Developmentally Appropriate Orientation and Mobility

1. Developmentally Appropriate Orientation and Mobility Sensory Development Session 2

2. Objectives After completing this session, participants will 1. describe why teachers of children with visual impairments and orientation and mobility specialists should know about sensory development in order to assess, plan, and implement appropriate interventions that will facilitate motor development and orientation and mobility development.

3. Objectives After completing this session, participants will 2. describe the seven types of sensory input (visual, auditory, tactile, vestibular, proprioceptive, olfactory, gustatory) and how they interact to facilitate understanding of near and distant space. 3. describe visual development, the relationship between vision and movement, and strategies for facilitating functional vision within natural learning opportunities and daily routines.

4. Objectives After completing this session, participants will 4. describe the importance of hearing for children with visual impairments, the development of hearing and auditory skills, and strategies for promoting the optimal use of hearing. 5. describe the impact of deafness, hard of hearing, or deafblindness on movement, exploration, and the development of orientation and mobility in young children with visual impairments.

5. Objectives After completing this session, participants will 6. describe the importance of the sense of touch in the development of movement, exploration, and play in young children with visual impairments, and describe ways that TVIs and OMSs can facilitate young children�s use of touch, including tool use.

6. Objectives After completing this session, participants will 7. describe the proprioceptive and vestibular systems and their role in facilitating movement, exploration, and play in young children with visual impairments within natural learning opportunities. 8. discuss the roles of smell and taste in facilitating development in young children with visual impairments.

7. Objectives After completing this session, participants will 9. describe the importance of identifying and providing meaningful sensory experiences that are graded to children's individual needs and tolerance levels. 10. describe the value of assessing sensory preferences in infants and toddlers with visual impairments.

8. Sensory Development:Intervention Issues The OMS and the TVI have key roles in supporting sensory development and organization. Work with the family to ensure that proper medical evaluations of vision and hearing have occurred. Appropriately interpret eye care and audiological reports. Anthony, 1993

9. Sensory Development:Intervention Issues

10. Sensory Development: Intervention Issues Assist the family and early intervention team in identifying and implementing appropriate adaptations to optimize sensory-based learning. Identify sensory-based motivators that can be used to entice young children to move and, later, to travel effectively and efficiently. Anthony, 1993

11. Seven Sensory Systems Vision Hearing Touch Smell Taste Proprioception Vestibular These seven senses are important for developing environmental awareness and motivation for movement.

12. The Importance of Vision �Vision, together with the vestibular and proprioceptive systems, provides the feedback mechanism by which children develop, self-monitor, refine, and integrate sensorimotor skills into daily functioning� (Rosen, 1997, p. 172).

13. Visual Development During the First 3 Years Light detection and light-dark adaptation Regard for faces Visual acuity Color perception Contrast sensitivity Visual field Defensive blink Eye alignment Binocularity Fixation and convergence Tracking Shift of gaze Visual reach Visual imitation Visual-cognitive skills

14. Environmental Adaptations Simple environmental adaptations promote children�s use of vision and the development of orientation and mobility skills: High contrast Appropriate lighting Familiarization of objects and concepts Decreased distance Predictable storage Decreased visual clutter Lowry, 2004a

15. How We Hear

16. Attending Localizing Recognizing Comprehending Takoda�s mother activates this sound toy to draw his attention to it. He localizes the sound before he looks and recognizes the toy that he likes. Auditory Skill Development

17. Auditory localization develops first in a horizontal plane. Infants who are blind are less likely to localize than sighted infants. Auditory Localization

18. Sighted infants learn to localize in the following order: Sounds at ear level Sounds at ear level and downward Sounds at ear level and upward Sounds directly upward Sounds in front and at other angles Auditory Localization

19. Promoting the Development of Auditory Localization Note children�s reactions to sounds Allow children to explore the source of the sound Label sound source Encourage older children to travel to the sound source

20. Echolocation/Spatial Hearing Echolocation or spatial hearing allows the traveler to avoid large objects, use sound to trail, locate openings, and detect large spaces.

21. Strategies to Encourage Hearing in Routines Introduce sounds and their sources in the course of the daily routine with objects and events that are meaningful to the child. When possible, present sounds initially in isolation to avoid auditory figure-ground confusion. Lowry, 2004c

22. Strategies to Encourage Hearing in Routines Take a moment to listen to and investigate sounds in the neighborhood. Monitor children for over- stimulation and hypersensitivity to specific sounds and settings. Lowry, 2004c

23. Strategies to Encourage Hearing in Routines Proceed cautiously when introducing sounds to neurologically at-risk children. Mediate play and exploration by giving distinctive word labels to especially meaningful sounds.

24. Hearing Tests for Young Children Auditory brainstem response (ABR) Otoacoustic emissions (OAE) Acoustic immittance Tympanometry Acoustic Reflex Audiometry

25. Identifying Hearing Loss on Audiograms From Handout 2K

26. Normal Tympanogram From Handout 2O

27. Types of Hearing Loss Sensorineural � permanent; individuals benefit from hearing aids or assistive listening devices Conductive � loss can usually be corrected; often occurs from otitis media Mixed � combination of sensorineural and conductive loss Auditory processing disorder � auditory pathway and/or auditory cortex are damaged; difficulty analyzing, understanding, and remembering sounds

28. Intervention for Children With Dual Sensory Impairment Team members must understand the impact of deafblindness (not just VI or HI); recognize the need for assistive technology (e.g., assistive listening device, hearing aid); consider family resources, concerns, and priorities; and facilitate sensory skill development, attachment, communication, and movement in natural learning activities and daily routines.

29. Touch The two functions of touch are discrimination and protection, and there are six different types of touch. Deep touch Light touch Vibration Pain Temperature Two-point touch Rosen, 1997

30. Tactile Defensiveness Children with tactile defensiveness or tactile sensitivity experience irritation and discomfort from tactile sensations. Common irritants include certain textures of clothing, grass or sand against bare skin, glue or paint on the skin, the light touch of another person, and having teeth brushed or hair combed. Parham & Mailloux, 1996

31. Tactile Selectivity While some children with visual impairments may truly be tactually defensive, others may be reluctant to touch new textures or materials because they have little information about them. Without vision to allow them to anticipate what is going to happen, children�s protective systems may be activated, and sudden touch may be perceived as a threat.

32. Preparation for Touching Let the child know you are present before touching the child or presenting an activity or object. Introduce yourself if you are unfamiliar to the child. Verbally explain what is going to happen and what you are going to do. Let the child know when the activity is over. Always let the child know when you are leaving. Morgan, 1995

33. Promoting Effective Use of Touch Facilitate and promote body awareness. Expose the child to a variety of textures. Provide opportunities for object exploration. Allow exploration of the environment to encourage identification of furniture and landmarks. Promote hand search skills. Encourage self-initiated exploration. Lowry, 2004b

34. Vestibular System Located in the inner ear Involves the interaction of movement and gravity upon the body Roles of the vestibular system: provides input about head position influences muscle tone contributes to neurological reactions of movement registers head movements Rosen, 1997

35. Proprioceptive System Activated through sensory receptors located in the tendons, muscles, and joints of the body Involved in balance, postural tone development, posture, and haptic perception Provides information about the body while it is in a static position

36. Vestibular and Proprioceptive Development Self-initiated movement�not passive movement where the child is moved by others�is essential for children to develop motor skills. Proprioceptive and vestibular awareness, muscle tone, and coordination are developed when children experience active movement.

37. Smell helps children to develop meaning and understanding of the world. Particular smells may assist children with orientation. Smell

38. Care should be taken not to expose children to overly potent smells. Highlight the natural smells in the environment that increase the meaning of an activity or a location. Smell

39. Gustatory experiences are more limited in their ability to provide orientation clues because they require direct contact. A rich repertoire of desirable tastes can contribute to pleasant mealtimes and provide additional motivation to move purposefully to these frequent and meaningful events. Taste

40. Young children should not be bombarded with sensory information in an attempt to provide �all possible information.� In order not to overwhelm children with visual impairments, particularly those with multiple disabilities, sensory stimuli should initially be introduced one at a time within naturally occurring contexts. Greeley, 1997 Sensory Overload

41. Signs of Sensory Overload Grimacing Frowning Finger splaying Back arching Changes in respiratory rates Sneezing Yawning Hiccupping Averting gaze Changes in complexion Brown, 1995 Hussey, 1988

42. Sensory processing involves two major components. Arousal�the ability of children to maintain and transition between different sleep and wake states Attention�the ability to focus selectively on an object or task Sensory Processing

43. Arousal States Deep sleep Light sleep Drowsy Quiet alert Active alert Crying Young children learn and attend best in the quiet alert state.

44. Touching children with visual impairments without warning them can elicit protective responses (e.g., startling, pulling away, crying). Protective responses could be interpreted as sensory defensive (hypersensitivity) behavior, but they may result from lack of anticipation due to limited visual information. Sensory Processing and VI

45. Decreased proprioception due to low postural tone is common among children with severe visual impairments. These children tend to be hyposensitive and function at a lower arousal state. Sensory Processing and VI

46. Self-stimulatory mannerisms or repetitive behaviors have been observed in children with visual impairments. These behaviors consist of repetitive, seemingly purposeless body motions (e.g., weaving, flipping objects, rocking, flapping arms, eye-poking, or rubbing). More acceptable types of sensory input should be provided. McHugh & Pyfer, 1999 Roley, 1995 Sensory Processing and VI

47. Children with hypersensitivity are easily over-aroused and have an increased sensitivity to ordinary sensory input. Examples of calming sensory input conducive to learning include firm touch, slow rocking, soft, quiet sounds, and dimmed lighting. Wilbarger & Wilbarger, 1991 Hypersensitivity

48. Hyposensitive children may be under-aroused or have decreased sensitivity to typical sensory input. Examples of alerting sensory input conducive to learning include light touch, irregular movement or bouncing, high frequency noises, bright lights, object movement, and busy patterns. Hyposensitivity

49. Sensory Profile The sensory profile provides information about sensory information that alerts, calms, informs, and overloads the child. Examples of assessment include reactions to noise, lighting, and contrast; preferred positions to attend to sensory information; and reactions to touch.