Get That Baby Moving

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Get That Baby Moving!

• Kay Ratzlaff,
• Coordinator of Instructional Resources
• Florida Instructional Materials Center for the
  Visually Impaired

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Florida Association for the Education and
Rehabilitation of the Blind and Visually Impaired

• Annual Conference
• October 26, 2006
• Working and Playing with FLAER
• Altamonte Springs, Florida

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Questions for Today???

• The presence of a visual impairment affects which
  aspects of development?
• What is the percentage of children with
  additional disabilities that also have a visual
  impairment?
• What are the 4 most common causes of visual
  impairments in infants and toddlers?

ALL
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Low birth weight, trauma, syndromes, eye diseases
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Essential Truths about Vision

• Vision is the primary data-gathering system of
  humans, providing both near and distance
  information and integrating information
  holistically. All the other senses together
  cannot provide equal information to the brain.
  (Gesell, Illg Bullis, 1949)

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Essential Truths about Vision

• At least 60 of the current population of young
  children with disabilities have multiple
  disabilities, and visual impairments are likely
  to be among those disabilities. (Bishop, 1991)
• Since the visual system is neurologically based,
  any impairment of the neurological system can
  also affect vision. (Koenig and Holbrook,
  Foundations, 2000)

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Essential Truth.

• Hearing is not a motivator equal to vision in
  encouraging an infant to reach for objects.
  There is a mismatch in the timing between when an
  infant is physically ready to reach (by about 5
  months) and when the auditory processing ability
  can attach meaning to sound (by about 9 months).
  (Barraga and Erin, 1992)from Koenig and
  Holbrook, Foundations 2000

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Intervention

• For children with these (severe) visual
  concerns, programming often focuses on massage
  and visual and auditory bombardment rather than
  on integrating the central nervous system so that
  the visual system can become organized and ready
  for taking in and using information that will
  enhance potential for gaining and expanding
  control over the world.
• Beth Langley, ISAVE

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Discussion Questions

• Why are gross and fine motor skills especially
  important for students who are blind or visually
  impaired?
• What are some characteristics that are often seen
  in children who are visually impaired?
• What toys and/or play activities foster
  appropriate motor skills, emergent literacy
  skills and concept development?

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Importance of Early Intervention

• The presence of a visual impairment affects
  every aspect of development and has a
  particularly profound effect on early
  relationships and communicative functions. Thus,
  the earlier the detection of a visual problem,
  the earlier the intervention can be implemented
  to offset many of the associated developmental
  problems that ensue as the result of visual
  dysfunction and to improve the general outlook
  for functional vision.

Beth Langley, ISAVE
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Development of Visual System
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Sequence of Sensory Development

• Alerting
• Orientation
• Localization
• Discrimination
• Recognition
• Interpretation
• Application

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Early Reflexive Behaviors

• Asymmetrical Tonic Neck Reflex (ATNR) creates
  just the right stimulus (the infants hands at
  just the right viewing distance) for visual
  practice. The ATNR exists from birth to 4 months
  where it disappears. Not coincidentally the child
  discovers and looks at his or her own hand just
  before the ATNR disappears. (Koenig and
  Holbrook, Foundations 2000)

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Developmental Stages of Visual Functioning
Global

• Reflexive
• Disorganized
• Random
• Alerting
• Motion
• Peripheral
• Following

• Reflexive visual behaviors
• typical child
• birth to 6 weeks

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Developmental Stages of Visual Functioning
Integrative

• Visual attending behaviors
• can use vision purposefully
• typical child
• 6 weeks 3-4 months

• Contingent
• Organized
• Novel
• Central
• Fixation
• Accommodation
• Convergence
• Binocular

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Developmental Stages of Visual Functioning
Specific

• Discrimination
• Association
• Form
• Depth
• Spatial
• Detail

Visual examining behaviors Visual perceptual
level typical child 6-12 months
Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Impact of Movement on Development of Visual
Systems
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Movement, Posture Vision

• To fixate gaze
• Child must have head stability
• Head/neck organization
• To recruit peripheral fields, shift gaze, or
  achieve horizontal pursuit
• Child must have active head/neck rotation

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• To achieve ocular alignment, oculocephalic
  integration, and eye-hand dissociation
• Child must have head/neck alignment
• Child must have antigravity head control and
  stability
• To achieve vertical pursuit and recruitment of
  central field
• Child must have graded extension and flexion of
  head and neck

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• To achieve horizontal gaze shift and control of
  saccadic movements
• Child must be able to shift head from midline and
  have active lateral head righting
• To achieve accommodation and convergence and
  depth perception
• Child must be able to grasp and bring hand to
  mouth or face

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• Weight bearing in prone on forearms facilitates
• Scapular/head/neck stability
• Stability of gaze (fixation)
• Mobility (direction) of gaze
• Emerging convergence

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• Proprioceptive input to hands and feet (weight
  bearing) facilitates
• Organization of gaze/fixation
• Active lateral weight shift in prone facilitates
• Fluid horizontal gaze shift
• Emerging pursuit across midline

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• Trunk organization/stability, with midline
  development and active antigravity flexion as in
  hand to foot play facilitates
• Fluid horizontal gaze shift
• Emerging pursuit across midline

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• Stability in sitting facilitates
• Near-far gaze shift
• Depth perception
• Eye-hand coordination
• Refined recruitment of peripheral fields
• Stability for scanning

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture Vision

• Movement in upright postures facilitates
• Refined visual adaptation to movement
• Expanded peripheral fields
• Visually directed movement
• Gaze control for distance vision

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Movement, Posture and Vision

• Antigravity side lying facilitates
• Organization of midline
• Stability of head for gaze shift
• Refining of depth perception
• Eye-hand coordination

Dr. Sandra Lewis, (2002) Visual Functioning
PowerPoint presentation
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Overview

• Children with low vision do not develop motor
  skills the same way sighted children do.
• How does this affect the child?

Moving Skills
Body Image
Social Skills
Posture
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Lack of Incentive to Move

• Infants and toddlers with visual impairments have
  little incentive to move because of
• Low muscle tone
• Reduced opportunities for movement
• Fears
• Insufficient understanding of the object world
• Inability to visually monitor environment

REview Fall 2002, Facilitating Walking by Young
Children With Visual Impairments Lowry, S. and
Hatton, D.
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Lack of Incentive to Move

• Children with severe visual impairments also
  faced with
• Unique movement patterns
• Lack of visual cues to motivate reaching
• Reduced opportunity to observe and emulate motor
  movements of others (repetitive motor play)
• Tendency to engage in non-productive interaction
  patterns
• Process of acquiring motor skills varies from
  child to child
• Developmental stages
• Methods to acquire movement skills

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Progression of Motor Development

• Atypical Muscle Tone
• Postural Fixations
• Compensatory Movement Patterns
• Habitual Movement Patterns
• Muscle Shortening or Elongation
• Contractures
• Deformities

• Typical Muscle Tone
• Movement for Postural Stability (Co-contraction)
• Movement for Mobility Against Postural Stability
  (Activation)
• Practice for Refined Coordination

Movement Analysis and Curriculum for Visually
Impaired Preschoolers, Brown and Bour, 1987
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Characteristics of Movement of Children with
Visual Impairment

• Movements are scarce or minimal
• Small ranges in exploration of environment
• Stays in one place (playground, swimming pool)
• Poor body image
• Kinesthetic awareness is lacking
• Proprioception is poor cant judge force,
  speed, posture, etc.

Movement Analysis and Curriculum for Visually
Impaired Preschoolers by Carla Brown and Barbara
Bour
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Characteristics cont.

• Fearful of movement that is out of contact with
  surface (in space)
• Jumping, hopping, diving, standing on one foot,
  etc.
• Movement is organized not fluid
• Grading is absent in mid-range transitions
• Either fully extended or flexed, nothing in
  between

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Characteristics cont.

• Movement is symmetrical or asymmetrical and
  primarily occurs in straight planes
• Rotation is inadequate and counter-rotation is
  absent
• Range of movement is restricted at spine in
  extension and/or rotation
• When movement is difficult (slick surface,
  increased height, etc.) the upper extremities
  tense and move to high guard position

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Characteristics cont.

• When moving from floor to standing there is
  usually weight loading on upper extremities as
  well as lower
• In transitional patterns the integrated function
  of trunk and pelvis is absent

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Characteristics cont.

• Gait is poor
• Decreased stride length
• Out-toeing
• Hyper-extension or increased knee flexion at mid
  stance
• Lateral head movements
• Inadequate weight shift over loaded side in
  stance
• Inadequate weight shift of trunk over pelvis

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Characteristics cont.

• Joint hypermobility is present at hips (double
  jointed)
• Muscle weakness is significant
• Hip adductors (movement together)
• Shoulder girdle
• Abdominal (especially obliques)

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Characteristics cont.

• Can be resistant to tactile input (tactile
  defensive??)
• Hypotonia low muscle tone
• Wrist instability
• Poor palmar arch development
• Poor flexibility
• Trapezius (back)
• Pectoralis (chest and shoulders)
• Lower back extensors (upright posture)

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Characteristics cont.

• Hyper-extension of elbows
• Finger flaring
• Hyper-extension of knees in stance
• Lumbar lordosis in stance (pelvic thrust)
• Pronation of feet (roll in)
• Shoulder elevation
• Cervical hyperextension (head down)

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Correcting Motor Problems

• What therapies, exercises, games or, activities
  can be used to enhance motor development?

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Preventing/Minimizing Motor Problems

• Encourage the infant to turn their head
• Infants need to spend time (supervised) playing
  on their stomachs (prone)
• Pushing-up is vital for development of balance
  skills and prerequisite for arm and trunk
  strength needed for reaching
• Encourages head control and trunk strength
• Can be introduced early by lying prone on the
  caregivers stomach

Developmental Guidelines for Infants with Visual
Impairments Lucek, A., Chen, D., Kekelis, L.
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Preventing/Minimizing Motor Problems

• Physically guide infant/toddler through basic
  movements (developmentally appropriate)
• Support rough-house games during playtime
• Improve body awareness by
• Naming and touching of body parts during usual
  daily activities. Wheres your ear? Lets
  put bubbles on your chin.
• Isolation and integration of body parts and
  movement

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Examples of Activities to Correct Motor Problems

• Crawling
• Weight bearing
• Weight shifting
• Tentative movements
• Exploration
• Body image
• Wrist instability
• Proprioception
• Finger flaring

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Benefits from Crawling

• Strengthens shoulder girdle
• Head positioning
• Provides stable base for movement and exploration
• Transition to kneeling, standing and cruising

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Examples of Activities to Correct Motor Problems

• Riding a tricycle
• Weight shifting
• Hip adductors
• Rotation
• Muscle tone and strength
• Lower back extensors
• Fluid movement
• Closes the wide base of support
• Directionality and spatial awareness

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Suggested Activities

• Heavy lifting, pushing, pulling
• Locomotor Movements
• Walking
• Jumping (two feet)
• Running
• Side Step
• Gallop
• Hopping
• Skip

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Suggested Activities cont.

• Tumbling/gymnastics different body and spatial
  positions
• Swimming
• Balance activities (skating, statues, balance
  beam, etc.)
• Climbing
• Music play
• Guided free movement
• Tempo fast and slow
• Body awareness

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End Result

• With proper assessments and activities to
  minimize motor development problems the child can
  develop efficient skills in

OM
Motor
Self Esteem
Body Aware
Posture
Social
Daily Living
Concepts
Spatial
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Whats the Connection Between Movement and
Learning?

• Strong, smart hands, in flexible, competent
  bodies comprise the physical component for later
  development of braille skills.
• ..Wendy Drezek in Move, Touch, DO

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Whats the Connection Between Movement and
Learning?

• Developing Concepts
• Spatial relations
• Integration of sensory cues
• Object permanence
• Provide experiences with objects in contact with
  body, slight distance at midline, left of
  midline, right of midline, above and below
  midline, to develop concept of permanence.

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Factors that Affect Concept Development

• Hesitancy in exploration and initiation of
  movement
• Lack of opportunity to imitate
• Focusing on isolated parts of a whole
• Problems transferring information to new
  situations

• Auditory system does not provide same integration
  as the visual system
• Tactual sensory bank is smaller than the
  visual bank
• Tactile defensiveness

Early Focus by Pogrund, R., Fazzi, D., Lampert,
J. American Foundation for the Blind 1992
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Fine Motor Skills
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Results of Poor Motor Development on Fine Motor
Skills

• Contrary to popular opinion, babies born with
  visual disabilities are often less receptive with
  their hands.
• Tactile defensiveness is a misnomer actually
  defensive to touching unknown things.
• Have weak, ineffectual hands from lack of
  movement

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Activities for Building Finger and Hand Strength

• Squeeze and mold play dough, clay
• or Thera-putty
• Hammer on a toy workbench
• Shovel sand and lift pails filled with sand
• Pull a string to activate a talking toy (rather
  than push button)
• Opening jars with screw on lids
• Objects to pull apart and push together
• Tinkertoys, pop-beads, locking blocks,

On the Way to Literacy
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Hand Strength cont.

• Opening and clipping clothespins
• Grasping and holding own weight on the monkey
  bars (or chin-up bar)
• Playing tug-of-war with wash cloths or hand
  towels (increasing the length of time to sustain
  pulling)
• Playing toy drums or xylophones

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Activities for Developing Dexterity

• Finger games, such as Where is Thumbkin? or
  touching each finger to the thumb one at a time
• Finger puppets
• Twisting small knobs
• Plunking the keys of a toy piano
• Pulling a zipper

On the Way to Literacy
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Activities for Developing Dexterity

• Velcro blocks
• Stringing beads
• Tying and untying strings
• Nylon rope
• Thick plastic clothesline
• Leather shoe strings
• Shoe strings

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Developing Tactile Sensitivity

• Opportunities to play with toys of varied
  textures
• Have child use, touch and talk about the feelings
  of hairbrush, toothbrush, wet and dry bath items,
  etc.
• Eating finger foods of different textures
• Finger paint (Use pudding so they can eat the
  paint)

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Developing Tactile Sensitivity in Real-Life
Situations

• Crawl on different textures tile, carpet, sand,
  mud, grass, concrete, etc.
• Experience different temperatures ice cube,
  hair dryer, warm car, etc,
• Play with lotions with different textures baby
  oil, lotion, Vaseline, exfoliating scrub, etc.
• Experience different textures of fabrics

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Developing Tactile Abilities

• Use real objects whenever possible
• When real object too large to examine at one time
  (car, tree, etc.) break down into smaller
  concepts and build the whole picture with
  experience.
• Teach the child to explore the environment
• Use routines and every day objects
• Teach systematic scanning of objects
• Begin with hand-under-hand modeling
• Encourage child to verbalize what they are
  feeling
• Move to auditory cues
• Eliminate cues and prompts

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So now you know the importance of

• Getting that baby moving!

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Contact Information

• Kay Ratzlaff
• Coordinator of Instructional Resources
• Florida Instructional Materials Center for the
  Visually Impaired
• 4210 W. Bay Villa Avenue, Room 26
• Tampa, FL 33611
• kratzlaff_at_fimcvi.org www.fimcvi.org

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Resources

• Early Development in Children with Severe Visual
  Impairment by Susan Timmins
• Movement Analysis and Curriculum for Visually
  Impaired Preschoolers by Carla Brown and Barbara
  Bour
• Handout Working with Young and Multihandicapped
  Students who are Visually Impaired by Carla Brown
• Handout Foundations of Orientation and Mobility
  Birth to Three Years by Susan Holmes Shier
• Handout Working with Young and Multihandicapped
  Students who are Visually Impaired Sensory
  Processing by Carla Brown

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Resources

• Individualized, Systematic Assessment of Visual
  Efficiency (ISAVE) from APH