This past week we had our first assessment with Arkansas School for the Blind’s Early Intervention program. First off, let me say how amazing this program truly is. Since the school for the blind does not start until the child hits school age (between 4 and 5 yrs old) they have developed the Early Intervention Program for children birth to age 3 to follow the child until they become of school age. At first I thought this program only applied to completely blind children or that you would be expected to go to their school instead of public or private schools in the future but that is not the case. Our Early Intervention Specialist explained that many students choose to go to public or private schools and some do fine that way, if they start having problems then they may transfer to their school if they wish. (If the public school is unwilling to assist the child in the best ways or if the child starts doing poorly they will reevaluate.) She explained that they encourage them to go on to public schools if they feel they can and if the parent wishes they will even come to the child’s classroom to meet with the principal and the child’s teachers to inform them how best to help your child. (It is up to the teacher how much she wants to change in her classroom. The Early Interventionist can urge them to change certain things but it is not mandatory. Some teachers will go the extra mile for their students and some will not.) Also, we were informed that only around 30% of their students are fully blind and need Braille the rest are just visually impaired like Liam and need varying degrees of help. Our Early Intervention Specialist was Pam Raspberry (who we had heard such great things about before hand) who will be doing Liam’s sessions once a month from now until he is three years old. The program gives you the option of having the sessions done at your home or the home of the sitter/daycare so we chose to have Ms. Pam come to our house once a month. I had feared Liam would have some “stranger anxiety” issues like he has in the past with strangers trying to hold him before giving him time to adjust to them but he instantly reached for her and allowed her to hold and play with him. The session lasted around an hour and as Ms Pam evaluated him she had us fill out the Oregon Project Assessment to track his developmental progress. Each time she returns we will go over the same questions asking about tasks he can or cannot do to track his improvement. She had Liam play with several lighted toys and our favorite, the light box. Typically these are used for tracing in art classes but they work great to show high contrast so that Liam’s eyes can spot objects blocking the light and grab hold of them. Imagine the light on the wall of the doctors office that he uses to read an x-ray….there is a foggy white glass covering the bright lights so it does not hurt your eyes and it lights up the dark x-ray. Ms. Pam used this light box with colored slides just like you would a projector. Liam could see the objects better in front of the light because of the contrast. It really was amazing. She had slides that looked like zip-lock bags filled with colored gel and toy fish inside that looked like the ocean so he chased after the fish and smashed on the gel to move the waves around. Ms. Pam is bringing us one at the next visit that the school supplies for us until he is 3. (I plan on posting lots of pictures and videos to show how we use it once we have it so stay tuned!!) Besides the light box Ms. Pam used several flashing lighted balls that had neat rubber textures and a few light up sticks for Liam to try and track with his eyes. She figured out very quickly that Liam could follow much better when the objects were in his null point (up high with head tilted down) than he did if she lowered the objects and moved them side to side opposite of his Nystagmus movement. She also found he preferred some of the toys over the others due to light, color and texture. (This will help us immensely in the future in keeping his attention during the therapy sessions.) Ms. Pam was very excited to get to work with Liam and shared a lot of information with us on Arkansas’s chapter of NAPVI –the National Association of Parents of the Visually Impaired. They do local functions and events that she encouraged us to look into and participate in to connect with other families like ours. It was very helpful and we are looking forward to the monthly visits.
Below are Ms. Pam’s recommendations and Liam’s scores based on the OR Assessment.
Liam is able to obtain a toy when it is dropped within his reach.
Liam is able to visually follow SLOW moving objects and shows attention for 30 seconds or longer.
Liam displays a preference of one object over another.
Liam will look at a picture briefly.
He scored at:
Self help 81%
Gross motor 86%
Social 100% (of course!!!)
Liam shows strength in the areas of social, gross motor, and cognitive skills but shows minor weakness in language and fine motor skills. My recommendations are 1. continue to be followed by primary eye care physician 2 participate in ASBVI Early Intervention Program 3. continue providing opportunities for Liam to use his vision to access information of his environment.
How to increase visual awareness:
1. Use high contrast (colors) when materials are presented to him. Present lighter material against a dark background or dark against a light background.
2. Keep visual environment simple and uncluttered. Use one object at a time on a simple background. Sometimes shiny/reflective items work better.
3. The use of lighted toys or flashlights in a dark room can increase visual awareness (light box)
4. Use movement to help elicit visual response. (slinky, pinwheels)
5. Try presenting objects centrally and on either side to see if he will look towards the object
6. For tracking, move objects slowly across visual field from the side toward the midline. Move in all directions slowly from side to side and up and down.
7. Allow him to get as close to items as necessary for viewing.
8. Integrate visual and tactual input. Allow him to touch and feel items and assist in exploration while encouraging him to “look”, “watch,” etc. The use of touch can serve as a means to validate the visual image.
9. Allow ample time for him to process visually and respond physically.
10. Be aware of background noises when working on visual skills. Ambient noise can be distracting and can compete for the child’s attention
11. Consider best positioning for his viewing objects and activities.
Many of this advice can be used for kids with different disabilities not just the visually impaired. Today we have our vision therapy session at Pediatrics Plus with the Occupational Therapist so I will have more on that later this week.