University of Edinburgh
 

Vision for Doing

Assessing Functional Vision of Learners who are Multiply Disabled

Chapter 7 Assessing Vision for Doing

Section 16 Visual Responses to People

Aims of section 16

This section is designed for you to discover if there is any major discrepancy between what the learner sees when confronted with people rather than objects in the world.

How to use

section 16

Try to discover if there are Consistent responses to any of the four items on the checklist at the start of this section. For Occasional responses you should try again on subsequent occasions in various conditions of lighting and with different people.

Cautionary Notes

As we stressed before, remember not to allow previous items to influence subsequent items. Throughout the sections in this chapter we have been concerned to point out that it is important to carry out each section without sound. Often this is difficult to do. In this particular section it is extremely difficult to carry out the items while not speaking. It is very unnatural so do not worry if you find this difficult. Reassure yourself that you will not be doing this too often.

Transferring results to Section 18:

As with the other sections, you now have to decide what the results of your observations mean for the Summary Chart in Section 18. In that Summary Chart, you will find that in the row for Section 16 there is space to tick under a variety of boxes. It depends on which particular responses you observe.

No response to any of the four items?

If the learner Never shows any response, try again on subsequent occasions with different people and in different lighting conditions (that is in other Settings). If these too result in Never you should refer back to the curriculum suggestions in Sections 9, 10, 11, 12, 13, 14 and 15. You should still try Section 17 in this chapter.

If you found that the result for Section 15 on Size indicated she sees small objects Consistently but not faces or parts of faces, you should also read the suggestions in the present section.

OR score recognise if:

the learner Consistently recognises people by sight. If so, go to the Summary Chart, find row 16, and tick Recognise. You should certainly try to obtain a measure of visual acuity (see Appendix III for further information on one example of how to do so).

OR score localise if:

she Consistently makes eye contact but does not Consistently recognise people. In this case go to the Summary Chart (Section 18), find row 16, and tick Localise.

OR score attend if:

the learner Consistently looks at people's hairline or when glasses are worn, but does not easily make eye contact. In this case go to the Summary Chart (Section 18), find row 16, and tick Attend. Again come back and try again under different lighting conditions. You will probably want to return to the suggestions for curriculum development given in this present Section as well as using suggestions contained in the other sections.

OR score aware if:

she shows responses Occasionally but only to hairline or glasses. If so, go to the Summary Chart and tick Aware. Try different positions and under different lighting conditions, noting optimum responses by the learner. Then move on to Section 17. You may well want to return and use the curriculum suggestions given in this present Section as well as those in previous sections.

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. The choice you make will depend on the results you obtained.

EITHER

you can skip the remainder of this section and proceed directly to Section 17, dealing with assessment of the learner's mobility. By doing this you will complete your assessment.

OR

postpone further assessment and read the remainder of this section. In it we suggest activities for curriculum development.

Developing a curriculum

Improving awareness:

You will be interested in this topic if the Summary Chart has shown the learner to be functioning at this "level". The suggestions given in Sections 9 to 14 and in Chapter 6 will be more useful to you before trying out suggestions given in this chapter.

Improving attending:

You will be interested in this topic if the Summary Chart has shown the learner to be functioning at this "level". In addition you are likely to have found that the learner looks only at hairlines, and this response will probably be Occasional.

Learners may appear not to make eye contact but instead direct their gaze to a person's hairline. Because in the process the learner appears to be avoiding making eye contact this may be interpreted mistakenly as indicating autistic features. An explanation relying on the presence of a visual impairment should not, however, be discounted. Just as different colour combinations or of black and white shading give different effects in contrast, so too do different features of the face give varying levels of contrast. On many occasions, contrast between a person's hairline and background of a wall will offer enhanced contrast - more than that afforded by the same person's eyes. This is by no means true in every instance. Where possible, encourage the learner to look towards the eyes, making more of a fuss of her if she does so.

Looks at faces if wearing glasses

Often the same learner will look towards a persons eyes only when that person (not the learner!) is wearing spectacles. It is therefore worth experimenting to see if a person may be identified in this way. The reflectiveness of their glasses may be varied by moving towards and away from a light shining from behind the learner's head.

This technique may also be used in reverse. If the learner does not seem to be attending to faces, but does seem to be attending to the reflective surface of spectacles, then this can be paired with something that the learner prefers. Suppose a young child likes being tickled. As soon as the child looks at the glasses, tickle him. Then remove your glasses. After a time, tickle him while he is looking in that direction, even though no glasses may be worn at that time.

Light from behind head

A light shone from behind the learner on to the face of the teacher or other person interacting helps to accentuate the person's features and facial expressions. This enhances the possibility of encouraging imitation and of establishing eye contact. The most salient facial expressions to be used in encouraging imitation are through mouth opening, tongue protrusion, smiling and fluttering of the eyelashes. Different kinds of make-up such as eyeliner may be used to help highlight these features.

It may be helpful to introduce a variation on this theme by designing diagrams of faces, and have the learner point or otherwise locate different parts of the face.

Try encouraging turn-taking games. This conveys the idea that the learner can take the initiative in communication. This is something which is often difficult for a blind child to understand.

Improving localising:

You will be interested in this topic if the Summary Chart indicates Localising, and if there appears to be Consistent eye contact.

Should the learner actively avoid making eye contact then you should begin some further questioning. As a sign of visual competence, consistent avoidance of eye contact is as good an index of a degree of visual functioning as is the establishment of eye contact. However the question then becomes one of why the learner should avoid making eye contact. Some possible reasons include:-

  • being forced into making eye contact;
  • the presence of autistic features.

Forced eye contact

Often professionals mistakenly force the learner into making eye contact. This usually happens when making eye contact is regarded as a "stage" which the learner must be able to achieve, prior to moving on to greater things. However unless there is a very clear aim in mind then it can be an irrelevance for the learner. Ask yourself what is in it for the learner to engage in this activity. Some indications that this is the underlying reason for avoidance of eye contact could come from a difference in results when different people are interacting with the learner. If this avoidance occurs only with certain individuals this would suggest the need for a change of task - and perhaps a change of person.

It is important to try to explain consistent avoidance of eye contact. For such avoidance may indicate sufficient visual functioning to merit an investigation of the use of well-contrasted pictures or symbols as a system for augmenting communication. This would be particularly appropriate if the learner does not use speech as a method of communication.

Some learners may be sensitive seeming invasion of their personal space by someone coming very close to achieve eye contact. One way around this is to use a "third party" that is not a human eg; a puppet or doll. This may serve to relieve the stress of a situation and make it good fun to participate.

Autistic features

There is little to be gained by simply labelling a learner as autistic. You would still want to pursue methods of developing a curriculum for the learner.

The working principles set out in Chapter 4 would still apply. Moreover much of the information contained in the sections of this book would also apply. Lilli Nielsen has also done much to promote a re-consideration of rigidly held views1.

Improving recognising:

You will want to pursue this topic if results in the Summary Chart indicate the level of Recognising to be appropriate. Moreover, the learner may be recognising people's faces.

You will no doubt want to pursue this to determine at which distances face recognition can be obtained. As the individual features of a human face are mostly objects with fairly poor contrast (cheeks, lips, chin) this level of ability represents a fairly high degree of visual functioning.

Prosopagnosia

If the learner shows tick Never able to recognise faces but he can recognise small objects, pictures, symbols and/or text then you may be interested in this topic. In most instances it is not too surprising to discover that those who have visual impairment are less able to recognise faces than are the able sighted. However it may be surprising to learn that a few people, who are quite able to see smallish objects and to identify their features, are still unable to recognise faces. They may not even recognise the faces of close relatives whom they have known for many years. This unusual condition is known as prosopagnosia. Most people who suffer from this condition are elderly where the condition has arisen following a stroke, affecting a particualr area of the brain. Nonetheless a few children have also been reported as having the same disability.

There are different kinds of prosopagnosia. First there are those who can identify familiar faces. More severe cases cannot even recognise faces that are very familiar. In the latter case friends, teachers and even family members go unrecognised. Nevertheless those learners, while not recognising people, will still be able to see small objects, pictures and often text of the size you are reading now. It is not therefore a problem of visual acuity.

What to do?

Often recognition can still occur by voice and this should be encouraged. Also, interestingly, specific facial expressions may still often be readable even though the whole face is not. Mnemonic tricks may then act as an aid to memory. This is where the learner is encouraged to build up associations between a feature of a face, the context in which that feature was seen, and who belongs in that context. Clearly this requires fairly good cognitive functioning2.

Use of computers

A couple of computer based games are available which allow a child to 'touch the clown's nose'. But you do not need a computer to do this kind of activity. Use dolls, draw them life-size and accentuate specific features. For further information on useful software, consult some of the sources listed in Appendix II.

Improving understanding:

At this level of ability in visual functioning, you will certainly want to obtain a measure of visual acuity (see Appendix III). The learner will have access to a range of non-verbal communication abilities. These include shared gaze, joint focus of attention, facial expression, and others.

At this point the reader is also referred on to other sources such as Look and Think (see Reference section of the present book).