EARLY INTERVENTION IN LV MANAGEMENT

EARLY INTERVENTION IN LOW VISION MANAGEMENT

YOGITA L RAJGANDHI
Optometrist, Manageing
Director – RECI
President – VOSH International (USA) India – Maharashtra Chapter
Faculty – COOS
Ex-Head of Low Vision Department: NAB Workshop for the Blind (Mumbai)
Ex-West Regional Representative (IOA)

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WHAT IS EARLY INTERVENTION?

Visual impairment limits the opportunities of a child who has to learn about their world. A visually impaired child needs unique instruction, modelling, and hands-on opportunities to make sense of their world. Such children can benefit immensely through “early intervention.” This term is used to describe the services and support system that is made available to babies and young children with developmental delays/disabilities and their families. Early Intervention is a critical service provided since birth through two years of age for kids or toddlers with visual impairments as it builds a foundation for further learning. It provides parents with resources, support and information to enhance their child’s communication skills which can include speech therapy, physical therapy, and other types of services based on the needs of the child and family. Working together with a trained provider enables parents to feel confident that they are facilitating their child’s communication development.

An infant begins learning about the world around them almost immediately. When a child is unable to gather information through his sense of sight, it is essential to help him get that information in other ways. The sooner he can get some assistance with his explorations, the sooner his growth, development, and learning can be encouraged – this is why early intervention is so important for infants who are visually impaired – basically, it is a system of services and supports designed to help families care for and encourage the development of their infants and toddlers (birth to 36 months of age) with disabilities.

DEVELOPMENTAL MILESTONES

A child with a visual impairment may achieve developmental milestones at a slower pace than their sited peers. This is not related to a lack of cognitive skills as visual impairment is a sensory loss and is not related to cognition. Vision is the primary sense that infants and toddlers use to organise and learn about the world. Social development is affected as children are not able to pick up on non-verbal clues or if they are unable to make eye contact they may appear disinterested and can reduce sustained social interactions. Loss of vision impacts motor development as a child may not be motivated to move toward that which can’t be seen or causes inhibition to move for fear of the unknown. An exploration of the environment and materials is critical in cognitive development, therefore, movement is important not only for motor development but for the development of concepts. Language acquisition can also be affected by the loss of vision as active interaction with people and the environment is important in language development.

An effective early intervention program can help to meet a child’s needs in five primary areas:

  • Developing ideas, concepts, and knowledge
  • Physical development
  • Communication
  • Social and emotional development
  • Adaptive development

There are various departments which can offer this service for each disabled child in different regions at government and non-governmental organisations

  • Health
  • Human services
  • Education
  • Rehabilitation

A child who has been diagnosed to have a physical or mental condition will likely face developmental delays. A child needs cannot be separated from the needs of his or her family. 

For this reason, early intervention services are designed to help the family to feel comfortable and confident while raising such children. Additionally, because parents are their child’s best teachers, it is important for parents to be involved in all the services which a child receives. Parents can continue working with a child at home to reinforce lessons and skills that the early intervention team members may have introduced to them.
Early intervention services start with an assessment to determine the child’s needs and what type of help parents of the visually impaired child want for their child. These programs employ a variety of professionals, including early interventionists, counsellors, instructors and others who can provide a variety of services. It is imperative that a key member of the team works with the parents of the child and trains them to be sensitive to the needs of young children who are visually impaired—very often, a teacher can provide these services in home, at a school or hospital, clinic or other location in the community, or combination of any one.

A wide range of services may be provided through an early intervention program, including:

  • Assessment and planning
  • Speech and language therapy
  • Occupational and physical therapy
  • Vision services including orientation and mobility (body awareness and travel skills)
  • Audio logical services
  • Medical and nursing services
  • Health services necessary for the child to benefit from other early intervention services
  • Family training, counselling, and home visits
  • Transportation to enable the child and family to receive early intervention services
  • Special instruction services
  • Psychological and social work services

PROVIDE A VARIETY OF EXPERIENCES TO THE CHILD

Infants who are blind cannot observe the actions of others or see objects and materials around them. Even baby’s with some usable vision will have difficulty making sense of the limited visual information they are receiving. Additionally, they are not able to see the effects of their own actions on objects, that the object continues to exist when out of reach (object permanence), or observe how others interact with the object. At home, parents and at clinics, professionals need to act actively modelling play activities for the child, participating in everyday experiences with the child and explaining daily events that will enable the child to learn about people, objects and events. The child will learn new skills best by doing them with parents or teachers. Let the child be a part of the experience. Naturally, find a balance between encouraging touch and exploration and keep the child safe! By allowing the child to participate, it will help the child to understand the process.

PROVIDE TACTUALLY INTEREXTING TOYS AND MATERIALS

There are many commercially available toys for infants and toddlers that are very similar in their feel. Although they may make a variety of sounds, the material is a hard plastic or within a fuzzy stuffed animal. An effort should be made to find or adapt toys to add variety to what the child is able to feel as well as hear. One should look for unbreakable toys that have interesting textures, weights, and temperatures. If a child has some vision, look for toys and materials with high contrast that will make it easier to see. Playing with real objects provides the child with various textures but also provides them with information about their world.

Children who are blind or visually impaired can frequently be sensitive to different textures and temperatures. Exposing the child to a variety of textures will not only lay the foundation for braille but will motivate the child to explore and begin making comparisons and will also enable them to be more accepting.

It is important to talk to the child about what is happening, to find a balance between verbal descriptions and incessant talking. Provide a short, clear description of daily events and activities. Be sure to let the child know when you leave the room, and let him know when you return. Also inform the child about what you are going to do prior to doing it. For example, tell the child that you are going to wipe his nose prior to wiping it.

SIBLINGS

To provide siblings a role in caring for their brother or sister is very important for the visually impaired child. Although they shouldn’t be forced, at times older children may enjoy helping the child practice activities suggested by the teachers or therapists.

REDUCE AUDITORY DISTRACTIONS

Be aware of auditory distractions. It is ideal to not have the television or radio on nonstop or loud as the child will not be able to focus on other sounds and language spoken by people in the same room.

CREATE CONSISTENT ROUTINES AND TRANSITIONS

Creating a consistent routine will help the child learn to anticipate events. When there is predictability and consistency in the schedule, the child will find comfort by being able to anticipate what is going to happen next. Prepare the child for each transition. If the child does not yet understand words/language, use an object, or touch cue, associated with the next activity to prepare them for what will happen next.

ENCOURAGE THE CHILD WHO IS VISUALLY IMPAIRED/BLIND TO MOVE

Students with significant visual impairments may need the motivation to move and explore objects outside of their immediate reach. The student may not be motivated to explore the world without seeing things to entice them. It may be tempting to bring everything to the student, but this will prevent the student from discovering things and the student may become dependent on others bringing the world to them. The student must be taught to move confidently and independently in order to explore and learn from their world. Encourage the student to use any remaining vision but to also use their other senses to make sense of their world; to learn by listening, touching along with using their sense of smell; to hold his head up and reach towards objects in order to learn to walk and to explore their world. This will lay the foundation for Orientation and Mobility skills.

FOSTER INDEPENCENCE

Many well-intentioned parents and therapists will feel tempted to do everything for the child who is blind or visually impaired. It can be easier to do it yourself because it takes the child much longer to complete the task. It is, however, in the child’s best interest to not give in to this temptation. Teach the child new skills by completing tasks with the child, not for the child. Although it may take longer to acquire skills, with repeated experience and extra time, the child will learn to become more independent.

DISCUSSION

Loss of vision can affect all areas of development. Every child is unique, every child has his/her own style of communication with others, and each child develops its own pace to react to the situation, people and the world around them. Parents, family members, therapists and other professionals need to be efficient, skilful, patient and creative in the best interest of the child.

REFERENCES

1. Chen, D. (2014) Essential elements in early intervention: Visual impairment and multiple disabilities (2nd ed.). New York, NY: AFB Press.

2. Anthony, T. L. (2014). Family support and early intervention services for the youngest children with visual impairments. Journal of Visual Impairment and Blindness, 108 (6,SI), 514-519.

3. Binns, A. M, Bunce, C., Dickinson, C., Harper, R., Tudor-Edwards, R., Woodhouse, M., & Linck, P. (2012). How effective is low vision service provision? A systematic review. Survey of Ophthalmology, 57(1), 34-61. http://dx.doi.org10.1016/j.survophthal.2011.06.006.

4. Ozaydin, L. (2015). Teaching play skills to visually impaired preschool children: Its effect on social interaction. Educational Sciences: Theory & Practice, 15(4), 1021-1038. http://dx.doi.org/10.12738/estp.2015.4.2746

5. Popp, T. K., & You, H. K. (2014). Family involvement in early intervention service planning: Links to parental satisfaction and self-efficacy. Journal of Early Childhood Research, 1-14, http://dx.doi.org/10.1177/1476718X14552945

6. Trivette, C. M., Dunst, C. J., & Hamby, D. W. (2010). Influences of family systems intervention practices on parent-child interactions and child development. Topics in Early Childhood Special Education, 30, 3-19. http://doi.org/10.1177/0271121410364250

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