From Rolling to Walking

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From Rolling to Walking

• Therapeutic Living Centers
• for the Blind
• Eunice Lee, DPT, Physical Therapist
• Rosa Tu, MA, Teacher of the Blind and Visually
  Impaired

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Outline

• Discussion on the challenges parents face with
  early motor development for a child who is blind
  or visually impaired and who may also have
  multiple disabilities.
• How to avoid long term impact by creating a
  stimulating space for learning.
• How to facilitate childrens movement without
  interfering with their development, but rather
  designing opportunities for children to be active
  learners and learn through their own actions
  within the home or natural environment.
• Make and take session with simple tools for
  families to use to improve motor planning,
  promote active listening and learning, and
  encourage social-emotional development.

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Considerations

• Remember that each child is unique
• A severe visual impairment affects visual skills
  as well as other areas of development, and many
  infants who are visually impaired may have
  additional disabilities
• Collaborating with the educational team to help
  the child optimize his/her skills in all areas is
  a crucial
• Depending on the childs areas of needs, the
  child will benefit from a multidisciplinary team
  approach to address the family and teams
  concerns
• Use of adapted equipment
• Safety is a priority!

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Vision in Early Motor Development

• Newborns - Visually goal-directed movements
  looking, reaching, grasping, head control,
  learning equilibrium, communication with gaze and
  reciprocating expressions and body language
• Mobile - Moving is guided by vision for
  direction, for equilibrium and balance.
• Objects that cannot be seen do not exist
• Cause and effect
• Seek independence
• For those affected by a visual impairment, they
  learn about the world with different senses and
  then process it differently. It does not mean
  they are impaired. It just means when addressing
  and working with them, we have to be aware, they
  dont learn like you learn.

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Typical Pattern for Early Motor Development

• Cephalocaudal (Head to Tail progression)
• Proximal to Distal (midline out to extremities)
• Early large range movements to fine and precise
  small movements (random kicking to proper feet
  placements while walking)
• Core stability is essential to ALL movement

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Impact of Early Motor Development due to Visual
Impairment

• Getz (2000) states that approximately 75-90 of
  all learning is facilitated via the visual
  pathways
• Children may appear as uninterested or passive
  (First Steps, BCC, 1993)
• Achievement of developmental milestones (e.g.
  acquisition of fine and gross motor skills) may
  be delayed or out of order (Kastein, Spaulding,
  Scharf, 1980)
• Purposeful and self-initiated movement may be
  delayed
• Children may be fearful of open spaces

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Motor Development with Visual Impairment

• Visible Traits
• Decreased muscle tone (First Steps, BCC, 1993)
• Postural differences (Barraga, 1976) such as
  Deviated Head Position, with Stiff trunk and poor
  quality of movement
• Wide base for stability
• Self initiated vestibular system stimulating
  movements for a long time- e.g. rocking,
  swinging, eye poking, hand shaking and spinning.
  These inhibit acquisition of normal gross and
  fine motor skills
• Diminished Static and Dynamic Balance
• Fisted Hands
• Diminished or altered self-image (low confidence)
  (Sonsken, Levitt, Kitsinger, 1984)

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Gross Motor Development (0-3 months)

• Without VI

• With VI

• Extension strength from flexed position
• Tummy time weight toward head without arm
  support due to being flexed
• Gradual forward arm reach with straightening of
  body
• Head up to look around
• Sitting rounded back with head lag. Falls
  forward
• Standing bears weight with legs and may step
  from reflex and not controlled movements

• Similar awareness of her body and movements by
  reflexes
• Delayed head control and may present with
  inability to focus on objects
• Muscle tone fluctuations hyper or hypotonic
• Severe head lag during pull to sit
• Sitting back arched excessively

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Gross Motor Development (4-6 months)

• Without VI

• With VI

• Improvements of head control while being held or
  held in sitting.
• Tummy time weight bear on their forearms with
  head up and shift weight. May push up on hands.
  Able to roll to side to free up hands.
• Supine Raise arms and legs up with kicking and
  hands to feet.
• Sitting back is more straight and needs less
  support.

• Less motivation due to lack of visual stimulation
  leading to less head lifting exercises.
• Because less opportunity to work on head
  strength, other postural stability achievements
  become delayed and more difficult.
• Very important to introduce different movement
  experiences during this time to provide sensory
  input to elicit motor output.

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Gross Motor Development (7-9 months)

• Without VI

• With VI

• Sitting with arm support eventually to requiring
  no support. To challenging balance with reaching.
• Tolerate hands and knees position (quadruped) and
  may rock forward and back. Eventually separate
  hands and knees and learn to creep.
• Transitions move in and out of positions from
  floor to sitting providing more freedom and
  opportunities to interact with environment.
• Standing weight bears better with support and
  may shift weight side to side.
• May kneel, squat, and lower self to the floor and
  able to get in and out of position and has gained
  most of all components of movement.

• Less variety of movement.
• Rounded postures due to decreased muscle tone,
  forward head.
• Self stimulating motions like rocking while on
  hands and knees but not moving outside base of
  stance.
• Wide base of support in various positions causing
  difficulty moving in and out of position.
• Decreased trunk segmentation. The stiffness
  reduces exploration and manipulation of their
  environment.

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Gross Motor Development (10-12 months)

• Without VI

• With VI

• Higher level of movements with various speed,
  coordination, adjustments and refined balance
  control.
• More use of hands with accuracy and coordination.
  Hands are used purposefully for daily functional
  activities.

• Due to fear while standing, arms may be W and
  feet are positioned wide.
• Slowly, but able to learn to transition from
  horizontal to vertical position using less area
  for base of support.
• With parents to encourage and OM to teach how to
  make environment safe and use sensory cues, child
  learns to initiate movement.

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Orientation and Mobility

• Per Anthony (Pogrund Fazzi, 2002, p. 330),
  there are four main areas to focus on
• 1. Continue to expand the childs understanding
  of his or her own body, daily settings and
  location in various environments
• 2. Encourage, then help refine the childs means
  of movement
• 3. Reinforce the childs purpose to move within
  his or her environment so that he or she is
  motivated to explore and is capable of
  accomplishing a goal which requires having to
  move as the means to achieve that goal and
• 4. Assist the family and service providers in
  analyzing the childs daily environments for
  safety and possible modifications that will
  maximize self-initiated and goal-oriented
  movement.

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Strategies to Help Your Child Move and Explore!

• Strategies for families to support movement and
  exploration
• Support the childs orientation by maintaining
  the placement of objects in the house in a
  consistent manner and using spatial terms to
  describe locations (e.g. Your toy box is next to
  the tv)
• Provide additional time for your child to look
  at, listen to, and explore new objects or
  actively participate in household tasks to
  promote hands-on experiences in a functional
  manner so that they can expand in their
  understanding of their environment (and be
  independent as well!)
• Provide a safe home environment for the child to
  encourage the child to explore on his/her own
  (e.g. using electrical outlet covers, keeping
  blind cords out of reach)
• Positively accept the use of low vision and
  mobility devices in the childs natural
  environments (i.e. home, school, community)
• Optimize lighting and the use of color and
  contrast in the home to facilitate ease of
  movement and exploration for young children

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Strategies to Help Your Child Move!

• Strategies for families to support movement and
  exploration (continued)
• Using objects with multi-sensory qualities
• Tactual (e.g. chains of beads with a bead in
  between each one, combs, whisks)
• Auditory (e.g. bells, measuring spoons, metal
  teaspoons)
• Stand in front of the child instead of behind
  him/her or on the side to orient the child to
  move forward in movement and through space
• Use tactile markers to help and motivate a child
• Tummy Time

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Strategies to Help Your Child Move and Explore!

• Individualized Adaptations include but are not
  limited to
• Number of items used
• Size of objects used
• Distance of visual target from the child (e.g.
  within the childs grasp to promote reaching)

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Strategies to Help Your Child Move and Explore!

• Vividness of color

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Strategies to Help Your Child Move and Explore!

• Vividness of color (continued)

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Strategies to Help Your Child Move and Explore!

• Contrast or simplicity of the background

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Strategies to Help Your Child Move and Explore!

• Complexity of the visual target

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Strategies to Help Your Child Move and Explore!

• Presentation method

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Strategies to Help Your Child Move and Explore!

• Illumination (e.g. natural lighting)
• Familiarity with the materials
• Preferred area of vision
• Position of the child

Source Everyday Activities to Promote Visual
Efficiency (Trief Shaw, 2009), pg. 27, 398
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Encouraging Children with Multiple Disabilities
to Move and Explore!

• Attach toys using suction cups or elastic to
  sturdy equipment (e.g. table, highchair)
• Place safe materials in an area that is easily
  accessible to the child who may not be able to
  move independently (e.g. solid, high contrasting
  bins to store toys)
• Create positive experiences when exploring
  various objects and textures (e.g. being held by
  a caregiver, lying on top of a comfortable
  blanket)
• Describe everything in the childs environment
  along a route while providing additional time for
  the child to process the information and explore
• Use real objects
• Have children participate in daily living
  activities using accommodations that are
  appropriate for the child

Source Early Focus (Pogrund Fazzi, 2002), p.
373
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Lilli Nielsen and Active Learning

• What is Active Learning?
• As the name implies, Active Learning revolves
  around the learner being active.
• Since I am unable to come to the room, the room
  must come to me. (Nielsen, 2003)
• Please Note Dr. Nielsens approved equipment and
  books in the United States is through the
  LilliWorks Active Learning Foundation. Also,
  remember that safety of materials is a priority!
• www.lilliworks.org

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Strategies to Help Your Child Move!

• Head Control Back, Tummy, Sitting
• Rolling - Back to Tummy, Tummy to Back
• Sitting Supported, Weight bearing through arms,
  Unsupported
• High Kneeling to Pull to Stand
• Cruising
• Walking

Source Snell, R. (1997) http//www.csun.edu/hfed
u009/innovations/html/motordev.html
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Case Studies

• Our parents have provided us permission to share
  videos and photographs of their children
• Release of information and photographic release
  forms were obtained

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Parent Panel

• Tatiana

• Aishling

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Household items are inexpensive yet stimulating
and fun educational toys/activities that may
improve motor planning, promote active listening
and learning, and encourage social-emotional
development!

Cardboard Tube
Penny Can
For additional copies of these hand-outs as well
as other great resources for parents and
educators, please visit the Braille Institutes
Child Development Center website http//www.brai
lleinstitute.org/documents/index.php/
category/child-development

• Make and Take!

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References

• Anthony, T. L., Bleier, H., Fazzi, D. L., Kish,
  D., Pogrund, R. L. (2002). Mobility focus
  developing early skills for orientation and
  mobility. In R. L. Pogrund, D. L. Fazzi (Eds.),
  Early focus. Working with young children who are
  blind or visually impaired and their families
  (pp. 326-404). New York, NY AFB Press.
• Blind Childrens Center. (1993). First steps. A
  handbook for teaching young children who are
  visually impaired. Los Angeles Blind Childrens
  Center.
• Getz, D. J. (2000). Comments on attention deficit
  disorder (or attention deficit hyperactivity
  disorder) and vision therapy. Retrieved from
  http//www.add- adhd.org/attention_deficit_disorde
  r.html
• Lilliworks. (2014). 10 Principles. Retrieved from
  http//www.lilliworks.org/sample-page/10-principle
  s/
• Lilliworks. (2014). About AL. Retrieved from
  http//www.lilliworks.org/sample-page/
• Nielsen, L. (2003). Space and self. Active
  learning by means of the little room. Copenhagen,
  Denmark SIKON.
• Orel-Bixler, D. (1999) Clinical vision
  assessments for infants. In D. Chen (Ed.),
  Essential elements in early intervention. Visual
  impairment and multiple disabilities (pp.
  107-156). New York, NY AFB Press.
• Pogrund, R. L., Fazzi, D. L. (2002). Early
  focus. Working with young children who are blind
  or visually impaired and their families (2nd
  ed.). New York, NY AFB Press.
• Shumway-Cook, A., Woollacott, M. H. (2001).
  Motor Control Theory and Practical Applications.
  Maryland Lippincott Williams Wilkins.
• Snell, R. (1997). Gross motor development in
  infants with multiple disabilities. In D. Chen
  (Ed.). Effective practices in early
  intervention. Infants whose multiple
  disabilities include visual impairment and
  hearing loss (pp.167-176). Northridge, CA
  California State University, Northridge,
  Department of Special Education (ERIC Document
  Reproduction Service No. ED 406-795).
• Trief, E., Shaw, R. (2009). Everyday activities
  to promote visual efficiency a handbook for
  working with young children with visual
  impairments. New York, NY AFB Press.
• WeeWaterways, LLC. (2014). Water-based method to
  improve your child's physical and mental
  development. Retrieved from http//www.waterwayba
  bies. com/ contact-us-order/

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LilliWorks is dedicated to the Active Learning
principle that Everyone Can Learn
Source http//www.lilliworks.org/sample-page/
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Braille Institute will be hosting a special
Active Learning Conference! The
2014 Southern California Active Learning
Conference will provide information on Active
Learning with special focus on a budget friendly
approach. No childcare will be provided.
Presenters Trisha Borg, Special Education
Teacher,
Narbethong State Special School, Australia Lori
Enroth, LilliWorks Active Learning Foundation
Board Member Educational Outreach
Coordinator Debbie Zimmer, Active Learning
Advocate Parent Deadline to register for this
FREE event is on Friday, 4/18/14
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In Summary
We aim for success no matter how small or how
big the movement is!
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Questions?

• Eunice Lee - eunicelee012_at_gmail.com
• Rosa Tu - Rosa.Tu.117_at_gmail.com
• Thank you for attending our presentation!
• A warm thank you to all of our TLC families who
  gave us permission to share their wonderful
  children and unique stories and experiences with
  you all. A special thank you to our parent
  panel, Tatiana and Aishling, for participating in
  todays presentation and sharing their children
  with us!
• We would also like to thank
• - Diana Dennis and TLC for their unwavering
  support and providing us this wonderful
  opportunity to share stories of our beautiful
  children and families.
• Sue Strafaci and The Braille Institute for
  granting us permission to use the wonderful Child
  Development Centers resources.
• Lori Enroth for sharing information pertaining
  to Active Learning.
• Nikki Blackburn for her knowledge and
  thoughtfulness.