TETN

1
Welcome to TSBVI Outreach

• TETN 30910
• Visually Impaired Students with Vestibular Issues
• Presented by
• Kate Hurst and Jim Durkel
• TSBVI Outreach
• KateHurst_at_tsbvi.edu
• JimDurkel_at_tsbvi.edu
• With Special Guest
• David Brown
• California Deaf-Blind Services

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Workshops and Conferences

• June 5-7 Appropriate Communication Assessment for
  Babies with Deafblindness HAS BEEN CANCELED
• June 25-26 ECI Conference _at_ Embassy Suites in San
  Marcos
• June 26-27 5th Annual Statewide Texas Parent to
  Parent Conference?_at_ Omni Austin Hotel at
  Southpark in Austin

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Roll Call

• How many participating?
• Remote sites?
• Taping or streaming?

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Visually Impaired Students with Vestibular Issues

• Presented by
• Kate Hurst, Statewide Staff Development
  Coordinator, TSBVI Outreach with
• Jim Durkel, Audiologist/Speech-Language
  Pathologist and APH, VI Registry, Deafblind
  Census Coordinator, TSBVI Outreach and
• David Brown, Education Consultant, California
  Deaf-Blind Services

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Our Special Guest . . .

• David Brown
• Formerly of SENSE, UK
• Currently with California Deaf-Blind Services
• World-traveler
• Funny guy

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How do we achieve balance?

• Three separate components make up Equilibrium
  Triad
• Input from the eyes (vision)
• Input form the muscles and joints
  (proprioception)
• Input from the vestibular organs (balance)

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A Good Place to Start

• Pediatric Resource - Vestibular Disorders
  Association
• (http//www.vestibular.org/vestibular-disorders/sp
  ecific-disorders/pediatric-vest.-disorders.php)

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Causes Pediatric Vestibular Disorders

• Head/neck trauma
• Chronic ear infections
• Maternal drug/alcohol abuse
• CMV
• Immune-deficiency disorders
• Meningitis
• Migraine
• Metabolic disorders (e.g., diabetes)
• Ototoxic drugs

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Causes Pediatric Vestibular Disorders

• Neurological disorders (CP, Hydrocephelus)
• Genetic syndromes (e.g., Wallenberg, Usher,
  CHARGE)
• Posterior brain tumor
• Family history of hearing loss/vestibular issues
• Cochlear implants
• Lack of use - movement issues, fear, ill health

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Some data . . .

• VI Registry - 84 or 14
• CP - .3
• CHARGE - 7.7
• CMV - 2.7
• Hydrocephaly - 1
• Meningitis - .5
• Shaken Baby - .5
• Usher 1 - 1.7

• Deafblind Census - 147 or 19.9
• CHARGE - 9.7
• CMV - 4.8
• Hydrocephaly - 1.9
• Usher 1 - 1.2

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So how does the vestibular system work?
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Vestibular organs

• Located in the bony chambers of the skull in the
  inner ear
• 3 semi-circular canals positioned in different
  planes for rotational movements
• Otoliths (Utricle and Saccule) for linear
  accelerations

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Semicircular Canals

• Bulge at base of canals - ampulla
• Ampulla contain sensory receptors for each canal
• Canals filled with endolymphatic fluid and
  surrounded by perilymphatic fluid
• Detect heads rotation
• Demonstration on The Physiology of the Senses
  Transformations for Perception and Action, Tutis
  Vilis, University of Western Ontario, Canada

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Otolith Organs

• Utricle
• Saccule
• Demonstration on SenseWeb

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Vision and Balance
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Vestibular Occular Reflex

• Normal head rotation eyes move in opposite
  direction of head to stabilize retinal image
  (VOR)
• Conflicting sensory information from visual and
  vestibular senses is a problem
• The cerebellum repairs slippage
• Demonstration

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What Part Does Proprioception Play?

• Sensation experienced by muscle and joint
  receptors
• Requires a normal range of muscle tone to work
  properly
• Feeds information to the brain that allows for
  awareness of where body parts are in space,
  movement, speed and direction of movement

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A Redundancy for Balance

• Brain and Spine Foundation Online
• When one of the three parts of the Equilibrium
  Triade do not work or work well, the other two
  can compensate.

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Moving Platform Posturography
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From Jean Ayers Sensory Integration and the
Child

• The vestibular system is the unifying system.
  It forms the basic relationship of a person to
  gravity and the physical world. All other types
  of sensation are processed in reference to this
  basic vestibular information.

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From Jane AyersSensory Integration and the Child

• The activity in the vestibular system provides a
  framework for the other aspects of our
  experience. Vestibular input seems to prime
  the entire nervous system.

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From Jane AyersSensory Integration and the Child

• When the vestibular system does not function in
  a consistent and accurate way, the interpretation
  of other sensations will be inconsistent and
  inaccurate, and the nervous system will have
  trouble getting started.

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From Carol Stock KranowitzThe Out-of-Sync Child

• Gravitational insecurity is manifested by
  abnormal distress and anxiety in reaction to
  falling or the possibility of falling. It is a
  primal fear.

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From Carol Stock KranowitzThe Out-of-Sync Child

• Indeed, our need to know where we are in
  relation to the earth is more compelling than our
  need for food, for tactile comfort, or even for a
  mother-child bond.

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References on Vestibular Issues

• David Brown, California Deaf-Blind Services
• The Vestibular Sense, DbI Review, June, 2007
• Educational and Behavioral Implications of
  Missing Balance Sense in CHARGE Sydrome,
  reSources, Spring 2003.

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Effects of vestibular problems

• Organization of ALL sensory information
• Postural security/muscle tone
• Use of residual vision
• Perception/processing sound
• Remembering auditory sequencing

• Memory development
• Speech/Language development
• Behavioral challenges
• Bilateral coordination
• Breathing, feeding, digestion, nutrition
• Sociability

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What do we do?

• A
• S
• S
• E
• S
• S

• Vestibular Dysfunction Checklist in Out-of-Sync
  Child
• Sensory Learning Kit
• Vestibular assessment by Audiologist
• OT/PT Evaluation
• Sensory Integration Evaluation

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Various testing deviceshttp//www.tchain.com/oton
eurology/testing/engrot.html
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What do we do?

• With OT knowledgeable about SI to develop menu of
  interventions
• To plan flexible schedule related to fatigue and
  need for breaks
• To select / train staff to respect individual
  differences in behavior, performance, pacing
• With family to gain insight to home challenges,
  child preferences and for support

• T
• E
• A
• M

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What do we do?

• Seating to address postural concerns
• Positioning for visual and auditory tasks
• Materials and learning environment (isolate lines
  of text, reduce distractions)
• Activities to incorporate SI approaches
• Pacing
• Schedule (general / day-to-day)
• Staffing patterns

• M
• O
• D
• I
• F
• Y

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What do we do?

• R
• E
• S
• P
• E
• C
• T

• Student challenges in learning
• Family struggle to address challenges / knowledge
  of the child
• Staff challenges to adapt programming and the
  expertise each has to offer

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To Learn More . . .

• Brown, David, 2007. The Vestibular Sense, pp.
  17-22. Dbl Review, January-June 2007, Deaf-Blind
  International.
• Brown, David, 2003. Educational and Behavioral
  Implications of Missing Balance Sense in CHARGE
  Syndrome, pp. 1-4. reSources, Spring, 2003.
  California Deaf-Blind Services, San Francisco,
  CA. http//www.sfsu.edu/cadbs/Spring03.pdf

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To Learn More . . .

• Brown, David, 2008. The Sensory Integration
  Perspective and What It Offers Us in the Field of
  Deafblindness, pp. 22-26. DbI Review,
  July-December, 2008. Deaf-Blind International.
• Brown, David, 2008. The Forgotten Sense -
  Proprioception, pp. 20-24. DbI Review,
  July-December, 2006. Deaf-Blind International.

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To Learn More . . .

• Kranowitz, Carol Stock, 1998. The Out-of-Sync
  Child. The Berkley Publishing Group, 375 Hudson
  Street, New York, NY 10014.
• Kranowitz, Carol Stock, 2003. The Out-of-Sync
  Child Has Fun. The Berkley Publishing Group, 375
  Hudson Street, New York, NY 10014.

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To Learn More . . .

• Vestibular Disorders Association
  www.vestibular.org
• Brain and Spine Foundation - Dizziness and
  balance problems http//www.brainandspine.org.uk/i
  nformation/publications/brain_and_spine_booklets/d
  izziness_and_balance_problems/how_does_the.html
• Tutis Vilis - SenseWeb http//www.physpharm.fmd.uw
  o.ca/undergrad/sensesweb/L10Balance/L10Balance.swf