Vision Stimulation of Visually Impaired Infants and Young Children
and Other Considerations
by
Dr. L. E.
Leguire
Columbus Children's Hospital
Once an infant or child has been
diagnosed with a vision loss, one of the first things that the parent(s)
should do is find professionals and organizations that work with infants
and children with vision loss. For example, services are provided by
numerous programs including MRDD (Mental Retardation and Developmental
Disability), BSVI (Bureau of Services for the Visually Impaired) and the
local school system. Early infant vision stimulation programs are also
sometimes available through other local and state agencies, so you'll
have to search and ask everyone you have contact with about the services
available for the visually impaired (VI) child in your local area. Start
with the doctors that diagnosed the vision loss; ask their opinion.
One of the most important pieces of
information that will help in providing services to a VI child is to
know his or her visual acuity - how small of an object can the child
see? Visual acuity is usually listed as a "Snellen" fraction; for
example, a normal 6 year old child sees 20/20. One way to think of the
Snellen fraction is that the top number is how far away the VI child can
see the object and the bottom number is how far away a normal child can
see the same object. For example, if a VI child has 20/200 visual acuity
this means that the VI child can see an object that is 20 feet away and
a normal child can see the same object 200 feet away. Visual acuity can
be measured in most, but not all, infants and children (usually by the
Acuity Card Procedure/Preferential Looking Technique (ACP/PLT) or Visual
Evoked Potential, VEP). Some VI children can only see light (light
perception) and other VI children can see only see a light and the
direction of the light (light projection).
The information detailed below is
directed towards rehabilitation specialists, teachers and parents who
work with VI infants and young children.
In order to maximize vision, a young VI
child must have appropriate visual stimulation as well as physically
interact with the visual stimulation to form the brain connections that
will last a lifetime. Appropriate visual stimulation involves visual
objects that are of sufficient strength to provide the visual centers of
the brain and other brain areas with visual information for "seeing" and
for action. However, visual stimulation alone is not enough - the young
child must also interact with the visual object (e.g., reaching for the
object, gazing at the object, walking through the doorway, etc.), in
order to maximize vision.
Appropriate visual stimulation is
possible with visual objects that can stimulate the brain of a VI child.
For example, a VI child with 20/600 visual acuity can only see objects
that are 20 feet away that a child with normal vision can see 600 feet
away. Or, the VI child can only see an object that is 2 feet away that a
child with normal vision can see 60 feet away. In this case, many
objects would be too small for the child with 20/600 vision to see and
these objects would not provide visual stimulation. To provide the VI
child with appropriate visual stimulation, the object would have to be
larger than 20/600. Remember, visual acuity only tells us the smallest
object the child can see (i.e., discriminate from other objects). In
order to maximize vision stimulation, objects must be much larger than
that based on visual acuity alone.
Some of the most "powerful" visual
objects include high contrast, black and white objects including
alternating black and white bars (Figure 1), known as a grating, as well
as checkerboards (Figure 2). More complex visual objects include faces
(Figure 3). Contrast refers to the brightness difference between the
light and dark parts of the visual object. The greater the difference
between the light and dark areas of the object the higher the contrast
and the more likely the object will provide appropriate visual
stimulation. Low contrast objects (Figure 4), like an object drawn with
a pencil on white paper, are difficult or even impossible to see for a
VI child. This is one reason why older VI children should use thick
black felt tipped pens for all writing and drawing.
Figure 1
To
provide appropriate visual stimulation, gratings should have different
orientations (vertical, horizontal, oblique 45o, 135o)
and bar sizes. The white area should never be small than the black
areas. Given a stroke width of 3/4" for electrical tape, a child with
20/200 vision will be able to see the black and white stripes of the
grating up to 6 meters away; however, at 6 meters this would the
absolute minimum size that the child could see. To stimulate vision, bar
or stripe size should be larger than that based on visual acuity (at
least 2-3 times larger).
Figure 2
A
checkerboard made from black electrical tape and white cardboard.
Checkerboards should also vary in overall size and orientation in order
to provide appropriate vision stimulation. Individual bar size can also
be varied by making checkerboards with two and even three strips of
electrical tape, particularly if the child has very low visual acuity
(e.g., worse than 20/400).
Figure 3
More
complex visual objects can include faces, squares, and stars...use your
imagination. For older children, letters of the alphabet as well as
numbers can also be constructed to teach the child the alphabet and
numbers, accordingly. The white area should never be less than the black
(tape) area or stroke width.
One of the easiest ways to create a
high contrast powerful visual object is with the use of black electrical
tape (3/4") and white cardboard. Mobiles placed about 1/2 - 1 meter from
the child, beyond arms reach, can be easily constructed with this
material. The contrast between the black electrical tape and white
cardboard is the highest possible. The tape and cardboard are also very
inexpensive. Both sides of the white cardboard can contain objects
(e.g., Figs 1-3) and a small fan or open window can even be used to give
the mobile continuous movement. Posters constructed from black
electrical tape and white cardboard can also be constructed for hanging
on walls. However, in order for the VI child to see the object, as
viewing distance increases the object must be larger and larger and the
stroke width wider and wider.
Objects that are created with the tape
and cardboard must be of sufficient size for the VI child. If the VI
child has very reduced vision, several pieces of black electrical tape
can be placed side-by-side to create larger stroke widths (e.g., 2
pieces of tape = 1 1/2").
Table 1 provides guidelines for minimum
stroke width of an object given a VI child's visual acuity. For example,
a child with 20/600 visual acuity would be able to just see a grating
(Figure 1) whose black and white bars were 4 mm wide at a viewing
distance of 18". Table 1 DOES NOT provide the minimum size of an object
that a VI child could see - just the width of the lines that make-up the
object. For example, for Figure 3, a child with 20/600 visual acuity
would have to have a minimum stroke width (black lines) of 4mm BUT THE
FACE WOULD HAVE TO BE MUCH LARGER.
Table 1
|
VA |
SIZE (mm) |
VA |
SIZE (mm) |
VA |
SIZE (mm) |
VA |
SIZE (mm) |
|
20/100 |
0.7 |
20/400 |
2.7 |
20/800 |
5.3 |
20/1200 |
8 |
|
20/200 |
1.3 |
20/600 |
4.0 |
20/1000 |
6.6 |
20/1600 |
10.6 |
Relation between visual
acuity (VA) and size (millimeters, mm) of the stroke width (width of 1
dark bar of a grating) at a viewing distance of 18 inches. The purpose
of this table is to provide guidelines as to the minimum stroke width,
of a much larger object, a VI child could discriminate from another,
similar, object (e.g., letters).
We cannot emphasize enough that an
object and the stroke width that makes-up the object must be easy for
the VI child to see. If the object is difficult to see, for example
because stroke width is too small or lines are of too low contrast, the
child will have great difficulties in using the object for a motor task.
If objects are difficult or impossible to see, performance may be
affected on certain tasks (e.g., tracing, writing and even reading).
Figure 4 shows simple line drawings
made by different types of writing instruments, to illustrate the
importance of utilizing objects that are easy to see by the VI child in
vision stimulation programs, as well as in a school setting. A VI child
with, for example, 20/200 visual acuity would have great difficulty in
seeing the pencil drawing but would easily sees the medium felt-tip pen
drawing. A VI child with 20/600 visual acuity may have difficulty seeing
the medium felt-tip pen drawing but more easily see the drawing made by
the heavy thick felt-tip marker.
Figure 4
Figure 4 illustrates simple drawings
made with different writing instruments (simulated, this figure did not
scan well). For a VI child, the drawing made with the pencil (far left)
may be difficult or impossible to see while the drawing with the medium
felt-tip pen is easy to see, even though the drawings are of the same
overall size.
To further illustrate the importance of
a high contrast and thicker stroke width for older VI children with good
communication skills, do the following exercises.
Exercise 1. Test Yourself
Read the following lines, out loud.
Larry didn't see the ball coming and it hit him in
the chest. It startled him for a moment, but he soon recovered and
picked-up the ball. The runner had already rounded second base and was
heading for third. Larry threw the ball, but it went high and past the
third baseman. The runner headed for home. The left outfielder threw the
ball to the catcher at home plate. Home is where the buffalo roam.
Note your
slow reading speed and how difficult it was to make-out some of the
letters or words. Also, you probably held the page closer to your face
in order to make the print larger and easier to read. In many ways, a VI
child sees regular size print and perhaps even large size print with as
much difficulty as you were having with the #4 font print as shown in
the above lines. The point is - print should be of sufficient size and
contrast (and font type) to be easily seen by the VI child. When in
doubt make it BIGGER and BOLDER!
Exercise 2. See How Large Stroke Width
Makes a Difference - Tracing (older children)
Draw several simple figures (circle,
square, triangle) with a No 2 or No 3 pencil. Make the figures about 3"
across on white paper. Have the child trace the figures with a pencil
and time his or her performance. Also observe the child's behavior while
s/he is tracing the objects. Now, draw the same or similar figures but
with the medium felt-tip pen. Also have the child trace the figures with
a medium thick felt-tip pen. Many VI children will have difficulty with
the thinner and fainter stroke widths made by the pencil, however, the
children's performance will be much faster and easier when the figures
are drawn with the medium felt-tip pen. You can try different figures to
make sure that the better performance is not simply due to practice or
familiarity with the drawn objects.
Exercise 3. High Contrast is Important
- Naming Objects (older children)
Draw several simple figures with a
pencil and with a medium felt-tip pen, similar to exercise 1. At a
viewing distance of about 1 meter, have the child name the objects. Some
VI children will not be able to name the objects when they're drawn with
the pencil but will have no problem naming the objects when they're made
with the medium felt-tip pen.
Exercise 4. Employ High Contrast
Stimuli - Learning the Alphabet (2 years and older)
For VI children who are 2 years old or
older, construct all the letters of the alphabet using 5"x7" white index
cards and black electrical tape (single width). Use a block diagram that
is about 5" high and 3" wide to construct all the letters. Or, use a
computer and print the alphabet 1 or 2 to a page and cut the pages in
half (only one letter to a card). Use a simple font (e.g., Arial Black)
or another simple bold font with about a 300-font size (based on
WORD.doc, 2 letters per page). Place a letter about 12 - 18 inches in
front of the child as say the letter twice, about 2 seconds apart,
slowly but clearly (do not use "baby talk"). Repeat the process for
other letters, as long as you have the child's cooperation and
attention. You do not have to go through all the letters at the same
setting - break them up into manageable time slots. ANY vocalizations,
as if the child is trying to say the letter, should be immediately
rewarded verbally (e.g., Good!). You can even touch or tickle the child
to reinforcement each vocalization. Minimize other talking during the
exercise. Never say anything negative if the child does not respond,
just continue with the exercise.
Exercise 5. Discrimination of Letters
Once the child has had several months
or more to learn the alphabet, see if s/he can discriminate letters.
Place two letters side by side and say one of the letters while
attending to the child's eyes in terms of fixation. Reward the child
whenever the child looks at the correct letter after you have said the
letter. If the child does not respond, move or shake the correct letter
while saying the correct letter. If the child does not fixate the
correct letter, say nothing. Remove the other (incorrect) letter and
verbally repeat the letter. Move to the next pair of letters. Repeat the
process with other letters. NEVER give a child negative feedback (e.g.,
never say "No", "Wrong", etc.) if s/he gets the letter wrong or points
or looks at the wrong letter. Reward correct responses and ignore
incorrect responses. For older children with good motor skills, pointing
or a head turn to the correct letter is sometimes possible.
Overall Size of Objects for Vision
Stimulation of Younger Children
Table 2 provides guidelines for the
minimum size of a visual object to use for the vision stimulation of a
VI child, when the object is constructed from pieces of black electrical
tape as shown in Figures 1-3. Of course, objects can and should be
larger than the minimum size requirements. In general, an object that is
2-3 times minimum size may be preferred by the VI child.
Table 2
Visual
Acuity Minimum Object Size (inches) Tape
Width (# of pieces)
|
20/200 |
3" |
1 |
|
20/400 |
6" |
1
or 2 |
|
20/800 |
9" |
2 |
|
20/1600 or LPr |
12" |
3
or 4 |
LPr = Light Projection
The general guidelines as listed in
Table 2 are for infants and young children with limited or no
communication skills. For VI children with communication skills (e.g.,
child can fixate or visually follow an object) or with some form of
motor or verbal response, the child's response may be used as a guide to
determine the general size, shape and type of the visual objects used
for vision stimulation.
Again, the emphasis should be placed on
high contrast, black and white objects that are easy to see by the
child. Colored objects are generally not recommended because color
contrast is much less than luminance (brightness) contrast and colored
objects (e.g., drawings) are more difficult to discriminate from a
colored background. However, sometimes children with "cortical
blindness" or cortical visual impairment (refer to article on CVI at
http://www.ohiolionseyeresearch.com/past.htm) may
prefer colored objects to black and white objects.
Use these guidelines for constructing
visual objects, with black electrical tape and white cardboard, for a VI
child with limited or no communication skills. Viewing distance is 18".
Double object size and stroke width (number of pieces of tape) for each
doubling of viewing distance. For example, if the object is 36" from the
child with 20/200 visual acuity, the minimum size is 6" and the stroke
width should be 1 or 2 pieces of black electrical tape.
Detection vs Discrimination of Objects
It is important to know the difference
between detection and discrimination in a visual stimulation program.
Detection refers to simply being able to tell something is there and
discrimination is being able to tell what it is. For example, a VI child
might be able to detect a flash of light but not be able to see the
flashlight, itself (discriminate the flashlight from the flash). Along
similar lines, Figure 1 presents a black-and-white grating. Detection
refers to the ability to tell that something is there, for example, the
overall grating may have lower luminance than the surround area and the
child may be able to tell that something dark is there; however, the VI
child might not discriminate the individual bars of the grating.
Discrimination, in this case, refers to the ability to "see" the
different bars that comprise the grating. In general, a visual object
must be detected first and than discriminated from other objects
(exceptions include children with cortical visual impairment, see
below). This type of hierarchy, detection => discrimination, follows
general development of the visual system. It is easy to detect a visual
object (e.g., a light against a dark background). It is much harder to
discriminate the object from other objects (this is the basis for visual
acuity). Thus, a VI child may be able to see a very small light flash
but not able to discriminate a large "C" from a large "O".
We often
see parents of VI children, for example, who say that the child can
pick-up a very small object on the floor. However, our testing shows
that the child's visual acuity is, for example, 20/400. In other words,
the child is legally blind. So how can a legally blind child see such
small objects? This discrepency is due to the fact that the parents are
referring to the child's detection of an object while the eye
doctors are referring to the child's discrimination of the
object; that is, visual acuity. It is much easier to detect that
something is there vs to discriminate an object from other objects of
the same size.
Light perception and light projection
are somewhat analogous to detection - being able to see a light or the
source of light but not able to tell what it is. Form perception (e.g.,
20/1000 visual acuity) is analogous to discrimination - being able to
tell a "C" from an "O", albeit at a very close viewing distance or very
large letter size. One goal of vision stimulation is to allow the child
to discriminate the smallest visual objects possible. In other words,
maximize visual acuity.
Children with Nystagmus ("Dancing
eyes")
Nystagmus is defined as involuntary eye
movements that are usually very repetitive - a back-and-forth movement
of the eyes. Nystagmus is usually in the horizontal direction, although
vertical and even rotational nystagmus is possible. Some children with
nystagmus have a "null zone" - a certain direction of gaze where the
nystagmus decreases or stops altogether. Infants and children with
nystagmus and who have limited or no communication skills pose a
challenge to the eye doctor and to the rehabilitation specialist.
Nystagmus makes it difficult to tell if the VI child is "looking" at the
object of interest. We do know, however, that children with nystagmus
will show certain signs that they're looking at an object of interest:
-
VI children with nystagmus will
attempt to use their null zone as much as possible for seeing. They
may even turn their head in a certain direction in order to have
their eyes pointing to the object of interest and to use their null
zone so that their eyes don't move or move minimally.
-
The size and frequency of nystagmus
changes when a child attempts fixation on a visual object. Attempts
at fixation cause nystagmus size to decrease and frequency to
increase. As a consequence, if you place an object of interest in
front of a VI child with nystagmus and the size of the nystagmus
decreases and the frequency of the nystagmus increases, it is likely
that the child is attending to the object.
For stimulating a VI child with limited
or no communication skills and who has nystagmus, first you must get a
feeling for how the eyes move. Then, place the object of interest
ideally in the child's null zone for maximum vision. If the child does
not have a null zone, pay particular attention to the child's eyes in
terms of the size and frequency of the nystagmus. Present the object of
interest directly in front of the child, no more than say 18" away, and
observe the nystagmus. If there is no change in the nystagmus try other
objects until you're confident that the child is responding. Again,
however, it is important that the object of interest is of sufficient
overall size, stroke width and contrast to be seen by the child. (For
information on congenital nystagmus, go to
http://www.ohiolionseyeresearch.com/past.htm.)
VI Children with Abnormal Head Posture
(AHP)
Some VI children, particularly children
with nystagmus and who have a null zone, will tilt their head a certain
way when reading, writing or when doing close work. Such a child may
have developed the AHP because it allows the child to maximize vision.
You should inform your doctor about the abnormal head posture. However,
you should NOT discipline the child for an AHP - after all, this is
simply the best way for him or her to see objects and to minimize
nystagmus. In general, the VI child should be free to look at objects
any way possible to maximize vision!
VI Children and Holding Visual Objects
Close
Depending on the amount of vision loss,
some VI children may hold objects very close to their eyes or they may
even watch TV only a few inches away. LEAVE THEM ALONE. Do not try to
get the child to hold the book at a certain distance or watch TV from a
certain distance. The child knows best in terms of how he or she can
see. DO NOT impose your ideas of how he or she should hold a book, for
example. Also, some VI children, particularly those who are near sighted
(myopic), may take-off their glasses in order to see close objects
clearly. LEAVE THE CHILD ALONE. In order to see close objects clearly,
myopic VI children may have to remove their glasses. Again, they know
best. If a VI child wants to remove his or her glasses for close work
than let them!
VI Children
with central vision loss - Can't see straight ahead
For various reasons, a child may not be
able to see straight ahead but may have perfectly normal peripheral
(side) vision. In this case the child will actually look off to the side
of an object in order to see the object. A prime example is a child with
a macular degeneration. A child with a macular degeneration may look at
your ear in order to be able to see your face. DO NOT discourage or try
to prevent the child from looking at your ear when he is looking at you.
The child has learned and knows more than anybody else how he or she can
best see. DO tell your eye doctor about the child's peripheral fixation.
[When the child is older and is able to understand the importance of
social interactions, then the child can learn to make "eye contact" when
interacting with others.]
VI Children
with Light Perception (LP) or Light Projection (LPr)
Children with LP or LPr vision, by
definition, cannot see visual objects or can see only objects that are
VERY large. However, children can tell if it is light or dark in the
room (LP) or they can tell the direction of a light source (LPr). One
strategy with such VI children is to use a dark room and provide a
lighted object (the bigger the better) and try to teach the child to
respond (e.g., head turn, or fixation) to the lighted object. In
general, with LP or LPr children, a dark object against a lighted
background (e.g., window) is not recommended. Light scatter will reduce
the contrast of the object and make it difficult to see the dark object
against the window.
Use of a light box is recommended for
VI children, even when the child only has LPr. The light box can serve
as the visual object of interest in a dark room. Very large, high
contrast objects can be back-lighted, but again, the objects would have
to be very big to elicit a response from a child with such low vision.
VI Children
with Seizure Disorders
Children with seizure disorders require
special considerations because certain environmental stimuli may pose a
risk of triggering a seizure. Flickering light or flashing an object
on-and-off should be avoided. In general, parents and the child's
doctor(s) know best in terms of what might trigger a seizure in a
particular child - pay attention to the parents! Seizure disorders may
cause cortical visual impairment - the eyes and optic nerves look normal
but the child may exhibit abnormal visual behavior (see article on CVI
at http://www.ohiolionseyeresearch.com/past.htm).
VI Children
with Over Stimulation Syndrome (OSS)
Some children, particularly VI children
diagnosed with cortical visual impairment (CVI) and with multiple
handicaps, may not handle very much stimulation of the senses. VI
children with OSS appear to be overwhelmed by visual, auditory and/or by
things touching their skin. They may pull away when their hand is
touched or they may actively look away from a powerful visual stimulus,
like that shown in Figure 1. Children with OSS require special care and
handling - they may require less stimulation, not more as is usually the
case in early stimulation programs. OSS is a rare, previously
unrecognized condition and we are gathering information on these
children. See article on Over Stimulation Syndrome for more information
on this topic (http://www.ohiolionseyeresearch.com/past.htm).
VI Children
with Sensitivity to Lights (Photophobia)
Some VI children will be very sensitive
to lights, particularly sun light. Children with photophobia will squint
or close their eyes and allow only a little light to get to the eyes. VI
children with photophobia prefer cloudy days, prefer to stay inside and
like going outside at dusk and dawn - when the sun is not high in the
sky. Photophobic children prefer to wear a hat and darker sunglasses.
They will tend to shade their eyes with their hands. If the child has
photophobia, when outside s/he should always wear a hat with a wide brim
and sunglasses. Sometimes children with photophobia like wearing a hat
and even sunglasses if inside lighting is bright. If a child sees better
outside or inside with a hat and/or sunglasses than s/he should be
allowed to wear a hat or sunglasses. Often, however, the photophobic
child will remove the hat or/and sunglasses when inside because of peer
pressure and to fit-in and not be different. Again, the child knows
best. If s/he can see better inside with a hat or sunglasses than s/he
should be allowed to do so to maximize vision.
While sunglasses are often recommended
for children with photophobia, it is often the case that glasses that
allow different amounts of light to reach the eyes work best, like
photo-grays or so-called transition lenses. Our research has shown real
benefits with the use of Corning Photochromic (CPF) lenses (511, 527,
550) in photophobic children, particularly in children with retinal
disease (cone dystrophy, macular degeneration, achromatopsia). CPF
lenses darken when the child is outside and lighten when the child is
inside, much like photo-grays and transition lenses. Also, the CPF
lenses block-out wavelengths of light that the photophobic child is
particularly sensitive to, including UV and blue light. Be sure to tell
the child's eye doctor that the child is photophobic and ask about the
different types of eyeglasses with light filters that might be
available.
Moving vs Stationary Visual Objects for
Vision Stimulation - What is it vs Where is it
Some children with cortical visual
impairment (CVI) may actually see moving or flashing objects better than
stationary objects. For example, one patient that we examined several
years ago could run after a small ball as it rolled across the floor,
but the child could not localize or see the ball once the ball stopped
moving. We now know that the visual system is separated into two main
pathways - one pathway is used for determining where an (moving) object
is relative to the observe. The other pathway is responsible for
identifying what the object is and assigning properties to the object
like size, color, and shape. The child that we examined had a loss of
the WHAT pathway, so that he could not see the object when it was
stationary.
It is important to remember that moving
and flashing visual objects stimulate the WHERE pathway. The WHERE
pathway is sometimes called the "egocentric" (i.e., self-centered -
where is the object relative to where I am) pathway. As a consequence,
some VI children will do much better if the visual object is moving or
flashing rather than stationary. Because of these differences,
moving/flashing objects as well as stationary objects should be a part
of visual stimulation programs. In general, VI children with a loss or
impairment of the WHAT pathway will have 20/200 or worse visual acuity.
If the VI child has 20/100 or better visual acuity it is unlikely that
he or she has an impairment of the WHAT pathway. By capitalizing on
moving or flashing a visual object, a VI child with an impairment of the
WHAT pathway may do surprisingly well at identifying objects which, if
stationary, are not even seen by he child.
Some children with an impairment of the
WHAT pathway may see better when they're moving (e.g., walking) in the
environment rather than when they're stationary. These children may not
be able to tell, for example, where the doorway is, but they can walk
through the doorway (this is one exception to the detection =>
discrimination hierarchy). Or, they may walk around and avoid objects
that they cannot see when standing still. Children with a WHAT pathway
impairment may have great difficulty in identifying objects or in naming
attributes of a stationary object. Such unusual behavior should cue the
rehabilitation specialist or parent of the possibility of a WHAT pathway
impairment. [See section on VI children with seizure activity for
precautions.]
Little is know about selective damage
to the WHERE pathway (when the WHAT pathway is intact). Theoretically,
children with a WHERE pathway impairment would have difficulty seeing
objects that move or flash, and would have particular problems in
orientation and mobility. Such a child might be able to see the doorway,
for example, but would have great difficulty in walking through the
doorway. Likewise, a child with a WHERE pathway impairment might be very
bright, have great communication and verbal skills, but may have great
difficulty in reading, for example, because placement on the page would
be lost each time the child moved his or her eyes. Such a child might be
able to see and identify small objects but have difficulty with large
objects. There is some evidence that dyslexia may, in part, be
attributed to a WHERE pathway deficit.
Interaction with other Children
By far, the best vision rehabilitation
specialists for a VI child are other children. Within reason (and with
safety concerns in mind), interactions between a VI child and other
children should be emphasized. Other children will bring-out every bit
of visual and motor potential of the VI child. Other children will
continuously stimulate, aggravate and push the VI child to reach his or
her maximum potential. Overprotection of a VI child by parents or
caregivers should be actively avoided.
Interaction with the Visual Environment
As noted in the opening paragraph, it
is not sufficient to just provide vision stimulation to a VI child. The
child must also interact with the object or visual environment. Such
interactions may take-on the simplest task like moving ones eyes to
fixate on an object. More complex tasks may include reaching for an
object or turning to a visual object that is also making a sound.
Ideally, interactions with the environment ultimately involve
orientation and mobility. Only though such motor interactions with the
environment can a child form the brain connections necessary for using
vision for motor responses and orientation and mobility tasks.
____________________________
For a theoretical basis of some of the
information contained in this handout, see the following references:
Fellows, RR, Leguire, LE, Rogers, GL,
Bremer, DL. A Theoretical Approach to Vision Stimulation. Journal of
Visual Impairment and Blindness. October 1986, p907 - 909.
Leguire, LE, Fellows, RR, Rogers, GL,
Bremer, DL, Fillman, RD. The CCH Vision Stimulation Program for Infants
with Low Vision: Preliminary Results. Journal of Visual Impairment and
Blindness. January 1992, p33 - 37.
_____________________________
Dr. Leguire is the Director of
Electrophysiological Testing and Eye Research at Columbus Children's
Hospital. Dr. Leguire is also a Clinical Associate Professor in the
Department of Ophthalmology at The Ohio State University, Executive
Director of the Ohio Amblyope Registry, Scientific Chair of the Ohio
LIONS Eye Research Foundation and Immediate Past
Chair of Prevent Blindness Ohio. He has worked "hands-on" with visually
impaired infants and children for the past 25
years. He has published extensively in the field of low vision and
vision rehabilitation, and is the Editor of three large print joke books
for visually impaired children.
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