Get That Baby Moving!

1. Get That Baby Moving! Kay Ratzlaff, Coordinator of Instructional Resources Florida Instructional Materials Center for the Visually Impaired

2. Florida Association for the Education and Rehabilitation of the Blind and Visually Impaired Annual Conference October 26, 2006 Working and Playing with “FLAER” Altamonte Springs, Florida

3. Questions for Today??? • The presence of a visual impairment affects which aspects of development? • What is the percentage of children with additional disabilities that also have a visual impairment? • What are the 4 most common causes of visual impairments in infants and toddlers? ALL 60% Low birth weight, trauma, syndromes, eye diseases

4. Essential Truths about Vision… • Vision is the primary data-gathering system of humans, providing both near and distance information and integrating information holistically. All the other senses together cannot provide equal information to the brain. (Gesell, Illg & Bullis, 1949)

5. Essential Truth…. • Hearing is not a motivator equal to vision in encouraging an infant to reach for objects. There is a mismatch in the timing between when an infant is physically ready to reach (by about 5 months) and when the auditory processing ability can attach meaning to sound (by about 9 months). (Barraga and Erin, 1992)…from Koenig and Holbrook, Foundations 2000

6. Intervention “For children with these (severe) visual concerns, programming often focuses on massage and visual and auditory bombardment rather than on integrating the central nervous system so that the visual system can become organized and ready for taking in and using information that will enhance potential for gaining and expanding control over the world.” Beth Langley, ISAVE

7. Discussion Questions • Why are gross and fine motor skills especially important for students who are blind or visually impaired? • What are some characteristics that are often seen in children who are visually impaired? • What toys and/or play activities foster appropriate motor skills, emergent literacy skills and concept development?

8. Importance of Early Intervention “ The presence of a visual impairment affects every aspect of development and has a particularly profound effect on early relationships and communicative functions. Thus, the earlier the detection of a visual problem, the earlier the intervention can be implemented to offset many of the associated developmental problems that ensue as the result of visual dysfunction and to improve the general outlook for functional vision.” Beth Langley, ISAVE

9. Development of Visual System

10. Sequence of Sensory Development • Alerting • Orientation • Localization • Discrimination • Recognition • Interpretation • Application Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

11. Early Reflexive Behaviors • “Asymmetrical Tonic Neck Reflex (ATNR) creates just the right stimulus (the infants hands at just the right viewing distance) for visual practice. The ATNR exists from birth to 4 months where it disappears. Not coincidentally the child discovers and looks at his or her own hand just before the ATNR disappears.” (Koenig and Holbrook, Foundations 2000)

12. Reflexive Disorganized Random Alerting Motion Peripheral Following Reflexive visual behaviors typical child: birth to 6 weeks Developmental Stages of Visual Functioning: Global Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

13. Visual attending behaviors can use vision purposefully typical child: 6 weeks –3-4 months Contingent Organized Novel Central Fixation Accommodation Convergence Binocular Developmental Stages of Visual Functioning: Integrative Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

14. Developmental Stages of Visual Functioning: Specific • Discrimination • Association • Form • Depth • Spatial • Detail Visual examining behaviors Visual perceptual level typical child: 6-12 months Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

15. Impact of Movement on Development of Visual Systems

16. Movement, Posture & Vision • To fixate gaze • Child must have head stability • Head/neck organization • To recruit peripheral fields, shift gaze, or achieve horizontal pursuit • Child must have active head/neck rotation Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

17. Movement, Posture & Vision • To achieve ocular alignment, oculocephalic integration, and eye-hand dissociation • Child must have head/neck alignment • Child must have antigravity head control and stability • To achieve vertical pursuit and recruitment of central field • Child must have graded extension and flexion of head and neck Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

18. Movement, Posture & Vision • To achieve horizontal gaze shift and control of saccadic movements • Child must be able to shift head from midline and have active lateral head righting • To achieve accommodation and convergence and depth perception • Child must be able to grasp and bring hand to mouth or face Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

19. Movement, Posture & Vision • Weight bearing in prone on forearms facilitates • Scapular/head/neck stability • Stability of gaze (fixation) • Mobility (direction) of gaze • Emerging convergence Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

20. Movement, Posture & Vision • Proprioceptive input to hands and feet (weight bearing) facilitates • Organization of gaze/fixation • Active lateral weight shift in prone facilitates • Fluid horizontal gaze shift • Emerging pursuit across midline Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

21. Movement, Posture & Vision • Trunk organization/stability, with midline development and active antigravity flexion as in hand to foot play facilitates • Fluid horizontal gaze shift • Emerging pursuit across midline Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

22. Movement, Posture & Vision • Stability in sitting facilitates • Near-far gaze shift • Depth perception • Eye-hand coordination • Refined recruitment of peripheral fields • Stability for scanning Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

23. Movement, Posture & Vision • Movement in upright postures facilitates • Refined visual adaptation to movement • Expanded peripheral fields • Visually directed movement • Gaze control for distance vision Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

24. Movement, Posture and Vision • Antigravity side lying facilitates • Organization of midline • Stability of head for gaze shift • Refining of depth perception • Eye-hand coordination Dr. Sandra Lewis, (2002) Visual Functioning PowerPoint presentation

25. Overview • Children with low vision do not develop motor skills the same way sighted children do. • How does this affect the child? Moving Skills Body Image Social Skills Posture

26. Lack of Incentive to Move • Infants and toddlers with visual impairments have little incentive to move because of: • Low muscle tone • Reduced opportunities for movement • Fears • Insufficient understanding of the object world • Inability to visually monitor environment RE:view Fall 2002, Facilitating Walking by Young Children With Visual Impairments Lowry, S. and Hatton, D.

27. Lack of Incentive to Move • Children with severe visual impairments also faced with: • Unique movement patterns • Lack of visual cues to motivate reaching • Reduced opportunity to observe and emulate motor movements of others (repetitive motor play) • Tendency to engage in non-productive interaction patterns • Process of acquiring motor skills varies from child to child • Developmental stages • Methods to acquire movement skills

28. Typical Muscle Tone Movement for Postural Stability (Co-contraction) Movement for Mobility Against Postural Stability (Activation) Practice for Refined Coordination Atypical Muscle Tone Postural Fixations Compensatory Movement Patterns Habitual Movement Patterns Muscle Shortening or Elongation Contractures Deformities Progression of Motor Development Movement Analysis and Curriculum for Visually Impaired Preschoolers, Brown and Bour, 1987

29. Characteristics of Movement of Children with Visual Impairment • Movements are scarce or minimal • Small ranges in exploration of environment • Stays in one place (playground, swimming pool) • Poor body image • Kinesthetic awareness is lacking • Proprioception is poor – can’t judge force, speed, posture, etc. Movement Analysis and Curriculum for Visually Impaired Preschoolers by Carla Brown and Barbara Bour

30. Characteristics cont. • Fearful of movement that is out of contact with surface (in space) • Jumping, hopping, diving, standing on one foot, etc. • Movement is organized – not fluid • Grading is absent in mid-range transitions • Either fully extended or flexed, nothing in between

31. Characteristics cont. • Movement is symmetrical or asymmetrical and primarily occurs in straight planes • Rotation is inadequate and counter-rotation is absent • Range of movement is restricted at spine in extension and/or rotation • When movement is difficult (slick surface, increased height, etc.) the upper extremities tense and move to high guard position

32. Characteristics cont. • When moving from floor to standing there is usually weight loading on upper extremities as well as lower • In transitional patterns the integrated function of trunk and pelvis is absent

33. Characteristics cont. • Gait is poor • Decreased stride length • Out-toeing • Hyper-extension or increased knee flexion at mid stance • Lateral head movements • Inadequate weight shift over loaded side in stance • Inadequate weight shift of trunk over pelvis

34. Characteristics cont. • Joint hypermobility is present at hips (double jointed) • Muscle weakness is significant • Hip adductors (movement together) • Shoulder girdle • Abdominal (especially obliques)

35. Characteristics cont. • Can be resistant to tactile input (tactile defensive??) • Hypotonia – low muscle tone • Wrist instability • Poor palmar arch development • Poor flexibility • Trapezius (back) • Pectoralis (chest and shoulders) • Lower back extensors (upright posture)

36. Characteristics cont. • Hyper-extension of elbows • Finger flaring • Hyper-extension of knees in stance • Lumbar lordosis in stance (pelvic thrust) • Pronation of feet (roll in) • Shoulder elevation • Cervical hyperextension (head down)

37. Correcting Motor Problems • What therapies, exercises, games or, activities can be used to enhance motor development?

38. Preventing/Minimizing Motor Problems • Encourage the infant to turn their head • Infants need to spend time (supervised) playing on their stomachs (prone) • Pushing-up is vital for development of balance skills and prerequisite for arm and trunk strength needed for reaching • Encourages head control and trunk strength • Can be introduced early by lying prone on the caregiver’s stomach Developmental Guidelines for Infants with Visual Impairments; Lucek, A., Chen, D., Kekelis, L.

39. Preventing/Minimizing Motor Problems • Physically guide infant/toddler through basic movements (developmentally appropriate) • Support rough-house games during playtime • Improve body awareness by • Naming and touching of body parts during usual daily activities. “Where’s your ear?” “Let’s put bubbles on your chin.” • Isolation and integration of body parts and movement

40. Examples of Activities to Correct Motor Problems • Crawling • Weight bearing • Weight shifting • Tentative movements • Exploration • Body image • Wrist instability • Proprioception • Finger flaring

41. Benefits from Crawling • Strengthens shoulder girdle • Head positioning • Provides stable base for movement and exploration • Transition to kneeling, standing and cruising

42. Examples of Activities to Correct Motor Problems • Riding a tricycle • Weight shifting • Hip adductors • Rotation • Muscle tone and strength • Lower back extensors • Fluid movement • Closes the wide base of support • Directionality and spatial awareness

43. Suggested Activities • Heavy lifting, pushing, pulling • Locomotor Movements • Walking • Jumping (two feet) • Running • Side Step • Gallop • Hopping • Skip

44. Suggested Activities cont. • Tumbling/gymnastics: different body and spatial positions • Swimming • Balance activities (skating, statues, balance beam, etc.) • Climbing • Music play • “Guided” free movement • Tempo – fast and slow • Body awareness

45. End Result • With proper assessments and activities to minimize motor development problems the child can develop efficient skills in: O&M Motor Self Esteem Body Aware Posture Social Daily Living Concepts Spatial

46. What’s the Connection Between Movement and Learning? Strong, “smart” hands, in flexible, competent bodies comprise the physical component for later development of braille skills.” …..Wendy Drezek in Move, Touch, DO

47. What’s the Connection Between Movement and Learning? • Developing Concepts • Spatial relations • Integration of sensory cues • Object permanence • Provide experiences with objects in contact with body, slight distance at midline, left of midline, right of midline, above and below midline, to develop concept of permanence.

48. Hesitancy in exploration and initiation of movement Lack of opportunity to imitate Focusing on isolated parts of a whole Problems transferring information to new situations Auditory system does not provide same integration as the visual system Tactual sensory “bank” is smaller than the visual “bank” Tactile defensiveness Factors that Affect Concept Development Early Focus by Pogrund, R., Fazzi, D., Lampert, J.; American Foundation for the Blind 1992

49. Fine Motor Skills

50. Results of Poor Motor Development on Fine Motor Skills • Contrary to popular opinion, babies born with visual disabilities are often less receptive with their hands. • Tactile defensiveness is a misnomer – actually defensive to touching unknown things. • Have weak, ineffectual hands from lack of movement