Scottish Sensory Centre

Disorders of vision in children: a guide for teachers and carers

CHAPTER Four: Educating visually impaired children

• 4.1 Motivation for learning
• 4.2 Creating an optimum environment
• 4.3 Materials which aid functional vision
• 4.4 Specialist technology
• 4.5 Training in the use of functional vision

 

Children's visual problems vary from relatively minor to profound in nature. The principle challenges which teachers encounter are with those whose vision is more profoundly impaired. This chapter is primarily written with this group of children in mind. Much of what follows will be relevant to children who use braille as their main means of reading but this chapter does not attempt to cover the teaching of braille or the use of braille-related technology. The bibliography lists some books in which these topics are covered.

Before a teacher, parent or carer begins to think about the educational implications of a child's visual impairment, they must remind themselves of one important fact: any labels accompanying a child, whether it be the medical term for the visual impairment, or a clinical assessment of the child's vision, should be taken into account but not considered as prescriptive. Two children may well have the same medical condition and even the same visual acuity and yet require remarkably different support within a school.

Why is that? Many factors contribute to a child's ability to see; only one of those factors is the physical condition of the eye, or the intact pathways between the eye and the brain which enables sensory information to be interpreted. Any problem in these areas results in the visual impairment. However, the other factors which affect a child's functional vision, that is, the ability to use eyesight in everyday situations, include his or her:

• Motivation for learning
• Access to an environment which encourages use of functional vision
• Access to materials and technology which aid functional vision
• Training in the use of functional vision

Clearly, a child's medical condition is important and the term will provide useful information to the carer. For example, the implications of albinism are likely to include ensuring the child is protected from bright lighting, but the term albinism does not mean that every child with albinism will require exactly the same measure of protection. Each child's needs must be assessed individually.

If you are a fully-sighted person you will know that even your ability to see can be affected by environmental factors or personal circumstances. So, if you are very tired, perhaps ill, you will find it hard to read, to take in information and process it. Similarly, if the print of a book is too small, or you are reading in poor lighting conditions, you will find it harder both to discriminate the letters and concentrate, and so your speed of reading will decrease. Furthermore, if you are struggling to see, then your motivation to concentrate and learn will also be adversely affected. If, for example, you are in a large meeting, unable to see the facial features of the speaker clearly, then it is often harder to maintain an interest in what is being said. As your visual attention decreases, so often does your motivation to listen. Visually impaired children face these situations all the time, and yet they are not an inevitable consequence of visual impairment. Children can be trained to use their functional vision to maximum effect; their motivation can be encouraged by following simple, often common­sense principles when providing them with educational materials, planning their environment and allowing them the freedom to explore, experience and memorise this environment. Thus, the adults involved with a visually impaired child should be knowledgeable about both the visual impairment of the child and the other factors which affect his functional vision. It is these factors which are considered in this chapter.

Motivation for learning

The motivation to use the vision that is present is, in the final analysis, the responsibility of the child, but the importance of early intervention in a visually impaired child's development cannot be over-emphasised. A visually impaired baby or young child might not have the stimulus of sight to encourage him to develop all or any of the following normal steps that typically characterise development:

1. focus on faces, objects
2. follow movements
3. realize an object is there and so reach out to grasp it
4. see different facial expressions and gradually attach meaning to them
5. see lips move and realize language is emerging
6. realize that even if an object cannot be touched, it still exists and is still there
   
7. copy movements

The importance of sensory stimulation at a young age for the development of the brain is well-known. As the visually impaired child gets little incidental motivation to use his vision, it is understandable that there may be a tendency for that child to withdraw into passivity or self-stimulation within his own body eg; eye-poking, hand-flapping etc. Fully sighted babies or young children not only have a constant input of information through sight; his early communication with others is generally visual, and stimulates further development. A visually impaired child will often miss the visual clues of an adult's face eg the delighted smile at something the child has done. Instead of responding by repetition of that action and further developing it, the child may appear passive and unresponsive. This can in turn discourage the adult from further interaction with the child. It need not be so, however, if the adult is aware of this and instead uses touch or noise to communicate feelings of delight and pleasure. If the adult is also aware of the developmental needs of a sighted child, eg; what stimulates him to explore and learn, then it is possible to think about how to adapt those same principles for a visually impaired child by:

• bringing objects and faces nearer
  
• making objects brighter
  
• providing greater contrast, or better lighting
  
• attaching noises to objects
  
• reducing visual crowding, for example, by presenting objects one at a time, against a suitable background.

We are not talking of expensive specialised resources, but of adapting what already exists for fully-sighted children. One excellent source of ideas and explanation for stimulating vision is 'Show Me What My Friends Can See' by Sonksen and Stiff. As the visually impaired child gets older, he will need to have objects in the environment explained and pointed out. It will depend on each individual's intellectual ability, as well as the nature of their visual impairment, as to how often explanations need to be repeated, perhaps once, perhaps several times. Thus, a child with poor distance vision may be told one day that the large red vehicle approaching is a bus; note that the child will not necessarily know this and will need it pointed out at least once (and will have to have explored a bus to know what it is). The colour, sound and shape of the object will need to be memorised and retrieved by the child to identify a bus at a later stage. Such learning will depend on the child's ability to retain such information and use it at an appropriate time.

However, early intervention to encourage such active looking is vital. Later on, the child's sense of direction will be affected, as he will not see obstacles clearly and be able to plan routes. The child's concept of the surrounding world is also affected by visual impairment; he cannot subconsciously take in visual information and begin to build up an ordered categorization of objects. For example, it will take longer for a visually impaired child to identify the common elements of a chair, (that is, it has 4 legs and is for sitting in,) and then to realize that a chair can be tall, small, made of wood or plastic and yet still remain a chair. This will probably never need to be explained to a fully-sighted child. The visually impaired child needs to explore objects by touch, trying to put the different pieces together mentally; this will take far longer than the sighted child's glance and recognition of an object.

It is important that the carer makes no assumptions about a visually impaired child's previous experiences and level of understanding about any subject, but finds out first what has been understood before moving on to the next stage, and provides enough time for the child to explore and memorise his environment. As the child realizes he can make sense of what is around him, he will be motivated to explore and learn more.

Creating an optimum environment

The school or home environment is not usually within the direct control of the visually impaired child, but it may well be possible for the carer to adapt it to provide the best conditions for him. This will involve thinking through the following issues:

• safety
  
• clarity and contrast
  
• lighting
• ease of access for mobility and independence
  
• the sound environment; providing good acoustic conditions.

i) Safety

Every child, whether sighted or not, will learn best in a safe, secure environment. The school or home environment is not always ideal, as it often has not been designed with the visually impaired child in mind. Nevertheless, adaptations can be made, and common sense applied to improve it. Make sure that there are clear pathways and routes between areas; clear pathways will include ensuring there are no projections such as shelves at eye and head level. Be organised in storing materials and resources, so that a visually impaired child can find them without having to search in unknown places. An orderly and reasonably predictable environment will greatly enhance a child's confidence and enjoyment in the learning situation. Be aware of such hazards as trailing leads, or ill-fitting carpets which might cause the child to trip. Encourage the child to explore his environment and get to learn routes between various places. If a visually impaired child is coming to a new school, it is a good idea if he can visit beforehand during the holidays with a mobility officer and become familiar with the school lay-out and learn important routes.

ii) Clarity and contrast

Clarity and contrast are important in relation to printed material; they are as important in the environment. Strong  colour contrast can greatly aid orientation. Doorways can be outlined in a contrasting colour to the rest of the room, as can light switches, power points etc which are normally coloured to blend in with the room. Contrasting paint along the edges of stairs is an effective means of aiding mobility and making the environment safer; white or yellow is commonly used. The type of paint used within a room is also important, as different colours reflect different amounts of light. For example, a glossy white will reflect about 80% of the light falling on it, whereas a matt black surface reflects almost no light. As too much light or glare can add to a child's discomfort, this is a factor which should be borne in mind, especially when re-decoration is an option. Many classes and schools have labels and notices throughout, providing necessary information for sighted and visually impaired children alike. It need not be a problem to ensure such notices are clearly printed and placed at eye level, as the Royal Institute of Architects recommend; as with many of these measures, they will help the sighted child as much as the visually impaired child.

iii) Lighting

Each individual will have different lighting needs, and whilst it may not be possible to change the environmental light, it is possible to suit task lighting to an individual's needs. Be aware of the fact that bright lighting is not necessarily the best for a visually impaired child; this will depend on his visual condition. The CIBS' (Chartered Institute for Building Services) recommendation for the proper level of illumination for near tasks is 300 lux for young, fully sighted people. For the over 60s, 450-600 lux is thought necessary, and for visually impaired people, something over 1000 lux is probably needed. However, as each visually impaired individual will vary, each person's preference should be assessed. It can be helpful to have a light meter to measure light levels in the different areas a visually impaired child may be using or passing through at school and at home.

Condition	Lighting Environment
Corneal opacities eg; Peter’s, metabolic diseases, cataract, albinism, aniridia	Avoid focal light sources in front of child which may cause glare.
Retinitis pigmentosa	Adequate general light levels essential - children have poorer vision in dark conditions. However excessively bright light sources can temporarily damage the retina and cause glare is there is associated contact.
Cone dystrophies	Excessively bright lighting causes discomfort and poorer vision and should be avoided.
Macular disorders	Bright focal light sources placed behind child and directed onto target may improve detailed vision.
Optic nerve disease	Increased level of background lighting may be beneficial.

Positioning of task lighting is very important. It can be difficult to find the best position; if placed to the side, the light source can cause unpleasant glare in the peripheral field vision, or the head may block the light and form shadows. However, if the lighting is placed over the text, which is often best, then heat coming from the light can cause problems too. One solution is to use a fluorescent tube. It is cheap, provides diffused light  and stays cool.

iv) Ease of access for mobility and independence

Orderly and predictable layouts of classrooms and school enable a visually impaired child to learn routes that remain constant. This builds up confidence and speed in moving about the learning environment. It also means a visually impaired child will be increasingly able to fetch necessary materials and resources independently. The effect of independent mobility on a child's self-esteem can be considerable and this in turn can benefit learning.

v) Sound environment: ensuring good acoustic conditions

A visually impaired child is much more reliant on other senses for input of information than sighted children, and hearing is the most important of these. It is vital then, that the child is not distracted from listening to another person, or from his own work, by unnecessary background noises. If walls and floors can be covered with sound absorbing acoustic tiles or carpets. so much the better; these will muffle background noise and allow meaningful noise to be more audible. If this isn't possible, then try to eliminate as much background noise as possible, for example from radios. Create quiet areas for private work through the use of movable screens. If possible, allow children using technology such as a Perkins brailler a designated place to work, where they feel comfortable they are not disturbing others, and they also are not disturbed in their work.

Materials which aid functional vision

As in the environment, the following factors are important when preparing materials for the use of visually impaired children:

i) Size of print and font

A visually impaired child's preferred size of print is usually found using a standard reading card, such as the Maclure reading types for children (see Figure 2.4). This gives examples of different sizes of type in decreasing size. A child will read these and decide which size print is most comfortable (see Figure 4.1).

Figure 4.1

The larger the print, the fewer letters can be perceived by the eye in anyone position, and so the longer it can take to read. Thus, what is comfortable for a few sentences might become an unnecessarily tedious and slow process when faced with whole textbooks and novels in that size print and it might be preferable for that child to persevere with a smaller print when needing to access a lot of information.

Conversely, a child might opt for a smaller size of print that is fine for a couple of sentences, but would become fatiguing when reading for sustained periods or in lighting conditions that are less than perfect. The font chosen by a child can often clarify print. The teacher should therefore test a child's preferred font and size of print over a sustained period of reading, and in different lighting conditions, ranging from the optimum to the less than satisfactory.

Figure 4.2  Different type point sizes

It is important to make the pupil aware of the effects of sustained reading and different lighting conditions and to enable the pupil to choose the appropriate strategy by using different size print for different purposes, and to know when and how to use Low Vision Aids (LVAs). All too often, once a preferred print size has been chosen, it is used for all materials, whereas different sizes for different uses may well be better for the child. This should not be a difficulty as it only needs a change in the font or photocopier degree of enlargement. It is worth remembering that visually impaired children will often be faced with material that is not printed in their optimum size of print and font, especially outside school, and their educational training must prepare them to cope with this.

ii) Clarity and contrast

Clarity in the material presented to visually impaired children is essential. Illegible writing, diagrams and graphics which overlap, smudged or faded print, all hamper their ability to see, whereas material which has been clearly printed and laid out may mean a same child who is partially sighted has equal access to material as his sighted peers. There are general principles on preparing printed texts for visually impaired children which are simple to put into practice and will probably also benefit those who are fully-sighted.

• Black against white generally though not invariably gives the best contrast.
• Where possible, avoid writing in block capitals. Words are read by recognising the overall shapes, rather than by reading letter by letter. An upper and lower case mix gives the reader the benefit of visual clues and so speeds up the process of reading.
• Printed text rather than cursive handwriting is often easier for visually impaired children to read.
• Choose paper with a matt surface, as a glossy paper can give glare from reflected focal lighting. Glare can also be a problem with white boards.
• Content layout is important. Headings and paragraphs should be left justified. Leave a line space between paragraphs and between questions.
• Key in the number/letter of a question, then tab the text. This helps the reader, if moving from question paper to exercise book, to find the relevant question again quickly.
• Where brackets are used, leave a space between brackets and text, so that the visually impaired child doesn't try to read the brackets as part of the text.
• Try to keep whole questions together on one page. If the text or question refers to a diagram or table, try to have that information facing the question, so that the visually impaired children are not having to cope with turning over pages and trying to find the right place again.
• In mathematics, it is sometimes worth using a larger print size for the division sign, as pupils often misread this for a plus sign.
• Avoid unnecessary pictures and diagrams, and decorative fonts. Most readers benefit from having less, rather than more, text and graphics on a page.

Contrast is an important factor not only in printed materials but also on the screens, or visual displays of the technology used by visually impaired children. Firstly, think about the background and the text colour. Is there clear contrast or does the text merge into the background? If colour is used, is it chosen with visually impaired children in mind? Pastel shades can be very indistinct, although to the sighted person they may be aesthetically pleasing. Where contrast is adjustable such as on ((TVs and computers, allow the visually impaired child to choose their preferred setting. Many visually impaired children favour white text on a black background, as it gives a good contrast and produces less glare than a white background.

iii) Best use of colour

Colour confusion is a common additional impairment to many conditions which reduce vision, but is one often ignored by professionals working with visually impaired children, because it usually doesn't have educational implications (as long as the points made previously about contrast and clarity are borne in mind). However, there are simple tests such as the Ishihara colour test which indicate which colours cause particular confusion, and these colour combinations can be avoided when preparing materials. This is perhaps more important with primary school age children.

Certain conditions, such as cortical visual impairment (CVI), do not necessarily imply accompanying colour confusion, and so children with CVI are as attracted to primary colours, such as yellow and red, as their fully-sighted peers. Experimental data suggests that the use of colour helps the perception of forms by children with CVI. This has implications for teachers who work with such children; a simple method of outlining shapes and letters with colour makes it easier for the child to perceive, and hence progress in learning. The same principle applies when it is obvious that certain colour boundaries are not seen· for example a dark green frog on light green grass. In that case, a line in a bright contrasting colour to highlight appropriate boundaries may be helpful.

Specialist technology

Technological advances mean that a child with little or no useful vision can work well within a mainstream class. Equipment includes computers that translate print into braille, that can speak out the text, personal note-takers that can produce both braille and print, Closed Circuit TVs (CCTVs) that allow access to print and diagrams. Increasingly, there is a wider range of machines on offer that can perform similar functions, so it is important that advice is sought from the appropriate advisory and support services as to what particular piece of equipment would best suit each visually impaired child's needs. The requirements of professional back-up in the form of training and maintenance should also be planned and budgeted for, as they can often prove to be as expensive as the purchase of the equipment. However, many Low Vision Aids (LVA) for visually impaired children are much simpler and therefore cheaper. Despite their relative simplicity, though, they are often not used to any effect because the carer and the child have not received even basic training in their use, perhaps because it is assumed that their function is self-explanatory. This is not the case: the following section presents the range of LVA commonly found in schools, and describes how they should be used.

Hand-held LVA

LVA is by itself a very broad term. It can apply to anything that improves a person's visual functioning, and so can include tinted lenses, extra lighting, or hand-held magnifiers. However, the following applies to hand-held optical LVA, that is, those LVA which use lenses (see Plate 32 for different examples).

Plate 32 Hand-held LVA

The purpose of most optical LVA is simply to magnify the detail of an object to a size which the visually impaired child finds easier to see. There are various ways of achieving this magnification:

• increase the size of the object eg; enlarge print, diagrams etc
• decrease the working distance. Children have greater accommodation than adults and can move objects closer to the eye
• use an LVA

To use an LVA effectively, and to avoid frustration, it is important for the child to learn how to use it properly. The LVA used for near vision must be held at the correct distance. The amount of magnification and the size of the field of view decrease as the distance from the magnifier to the eye increases. Therefore, as a general rule, magnifiers should be used close to the eye (see Plate 33). To keep the LVA at the correct distance from the text, it is helpful to put the little finger down on the text to act as a support and maintain the distance. In order to make reading comfortable, it is important that the printed material is brought up to the child's face, rather than the child having to bend over to the table. Wooden stands or angle-poise book-holders can be used for this.

Plate 33 x8 illuminated LVA

Using the LVA The child will need to practise:

• finding the start of the line
• tracking along and back a line
• dropping down lines
• scanning text
• developing speed and fluency in using the LVA
• cleaning and maintaining the LVA

When using the far distance LVA such as telescopes, the child will need to practise the above skills as well as the following:

• locating objects
• focusing
• scanning along a blackboard

Choosing the right magnification

The number on the box accompanying the LVA indicates the focusing power of the LVA (measured in units called dioptres, abbreviated to '0') and this can be used to calculate the amount of magnification. Thus, if the focusing power is + 16 0, the magnifying power of the LVA can be worked out by the following formula:

magnification = focusing power/4

In the above example, the magnification would be 16/4 ; 4 and would thus magnify the image by a factor of 4, or x4.

However, this is a simplified formula, and does not take into account the working distance at which the LVA is being used. It is important to remember that generally, as the working distance increases, so the magnification of the LVA decreases. Hence the magnification calculated should be taken only as a rough guide.

Field of view must also be considered. For a near vision magnifier, field of view can be defined as the number of letters that can be seen at one time through the magnifier. It is important to note that the narrower the field, the harder it is to read whole words, and thus read quickly, and to find one's way around a page. This effect is illustrated with a map in Plate 34. This should therefore be borne in mind when deciding the strength of magnification, so that the size of letter is balanced by the field of view.

The width of field of view can be affected by:

• The working distance between the LVA and the eyes. The shorter the working distance, the greater the field of view.
• The diameter of the magnifying lens. The larger it is, the greater the field of view.
• The magnification rating of the lens. The lower the rating, the greater the field of view.

Types of hand-held LVA and their use

a) Simple Magnifiers:

Hand-held:
the user has to find the correct distance from the page, and has to maintain the position. The eyes must be close to the lens, so a work-stand that brings the material up to the face may help with posture.

Limitation: it is not possible to write easily underneath this LVA.

Stand magnifier (Plate 35):
the stand has the advantage of maintaining the correct distance from  the page.

Limitation: the user can't easily write underneath it, and if it doesn't have its own illumination, then shadows are cast.

Plate 35 Stand magnifiers

Flat field:
these have excellent light gathering properties, and less distortion than the above LVA.

Limitation: they are limited to x2 magnification and do not allow writing underneath; they can only be used for reading.

Bar magnifiers:
these have excellent light gathering properties.

Limitation: they only magnify the height of letters, not the width, and are generally limited to x2 magnification. They are only useful for reading.

Spectacle mounted magnifiers (Plate 36):
the great advantage of these is that they keep both hands free, and allow the user to both read and write. They also provide maximum field of view for near vision. Limitation: they have a short working distance, so it is important that task lighting illuminates the work.

Plate 36 Spectacle-mounted magnifier

Bi-focals are useful when needing to focus on close work eg; reading and writing and distance work, eg; looking up at a blackboard to copy. They are not usually recommended for use in walking around. although in practice, many children seem to manage.

b) Telescopic Systems (Plate 37):

Plate 37 Telescopic systems

Telescopes for both near and distance vision are available; some models have focusing power for both near and distance work.

Example of magnification rating: 6 x 16

The first figure indicates the magnification rating, and the second indicates the diameter of the front lens in millimetres. This affects the light-gathering properties of the lens; the wider, the better. As magnification increases, the field of view decreases. Telescopes are therefore sometimes prescribed with less than maximum magnification in order to allow the user the benefit of a greater field of view.

Optical LVA can be the correct magnification for the child, and the child may be well-trained in their correct use, but their effectiveness will be nullified if lighting is poor. Optical LVA tend to require task lighting.

All adults concerned with the child should be aware how the LVA should be used. Teachers, parents and carers can encourage the child to use the LVA correctly, that is,  at the right distance, with the appropriate lighting and posture. It is worth assessing children's use of LVA regularly to ensure that they are still benefiting from them. If there are problems, these should be addressed before the child becomes discouraged and reluctant to use any type of LVA.

c) Closed Circuit TV or CCTVs (Plate 38)

Plate 38 Closed Circuit Television

CCTVs can be used for reading print and diagrams. They usually consist of a camera, a platform on which the material to be read rests, and a screen. Some ((TV systems are also able to focus on material at a distance, for example on the blackboard or whiteboard. The advantages of a CCTV over a hand-held LVA are many:

• The degree of magnification is greater.
• The user can control the degree of magnification.
• This is more flexible when faced with textbooks with varying print sizes.
• The user can adjust the contrast and brightness.
• The picture can be reversed, to provide, for example, white against a black background.
• Other facilities such as line markers or split-screen (blacking out the text except for the line to be read) help the user track along a line and read more quickly.

CCTVs are expensive and cannot always be transported to every room by trolley. However, many schools make arrangements for a CCTV to be available for as many lessons as possible. They can be particularly useful for science and geography where sighted pupils can also benefit from the magnification of diagrams. In addition CCTVs are often made available in a resource area. A hand-held CCTV could also be an option where portability is a factor, although these can be more difficult to use and may be more appropriate for secondary school pupils.

The training skills outlined for using hand-held LVA will apply to using CCTVs.

Techniques relevant to CCTVs will also need to be mastered by a child:

• Camera controls: print size, focusing, zooming, contrast
  
• Screen: contrast, brightness, positive/negative image, line marker, split screen facility using the platform to move work.

The child will gain confidence in using a CCTV through careful explanation of all the controls and practise in using them. Teachers may find it helpful to have a collection of different types of print eg text in columns, drawings, comics, photos, graphs, maps and a selection of different print sizes and styles so that the child can get used to changing the controls for different materials.

Matching the LVA to the individual child These should be prescribed by an appropriately trained person at a Low Vision Unit. Different magnifications may be needed for different tasks. The approximate magnification necessary is worked out by comparing the size of the task detail to the person's comfortable print size (not their near acuity, which is the smallest print they can see, but which will be read slowly and with difficulty).

• eg; Child's comfortable print size = N36
• Size of print to be read = N12
  
• Magnification = 3x

If the size of print to be read was N6, the magnification needed by the same child would be 6x.

Other factors need to be taken into consideration when deciding on the type of LVA and level of magnification. Children's visual impairment may mean that certain LVA are unsuitable for them. As a rule children with impaired visual acuity benefit most from optical LVA whereas for instance, a child with retinitis pigmentosa and tunnel vision, but normal visual acuity would probably not benefit from them. Children need huge encouragement to see the benefit of LVA and overcome feeling self-conscious about using something different from their sighted peers. In particular LVA given them greater access to written material which has not been specifically modified for them. Being able to look at CD covers, magazines and cereal packets promotions may be more motivating than being able to read a textbook!

Training in the use of functional vision

It has increasingly become accepted that it is important to encourage and train children to use their vision to the full, whilst providing them  with the optimal environment, materials and technology. This involves:

1. learning to use the other senses
   
2. training in the efficient use of functional vision

1. Learning to use the other senses

If children have impaired vision they, to a greater or lesser degree, rely on their other senses. The most obvious one is hearing. Sight has various degrees of usage; the glancing 'seeing' which takes in the general picture but doesn't pick out details, is different to concentrated 'looking' where the viewer is working hard and using sight to gain specific information. In the same way, hearing can have various degrees of attention. Seeing could be equated with hearing, and looking with listening. Visually impaired children will not automatically listen with concentration, nor be able to interpret and use different sounds. In order for them to become skilled at listening, the following should be part of the visual impairment education programme.

a) Learning to use equipment

Tapes can be a significant tool in a visually impaired children's education, especially as they get older and have to cope with increasingly large amounts of information. It is important, then, that the child is familiar with the controls of a tape recorder, so that using tapes helps rather than hinders. The facility of variable speed on some tape recorders means it is possible to listen to speech at a speed of around 250 words per minute, which is about the same as a good silent print-reading speed; spoken speech is usually about 100 words per minute. Another important feature is tone-indexing, which allows the listener to find a specific section on a tape quickly, without having to listen to the whole tape. It works by using different tones to mark parts of the text eg three short tones could indicate the start of a chapter. Once familiar with the meaning of the tones, the child can move quickly about the tape.

b) Listening skills

The child needs to be able to listen for:

• factual details
• the main point of the passage
• whether opinion or fact is being presented

When young, children can play listening games eg recognising familiar sounds, picking out one sound from background noises etc. As they get older, children need to be questioned by the carer. This can be done in conjunction with training for speed listening. The carer could give the child a passage to listen to for the main points, set at a speed which is the maximum that is comfortable. With practice, it should be possible to increase the speed gradually.

c) Interpreting the sound environment

Visually impaired children should also be taught to interpret sounds in the environment. This will help their understanding of the world in which they live and move, and aid orientation and mobility. So although we have said it is valuable to have a learning environment in which background noises are muffled, it would not be good if all such noises were cut out altogether. Many noises give clues as to what is going on. For example the sound of doors opening and closing may alert a child to the entrance or exit of a person to the room. The sound of chalk on a blackboard can be recognized as a signal that significant notes are being made, and can be a cue for a blind child to start noting the teacher's speech straight away, without:

• needing to be told to take notes, or
• missing the vital first sentences.

The ability of a visually impaired child to move around familiar and unfamiliar places can be increased through organized mobility training that includes:

• The recognition of common sounds such as clocks, office sounds. The location of certain fixed sounds, such as a clock above the doorway, can be memorised and used to help visually impaired children move around with more confidence.


• The use of reflected sound. Studies have shown that it is possible to become aware of an object in one's path by hearing reflected sound coming back from that object. Echo-detection or echo-location means using this phenomenon by actively listening to returning sound, or even deliberately making noises in order to interpret the echoes made. Such deliberate noises could be tongue snapping, finger clicking or stamping. In one study, blind people making artificial noises were able to distinguish a disc covered in velvet from one covered in denim. Knowing how different objects sound give clues as to when there is an absence of an object such as a doorway, or an open door. The obvious drawback to making deliberate noises is that it draws attention to the visually impaired person. Nevertheless, it could be one strategy that some children find useful. Training in this is part of mobility specialists' expertise, and advice in training programmes should be sought from them.

2. Training in the efficient use of functional vision

In the earlier part of the 20th century there was a tradition in European schools for blind children that visually impaired children should not be encouraged to use their eyes. in order to prevent further deterioration of vision. This was the medical view, and so was largely supported by the educationalists. There was also a tendency to classify most visually impaired children as blind, and thus to treat them as having no useful vision at all. These views began to change in the mid 1900s. Dr Natalie Barraga from the University of Austin, Texas, USA, was one of the first educationalists to act on the changing medical views. Ophthalmologists began to believe that the practice of 'sight-saving' by not using their eyes at all had no medical justification in most cases; furthermore, the work of psychologists was finding that lack of visual stimulation could lead to a lessening of visual functioning, whereas specific training could lead to improvements in discrimination. Dr Barraga's work in the 1960s showed that children classified as blind could be taught to perceive and manage their near environment using their functional vision as well as their other senses. This has great implications for visual impairment education in the developed world, as the majority of visually impaired children have some potentially useful vision. Her work was the basis for a British project based at the University of Birmingham, which produced a handbook for teachers, 'Look and Think', whose aim was the visual perception training of visually impaired children aged 5-11. It provides a useful checklist of the skills involved in visual perception; a means of assessing whether an individual possesses those skills, and most importantly, suggestions for training the child in those specific skills, so that a less developed skill can become fully developed.

These areas of visual perception include:

• depth perception
• 3D discrimination
• perspective
• line drawings
• photos
• facial expressions and body language
• patterns and symmetry

In order for visually impaired children to begin to use their vision most efficiently, they must be encouraged to look properly; to be trained in scanning and search procedures. They should find such training interesting and rewarding, for they might well be too accustomed to not seeing and therefore feel no incentive to look for visual information. Training in these skills should be part of an overall programme of learning to use functional vision which includes all the points made in this chapter. Rather than be a tick-list of skills to be covered, training visually impaired children to use their functional vision should be tailored to their individual needs, and involve a lot of creative common sense. Observe the child and identify strengths and weaknesses, then work out what can be done to overcome any problems that exist. Above all, remember that the child will be in school, with all its support systems, for only a few years, and the ultimate objective of any training programme should be to enable the visually impaired child to cope as well as possible in a world that still makes few allowances for visual impairment. Newspapers will not necessarily be enlarged for her, obstacles on the pavement may not be removed, and a good training programme will have provided the young person with the strategies and confidence to deal with such challenges.

Continuing visual assessment on a day-to-day basis Normally, the first assessment of a visually impaired child will have been carried out by the doctors who diagnosed the visual impairment. It will have included the assessment of near and distance vision, but significantly, the tests will have been carried out in clinical conditions. It is important, therefore, that visually impaired children are assessed by teachers of the visually impaired for near and distance vision as described in this chapter, and that any information gathered is conveyed to others. As stressed before, the visual acuity and print size should be one that the child finds comfortable in normal surroundings, rather than the absolute best that can be seen, which is hard to sustain during a whole lesson.

However, once an initial assessment has been carried out, it is important that there are regular formal and informal assessments throughout the child's education by teachers of visually impaired children. How often the formal assessment is carried out will depend on the resources of the staff; once a term is probably a good target.

The formal assessment should include:

• The near and distance acuity of the child. Once print size has been determined, one idea is to time how long the child takes to read quite a long passage in classroom conditions, and to repeat the exercise termly, to check whether the print size is still comfortable. If it becomes clear that the child is taking longer to read a similar passage, then print size needs to be reassessed. If the child reads aloud, it might also be possible to determine whether the child is struggling in other areas, such as finding the next line, going back to search for information, scanning text to get an overview. These are all study skills which are important for learning and may need to be taught. For distance acuity, find an empty classroom and write on the blackboard or whiteboard. See if the child can still see the same size writing from the same distance. If not, the child or teacher of visually impaired children should ask for class seating arrangements to change.


• Checking that the chosen print size is comfortable in all media used eg novels, maths books, computer screens. Remember that an intermediate acuity might be required for reading music, or public reading.


• Testing peripheral vision as explained in Chapter 2.


• Testing colour vision. This can be done using commercial tests such as Ishihara, or by simply asking the child about coloured objects spaced around the room, or illustrated in books. Special attention needs to be given to the background contrast.


• Checking the child's lighting and seating requirements are still the same.


• Checking that the child is comfortable with any technology and LVAs. Regular speed tests with the child's technology such as laptops, and his or her LVAs can show if they are being used successfully.


• Regular liaison with the class teachers involved with the visually impaired child, to anticipate and deal with any issues before they become problems. A simple, quick to use tick-sheet can be used, and if any problems are identified, then teachers of the visually impaired can spend time solving them, and giving support where it is needed.

There is also scope for informal assessment. Observation of how visually impaired children move around school is very helpful. as is classroom observation. Is the LVA being used appropriately? Is the child joining in class and group activities or is it clear that some support is necessary? Is the child able to ask for better lighting or seating? Is there any imagery in the worksheets which is not seen or misinterpreted because it is too small or of the wrong contrast? Such observations will help the teacher of the visually impaired plan an appropriate programme for each child.

Working to the same agenda as the family

The relationship between the carer of the visually impaired child and teaching staff is very important. Good communication between home and school means that useful information is pooled and available to all those involved with visually impaired children, so that problems at home or school can be solved before they begin to hinder progress. If teachers and carers agree on using common vocabulary and strategies. visually impaired children can only benefit from the constant reinforcement and encouragement. It is particularly important with younger children or visually impaired children with additional learning difficulties that school and home use the same vocabulary to avoid confusion and aid reinforcement.

Carers of visually impaired children are clearly the best people to give teaching staff information on the day-to-day implications of a child's visual impairment. They are the ones who will have noticed certain habits or problems or abilities the child has. They can give suggestions as to what may motivate the child and what interests may be used to help in his or her education. They are also able to inform staff about any relevant medical information. Of course it is also crucial to involve the child in all of this too - it is the child who should lead the way.

The flow of information should be two-way. It is important that teachers ensure that carers are informed about what is going on at school. Clearly, the education of visually impaired children is best carried out as a team effort, with input from all those involved. How such consultation takes place, whether it be formally or informally, is down to the individuals concerned, but staff should ensure that communication with the child's carers remains a priority. A diary which 'belongs' to the child and is filled in by all interested parties can prove very helpful.

Richard Bowman, Ruth Bowman & Gordon Dutton
First published by RNIB in 2001
ISBN: 1858782139

Where next

• Index
• Appendices