University of Edinburgh
 

Vision for Doing

Assessing Functional Vision of Learners who are Multiply Disabled

Chapter 6 The Other Senses

For consistency you will, in this chapter be using a format similar to that introduced in the previous chapter.

Having carried out the items in each of the four sections that make up this chapter, you are invited to integrate your findings with those from Chapter 7 - responses to visual information.

Background

You may be wondering why it should be that in a book about assessing vision, we should. spend time discovering how a learner responds to non-visual events in her world. For in this chapter the intention is to give you the chance to assess the learner's responses to information about the world coming through sound, touch, smell taste.

Our rationale for doing this was set out in great detail in Chapter 3. You will be pleased to know that we do not intend to repeat that rationale here. Instead we give a brief summary as to why it is so important, in the case of the learner who is multiply disabled, to investigate response to non-visual information.

This helps us build up a wider knowledge of the learners and gives us a means of comparing her visual responses with those responses made to information detected through other senses. Also by channelling some of our observational energies into assessing response to non-visual information, we have a better chance of offering to the learner a wider range of suitable activities. However, as we pointed out in Chapter 3, if we were to enter into as great detail for non-visual items as we will do for visual items, you would be reading a set of volumes which would cure your insomnia! We offer a short hand version for observing response to non-visual information.

Sections in chapter 6

In this chapter there are four short sections. These are numbered Sections 4, 5, 6 and 7. They are numbered in this way so that they follow on from the final section of the previous chapter. Thereby if you only wish to use the front page of each section, these will follow in a logical numerical sequence.

  • Section 4
  • In this section you have an opportunity to observe the learner's responses to sound information.

  • Section 5
  • The items of this section are geared to helping your observations of responses to pressure - for convenience we call it 'touch'.

  • Section 6
  • Here you will take a look at response to one form of chemical information - again for convenience we will call it 'smell'.

  • Section 7
  • In the final section of the chapter we take a look at another form of chemical information, this time 'taste'.

NB For general Information as to the meaning of Consistently, Occasionally, and Never refer to Chapter 5, Section 3.

What to do with results

Each time you complete one of the Sections 4, 5, 6 or 7, carry forward the result for that section to the Summary Chart at the end of PART TWO. This will give you an at-a-glance profile of your learner.

On the basis of that Summary Chart, you will discover at which 'level' the learner is functioning. With this knowledge you can then proceed to collate all of the suggestions for curriculum development which have as their theme that particular 'level'. (If you are uncertain, you can refer back to Chapter 3. This sets out in great detail the meaning of these functional 'levels', which are used as organising themes for suggestions as to curriculum development).

 

Section 4 Learner's Responses to Sound

Aims of section 4

In this section we have five categories o! items. You will be using these to give some idea as to the learner's level of responsiveness to sound.

From this you can be more precise in selecting which of the intervention strategies outlined in Chapter 6 and Chapter 7 are most relevant to your learner.

How to use section 4

Refer to the diagram. For each of the items under the five broad headings to the left you will want to record whether the learner responds in a manner that is Consistent, Occasional or Never.

While carrying out the items in this section, as far as possible try to use stimuli that only involve sound. Remember also to remove the previous stimulus before going on to the next.

Note that you should not consider this in any way as a substitute for a test of hearing.

Transferring Results to Section 18

Learner is aware..

For this to be the case you may not have found any specific response. Instead, you will observe only a vague and non-specific response to sound.

If your results show that the learner responds Consistently to the item, go to the Summary Chart (at the end of PART TWO), find the row for Section 4 'Sound' and put a tick in the box for Awareness. Then move on to the next topic (Learner attends to...).

If instead the learner responds only Occasionally, try again on different occasions. If the result is still Occasionally use Awareness as the level of responsiveness. If so, go to the Summary Chart (in Section 18 at the end of PART TWO), find the row for Section 4 'Sound' and put a tick in the box for Awareness.

If the learner Never responds to any of the items under this heading go on to Section 5 dealing with 'Touch'. Note that you should not have results in which the learner Attends or Localises, or Recognises or Understands sound but is still not Aware of sounds. A learner has to be Aware of sound in order to Attend to, Localise, Recognise or Understand a sound.

Learner attends to..

In order for you to observe an ability to Attend, you must first have found that the learner is Aware. If you are uncertain, read over the previous information on "Learner is Aware..">

For the learner to Attend you will have observed a more specific response to sounds such as to people's voices.

If your results show that the learner Consistently responds to each of the items on the checklist under Attends, go to the Summary Chart (at the end of PART TWO), find the row for Section 4 'Sound' and put a tick in the box for Attending. Then move on to the next topic (Learner localises sound..).

If the learner responds Occasionally to one or more of the items, and one of them is Consistent, take Consistent as the level of response. In this case too, tick Attend in the Summary Chart and move on to "Learner localises sound..">

If all are Occasional try these out on different occasions. If the result is still Occasional use Awareness as the level of responsiveness. The Summary Chart should already have been ticked.

If the learner Never responds to any of the items under this heading go on to Section 5 dealing with 'Touch'. Note that you should not have results in which the learner Localises, or Recognises or Understands sound but does not Attend to sounds. A learner has to be able to Attend to sound in order to Localise, Recognise or Understand what that sound is.

Learner localises sound..

In order for you to observe an ability to Localise, you must first have found that the learner can Attend. If you are uncertain, read over the previous information on "Learner Attends to.."

For the learner to Localise you will have observed specific directional responses to sounds indicating the learner knows where the sound comes from. This may, but will not always, be seen as a head turn towards the source of the sound. If the learner cannot turn her head then clearly you will be looking for a change in response which is still specific enough to indicate she knows the direction from which the sound came.

If your results show that the learner Consistently responds to each of the items on the checklist under "Learner localises sound..", go to the Summary Chart, find the row for Section 4 'Sound' and put a in the box for Localises. Then move on to the next topic (Learner recognises sound..).

If the learner responds Occasionally to one or more of the two items, and one of these two results is Consistent, take Consistent as the level of response. In this case too, tick Localise in the Summary Chart and move on to "Learner recognises sound".

If all are Occasional try these out on different occasions. If the result is still Occasional use Attending as the level of responsiveness. The Summary Chart should already have been ticked.

If the learner Never responds to any of the items under this heading, still try Recognises. Note that you should not have results in which the learner Recognises or Understands sound but is not Aware or Attending to sounds.

If the learner is physically disabled such that she is unable to turn to sound, consider whether there is another means open to you to introduce that sound. If her response indicates localisation of the sound then record this as a consistent response (tick Consistently).

Learner recognises sound..

In order for you to observe an ability to Recognise sound, you may first have found that the learner can Localise1. If you are uncertain, read over the previous information on "Learner localises sound..">

For the learner to Recognise you will have observed specific responses to sounds indicating that these are familiar to the learner. In order for you to justifiably say that the learner Recognises sounds, it has to be very clear to you that the learner is making a clear distinction across a range of familiar and unfamiliar sounds.

If your results show that the learner Consistently responds to each of the items on the checklist under "Learner recognises sound", to to the Summary Chart, find the row for Section 4 'Sound' and put a tick in the box for Recognises. Then move on to the next topic (Learner understands sound..).

If the learner responds Occasionally to one or more of the items, even if one is Consistent, still take Localise or Attends as the level of response. In this case, tick Localise or Attend in the Summary Chart. Do not move on to 'Learner understands sound.">

If all are Occasional try these out on different occasions. If the result is still Occasional use Localise or Attends as the level of responsiveness. The Summary Chart should already have been ticked in the appropriate box. Do not tick Recognise.

If the learner Never responds to any of the items under this heading go on to Section 5 dealing with 'Touch'. Note that you should not have results in which the learner Understands sound but is not first Aware, Attends and Recognises sounds. A learner has to be able to Recognise sound in order to Understand that sound.

Learner understands..

In order for you to observe an ability to Understand sound, you must first have found that the learner can Recognise. If you are uncertain, read over the previous information on "Learner recognises sound..">

For the learner to Understand you will have observed a very clear response to sounds including an understanding of a wide vocabulary. It will be clear that the learner is making sense of this wide vocabulary.

If your results show that the learner Consistently responds to each of the items on the checklist under "Learner understands sound", go to the Summary Chart, find the row for Section 4 'Sound' and put a tick in the box for Understands. Then move on to the next section (Section 5) dealing with Touch.

If the learner responds Occasionally to one or more of the items, use Recognise as the level of responsiveness. If this is so, do not tick Understands.

If the learner Never responds to any of the items under this heading go on to Section 5 dealing with 'Touch'. Note that you should not have results in which the learner Understands sound but is not first Aware, Attends and Recognises sounds. A learner has to be able to Recognise sound in order to Understand that sound.

Where to go now?

Having noted the results of your observations and transferred these to the Summary Chart, you are then ready to make a choice.

EITHER you can skip the remainder of this section and proceed directly to carry out Section 5 dealing with Touch. By doing this you will complete more of your assessment on the learner's use of 'The other senses'.

OR postpone further assessment and read the remainder of this section. In it we suggest activities for curriculum development. These are to do with the use of sound. You might want to follow this option if you feel you need a break from presenting objects. At some point you should still carry out further assessment using the remaining sections of this chapter.

Note: Much of the text above (on completing the results) seems complex. Be assured that throughout the following sections you will be using a very similar system.

We assume, if you are reading this paragraph, that you will have carried out all of the assessment items for each section in Chapter 6 and 7. We also assume you have completed the Summary Chart showing a profile for your learner. (Or you might be reading this whole section out of interest, for a break, or in order to get a 'feel' for the whole approach.)

You are now ready to proceed with structuring your intervention. The suggestions for curriculum development are presented under each of the five themes of Awareness, Attending, Localising, Recognising and Understanding.

Improving awareness of sound:

The washing line

When out in the back garden hanging out the washing, sounding objects may be attached to the clothes on the line. Any objects which come to hand may be used - such as milk bottle tops, cat bells and cutlery (not knives or forks in case they fall) can be used in this way.

Hearing impairment and severe visual impairment

If you suspect hearing impairment, you should not regard this short assessment as an adequate diagnostic form of hearing assessment. If not already done you should consult or refer on to relevant services such as the School Medical Officer or peripatetic hearing impairment service (where appropriate), or educational audiologist2.

There is however one thing to bear in mind when anyone carries out an assessment of hearing with a learner who happens also to have a severe visual impairment or is blind.

When screening children's hearing, a common method is to use what is known as Free Field Distraction. In this, the attention of the learner (usually a child) is engaged and a sound is made - perhaps using a rattle to one side of the child. Recording is then made as to whether he or she then turns to that side. When carried out with blind children, however, the result is often a misdiagnosis of hearing impairment3. It is easy to see why a blind child would not turn to a sound source.

The difficulty for totally blind children is that they will not see any object if a head turn is made to the sound source. It would in fact be counterproductive for a blind child to turn its head towards a sound source. To do so would not gain additional information as to the location of an event. Moreover, a head movement will create additional sound, through clothes rustling, perhaps bedding being disturbed. It is likely therefore that by a certain age a blind child will have learned not to turn its head to a sound source. Those who are late-blinded, as opposed to congenitally blind, do continue to turn to sound sources.

That the behaviour - head turn to sound - is present in a young blind infant is suggested by observations of those born blind. Blindness is often not diagnosed until several months after birth. In many ways the young baby behaves as if sighted, and may well turn appropriately in the direction of sounds presented off to one side - with unseeing eyes. Evidence as to the degree of residual vision necessary for this auditory-visual coordination to continue beyond this early age is also by no means clear. For our purposes, it is important to note that children who are born blind or have a severe visual impairment may be misdiagnosed as also having a profound hearing loss. Consultation with other services, as mentioned above, is important.

One question which arises is whether head turning to sound indicates the presence of cortical vision. Surely, you might ask, if a head turn occurs then this must indicate an expectancy to see something? This would in turn imply a higher level use of vision. If this were true, you would not expect to observe this response in a learner who is described as cortically blind. Or indeed in a learner who is only Aware. Unfortunately the jury is out on this one, there is simply not enough evidence to come down on either side.That being the case, you may find a learner who does appear to turn to sound but who is indeed 'cortically blind'4.

Music with movement

Here we propose to have a short discussion on the use of music, or indeed any sounds which are motivating to the learner. We wish to stress use of the kind of contingency framework presented in Chapter 4 (Thou shalt follow the learner's lead).

It may be possible to augment small movements of the foot, hand, finger, or other part of the body. One routine could be to associate the movement with various musical rhythms. This would be similar in many respects to the use of music and movement therapy sessions. The best of these occur when it is the learner who has to make a movement in order to have the musical rhythm occur. Where there is no active movement to begin with, one can begin by making passive movements with the learner.

A second routine is to place the foot or hand into a container with one of a variety of materials. On the leg being lifted (or some other selected movement), simultaneously switch on a tape recorder, following this by moving the leg or foot in rhythm with the music. As this may involve the limb going into extension you should consult with a physiotherapist before embarking on this activity. Indeed this would be an ideal opportunity to investigate ways of carrying out physiotherapy exercises in conjunction with music. You could:-

invite along a music therapist to help work out suitable music to accompany the exercises. Record the music to be used in future physiotherapy sessions. Watch for any sign by the learner that he is anticipating the physiotherapy movements to come. Decide in advance what to do about movements begun by the learner that are appropriate to the exercises but out of sequence. Reach agreement with the physiotherapist as to whether it would be acceptable to take up the lead from that movement. (Switch off the music if it is the wrong rhythm and hum or sing along, to the rhythm of the new movement). The exercises might end up out of sequence, but the learner would become in control5.

If carrying out some sort of wheelchair dancing to music look for opportunities for allowing the direction of movements to be brought under the control of the learner in the wheelchair. Allow the learner to go beyond the passivity of wheeled around. This does not mean having to fit a joystick controller to guide the wheelchair (but see Section 17 for a discussion on this issue). Control of movement might be something as simple as you responding to a movement by the learner's right hand by turning the wheelchair to the right.

A sound source placed around the wrist or ankle can help encourage hand or foot movements.

attending:

Imitation

Give back to the learner any sounds they utter. Mimic any sound the learner will make. After some success, follow this by changing it slightly and see it you can obtain a different sound. Try changing the intonation as well as the word ending/beginning.

Encourage understanding of finger play and action songs. Games with actions such as clapping hands; bouncing on lap; see-sawing are all good additions. Here a few more action songs are given, to which you could add the learner's and your own favourites. Because action songs are carried out one-to-one and are great fun as well as being reassuring, they can offer a rich learning environment. The learner and caregiver are involved in communicating; the closeness of the care-giver facilitates both attending and Iocalising parts of the learner's own body. Often repeated words and actions are gradually recognised and anticipated. Eventually the learner may come to understand. (See list of a few action songs).

Echoes

Refer also to Section 10 which discusses the use of echoes. In Section 10, discussion centres around the use of echoes in conjunction with reflected light. But the sound information produced by echoes can be used in conjunction with other visual and non-visual information.

Improving Iocalising:

Babywalker

In Section 9, we discuss the use of light sources to help in Iocalising while using a babywalker. For the visually impaired child, trundle truck types of walkers offer a better chance for establishing independent mobility than the makes of babywalker in which the child is seated. Another idea used successfully has been to use a small rollator at the front of which is attached a sounding toy in which the child is known to be interested.

Emphasise game-playing through which primary aims (of the teacher/therapist) to establish physical movements and positioning become (to the learner) secondary to having fun. For example this can be used in trying to encourage sitting posture. Place the learner's hands to either side in conjunction with music, songs, nursery rhymes. It achieves the same end and is less confrontational, while simultaneously helping anticipate and locate sound in different directions.

Stairs

When moving up or down with the learner, such as going up or downstairs, make your voice similar to the direction of movement. If going up stairs, raise the intonation of your voice; if going downstairs, lower your voice with the downward movement.

Sound map

Use sounds in different rooms as games. This can help to create a sound map of an area. The kind of object to use could be radiators - tapping on them with a fork or wooden spoon; cutlery and plates on a draining board; cupboards tapped on; walls and floors.

NB See also the comments on auditory-visual coordination (under topic Improving Awareness).

Improving recognising:

Make a slight incline with a piece of heavy cardboard or thin plywood and a small box. At the bottom of the slope place any toy which makes a sound when contacted such as a bell, squeezed toy. Encourage the child to roll a ball down the slope to make this sound.

Action Songs

Everyday sounds

Let her explore the association between everyday sounds and their meanings. This section topic alone could afford a book6.

Matching

For learners whose hearing is not severely affected, the concept of matching can be developed by using different musical instruments such as symbols, rhythm sticks, blocks. These can be simple rhythm patterns which the learner to move to or imitate, Often, these same routines can be used even where the learner has a hearing impairment, in which case relying on the detection of vibrations.

Improving understanding

6

At this stage we stop offering suggestions. We are after all dealing with the learner who is more multiply disabled. Nonetheless we offer a few suggestions for further reading in the accompanying footnotes.