University of Edinburgh

Vision for Doing

Assessing Functional Vision of Learners who are Multiply Disabled

Chapter 6 The Other Senses

Section 5 Learner's Response to Touch

Aims of Section 5

In this section, as in Section 4 on Sound, we have five categories of items. These correspond to the topic headings Awareness, Attending, Localising, Recognising and Understanding. In the same way as you did in Section 4, you will be using these headings to give some idea as to the learner's level of responsiveness to tactile information about the world. This knowledge will help when selecting which intervention strategies are most relevant to your learner.

How to use Section 5

Refer to the diagram on the previous page. For each of the items under the five broad headings to the left you will want to record whether the learner responds Consistently, Occasionally or Never.

You may already be able to complete some of the items of this section. For instance if presentation of objects by sound resulted in the learner reaching out to touch the object you will be able to show on the diagram which positions the learner was able to locate.

Transferring results to Section 18"Learner shows awareness.."

For this to be the case you may not have found any specific response. Instead, you will observe only vague and non-specific tactile responses. If, therefore, your results show that the learner responds Consistently to the item, go to the Summary Chart in Section 18, find the row for Section 5 'Touch' and put a tick in the box for Awareness. Then move on to the next topic (Learner attends to..)

If instead the learner responds Occasionally, try again on different occasions. If the result is still Occasional use Awareness as the level of responsiveness. If so go to the Summary Chart, find the row for Section 5 'Touch' and put a tick in the box for Awareness.

If the learner Never responds to any of the items under this heading go on the Section 6 dealing with 'Smell'. Note that you should not have results in which the learner Attends, or Localises or Recognises or Understands by touch but is still not Aware. A learner has to be Aware in order to Attend to, Localise, Recognise or Understand.

"Learner attends to touch.."

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 more specific tactile responses such as to certain surfaces, toys or food.

If your results show that the learner Consistently responds to each of the items on the checklist under Attends, go to the Summary Chart, find the row for Section 5 'Touch' and put a tick in the box for Attending. Then move on to the next topic (Learner localises by touch..).

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

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 6 dealing with 'Smell'. Note that you should not have results in which the learner Localises or Recognises or Understands through touch but does not Attend through touch. A learner has to be able to Attend in order to Localise, Recognise or Understand through touch.

"Learner localises by touch">

In this part of the checklist you are presented with a diagram. Use it to show areas around the learner which can be located. Possibly this will occur through reaching, showing preferred direction(s) for reaching. Of course, you may want to use it to show directed leg movements or to indicate attempts to roll. 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 indicating the learner knows how to search purposefully for objects by touch.

If your results show that the learner Consistently responds to each of the items on the checklist under "Learner localises by touch..", go to the Summary Chart (at the end of PAR TWO), find the row for Section 5 'Touch' and put a tick in the box for Localises. Then move on to the next topic (Learner recognises by touch..)

If the learner responds Occasionally to one or both 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 by touch".

If all are Occasional try these out on different occasions. If the result is still Occasionally 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 through touch but is not Aware of or Attending.

"Learner recognises by touch…"

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

For the learner to Recognise you will have observed specific tactile responses indicating that a range of objects is familiar to the learner. In order for you to justifiably say that the learner Recognises through touch, it has to be very clear to you that the learner is making a clear distinction between a range of familiar and unfamiliar objects, people and places by touch.

If your results show that the learner Consistently responds to each of the items on the checklist under "Learner recognises by touch.." , go to the Summary Chart, find the row for Section 5 'Touch' and put a tick in the box for Recognises. Then move on to the next topic (Learner understands..)

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..">

If all are Occasionally try these out on different occasions. If the result is still Occasional use Localise or Attend 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 6 dealing with 'Smell'. Note that you should not have results in which the learner Understands through touch but is not first Aware, Attends and Recognises. A learner has to be able to Recognise in order to Understand.

"Learner understands uses.."

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

For the learner to Understand you will have observed very clear tactile responses including an understanding of a wide range of uses. It has to be clear to you that the learner is making sense of this wide range of objects, people, events and places.

If your results show that the learner Consistently responds to each of the items on the checklist under "Learner understands uses of objects by touch..", go to the Summary Chart find the row for Section 5 'Touch' and put a tick in the box for Understands. Then move on to the next section (Section 6) dealing with Smell.

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 to Section 6 dealing with 'Smell'. Note that you should not have results in which the learner Understands but is not first Aware, Attends and Recognises through touch. A learner has to be able to Recognise in order to Understand.

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.


: You can skip the remainder of this section and proceed directly to carry out Section 6 dealing with Smell. By doing this you will complete more of your assessment of the learner's use of 'The other senses'.


: 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 touch. At some point you should still carry out further assessment using the remaining sections of this chapter.

Developing a curriculum

Improving awareness:


A fair amount of information has been written on the use of massage with learners who are multiply disabled. In fact a few 'specialist therapies' have suggested it as a panacea for all ills of people who are multiply disabled. It is important to retain some sort of perspective about the use of massage.

Massage can be very useful in alleviating the difficulties imposed by a learner being 'tactile defensive'; disliking being touched. It can also be useful when introducing new experiences to the learner. If massage is perceived by the learner as relaxing then the new activity or experience can be associated with this relaxing occupation. Another important area for its use is in the early establishment of a relationship with the learner: it can be useful to form trust.

When using massage always be prepared to turn this essentially passive event into one that is brought under control of the learner. If, during massage, you see the learner begin to massage or in some way indicate another part of his or her body, start to massage that area (within reason!). This is one way for a learner to begin to appreciate that people respond to movements she makes. In this way the foundations for signing as a medium of communication can be laid down.

Another method of massage is to use a hand massager which would be turned on only consequent upon the child moving her hand in the direction of the device. (Naturally, you would have to begin by switching on the device and introducing it passively for a few seconds. Otherwise the child will not be aware of its presence).

(Relevant to other sections too)

Encourage understanding of finger play and action songs (see the List contained in Section 4) Games with actions such as clapping hands; bouncing on lap; see-sawing are good fun.

Beyond the hands

There are many other approaches in trying to increase the type and extent of movement of a learner who is physically disabled and with a severe mental disability. Lilli Nielsen and others have noted that we too often concentrate upon one set of physical movements, while ignoring other potentially productive targets for our work. For example rather than concentrating upon the hands, a child's feet may be dangled in a metal or plastic basin, into which a different substance may be placed each day. Nielsen suggests the use of syrupy liquid, breakfast cereal, tepid water, you might also use table tennis balls, cat bells. Each substance is used to signal a different day of the week. The following week the same substances reappear in that order. Here one is looking for any type of exploratory foot movement. One may observe one kind of movement with one substance, perhaps different from that with sounding objects or cornflakes or liquid for example. If movements be come consistent and different from one substance to another then introduce some variety, such as a substance which is disliked always presented to one side. Note any signs of anticipation.

If there is any change noticed in using this approach then one would have the opportunity to begin the kind of environmental control that we discuss in more detail in Appendix I (Switches and Interfaces). For example, a foot kick against a switch might operate a tape recorder in the same way as it might activate a Pethna box.

Resonance board

Another practice introduced to this country by Lilli Nielsen is in the use of a resonance board (see Figure 6.5.1). Small movements of the learner will cause sounds to be magnified and the resulting vibrations can be felt by the learner. This may help to improve the understanding of a relationship between movement, sound and touch. This in turn increases awareness of position of the limbs2.

fig 6.5.1

There are several variations on the theme of using a resonance board. The board might be placed on wooden supports, providing a slight slope. A coating of varnish is preferable to gloss paint, both in reducing glare and in providing a source of clearer vibration. Omitting a pillow improves sound conduction, though this may not be ideal for every child. (Consult with a physiotherapist). You would want to avoid encouraging excessive rocking of the head from side to side. The resonance board can also be used with the learner lying in different positions, such as facing down the slope, up the slope, side lying as well as on her back.

Using movement

Although deprived of many of the cues we take for granted in face to face interaction, others, may often be recognisable in the child. For instance, subtle movements of the hands or legs of children may be present in a manner that seems consistent with different sorts happenings in the child's surroundings. Ask the parents and other staff about the kind of pleasure-like sounds their child makes, which they know to have emotional significance. Use, as the parents may, vocalisations and laughter to allow their smiles to be detected by the child. This gives non-visual feedback in conjunction with (or as a substitute for) visual feedback. Laughter can be felt through the body while holding the child. A whole field exists for work with learners who are deaf-blind trying to make use of such gross cues for information on emotion3.

A related area is mirroring of the learner's actions. At one level this movement therapy (as it has been called) can be done by responding in exactly the same way as the learner's movements. An alternative is for the learner's actions and reactions to be responded to by vocalisations and/or movements made with the learner. In this way one promotes the idea that her own actions may influence the environment. It is like trying to become an acoustic or tactile mirror, substituting these for the usual qualities of a mirror for the sighted child.

Improving attending:

Tactile cueing (signifiers)

Use an object to indicate the onset of a new activity. At this stage use only one object and one activity. It is best to choose an activity that seems to give pleasure to the learner. The object chosen to represent that activity has to be one that does indeed have some strong association with the activity in the mind of the learner.

Signifiers may also be used as a means of identifying people - members of staff. Again it is best to use an object which already has an association with that person - perhaps an earring. It is important that once the association is established between object and person that you move on to separate the object from the person. At that point the object begins to represent rather than be that person. This is the kind of single association - done at this stage - that lays down the foundations for use of tactile calendars, activity shelves and activity boxes discussed in later sections. (An example of following the Commandment Thou shalt think of tomorrow)4.

Resonance movement

The use of this technique is yet another instance in which the field of visual impairment in the presence of multiple disability can learn from that of deafblindness (or to be more precise dual sensory impairment). It is not to be confused with the use of a 'resonance board' as outlined earlier. It does however follow on from the discussion above on 'Using Movement'.

Think of a young baby. As the baby initiates a movement the adult may take it up and continue with the infant. Or the adult may await a slight movement by the child as a signal to begin a movement such as rocking to from side to side.

Resonance activities are just the same. In them the adult maintains physical contact with the learner. They then go through a kind of 'start-stop' process. The adult usually moves first, stops and waits for the learner to signal the start of the movement again. At that point the adult begins moving again. The signal by the learner may be of any kind - a smile, vocalisation, hand movement or other. The adult is in effect making his or her movement contingent on a signal from the learner. The adult is imbuing communicative intent to the signals from the learner.

Through this means not only is contingency being afforded. A relationship is being established and trust is being introduced, where both learner and adult are being allowed the opportunity to respond to each other's movements.

Other variations of this kind of activity have variously gone under the name of "Intensive Interaction", "Intensive Education" and so on5. It is not within the scope of this book to discuss similarities and differences of these approaches in any detail.

Co-active movement6

As with resonance movements described above, the coining of the term "co-active movement" along with its use as a technique of intervention, was introduced by Jan van Dijk in his work with dual sensory impaired children. Both are fine examples of adhering to one of our Ten Commandments - Thou shalt follow the learner's lead (contingently). Co-active activities are the next step after resonance. The major difference is in trying to create more of a physical (and thereby mental) distance between the movements of the adult and those of the learner. Instead of having the close physical contact of Resonance Movements, the movements of adult and learner are gradually separated. The time to introduce co-active movements is after the learner has participated in several resonance activities. It is important to link in another of our Commandments - Valuing the learner. In this case stress is laid on trying to recognise and value efforts by the learner to show intention. In a similar 'start-stop' sequence the adult is particularly sensitive to signals from the learner.

Co-active movements may become more complex through involving sequences of movements the learner is able to carry out, eg; walk-turn-walk. Through these the learner is encouraged to conceptualise the world in an increasingly abstract manner.

Improving Localising7:


Placing objects beside and within swiping distance gives both positive and negative affects. The positive effect is that reaching is thereby encouraged as well as outward movements of the arms. Mobiles are attractive and useful if placed close enough to be seen, heard or touched. However, their usefulness is limited as all that is necessary is to swipe from side to side. This will eventually result in contact. Similarly objects of different materials are often placed in the child's hand or nearby. The result is that grasping becomes a passive exercise and reaching a swiping exercise.

However, some of this movement may be capitalised upon. For example, one would be to place an object a table top and knock the object off. Attempts can be made to encourage locating the object either by visual scanning or to have the location provided through sound. The object could be attached by cord or string to control the distance it falls, and also make retrieval easier. Once successful in one plane, such as on a table top, then this should be extended more to free space.

Stabiles can be more useful to a blind child if fixed to a cot, on a baby chair or attached to a wedged chair or with the child lying on her back. Toys should require different types of manipulating such as a rolling ball, bell, one requiring a pulling effort. Commercially produced activity centres can be used but remember to change positions to challenge the learner by presenting the objects and activities in different orientations. This too encourages the child to explore.

Tactile playmats

Instead of using only differences in visual contrast when making a playmat (as in Section 14) these may also be made out of different textures. It is useful to have clearly distinguishable sides in order to give added clues to orientation. In this way, visual contrast is combined with tactile contrast. For example, a smooth dark coloured surface may be set against a rougher surface of a lighter colour. Sheets, quilts, or blankets can be decorated with paper, small bean bags, etc.

Involve the child in rolling movements. In this it is helpful provide a consistent textured surface as this encourages concept of place in space. It can also be helped with the addition of sound sources such as washing machine, fridge, running water.

Improving recognising:


Following Jan van Dijk, we present this term in the same context as that used for Resonance and Co-active movements. That is Imitation is seen as the next step after Co-active Activities. Now increasing emphasis is placed upon the gradual introduction of a time-lag between the activities of the adult and those of the learner. The learner is encouraged to join with the adult's movements. In a gradual fashion more of the movement is shown while the learner watches on. Eventually both are carrying out a series of movements by imitating one another.

In all three instances - resonance, co-active movement and imitation - the essence is that interest in the world follows from opportunities to influence that world8.

Tactile calendars

In Section 10 we also present the idea of constructing a tactile calendar. This idea has sprung mostly from the literature on deaf-blindness, being associated with Jan van Dijk at Sint Michielsgestel, a school in Holland. More recently it has been used with a wider range of learners who have visual disability in association with other disabilities. (Indeed the technique applies beyond those who have visual impairment). We do not propose to repeat the discussion contained later in Section 10. Here we will focus on some of the issues surrounding use of tactile calendars.

What is a tactile calendar?

A tactile calendar is no ordinary calendar. Rather than containing days and dates which would be too abstract for those who are multiply disabled an activity calendar may be designed using a mixture of real objects. The objects could be perceived both visually and non-visually through touch, smell, sound and taste.

Alongside each of the days, leave plenty of space in the row. These are used to position objects horizontally. Objects or parts of objects are used to indicate different activities. There are many ways to do this and a fuller discussion is given in Chapter 6. One strategy is to begin with the week blank, and as each activity occurs, its signifier (the object referring to it) is added to the calendar. The signifiers can be kept in a special box. By the end of the week, there are 'memory pegs' which can be discussed and explored in other ways.

fig 6.5.2

Why use tactile calendars?

Some suggestions for occasions in which a tactile calendar may be useful would include the following:-

  • in presence of memory difficulties;
  • where problems in representation (perhaps due to global learning problems or 'mental handicap
  • only limited use of gestures;
  • and of course visual impairment;


  • greater emphasis is placed upon perceptual rather than cognitive abilities. This opens up the potential number of learners who could make use of this as a system of communication;
  • they are relatively permanent, using recognition memory rather than recall memory;
  • although possibly cumbersome the calendar may be moved around, giving a semi-portable system of communication;
  • there are less demands made upon physical abilities, opening up a range of ways for the learner to indicate the object/activity such as pointing, touching, eye pointing;
  • figure versus ground relationships are enhanced: some visual perceptual problems (eg; due to 'cortical visual impairment or blindness result in difficulty for the learner to distinguish a 2-dimensional figure from its background;
  • there can be an obvious relationship between the object and its referent (the activity to which the object refers);


Practical problems with using tactile calendars are that:

  • although the calendar is somewhat portable, nobody could say that they are very portable;
  • difficulties exist in finding enough objects to represent activities.

In addition to these practical problems there are conceptual problems with tactile calendars.

The calendars do not give a high degree of specificity. If a learner should point to an object it could mean any of these: "I want to do that now" (a request); "Wasn't it fun when we did that" (a statement); "When are we going to do that?" (a question) and many more.

A second conceptual difficulty is the converse of specificity - it may be difficult to generalise out from the objects on that calendar. How does the learner communicate intentions that are not contained by objects that are on the calendar? The answer here is to plan ahead in order that you aim for generalisation.

Using the calendars

As the learner becomes familiar with one object/activity relationship, introduce change. Such changes may be to the object itself - just as a swimming cap may represent swimming so too could a bar of soap; or use the same object but change its size. Or change the activity slightly so that the same object may stand for a slightly different activity. In this way you are offering the same thing as the multiple meanings which may be afforded by a symbol - the same symbol may represent more than one meaning.

Other practical uses

There are many potential avenues of usefulness for the tactile calendar including:-

  • as forms of expressive communication - going beyond the passivity of the learner always having to respond to another person. Instead he or she can initiate communication;
  • going beyond the 'here and now';
  • avoiding making significant cognitive leaps in understanding;
  • where there is difficulty in moving to abstract relationships between conventional sign and the meaning of that sign.

Practical tips

  • where one activity takes relatively longer than others, allocate more space to the object on the calendar;
  • know ahead of time what you will do if the learner takes the wrong object from the calendar - will you be in control or will the learner be in control?
  • practical considerations in your work area will dictate whether you begin on Monday with a blank calendar (though days of the week will still be represented) and gradually fill it up as the activities are carried out; or you start with one whole day filled; or have the objects in place permanently.

How concrete is concrete?

It is important to get right the level of representation for your learner. Too abstract an association between object of reference (or signifier ie the object on the calendar) and its referent (the thing to which it refers) and you may well get success but for the wrong reasons. Here is why.

An abstract shape, say a square, could stand for "I want to go out" or "We're going out now". And one can teach chimpanzees these sorts of relationships. But you would be hard pressed to state why this relationship exists. In simplistic behaviour modification this could indeed work. For an association would be built up over a period of time so that

Square = Going out

But there would be no carry over to make learning of the next association any easier. Learning would be slow and pedantic and difficult for the learner. Two of our Ten Commandments - Thou shalt not compartmentalise and Thou shalt think of tomorrow - would be violated.

You want to encourage "learning to learn" to take place9. As an aide-memoire Table 6.5.1. sets out a hierarchy of difficulty of representation between signifier and activity. The top line gives an example of the most concrete relationship. The bottom line presents the most abstract relationship.

table 6.5.1

Activity shelf

The tactile calendar may be augmented using an activity shelf. For this an area is set aside that is easily accessible but until then not often used with that learner. In that area, set aside a space, perhaps a single shelf or a table in a cubby hole. Start with one activity and use a single object that is linked with that single activity. For instance, for a child it might be going swimming or playing in a mobile car. Suppose it is the latter, a big, bright, orange, yellow, and blue car. You then need something that signifies this activity. It may be that, when in the car, the learner loves to press a big bright red horn. That horn becomes the object on the shelf.

All the learner has to do is grab it from the shelf, or point to it (if she has enough vision), or reach for it. Arrange things so that the car is near enough to get quickly from the signifier (the horn) to the activity. Attach the horn and let her play a while. Suppose she has a go in the car and, an hour or so later, goes to the shelf and takes the horn. That's fine in the early stages, in fact that's what we are hoping for. If this happens often enough that she seems to have got the idea, then it's time to change. But what if she doesn't make the association? Do we just sit and wait? Before the activity, one person goes with the learner to shelf, picks up the horn, goes to the car and gets on with the fun. At the end of the activity, return with the learner to the shelf and replace the horn.

How would we let the learner know the start and end of the ride? If there is space on the shelf, you could put a 'finished box' there. The learner will probably not understand its purpose at first. Over a period of time, she may come to realise that, once the horn is in the box, that is that particular activity finished. Suddenly, a whole new set of possibilities is opened up. By this means, we could help the learner understand the different things that could be happening on any one day. You might have spotted a problem. Suppose someone goes to the shelf with the learner and begins to talk about the horn itself. You know the sort of thing. "Isn't it nice, what a lovely red colour, let's take it over there, and so on." This should be avoided, as it is then the horn that becomes the centre of attention to the learner. Instead, we need to focus upon the activity ie the car ride, not the horn. The horn only happens to be on the shelf because of its link to the car ride. The purpose of the objects on the shelf is in order to allow them to stand for the specific activity.

This activity can be used with many different levels of visual impairment, including total blindness. Use objects appropriate to the degree of the learner's visual disability - as assessed through these guidelines. For a learner who can see medium sized objects, as it is the start of a new activity, use highly contrasted materials against a plain background. For the learner without sight, use distinctive smells - those associated with the swimming pool for going swimming, for example. Or relevant tactile materials, or both. So long as the signifier is associated with the activity.

Pick up on this but not too many times. Car rides all day might be all right for a while, but there is a time for moving on.

The link should not be broken, nor the response of the staff stopped. Instead now is the time to add another object to stand for another activity in which the learner shows interest. Each individual link is a micro-teaching opportunity to discover. The bigger picture - the macro-teaching - is that other objects on the shelf have a similar overall usefulness. The list of objects that can perform the function of signifier is as endless as the list of activities in which the learner's interest is known to be engaged. This is not to say that a clutter of objects should be on the shelf at one time. However, it is a fine idea to place more than one signifier on the shelf. This enables the learner to demonstrate a choice between or among different activities.

Tactile books

Although discussed in detail in the next topic (Learner understands...) signifiers of activities in which the learner had been engaged can be glued into a loose-leaf book. This gives a personalised history of places and events that were of interest to the learner.

Communicating by sign10

To do justice to the topic of sign communication would require at least one book and at least the length of this book. We would nonetheless like to mention a few things about sign in communication.

We have included sign communication at this point simply because it is the most likely place a reader may look for discussion of the topic. However we do not believe - as we hope you, too, do not believe - that the full range from simple movement right through to sign language can be presented under one topic heading. There are many curricular suggestions which we have given throughout this book that would help to lay down the foundations for introducing sign in a more formal way. We chose not to describe these as signing because to have done so may have confused readers. This is the right place to have some limited discussion of the topic. Here are some thoughts to hold:-

  • just because a learner is blind and multiply disabled does not mean that signing is 'not for them'. Signing is not the exclusive province of the hearing impaired;
  • 'signing' does not have to mean the adoption of some formal system of sign;
  • adapting conventional signs can be very helpful where there is visual disability;
  • remember always that signing is two-way. Don't expect the learner to be a passive recipient of signs. If you do then there will be little chance of her using sign to initiate.

It is not only those who have the dual sensory impairment of deaf-blindness who might benefit from this form of augmentative communication. Often the learner who has low vision (or even total blindness), coupled with difficulties in expressive communication, may be able to use modified signing to achieving. Yet it may not be tried. There are clear reasons why this approach is often not tried. First, standard forms of assessment of communicative competence rarely fully incorporate the needs of the learner with severe visual impairment11. The effects of visual impairment are not taken into account in the assessment at the subsequent interpretation of results. The result is that the importance of non-verbal cues for understanding of language - taken for granted when dealing with the sighted learner- is often missed with the learner with both visual impairment and difficulties in expressive communication.

Use of computers

Some additional general information on the use of computers with learners who are multiply disabled is provided in Appendix 2. There are two areas of new information technology which are most appropriate within the context of using tactile information. One is to use computers which can make use of software operated through a Concept Keyboard. The second is in the provision of augmentative communication aids which have tactile overlays.

Concept keyboard


Instead of overlays containing 2-dimensional symbols, pictures, numbers or letters the overlay can have these presented in tactile form in 3 dimensions. You could use real objects in a similar way to the calendar mentioned earlier. The range of these signifiers (or objects of reference) can be as large as one's imagination. For non-speaking learners, or those with severe articulatory speech problems, a speech synthesiser attached to the computer can give spoken output.

Communication aids

There are available a host of dedicated communication devices. Their advantages over 'computer + concept keyboard arrangements' is that they are portable and they are designed specifically for the task of enhancing communication. Recently more work has been done in the use of tactile overlays for these devices, thus opening up their potential for those who are multiply disabled with visual disability.

If you are considering pursuing this as an option then it is important to obtain specialised assessment and training in the use of such devices. A number of centres in the UK (and in many other countries including USA, Sweden, Denmark, Holland, Australia and many others) offer these assessment and training services. Appendix 2 lists some of these centres. A final point is that although there are a few studies which discuss using tactile surfaces for these devices much more work needs to be carried out. Who knows perhaps it will be you who produces the next report!

From 3D to 2D

With the results obtained to items in the various sections of Chapter 7, you will be able to establish whether the learner has some visual ability to distinguish 2-dimensional shapes. If so you have the beginnings of communication through symbols (for those who are speech and/or language impaired). However to introduce symbols immediately would be too great a cognitive leap. Better to move gradually from tactile (concrete and real) through to symbol (abstract and less real). How to do this?

There are two main factors to bear in mind. One is the materials you use. Second is the teaching style adopted to introduce the more abstract symbols.


The essential idea is to devise ways which allow a gradual shift from the concrete to the abstract. Table 6.5.2 gave a way of thinking about signifiers on calendars. That table showed a move from concrete to abstract, with pictures and symbols coming at the foot of the list. There are a variety of ways in which to shift gradually from concrete to abstract. We could reduce the size of the real object by using a part of the whole object. A 2-dimensional raised diagram can eventually be used for a 'blind' learner, and a well-contrasted symbol for a learner with residual vision.

In conjunction with this a faint line can be marked around the signifier. Each week the line becomes heavier. Eventually it is the outline that is being responded to rather than the concrete object.

Another possibility is to embellish the signifier (or the symbol). This involves adding some other feature to the signifier so that the signifier takes on an extra meaning. With one signifier (or symbol) able to have more than one meaning this cuts down on the number of signifiers needed. It also gives rise to the possibility of symbols having multiple meanings.

Teaching techniques13

Any combination of ways of using these materials in moving from the most concrete to the most abstract can be enhanced by the use of a variety of teaching techniques. The main feature of these techniques is that some are very directive - the teacher/therapist/carer is in control - while at the other extreme there are techniques which are non-directive.

Examples which are most directive include Errorless Learning; Massed or Multiple Trial Instruction.

Those which come in between include Mand modelling; Time delay; Facilitative Communication.

And least directive include Prompt-free teaching, Incidental Teaching; Exploratory play.

A useful tip is to begin a new activity with most directive and as quickly as possible move on to least directive teaching methods. This is not meant to be prescriptive. You may well find that the learner responds best with non-directive methods even when beginning new activities.

Improving understanding:

Here it is time to move firmly into the province of those who are less multiply disabled, and more likely to have the single impairment of vision. We therefore consider only a few small areas and follow this up by suggesting other sources of reference. Of course, there is a wealth of variation in what is covered by the term "Understanding". As we indicated at the outset, the structure used throughout has been that of an organisational rule of thumb: there are no hard and fast rules which must be followed rigidly.

Books and pictures

There are certain activities in living and learning which could fit appropriately into several of the sections of this book. One of these is the use of books, both visual and tactile, for recreation and learning. We have chosen to place it in the section on Understanding through touch although it deals also with visual as well as tactile representations.

Books play a very important part in our culture and education. From about one year of age, when infants are learning to talk, being able to point to or name a picture in a book provides children with a feeling of achievement and further motivation to communicate, as well as thrilling their parents and family! It lets us know that the child is able to think symbolically, recognising that the visual representation in the book is a symbol for the real object, apple, book, brush or whatever, just as saying the name "apple", "brush" shows that the child is beginning to understand and use the symbol in system of language.

It is just as important for people with visual impairment as for people who can see, whether young or old, to have access to books and illustrations. It is also important for the families, teachers and others to make sure that they provide these for people in their care. But how we decide what would be suitable or meaningful? Let us think about it under the following headings: visual illustrations; hand-made books; tactile perception; learning from the learner.

Hand-made books

As we have said before, multi-sensory input, whenever possible, is very important. To help confirm for the child what she is seeing, additional tactile, auditory or olfactory clues can be used. There are a few tactile books, pop-up books and scratch and sniff books produced commercially but you would be lucky to find ones to suit your purpose. For all those whose vision does not allow them to see small objects with poor contrast it is advisable to use information additional to the purely visual. That does not mean that you don't let your student leaf through books or catalogues just for the pleasure of it! We all know that most children love the smell, feel and sound of turning pages and it also lets them imitate adults and feel "grown-up". However, illustrations used as a teaching aid will need to be more than purely visual.

Hand-made books share the features of both picture books and toys, combining the features of concrete objects with abstract features of a picture14. They can have detachable and re-attachable parts involving simple skills such as pulling or more complex skills of unfastening. They can contain objects to be found and re-hidden. They can be moving pictures or "movies": a monkey on a zip can be made to climb up and down a tree! (Imamura 1981).

Hand-made books can be used for many teaching and learning purposes. Here are some and you will probably want to add many more:

  • to coordinate movements of hands, arms and eyes (if vision is present);
  • to develop perception and recognition through vision, touch, hearing and sense of smell (or any combination of these);
  • to foster the development of symbolic understanding: from object to tactile symbol of it; from tactile to 2D and/ or sign or spoken language;
  • to provide the learner with "concrete" help in developing the concepts necessary to follow a story, eg; the main "character" can be moved from page to page;
  • to stimulate memory, anticipation and imagination through the combined use of the senses, eg; items as well as pictures, associated with the learner, family, home or holidays could be used to make a "photo album".

The materials chosen and the purpose for which the book is made is determined by the level of vision and other learning needs of the child. Some types of books, such as the alternative "photo album" mentioned above would be appropriate for all ages though the materials and items used would be chosen to suit the vision, hearing and manual dexterity of the learner.

Perhaps it would be useful to stress again the difference between making and using books as a teaching tool (which would take into account the sensory and cognitive development of the individual), and provision of books or illustrations for leisure, pleasure or because they are age-appropriate, eg; photo album for all; pop star scrap book, posters, diary for teenagers or older.

Tactile perception

Visual illustrations and written language have evolved over time and in different cultures to suit the detailed discriminations possible by sight and often depending on the drawing tools available at the time14. There are certain visual conventions that we learn to recognise, eg; a line for the horizon, shading representing contours, perspective representing distance. All of this means that there is more to translating from a visual image to a tactile representation than just making the outlines tangible! (though that can be helpful to someone who has some vision and could have this visual perception reinforced by feeling the outlines).

If you would like to get a clearer idea of what "seeing" by touch might mean ask a friend or member of your family to gather together different objects, some familiar, others not so familiar, and to present them to you with your eyes closed or with a blindfold on. See if you can recognise them and think about how you did it. How did you hold, touch and manipulate them? Did you just use your hands, fingers and palms, or did you use lips, tongue, cheek and other senses? Did temperature, weight, texture help? Did you use mental images to help you identify the objects?

If you can get tactile or raised pictures or diagrams from your local specialist teacher, school or centre for the visually impaired, then try making sense of these, unaided and blind folded. You will probably to ask for help as without any verbal or contextual clues you will find it very difficult, if not impossible to make sense of them.

From this experience have learned that underdeveloped tactual skills on their own cannot cope very well with interpreting the environment. The use of other senses can help, as can previous experience of the object or what is depicted and also knowing a bit about the context. Very fine detail is extremely difficult to perceive by touch even for those with well-developed tactual skills. Being "talked through" the picture helps. Bearing all these things in mind will help when you are making books or illustrations for your students.

If you have a student who would be able to cope with the equivalent of 2D representation and who has no useful vision, or a student who can see pictures but would benefit from raised outlines or other tactile clues, then contact the specialist teacher school or centre as there are materials and equipment which can produce enlargements and tactile pictures and diagrams. These can be made using an acetate - like sheet with stylus or spur wheel; a master collage reproduced on plastic sheets by means of a heat machine (thermoform); hand-drawn, photocopied or computer-designed drawings photocopied onto special paper and put through a heat machine (fuser).

Learning from the learners15

There is a very important source of insight and inspiration which we have not yet mentioned while considering pictorial representation: the learners themselves!

In the past we have expected blind people to accept and learn from our translations from the visual. Nowadays, thank goodness, more meaningful and beautiful diagrams are being produced for academic learning and appreciation of works of art15.

Much, however, still remains to be done to explore how very young blind or multiply impaired children would express and depict their perceptions of the world - if given the opportunity.

At this point we would refer the reader on to work of others. Their suggestions deal in much more detail with those children who are capable of Understanding. For those interested in the needs of learners who have residual vision, they are invited to refer to Look and Think which describes curricular development work with children who have the single impairment to vision