIES . . . Mine!

TEACHING ROUTES

DO THESE STRATEGIES MAKE A DIFFERENCE?

Yes, absolutely!

Acknowledged that they had specific orientation difficulties - that they struggled to learn and remember routes and find their own way around.

THEY BENEFITED FROM: