Transcript www.ctebvi.org

From
Rolling to
Walking
Therapeutic Living Centers
for the Blind
Eunice Lee, DPT, Physical Therapist
Rosa Tu, MA, Teacher of the Blind and Visually Impaired
Outline
• Discussion on the challenges parents face with early motor development for a child
who is blind or visually impaired and who may also have multiple disabilities.
• How to avoid long term impact by creating a stimulating space for learning.
• How to facilitate children’s movement without interfering with their development, but
rather designing opportunities for children to be active learners and learn through
their own actions within the home or natural environment.
• Make and take session with simple tools for families to use to improve motor
planning, promote active listening and learning, and encourage social-emotional
development.
Considerations
• Remember that each child is unique
• A severe visual impairment affects visual skills as well as other areas of development, and
many infants who are visually impaired may have additional disabilities
• Collaborating with the educational team to help the child optimize his/her skills in all
areas is a crucial
• Depending on the child’s areas of needs, the child will benefit from a multidisciplinary team
approach to address the family and team’s concerns
• Use of adapted equipment
• Safety is a priority!
Vision in Early Motor Development
• Newborns - Visually goal-directed movements: looking, reaching, grasping, head
control, learning equilibrium, communication with gaze and reciprocating
expressions and body language
• Mobile - Moving is guided by vision for direction, for equilibrium and balance.
• Objects that cannot be seen do not exist
• Cause and effect
• Seek independence
• For those affected by a visual impairment, they learn about the world with different
senses and then process it differently. It does not mean they are impaired. It just
means when addressing and working with them, we have to be aware, they don’t learn
like you learn.
Typical Pattern for Early
Motor Development
1. Cephalocaudal (Head to Tail progression)
2. Proximal to Distal (midline out to
extremities)
3. Early large range movements to fine and
precise small movements (random
kicking to proper feet placements while
walking)
4. Core stability is essential to ALL
movement
Impact of Early Motor Development due to
Visual Impairment
• Getz (2000) states that approximately 75-90% of all learning is facilitated via the
visual pathways
• Children may appear as uninterested or passive (First Steps, BCC, 1993)
• Achievement of developmental milestones (e.g. acquisition of fine and gross motor
skills) may be delayed or out of order (Kastein, Spaulding, & Scharf, 1980)
• Purposeful and self-initiated movement may be delayed
• Children may be fearful of open spaces
Motor Development with Visual Impairment
Visible Traits:
• Decreased muscle tone (First Steps, BCC, 1993)
• Postural differences (Barraga, 1976) such as Deviated Head Position, with Stiff trunk and poor
quality of movement
• Wide base for stability
• Self initiated vestibular system stimulating movements for a long time- e.g. rocking, swinging,
eye poking, hand shaking and spinning. These inhibit acquisition of “normal” gross and fine
motor skills
• Diminished Static and Dynamic Balance
• Fisted Hands
• Diminished or altered self-image (low confidence) (Sonsken, Levitt, & Kitsinger, 1984)
Gross Motor Development (0-3 months)
Without VI:
With VI:
• Extension strength from flexed
position
• Similar awareness of her body and
movements by reflexes
• Tummy time – weight toward head
without arm support due to being
flexed
• Delayed head control and may
present with inability to focus on
objects
• Gradual forward arm reach with
straightening of body
• Head up to look around
• Sitting – rounded back with head lag.
Falls forward
• Standing – bears weight with legs and
may step from reflex and not
controlled movements
• Muscle tone fluctuations – hyper or
hypotonic
• Severe head lag during pull to sit
• Sitting – back arched excessively
Gross Motor Development (4-6 months)
Without VI:
• Improvements of head control while
being held or held in sitting.
• Tummy time: weight bear on their
forearms with head up and shift
weight. May push up on hands. Able
to roll to side to free up hands.
• Supine: Raise arms and legs up with
kicking and hands to feet.
• Sitting : back is more straight and
needs less support.
With VI:
• Less motivation due to lack of visual
stimulation leading to less head lifting
exercises.
• Because less opportunity to work on
head strength, other postural stability
achievements become delayed and
more difficult.
• Very important to introduce different
movement experiences during this
time to provide sensory input to elicit
motor output.
Gross Motor Development (7-9 months)
Without VI:
• Sitting with arm support eventually to
requiring no support. To challenging balance
with reaching.
• Tolerate hands and knees position
(quadruped) and may rock forward and
back. Eventually separate hands and knees
and learn to creep.
• Transitions: move in and out of positions
from floor to sitting providing more freedom
and opportunities to interact with
environment.
• Standing: weight bears better with support
and may shift weight side to side.
• May kneel, squat, and lower self to the floor
and able to get in and out of position and has
gained most of all components of movement.
With VI:
• Less variety of movement.
• Rounded postures due to decreased
muscle tone, forward head.
• Self stimulating motions like rocking
while on hands and knees but not
moving outside base of stance.
• Wide base of support in various
positions causing difficulty moving in
and out of position.
• Decreased trunk segmentation. The
stiffness reduces exploration and
manipulation of their environment.
Gross Motor Development (10-12 months)
Without VI:
• Higher level of movements with
various speed, coordination,
adjustments and refined balance
control.
• More use of hands with accuracy and
coordination. Hands are used
purposefully for daily functional
activities.
With VI:
• Due to fear while standing, arms may
be “W” and feet are positioned wide.
• Slowly, but able to learn to transition
from horizontal to vertical position
using less area for base of support.
• With parents to encourage and O&M
to teach how to make environment
safe and use sensory cues, child
learns to initiate movement.
Orientation and Mobility
• Per Anthony (Pogrund & Fazzi, 2002, p. 330), there are four main areas to focus on:
• 1. Continue to expand the child’s understanding of his or her own body, daily settings and
location in various environments;
• 2. Encourage, then help refine the child’s means of movement;
• 3. Reinforce the child’s purpose to move within his or her environment so that he or she is
motivated to explore and is capable of accomplishing a goal which requires having to move
as the means to achieve that goal; and
• 4. Assist the family and service providers in analyzing the child’s daily environments for
safety and possible modifications that will maximize self-initiated and goal-oriented
movement.
Strategies to Help Your Child Move and Explore!
• Strategies for families to support movement and exploration
• Support the child’s orientation by maintaining the placement of objects in the house in a
consistent manner and using spatial terms to describe locations (e.g. “Your toy box is next to
the tv”)
• Provide additional time for your child to look at, listen to, and explore new objects or
actively participate in household tasks to promote hands-on experiences in a functional
manner so that they can expand in their understanding of their environment (and be
independent as well!)
• Provide a safe home environment for the child to encourage the child to explore on his/her
own (e.g. using electrical outlet covers, keeping blind cords out of reach)
• Positively accept the use of low vision and mobility devices in the child’s natural
environments (i.e. home, school, community)
• Optimize lighting and the use of color and contrast in the home to facilitate ease of
movement and exploration for young children
Strategies to Help Your Child Move!
• Strategies for families to support movement and exploration (continued)
• Using objects with multi-sensory qualities
• Tactual (e.g. chains of beads with a bead in between each one, combs, whisks)
• Auditory (e.g. bells, measuring spoons, metal teaspoons)
• Stand in front of the child instead of behind him/her or on the side to orient the child to
move forward in movement and through space
• Use tactile markers to help and motivate a child
• Tummy Time
Strategies to Help Your Child Move and Explore!
• Individualized Adaptations include but are
not limited to:
• Number of items used
• Size of objects used
• Distance of visual target from the child (e.g.
within the child’s grasp to promote reaching)
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Strategies to Help Your Child Move and Explore!
• Vividness of color
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Strategies to Help Your Child Move and Explore!
• Vividness of color (continued)
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Strategies to Help Your Child Move and Explore!
• Contrast or simplicity of the background
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Strategies to Help Your Child Move and Explore!
• Complexity of the visual target
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Strategies to Help Your Child Move and Explore!
• Presentation method
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Strategies to Help Your Child Move and Explore!
• Illumination (e.g. natural lighting)
• Familiarity with the materials
• Preferred area of vision
• Position of the child
Source: Everyday Activities to Promote Visual Efficiency (Trief & Shaw, 2009), pg. 27, 398
Encouraging Children with Multiple Disabilities to
Move and Explore!
• Attach toys using suction cups or elastic to sturdy equipment (e.g. table, highchair)
• Place safe materials in an area that is easily accessible to the child who may not be able
to move independently (e.g. solid, high contrasting bins to store toys)
• Create positive experiences when exploring various objects and textures (e.g. being
held by a caregiver, lying on top of a comfortable blanket)
• Describe everything in the child’s environment along a route while providing additional
time for the child to process the information and explore
• Use real objects
• Have children participate in daily living activities using accommodations that are
appropriate for the child
Source: Early Focus (Pogrund & Fazzi, 2002), p. 373
Lilli Nielsen and Active Learning
• What is Active Learning?
• As the name implies, Active Learning revolves around the learner being active.
• “Since I am unable to come to the room, the room must come to me.” (Nielsen, 2003)
• Please Note: Dr. Nielsen’s approved equipment and books in the United States is
through the LilliWorks Active Learning Foundation. Also, remember that safety of
materials is a priority!
www.lilliworks.org
Strategies to Help Your Child Move!
• Head Control – Back, Tummy, Sitting
• Rolling - Back to Tummy, Tummy to Back
• Sitting – Supported, Weight bearing through arms, Unsupported
• High Kneeling to Pull to Stand
• Cruising
• Walking
Source: Snell, R. (1997) http://www.csun.edu/~hfedu009/innovations/html/motordev.html
Case Studies
• Our parents have provided us permission to share videos and photographs of their
children
• Release of information and photographic release forms were obtained
Parent Panel
• Tatiana
• Aishling
Cardboard Tube
Make
and
Take!
Penny Can
Household items are
inexpensive yet stimulating
and fun educational
toys/activities that may
improve motor planning,
promote active listening and
learning, and encourage
social-emotional
development!
For additional copies of these hand-outs as well as other great
resources for parents and educators, please visit
the Braille Institute’s Child Development Center website:
http://www.brailleinstitute.org/documents/index.php/
category/child-development
References
•
Anthony, T. L., Bleier, H., Fazzi, D. L., Kish, D., & Pogrund, R. L. (2002). Mobility focus: developing early skills for orientation and mobility. In R. L. Pogrund,& D.
L. Fazzi (Eds.), Early focus. Working with young children who are blind or visually impaired and their families (pp. 326-404). New York, NY: AFB Press.
•
Blind Children’s Center. (1993). First steps. A handbook for teaching young children who are visually impaired. Los Angeles: Blind Children’s Center.
•
Getz, D. J. (2000). Comments on attention deficit disorder (or attention deficit hyperactivity disorder) and vision therapy. Retrieved from http://www.addadhd.org/attention_deficit_disorder.html
•
Lilliworks. (2014). 10 Principles. Retrieved from http://www.lilliworks.org/sample-page/10-principles/
•
Lilliworks. (2014). About AL. Retrieved from http://www.lilliworks.org/sample-page/
•
Nielsen, L. (2003). Space and self. Active learning by means of the little room. Copenhagen, Denmark: SIKON.
•
Orel-Bixler, D. (1999) Clinical vision assessments for infants. In D. Chen (Ed.), Essential elements in early intervention. Visual impairment and multiple
disabilities (pp. 107-156). New York, NY: AFB Press.
•
Pogrund, R. L., & Fazzi, D. L. (2002). Early focus. Working with young children who are blind or visually impaired and their families (2nd ed.). New York, NY:
AFB Press.
•
Shumway-Cook, A., & Woollacott, M. H. (2001). Motor Control; Theory and Practical Applications. Maryland: Lippincott Williams & Wilkins.
•
Snell, R. (1997). Gross motor development in infants with multiple disabilities. In D. Chen (Ed.). Effective practices in early intervention. Infants whose multiple
disabilities include visual impairment and hearing loss (pp.167-176). Northridge, CA: California State University, Northridge, Department of Special
Education (ERIC Document Reproduction Service No. ED 406-795).
•
Trief, E., & Shaw, R. (2009). Everyday activities to promote visual efficiency: a handbook for working with young children with visual impairments. New York,
NY: AFB Press.
•
WeeWaterways, LLC. (2014). Water-based method to improve your child's physical and mental development. Retrieved from http://www.waterwaybabies.
com/ contact-us-order/
LilliWorks is dedicated to the Active Learning principle
that “Everyone Can Learn”
Source: http://www.lilliworks.org/sample-page/
Braille Institute will be hosting a special
Active Learning Conference!
The 2014 Southern California Active Learning Conference will provide
information on Active Learning with special focus on a budget friendly
approach. No childcare will be provided.
Presenters:
Trisha Borg, Special Education Teacher,
Narbethong State Special School, Australia
Lori Enroth, LilliWorks Active Learning Foundation Board Member &
Educational Outreach Coordinator
Debbie Zimmer, Active Learning Advocate & Parent
Deadline to register for this FREE event is on Friday, 4/18/14
In Summary…
We aim for success no matter
how
or how
small
big
the movement is!
Questions?
Eunice Lee - [email protected]
Rosa Tu - [email protected]
Thank you for attending our presentation!
A warm thank you to all of our TLC families who gave us permission to share their
wonderful children and unique stories and experiences with you all. A special thank you
to our parent panel, Tatiana and Aishling, for participating in today’s presentation and
sharing their children with us!
We would also like to thank:
- Diana Dennis and TLC for their unwavering support and providing us this wonderful
opportunity to share stories of our beautiful children and families.
- Sue Strafaci and The Braille Institute for granting us permission to use the wonderful
Child Development Center’s resources.
- Lori Enroth for sharing information pertaining to Active Learning.
- Nikki Blackburn for her knowledge and thoughtfulness.