Supporting Learners with Visual & Multiple Impairments
Presenting materials in an intentional way will be a critical component of your instructional routines. These strategies may be utilized to select objects for routines, listed as steps in your lesson plan, and identified as accommodations within the routine steps.
Factors to consider when presenting materials:
- Choosing objects
- Accommodations to promote looking
- Establishing a presentation procedure
Not only do we want to choose objects that have attractive qualities for our learner, but we also want to avoid objects that our learners have an aversion to.
The best way to do this is to use the Sensory Response Record and keep an ongoing list of Likes and Aversions.
Utilizing the expertise of the team can help determine the best positioning for our learners.
Our Adapted PE teacher, Angela Campbell, and Physical Therapist, Allison Clark, share their perspective on positioning to promote engagement as we present objects:
Ensure the learner is well supported in positioning that promotes an upright posture.
Ensure the learner’s feet are supported on the floor, a footrest, or the wheelchair footplates.
Position items within the learner’s reach and within the field of vision.
Positioning of hips can affect the learner’s posture and his or her ability to use upper extremities in a functional way. Having a slumped trunk causes the shoulders and arms to rotate inward, making it more difficult to lift the arms and reach.
Some learners are unable to reach across midline or even to midline. Placing items at midline may be too difficult to reach and move for some learners. It may be more beneficial to position items slightly toward one side or the other and allow the learner to use a swiping motion if they aren’t able to push forward.
Supporting the learner’s elbows and forearms with a wheelchair tray or a table can offer more stability and better use of hands.
If the seating system does not provide adequate support, you can use foam roll, pool noodles, or towel rolls for positioning the learner.
Supported sitting isn’t the only position where a learner can engage with objects. Positions such as prone, side-lying, supine, or prone over a wedge/support are additional options for positioning for more successful engagement.
When in doubt, consult your campus physical therapist or occupational therapist for suggestions.
Accommodations to Promote Looking
Accommodations are always individualized for a specific learner's needs. Even learners with very limited vision can be provided the opportunity to look, taking advantage of all necessary accommodations. Referring to the learner's Functional Vision Assessment and collaborating with the TVI will help determine what is best for the learner.
Accommodations to consider:
- Preferred visual field: Present item in your learner's preferred field and within the appropriate distance. Add movement if needed.
- Color preference: Color can be added to an object with colored tape, ribbon, or paint. Or, a an object can be specifically selected for its color.
- Reduce auditory distractions: Choose a quiet space in the room. Limit talking during vision use.
- Reduce visual clutter: Utilize classroom dividers, black boards, or a blank wall to limit visual clutter and distractions. You may consider wearing plain clothing or wearing an apron as well.
- Consider visual contrast: Utilize a high contrast calendar box, tray, mat, or backdrop as you present materials.
- Add sound: Sound can help capture visual attention. Tap the object or make its natural sound when presenting the object.
- Add light: Using a flashlight to attract visual attention can be helpful for some learners.
- Allow time for latency: Be patient as you wait for the learner's visual attention on an object.
Establishing a Presentation Procedure
Presenting materials in the same way each time can help foster trust and coherence with your learners. Starting with distance senses and moving to near senses will help foster this sense of safety and attention.
Auditory ---> Vision ---> Touch to hand ---> Touch to cheek
Wendy Pray, our classroom teacher, describes the way she would present bells to a learner:
First, I would gently shake the bells and say, “bells” in the learner's peripheral vision. I then wait for 7-10 seconds to see if there is any response. It could be a head turn, smile, eye movement, change in breathing, or a movement of a body part showing interest. Be sure to watch for very subtle responses that may occur. I then repeat this step to see if I get the same response. This is great data to establish a baseline for learner response modes.
I will say “bells” and I can then gently put the bells on the learner’s hand and move them. Again, as I move the bells I will say, “bells.” I wait 7-10 seconds to see if there is any movement or response before repeating this step.
Finally, I would say, “bells” and I can gently touch the bells to the learner’s cheek. I will now wait for a response.
The wait time is crucial with presentation. When you talk or name the item over and over it restarts their thinking and processing. Imagine trying to watch two television shows at the same time. It is hard to know where to focus and process all of the auditory and visual clutter.
When objects are presented in the same manner and when possible in the same location this can give the learner a knowledge bank for anticipation of what is coming and what the objects do. This can help to build vocabulary in the future. (Ex: the names of the objects, body parts, movements, and specific responses.)
Following these steps can create a wonderful and engaging experience for you and your learner.
A Message from Millie
Early in my career as a TVI I used the term “tactually defensive” to describe my students who resisted hand touch by pulling away and who rejected objects I put into their hands by dropping and throwing. Eventually, I was trained by occupational therapists to learn the difference between tactual defensiveness and manual rejection. I learned that tactual defensiveness is an impairment of the tactual sensory system resulting in hypersensitivity and affecting the whole body, not just the hands. Tactual defensiveness manifests in a variety of ways that usually include several characteristics. Some of these may be eating difficulties related to food textures, intolerance of certain kinds of clothing, and avoidance of physical proximity to other bodies. Tactual defensiveness is identified by occupational therapists and is managed with therapy and accommodations to decrease sensitivity.
When I began doing workshops for sensorimotor stage learners with visual and multiple impairments, teachers wanted to know how to address the pulling away, dropping, and throwing issues that severely compromised learning potential for many of their students. I have come to believe that the best way to proceed is to consult with an occupational therapist to evaluate the presence or absence of true tactual defensiveness. If the problem behaviors are not related to tactual defensiveness, they still need to be addressed by the IEP team. A key part of this effort is the TVI’s learning media and sensory efficiency assessments. I believe that all sensorimotor stage learners need an evaluation of their tactual functioning in the same way that they receive evaluations of their visual functioning.
It helps to name the issue. I use the term “manual avoidance.” The presentation strategies discussed above are essential. When manual avoidance is so extreme that the learner will not engage with an object presented like the bells in Wendy’s description, other strategies may be necessary. Here are two that have helped me the most:
I learned from Jan Van Dijk that you have to make friends with the body before you can mess with the hands. Do resonance routines that involve rocking, bouncing, rolling and other whole-body things.
I learned from June Downing and Deborah Chen that you make learners like touching your hands before you touch theirs. Start with clapping, banging, squeezing, pulling and other things in routines where learners ride your hand and then are invited to take a turn without manipulation. As soon as leaners see your hand as a source of fun and readily engage with it when you touch their arm, hold an object in your hand and let learners discover it without placing it in their hands. The book Tactual Strategies by these two authors contains many wonderful ideas and helpful illustrations of each.
Please share this new resource with families! The ECC & Me has opened an Etsy shop with monthly themed boxes, and there is one specifically for sensorimotor learners! Boxes will include a book, objects, and resources for the learning partner.
Stacey Chambers, TVI
Angela Campbell, Adapted PE Teacher
Allison Clark, PT
Wendy Pray, Active Learning Teacher
Millie Smith, Consultant for Learners with Visual and Multiple Impairments
Tristan Pierce, American Printing House for the Blind
Contact Us: TheECCandMe@gmail.com