Using Assessment Results in Intervention Session 5

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Using Assessment Results in Intervention
Session 5
Visual Conditions and Functional Vision Early
Intervention Issues
The University of North Carolina at Chapel Hill
Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute
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Objectives

• After completing this session, participants will
• 1. recognize that intervention planning for
  young children with visual impairments should be
  based upon
• results from the functional vision assessment
  and/or developmentally appropriate learning media
  assessment
• family concerns, resources, and priorities as
  identified in routines-based assessment and
• assessment results from multiple disciplines.

5A
Visual Conditions
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Objectives

• After completing this session, participants will
• identify developmentally appropriate and
  functional interventions within the childs
  natural environment that facilitate the
  development of visual skills.
• describe the relationship between postural
  stability and optimal use of vision and the use
  of positioning to facilitate the use of vision.

5B
Visual Conditions
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Objectives

• After completing this session, participants will
• identify environmental modifications that promote
  young childrens optimal use of vision within the
  context of daily routines and naturally occurring
  activity settings.
• describe the use of cues and prompts as an
  intervention strategy that may promote optimal
  vision use for children with visual impairments.
• describe the TVIs role in supporting the use of
  corrective lenses with children with visual
  impairments.

5C
Visual Conditions
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Objectives

• After completing this session, participants will
• describe the role of TVIs and OMSs in
  implementing the recommendations from low vision
  specialists and in helping children learn how to
  use optical devices recommended by low vision
  specialists.
• describe the relevance of a patching
  (penalization) program and strategies to support
  young children in adapting to penalization.
• identify strategies that support efficient use of
  vision in children with cortical visual
  impairments.

5D
Visual Conditions
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Assessment guides intervention planning.

• The FVA and DALMA provide information about
  childrens use of functional vision and other
  senses in the context of daily routines.
• Assessment of families priorities, concerns, and
  resources as identified in a routines-based
  assessment provides useful information for
  identifying functional goals.
• Part C of IDEA (1997) requires that assessment be
  completed by professionals from at least two
  disciplines.

5E
Visual Conditions
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Current Levels of Visual and Sensory Functioning

• Describe how children currently use sensory
  information, provide baseline information about
  sensory skills, and can change considerably over
  the course of a few weeks or months

5F
Visual Conditions
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Assessment and Intervention Guidelines

• As addressed in Part C of IDEA (1997),
  assessments should be conducted by professionals
  from two or more disciplines, and interventions
  should be based upon assessment from multiple
  disciplines.

5G
Visual Conditions
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Intervention Goals

• Intervention goals should be continually
  monitored and updated to meet the changing visual
  and developmental status of the child as well as
  the familys concerns and priorities.
• Revised goals should be developed by all
  team members to ensure a consistent, holistic
  approach to promoting optimal development.

5H
Visual Conditions
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Motivational Considerations

• Meaningful learning occurs within the context of
  activities in which children are engaged and
  motivated.
• Intervention goals
• and strategies
• that motivate
• children are more
• likely to be
• effective and
• enjoyable.

5I
Visual Conditions
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Developmental Considerations

• Cognition is involved in visual processing.
• Basic visual behaviors that involve physical
  visual function are less difficult than those
  requiring higher cognitive ability.
• Children who are
• functioning at
• lower developmental
• levels may be
• expected to acquire
• basic visual tasks.

5J
Visual Conditions
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Visual Skill Considerations

• Integrating the use of visual skills within
  motivating, naturally occurring contexts and
  routines will enable the young child to have more
  meaningful visual experiences.
• Localizing Shifting gaze
• Fixating Tracking
• Scanning Eye-hand
• coordination

5K
Visual Conditions
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Localizing

• Localizing means locating a landmark and
  moving toward it.

5L
Visual Conditions
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Fixating

• Fixating means focusing on an object, such
  as a caregivers face during communicative
  exchanges or food during meals.

5M
Visual Conditions
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Scanning

• One example of scanning is looking for
  clothing items in a dresser drawer during the
  morning dressing routine.

5N
Visual Conditions
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Shifting Gaze

• Shifting gaze can be used when choosing
  between two toys during playtime.

5O
Visual Conditions
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Tracking

• An example of tracking is visually following the
  movement of a family pet.

5P
Visual Conditions
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Visual Clusters

• Visual clusters are observable
• behaviors that occur in a sequence.
• For example,
• Hayden looks
• for the red toy,
• reaches for it,
• and grasps it.

5Q
Visual Conditions
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Critical Visual Moments

• A critical visual moment is the time during task
  performance when continuous eye contact or
  fixation
• on the task materials is necessary
• to complete the task.
• If TVIs can identify critical moments within
  daily routines and can help the child look at
  that moment, the routine will be completed more
  efficiently.
• Goetz Gee, 1987b

5R
Visual Conditions
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Sensory Integration

• Recommendations to enhance sensory
• integration include
• providing children with opportunities to use
  vision and hearing during their daily routines,
  such as preparing food, and
• giving children ample opportunities to tactually
  and visually explore objects, particularly those
  objects that are outside the childs visual
  range.
• Erin et al., 2002

5S
Visual Conditions
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Sensory Integration

• Encourage children to use their sense of smell to
  provide additional cues in identifying objects
  and events. For example, a child might
  differentiate an orange from a lemon by smell and
  color.
• Expose children to different movement experiences
  to support the integration of vision and
  movement.
• Erin et al., 2002

5T
Visual Conditions
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Postural Stability

• Some children with visual impairments and
  dysfunctional postural and movement systems can
  improve visual efficiency through stable
  positioning.
• When working with children with physical
  impairments, it is important to consult with
  occupational and physical therapists to identify
  optimal positions for visual functioning.
  Erin, 1996 Langley, 1998b

5U
Visual Conditions
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Environmental Modifications

• Implement modifications during daily
• routines and activities across settings to
  facilitate optimal visual functioning.
• Change illumination
• Adjust seating
• Reduce glare
• Reduce clutter
• Alter color or contrast
• Minimize noise

5V
Visual Conditions
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Cues and Prompts

• Cues and prompts can promote
• optimal visual use for children with VI.
• Physical
• Auditory (tapping)
• Verbal (look at)
• Visual cues
• Time out
• Chen Dote-Kwan, 1995
• Utley, Goetz, Gee, Sailor, 1981

5W
Visual Conditions
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Corrective Lenses

• Eye care professionals will often prescribe
• corrective lenses and suggest that they
• be worn for specific amounts of time in
• the day.

5X
Visual Conditions
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Adjustment to Corrective Lenses

• Adjustment to corrective lenses may
• be challenging because
• toddlers assert independence,
• glasses may feel unusual and be
• a source of distraction,
• glasses may actually be
• uncomfortable, and
• lens prescription may be incorrect.
• Wisely et al., 1990

5Y
Visual Conditions
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Promoting Acceptance of Corrective Lenses

• Encourage the child to wear glasses
• for short periods of time initially (e.g.,
• during the beginning of mealtimes).
• Praise the child for wearing glasses.
• Gently replace the glasses without
• comment when the child removes them.
• Gradually increase the amount of time
• that the child wears the glasses.
• 
  Wisely et al., 1990

5Z
Visual Conditions
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Optical Devices

• Use of optical devices such as magnifiers and
• monoculars may help children with low vision
• gain visual access to their world. Optical device
  
• training may
• improve self-image,
• facilitate
• independence,
• facilitate learning, and
• heighten motivation
• and curiosity
• to explore. Wilkinson, 2000

5AA
Visual Conditions
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Optical Devices

• Facilitating the
• development
• of visual skills is critical
• because children with
• low vision cannot be
• expected to look through
• prefocused monoculars
• if they are not able to
• maintain fixation.
• Watson, 1989
• 
  

5BB
Visual Conditions
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Patching as an Intervention

• Eye care professionals
• may recommend that
• an eye with better
• vision be patched in
• order to allow the
• weaker eye to become
• stronger through
• forced use.

5CC
Visual Conditions
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Patching Methods

• Encouraging young children to
• tolerate an eye patch can be difficult.
• TVIs should be aware of methods
• that facilitate this medical treatment.
• Firmness and consistency
• Engagement/distraction
• Positive reinforcement

5DD
Visual Conditions
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CVI Strategies

• Levack, Stone, and Bishop (1994) suggest
• the following strategies for working with
• children with CVI
• Use other sensory cues to stimulate or support
  visual information.
• Avoid visual overstimulation by introducing
  items one at a time in an uncluttered
  environment.
• Levack, Stone, Bishop, 1994, pp. 16-17

5EE
Visual Conditions
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CVI Strategies

• Work with only one sense at a time when using
  other sensory cues to stimulate visual
  performance.
• Watch for preferences in color, shape, size,
  movement, and field.
• Make changes gradually, recognizing that these
  children can have difficulties processing
  information.
• Levack, Stone, Bishop, 1994, pp. 16-17

5FF
Visual Conditions
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CVI Strategies

• Try shaking or moving objects as they are brought
  into childrens line of vision.
• Determine the best position for individual
  children to use their vision.
• Make visual cues bold and simple, and use them
  consistently.
• Present visual stimuli in a simple figure-ground
  environment.
• Levack, Stone, Bishop, 1994, pp. 16-17

5GG
Visual Conditions