copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Objectives:
1. Students will learn specific skills that children with visual impairments must be taught.
2. Students will understand the limitations of a person with visual impairments.
Personal History
After completing an assignment in biology, Tracy puts away the microscope while her laboratory partner washes the slides. Tracy, who is blind from birth, is 12 years old and in the seventh grade in a rural high school.
Tracy and her friend have just used a cooperative learning style to look at water from a swamp through a microscope. First, they independently read the directions for the laboratory; Tracey's directions are in Braille. Looking through the microscope, her friend describes the swamp water to Tracy, who records the notes on her laptop computer. Later in the day, Tracy will print out her assignment in Braille for herself and print one for her friend and the teacher. Tracy has two types of Braille printing machines - one for language work and the other for mathematics. She usually carries her computer to her other classes.
After science class, she goes to physical education. This year, Tracy is learning about lifelong physical fitness. She works to improve her strength, flexibility, and endurance. After class, she walks to the lunchroom with four friends. She knows the school and can walk through the halls with her cane, but she prefers being with her friends.
On Tuesdays, Tracy stays at school later for a specialized training on mobility and orientation in her community. She is learning new skills to travel independently. She "sees" some interesting things as she walks since her teacher describes them to her. If possible she carefully examines what she sees with her fingers to understand the form and material it is made of.
At home, her mother helps her with a speech. It is available to Tracy only in print. Tracy types out the words as her mother reads them. To do her homework in geography, she needs a Braille map. However, the map does not have the exact area she is searching for, so she calls her friend who describes the area around the Saudi Arabian peninsula. The last question they discuss is what to wear to school the next day. It is "hat day" and everyone wants to wear some kind of funny hat.
Meditate Word By Word On These Verses:
Mark 8:22-26.
Defining Visual Impairment
There are two different types of blindness: the person who has been blind from birth and the person who has some usable vision. The legal definition of blindness is based on a clinical measurement of visual acuity. If they can only see at 6 meters what they should be able to see at 60 meters, they are legally blind. However, there are other types of blindness. If a person sees only 20% of what is around him, he is also legally blind for educational purposes. Sometimes after a stroke, persons may have vision that is only horizontal in the upper or lower field of vision. A definition of blindness is needed because the government gives special allowances for taxes, housing, education, and other support services.
There are three types of blindness that teachers use when determining the educational needs of a child:
LOW VISION: describes individuals who can generally read printed words, although they depend on aids such as magnifying lenses or optical aids. A few read both Braille and print. They may or may not be legally blind, but they are able to use what vision they have for learning.
FUNCTIONALLY BLIND: describes people who use Braille for efficient reading and writing. They may use what vision they have for other tasks such as mobility. They use vision to supplement the combination of auditory and tactual learning methods.
TOTALLY BLIND: describes those individuals who do not receive any meaningful input from visial sense. They must use tactual and auditory means to learn about their environment.
Describing Characteristics of Students with Blindness and Visual Impairments
The population of students with blindness is heterogeneous. These varying differences relate to the many areas that affect their learning (including visual functioning), socioeconomic status, parenting style, cultural background, age of onset of visual impairment, presence of other disabilities, and their cognitive abilities. Some students are gifted and others have multiple disabilities. But each child has limited ability to learn incidentally from the environment.
Limited Incidental Learning
Almost from the moment that a baby is born, he starts learning through visual sense, which helps a child to organize, synthesize, and give meaning to their environment. For example, a sighted baby spends hours looking at his hand before the hand becomes an efficient tool. Or a young child will drop a toy over and over again, watching it fall to the floor until he learns the concept of "fall down".
Incidental learning cannot occur in a child who is blind or nearly blind. For the child with limited visual access to his world, it is necessary for the family to provide him with opportunities to carefully and completely explore things in his environment by very close vision or through touch. It is important that the child touches or sees every aspect of an item in order to acquire, organize and synthesize information.
Because of the significance of incidental learning, if a child has visual limitations, his motor, language, cognitive, and social skills may also be affected. Generally though, these skills are learned with appropriate interventions.
Question:
1. To teach a blind child about his environment, we need to:
(One or more of the following answers may be correct.)
a) help him explore his world through sound,
b) give him a variety of experiences,
c) help him to touch and see objects as much as he can.
Limitations in Range and Variety of Experiences
Vision allows a person to experience the world meaningfully and safely from a distance. Touch is an ineffective substitute for vision: some objects are too big (skyscrapers, mountains), too small (ants, molecules), too fragile (snowflakes, moths), too dangerous (fire, boiling water) or too distant (sun, horizon). Their characteristics cannot be learned by touch. The other senses do not fully compensate for what can be learned visually. The song of a bird or the smell of baking bread do not provide one with useful information about those objects. Those children without sight often do not have the shared experiences of their peers with sight. Thus, their knowledge of the world may be different.
Early development is particularly influenced by the limitations in a child's range and variety of experiences. Language development can also be affected. Some blind students learn names for objects in their environment but have very few words to describe those objects' characteristics. Others can give detailed explanations about objects or events but have limited understanding of them. Both of these situations may affect the child's ability to socialize with sighted children because there is not a common base of knowledge between these children.
Social interactions are influenced by the lack of common experiences. The student who has not seen the latest movie, played the newest video game, seen the latest football match may be at a disadvantage in normal school culture. The potential for inadequate information about the world around him may affect the blind student for his whole life, especially in socializing with others and his self-esteem.
Vocational choice is also a problem. While blind people have a wide variety of occupations, others struggle because they lack enough information to make choices about a career.
Limitations of Mobility
People who cannot see are limited in spontaneous ability to move safely through their environment. Because of this restriction, children may lag in motor development and their exploration of the world. For blind adults, this aspect of life is most frustrating because they have only some control over where and how they can move.
Vision directs gross and fine motor involvement of even the very young child. The impaired child cannot sort out what is interesting or how to get to an interesting object. As a result, a child may become passive and further limit his world.
Limitations in Interaction with the Environment
Knowledge about and control over the environment concern blind persons. Their limited vision may reduce the information about their environment and their ability to act on that information. For example, they cannot determine with a glance the source of a loud crash or burning smell, nor quickly determine what their reaction should be and where they should go.
For young children, reduced vision stops them from moving about in their environment, manipulating toys, or initiate actions with playmates. If they don't participate, they are detached from social interaction that results in decreased feelings of mastery and competency in their lives.
Another consequence of not being able to know about your environment is a sense of anxiety about not knowing who is watching you and who is talking to you. If a teacher gives commands to someone, is she talking to the blind child or to someone else? They may feel apprehensive because they feel that someone is watching them all of the time, it is hard for them to relax and enjoy what they are doing.
Limitations in the range and variety of experiences, the ability to move about, and in interactions with the environment influence how a student with a visual impairment comprehends his world. Students with visual impairments can learn, but they require directed interventions to develop understanding about people, objects, and their environment. For these children acquiring a skill is different from the norm, but it can be done.
Question:
2. Blindness affects children by:
(One or more of the following answers may be correct.)
a) limited contact with the environment,
b) limiting language acquisition,
c) limiting their touch.
Causes of Blindness
There are many structures within the eye and its visual nerve pathways that work together so that we see. Seeing involves the transmission of light energy through the eye, the conversion of light energy into electrical energy, the transmission of electrical impulses to the brain, and the interpretation of what is viewed by the brain. Damage to any part of the system can lead to significant loss of visual functioning.
The nerves on the outer edge of the retina of the eye are particularly sensitive to light and the presence of motion. These receptors are essential to a person's ability to see at night or in poor lighting conditions. They are also the primary cells involved when a person moves through space or views moving objects. Damage to the outer edge of the retina can result in tunnel vision and inability to see in the dark.
Connections in the Brain
After the retina coverts light energy to electrical impulses, they are transmitted along the optic nerve to the visual area at the bases of the brain. There the nerve impulses are sorted and transmitted further to the association areas of the brain where interpretation takes place. Damage to the optic nerve or the visual area can result in having incomplete or inaccurate messages sent to the interpretive centers. This type of impairment is often difficult to understand because the eye itself is working well and the person seems to be seeing. But the visual message sent by the eye is impaired in some way by the messenger and the brain cannot interpret it. Optic nerve atrophy and hypoplasia (congenital underdevelopment) are the types of disorders that affect these parts of the visual system.
Research is continuing to assist those with blindness. If the optic nerve and brain centers for vision are intact, researchers can place a tiny electrode on the retina of a blind person and he begins to see light and shapes of objects. Then they place a very small camera on a pair of glasses. The camera sends the images to the electrode on the retina and through the optic nerve to the brain. It is estimated that in ten years, blind people will be able to see with these aids. The doctors and researchers have a dream of seeing a blind person walk alone in the outdoors without any type of help.
Timing
Damage to the structures involved in the visual process can be the result of an event that happens during the development of the child in the womb, can occur immediately after birth, or can result from an injury or disease that occurs anytime during the child's development. Congenital visual impairment can affect a child's earliest access to information and experiences. These effects can be significant.
Children who acquire a vision loss after having had normal vision have an advantage over the child who has never been able to see. Even a short period of vision and normal development can enrich the child's understanding of self, others, and relationships between things and people in the environment.
Question:
3. The causes of blindness are:
(Select the best answer.)
a) damage to the optic nerve from the eye to the brain.
b) lack of electrical energy to the eye.
c) retinal deterioration.
Evaluation
Medical specialists usually determine the type of visual disorder. Many times the disorder is found at birth or after trauma. Diagnosis is followed by a search for a medical solution such as surgery or types of medication. This process is difficult for the parents as well. They grieve over their child's loss of sight and ensuing disability.
If possible, it is essential to know the cause of the child's loss of vision. While a diagnosis of the cause may not give accurate information about how much a child sees, it is valuable for educational purposes. The diagnosis and cause gives an indication of what might be typical of a particular eye condition: what kind of light do they need to see, is the condition hereditary or genetic, is there potential for improvement, and the types of learning disorder the child may have in learning.
Determining How the Child Uses Vision
After the doctor determines that a child has a vision disorder, the educational and rehabilitation specialists need to determine the effects of the disorder on the child's functioning. It is not possible to determine how a student with some usable vision puts his vision to work to learn about his environment and do age-appropriate behaviors. This kind of an evaluation must be repeated frequently as the child grows and acquires new skills.
A teacher, along with parents, mobility specialist, and others, conducts a functional vision evaluation. The results of the evaluation are reported in language that informs others in concrete ways. For example, the student can see 10 cm. high letters on a vision chart at 1.5 meters distance or facial expressions can be copied at a distance of 1 meter.
Here is a functional vision evaluation for a pre-kindergarten child:
DISTANT VISION:
- mimics teacher facial expressions at ____ meter(s)
- locates the drinking fountain at ____ meter(s)
- recognizes own name, shapes of objects, numbers at ____ meter(s)
- Locates personal possessions (jacket, backpack) in closet at ____ meter(s)
- Identifies classmates at ____ meter(s)
- Interprets major forms in a picture at ____meter(s), but needs to be at ____ meter(s) to identify details of 7cm. in height
- Locates ____ of four dropped coins on a ______ (color) floor; 5 rubles at ____ meter(s), 1 ruble at ____ meter(s), 10 kopeks at ____ meter(s), 1 kopek at ____ meter(s)
- Tracks and locates a ____ (size) ball at ____ meter(s)
- Avoids obstacles in physical education, such as nets and stands: Yes____ No____
- Visually detects and smoothly navigates contour changes in surfaces such as ramps and steps: Yes____ No____
NEAR VISION:
- Completes ____ (number of pieces) of a puzzle with head _______ cm. from the board (describe how he does the task, ie. by trial and error, quickly, by touch, etc)
- Places pegs in a board at _____ cms. with head ______ cms. from pegs (describe how he performs tasks) with head ______ cm. from the pegs.
Functional evaluations describe a child's use of vision in various natural environments: for example, under florescent lights in a food store, on the playground in the glare of the sun or walking down a dimly lit corridor in a building. The evaluation also considers the activities that occur in these environments. For example, a child may be able to see products on the shelves, but he may not be able to read the price of an item or he may not be able to see the value of the paper money he uses at the check out counter. This type of information is vitally important to the vision teacher so that he understands the child's particular needs and designs relevant instructional strategies.
Ideally, the functional examination should occur prior to a visit to a low vision specialist who can evaluate and write the prescriptions for the proper type of optical aids. When the child has the right optical aids, the teacher needs to again evaluate the student to find out if the aids (glasses, etc.) really give him the vision he needs.
Question:
4. A functional evaluation is helpful because:
Curriculum for the Blind
The problem that teachers have in working with blind children is that they must meet as many of the educational need of the student as possible. Blind children with normal intelligence need to master the entire curriculum. In addition to regular schoolwork, they need to learn and practice a set of specific disability skills. These are:
- skills learned incidentally by seeing students
- skills needed to access the academic curriculum
- skills specific to children with
Accessing the Regular Curriculum
Blindness and visual impairment do not affect what a student can learn as much as they affect HOW a student learns. Those students who can learn efficiently through limited vision are supported in their academic curriculum by adaptations such as magnifiers, large print materials, and according to his particular needs.
Those with less vision need to use Braille to understand the school curriculum. There are special reading programs for these children to learn by touch. Learning Braille is somewhat more difficult because it uses contractions of two letters to save space and time when reading. If there are highly visual subjects such as geometry, then teaching is done one to one. Specialized skills needed for the classroom are also taught and they include devices such as a Braille writer, slate writer, computer use and word processing, listening skills, study and organization skills and the use of other specialized equipment that the student uses.
Skills Learned Incidentally by Sighted Children
Blind children cannot simply watch their parents and learn how to do things. Even the simplest task may require direct instruction before the blind person can master it. Spatial orientation and mobility require very specific techniques. These skills help a person to know where they are in their environment and how to move around safely. Orientation and mobility specialists teach a child how to listen to the flow of traffic, react to changes of street surfaces and use other senses. A cane can be helpful to detect objects in the environment and help them know where they are along their route to somewhere.
Young children concentrate on developing a strong body image (standing straight), understanding the spaces between objects, learning the rooms in an apartment, and listening to environmental cues. Older students focus on crossing streets and traveling more complex routes. Even as students get older, they may need mobility training if they move to a different area of the city or progress in school.
Teaching Specific Skills
Individuals with visual impairments must learn unique skills that typically are not taught to other students but are necessary to live in a community. They need to be their own advocate for personal needs, to access and use health care system for eye care, to seek or hire those people who can help with reading books for assignments, drivers, and shoppers for personal items.
A student may have to ask permission of professors to record lectures, request personal copies of overhead transparencies used in class, and to explain what they have written on the blackboard, as well as describe what he requires. He may require a reader to read the text to him or into a tape recorder or he may need more time during a test. He will also need to convince his professors that he can do the work required in class.
As you can understand, there is a great deal for blind children to learn. The team who works with the student needs to prioritize goals not only for academic work but for the skills the child needs to learn because of his disability. Creativity is the answer to many questions. Teachers, mobility specialists, etc. need to work together to reinforce and practice newly learned skills with the blind child.
Question:
5. The most effective way to work with blind students requires:
(Select the best answer.)
a) a good attitude.
b) an organized plan with specific professional teachers.
c) equipment to help the child communicate with his world.
Methods of Teaching
Commonsense
A commonsense approach is necessary to involve the child in learning and expectation that he acquires a new skill. Most students with visual limitations must develop their understanding of a whole object or task from its related parts. For example, Tracy's sister has experienced through visual observations the entire activity of cleaning up the kitchen after a meal. She knows there are dishes to put in the dishwasher, pans to soak in the sink, counters to wipe and food to return to the cupboards or refrigerator. On glance can tel her if the kitchen is clean or not. When Tracy was younger, she knew just her assigned role: to put her glass and plate from the table to the counter near the sink. Over time, she has been gradually introduced to more parts of this activity. Even now though, when asked if the kitchen is clean, she must feel each of the counter tops and other surfaces before replying.
Keep High Expectations
Sometimes adults have incorrect perceptions of a child and his expected level of performance is low and acquisition of skills is slower than necessary. For some low vision students, teachers think the student uses his vision more than he actually is able to do. They do not stop to show these children how to perform some of the activities that normal children perform naturally. These a activities might be as simple as putting on jeans or holding a spoon correctly. Low and inaccurate expectations of a child are his worst enemies. If a teacher wants to maximize the child's abilities, he must be constantly alert to what students are not doing for themselves and why.
Adapted Materials
Preparation of adapted materials takes a lot of time but is important. An enlarger can prepare large print reading material for some children. Recorded reading on tapes is also helpful. But for some assignments, adaptations must be made due to the way the exercises are printed on the page. Sometimes information is too crowded together and visually confusing for low vision student. The page needs to be re-worked and copied as needed.
Adapting materials is sometimes an art. For example, a mother wanted to teach her blind son about objects that do not belong in school. She had a worksheet from a preschool teaching booklet that she used for her sighted daughter, but wanted to teach her blind son as well. He could not see or feel the objects printed on the page. His kindergarten teacher gathered 5 objects - a Braille book, a spatula, a pan, a stick of gum, and a Braille reader. Then she asked the child to identify each object using his hands and then tell her which objects did not belong in school. This way the mother quickly understood the modification she needed to make up for her son's limitation.
Tactile Approach
Some academic subject materials require adaptation of materials that have been designed for sighted learners. Many of the concepts related to science, social studies, mathematics, and art need to be introduced to a student using tactile/kinesthetic approach.
For example, Tracy's science class studied seed germination. Her teachers arranged that she plant her seeds not in soil in a container, but in water in a container. She checked daily for changes in the way the seed felt and seemed. By using this method, she learned about root and leafy growth of a plant.
To teach a child to read requires important methodological changes. Books designed for sighted children have a lot of pictures to convey the meaning of the story. In addition, pictures reveal information about a world a child has never seen. Not all new readers have ridden in a rowboat, but from a picture they can discern what the words are trying to convey. For blind children, difficulty seeing and interpreting pictures may necessitate engaging in a similar activity before they can achieve understanding of the meaning conveyed by words.
Question:
6. What type of teaching would you use to best help a child understand what a cat is?
(Only one of the following answers is correct.)
a) Use a real cat for the child to touch.
b) If he has some vision, show him a picture of a cat.
c) Spell the word cat in his hand so he feels the letters.
Additional Experiences
Teachers and parents of students with low vision need to be sure that they have exposure to letters and words that can be seen clearly. This may mean having large print books, papers, and stories for their children. An essential component of a pre-reading program for blind children is systematically introducing Braille symbols as well as flooding their environment with opportunities to encounter Braille - on labels, storybooks, and magazines.
Collaboration
In the school setting, most general education teachers need some initial coaching on how to adapt their teaching style to benefit students with low or no vision. As older students prepare to leave school, collaborative relationships are needed between the teachers and the service agencies so that transition from school to job or higher education is successful. The rehabilitation counselor and mobility specialist worked together to help Tracy learn the route from her apartment to college. They also helped her find an apartment in the area where the college is located.
In the family, few parents are prepared to raise a child who is blind. Parents have no idea about the capabilities of a blind person and are unaware of what a baby with visual limitations needs. They need to learn to help their child's motor skills, language, and social development. Early on, parents need to talk about their emotions, conflicts, and feelings of ignorance, fear, despair and hope. A teacher or counselor can learn about the family's strengths and use them to help their child. Every new development can present difficult situations for the parents: how to teach a child to cut food on his plate, how to assist a young woman to handle her menstrual period, how to counsel a low vision person about driving or not driving a car.
In the classroom, if a low vision student works with one person on a project, it seems easier. In group projects, it is sometimes hard for the blind student to learn everyone's names and feel comfortable with a group. A mobility specialist can include a sighted child on a mobility lesson and end with a visit to the ice-cream store, which provides socialization for the non-sighted child. If there are camping excursions with other non-sighted children, a child can learn from them.
In the community, some local business clubs provide equipment, glasses, or corrective surgery for students. Other times, employers can offer opportunities for work depending on the type of business they have. Businesses may also be encouraged to assist blind students when they come into a store. This helps the student to practice communication skills and assertiveness.
Early Intervention in the Preschool Years
Megan Smith was born totally blind in one eye and had the barest of vision in her other eye. She was immediately enrolled in an early intervention program and Lois, a vision specialist, began visiting Megan at home one a week when she was 3 months old. Megan did not have a bright colored mobile hanging above her head, but a mobile made of rattles, bells, and squeaky balls that she could reach. When she was ready for crawling, Lois helped Megan and her mother to teach Megan to rock on her hands and knees and them move her arms and legs in preparation to crawl. Lois kept records of Megan's progress so that Megan's parents could see how she changed. Such home programs help a child to understand his body, increase sensorimotor skills, develop fine and gross motor skills, and early social interactions in the home.
Megan entered an early education program when she was three years old. In her public school, which is only for children with blindness, she is learning to read and write Braille and use a cane for mobility in and around the school. She asks such questions as, "What are stop lights and why are they?" Her mother and older sister (who is five years old) are also training in Braille reading. Before bed, she and her mother read a short Braille book together. Her extended family provides opportunity to be with sighted people and talk to them.
She is now aware of her different-ness. She asks, "Why am I blind? Do you have long eyes so you can see things far away?" Her family assures her that she was born blind and it is nothing to be ashamed about. Her parents have already decided not to press Megan into attending regular school right away with its many activities and noise. She will probably begin regular school a year later than normal. Meanwhile, she is in a transition period where is attends a local kindergarten and has opportunities for play with non-disabled peers.
Megan's preschool program is typical. It provides multiple experiences for learning and giving the students a good foundation for further study. Most activities are "hands-on" and related to real-life experiences. Students make their own snacks, wash their dishes, find opportunities to change their clothes often and thereby practice daily living skills. They collect memories of their day and dictate them to the teachers who print them in Braille. Teachers encourage movement, language acquisition, and exploration.
Question:
7. Why is it important for a parent to learn Braille?
Teaching Through the School Years
Elementary School
Here is one teacher's option about teaching children from Grade 1 to Grade 6. When you can't see the blackboard and you can't see exactly where the rooms are and you can't see this and you can't see that, it takes twice as much energy to get through the day. I provide instruction materials and support for students who may require many more hours to master what a sighted child can learn through casual observation. I assure my students that they will learn everything that sighted students learn. This means that every map, graph, handout be transformed into large print, Braille, or a tactual display so that my students have everything they need for learning.
Each blind child needs to become an active and integral part of his classroom, not just a passive receptor of information. Since so much of our social interaction is visual, blind children must learn the behaviors of sighted persons so that they are accepted by regular students. My students and I spend many hours practicing social skills that other students learn by observing. Learning to face the person to whom we are speaking, standing or sitting with appropriate postures, and eliminating mannerisms that might detract from their appearance are imperative.
In addition to learning school subjects, my students learn career-awareness skills, self-help skills, knowledge of human sexuality, social skills, and self-advocacy skills. At the same time the mobility and orientation instructor may be increasing the child's ability to travel safely.
Middle and Secondary Years
By the time these children leave elementary school, they are expected to function on their own with their various teachers. They may need special help with mathematics concepts from a special teacher. They have contact with a teacher who visits their school periodically and learn skills such as household management skills, career exploration, selection of an apartment, ways to access community recreation and social services, strategies for seeking jobs, and preparation for further education.
Question:
8. What type of attitude do we need to help the blind child?
(One or more of the following answers may be correct.)
a) pity.
b) understanding and patience.
c) practical ideas to help him learn about his environment.
What Happened to Tracy?
Tracy finished high school and about the same time she was eligible to vote. She also was eligible for jury duty and was called to be a juror in a local court. She was fascinated by the judicial process. From this experience, she decided to study law. She first attended a community college and then transferred to a larger university. Her grades and law school aptitude scores were very good and Tracy was admitted to the law school. She did have some special accommodations when she took classes and examinations.
She is now an assistant state's attorney. To find cases relevant to the ones she is investigating, she uses her computer that reads the cases to her. She knows her way around the courthouse because she hired an orientation specialist to teach her. Her use of assistive technology (her computer) helps to make her successful. She also has a close friend, a dog that helps her find her way to work each day.
Much of this lesson was adapted from the text: Exceptional Lives, Turnbill, Turnbill, Shank, and Leal, Prentice Hall, 1995, pp 595-637.
Additional information is from the website: http://www.tr.wou.edu/dblink