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So your kid has been diagnosed with a visual impairment, huh?
Visual Impairment Aids to Daily LivingWhat Is Visual Impairment?
Your child has been diagnosed with a visual impairment and you want to find out everything there is to know. When you tell friends and family about your child's condition, they may apologize or withdraw into awkward silence. Your eye care professional has told you about the physical aspects of the condition, and about whether or not there is a "cure," but you want more information about the potential long-term effects. This page will not provide that information; the consequences of visual impairment are different for each individual, and depend more on training, attitudes, and experiences then on the visual impairment itself.
Instead, this page offers a general overview of visual impairment in children. More information on this subject can be found in the grab bag, and on the links list.
Legal blindness is defined as vision of 20/200 or less in the better eye with correction, or/and as a visual field of less than 20 degrees (tunnel vision when compared the average visual field of 180 degrees). Low vision is defined as 20/70 or less in the better eye with correction.
Total blindness only accounts for about 10% of those with severe visual impairments.
A hypothetical person with legal blindness (20/200) would see an object or a sign at 20 feet with the same level of acuity or degree of clarity as someone with 20/20 vision would see the same object or sign at 200 feet. The numbers are merely a standard measurement for the purposes of funding etc. and really don't have value beyond that. Two people could possess the same level of vision (20/200) and it could affect them in totally different ways depending on their ages, on their eye conditions, and on a number of other factors. (More on what those numbers mean.)
Visual impairment has a wide range of causes such as injury, disease, or conditions present at birth (congenital). Some forms of visual impairment, such as cortical blindness, may have no apparent cause (idiopathic) but are believed to have been caused by the improper functioning of the occipital lobe of the brain [i].
Most legally blind people (about two thirds) are over the age of 65 and are losing their vision due to age related conditions. (e.g. Macular Degeneration [1], or Glaucoma)
Early Development
A visually impaired kid may hit her developmental milestones later then her sighted peers; she may walk later, talk later, and develop fine and gross motor skills later. Toilet training may also take more time. These delays are not necessarily due to additional (developmental) disabilities; rather than taking in information through her eyes and mimicking the behaviours of those around her, she has to use her other senses to gather the necessary information. This usually takes more time - don't sweat the milestones.
Nonetheless, blind babies must be encouraged to explore their environments. Some infants and toddlers are passive until they're encouraged to be otherwise, since they lack the visual stimulation that comes easily to their peers. Many parents say early intervention - often from Teachers of the Visually Impaired (TVI's) and Orientation and Mobility (O and M) Instructors - is helpful in dealing with these issues.
"Blindisms":
Congenitally blind children (blind from birth), not stimulated by sight may find other means by which to amuse themselves, like rocking and spinning. Such "blindisms" are common.
As the child grows, a parent must begin to point out the places where this is and is not appropriate. If the behaviors get out of hand, or may endanger the child (like too much eye pressing), seek professional assistance from an individual experienced in dealing with visual impairment. (More on "Beating Blindisms")
Normal day to day stuff:
As the child gets older, she will have to learn how to accomplish activities at an age appropriate level (do things other kids her age do).
Grooming- Like her sighted counterparts, a visually impaired child has to learn good grooming and hygiene. She must be taught to comb her hair, brush her teeth, deal with her bathroom needs, and dress herself JUST like everyone else. The difference between blind and sighted here is that sighted children often learn about grooming by watching their parents or older siblings. This is not so with a visually impaired child; one must physically show her [2].
Chores- Teach her, hand over hand [2] if need be, how to do chores. Make the chores age appropriate and expect her to do them.
Table manners (and manners in general)- She should be expected to live by the same manners both in public and private life as everyone else. She may take to identifying food by touch when young; as she gets older, tell her what's on her plate and where it's located. NOTE: Blind kids should use the same dishes and cutlery as sighted kids of the same age. Special accommodations in this area are not usually necessary.
Furniture- I think that parents should regularly change the home environment to give the child a safe place to learn how to adapt to the ever changing environment of the outside world [3]. Most people will not try to "protect the self esteem of the blind child" by not changing store displays and sidewalk displays in public; friends of the family of a visually impaired child shouldn't be subject to the belief that they can't change their furniture if they so wish. This is a contentious issue though.
Stairgates- Some parents opt to use stairgates for the protection of their blind toddlers. As the child ages, this accommodation should no longer be necessary; (in my opinion) by the time she reaches first grade, she should be able to safely navigate her own house without the gates. Do note, however, that this is a contentious issue among parents of blind kids; some will continue to use the gates until their child is much older, without any detrimental effects on her development. Ultimately, when it comes to safety, a parent must use personal judgment BUT balance that with the need for greater independence on the part of the child.
The best guide for how to treat your blind child can be found in how you treat other children.
Parents may feel embarrassed at the prospect of discussing this topic with their children, but it is especially important that kids with disabilities be taught about their bodies - including a discussion of anatomical differences between girls and boys, and of how the body changes as the child matures. This kind of education is necessary, and parents are usually the best source for this kind of information.
It is also prudent to teach the concepts of "good and bad touch," as this teaching better protects children against abuse.
As to how this teaching should be conducted, and what values should be inculcated in the process, that remains up to the parent. Do keep in mind, however, that blind children - like other children - should be groomed to participate fully in society when they grow up. This participation will often include dating and eventually the creation of a family. (Learn more about sexuality education)
There are no universal protocols for teaching blind and visually impaired kids their home economics, but rest assured, they are entirely capable of learning these skills.
Sewing- Using adapted methods, older blind children (defined here as children around ages 10-12) can learn to maintain their own clothing by mending rips. (Sewing while visually impaired) If, in your family, children are taught to sew when younger, well-coordinated blind children can probably learn at the same age as their siblings.
Food preparation- Blind children are fully capable of preparing their own food at an age-appropriate level. Food stuffs may need to be labeled in an alternative format, however. Children will also need hands-on guidance in specific methods of food preparation for the first little while, since they cannot "watch and do."
By using adaptive equipment - such as sticky tac, braille labels, and talking thermometers - older blind children are as capable of cooking their own food as sighted children. (Cooking tips)
Laundry- For an older blind child, doing personal laundry may not be difficult, since she has likely remembered which of her clothes are of what colour, and can sort and pile them appropriately. Family laundry duties, especially for a totally blind child, may be far more difficult because she'd be dealing in clothes with which she is unfamiliar. It is usually enough that she do her own clothes, if children in your family are expected to do laundry.
Money Management- Older blind children should be taught how to manage their money, starting either with an allowance or with proceeds from any jobs they hold. This teaching includes cultivating an understanding of how far money goes, by showing the child both how to budget and how to save.
Orientation and mobility
Orientation (knowing where you are in space) and mobility (the ability to safely navigate that space) are among the most important skills a child must learn.
Once, O and M training with a long cane wasn't conducted until a child was older. Now, however, canes and "pre-canes" are being given to toddlers and sometimes even to infants.[4]
There are 3 kinds of (adult) canes and within each type, many variations:
1) The long cane is usually given to those who are legally or totally blind. This cane functions as a bumper and probe detecting obstacles in an individual's path. O and M instructors will teach its use as a part of a larger program of teaching navigational skills, including bus routes, crossing streets, etc. The cane is measured to fit the individual and must be replaced as the child grows [5].
2) The Identification cane is usually given to individuals with low vision or legal blindness. It does not serve the same purpose as the long cane. The ID cane is shorter, lighter, and less durable. It is given to those with enough residual (remaining) vision to navigate without a cane, but who have a visual impairment serious enough that ID is needed when crossing the streets or asking store clerks for help etc. Some people (children and adults alike) also carry this cane to detect depth.
3) The support cane is usually carried by those with other conditions that effect mobility. It acts as both an ID cane and as a means of support. Some of these canes were designed to bear the entire weight of the individual while others are only designed to support part of their weight. These canes are not usually carried by children.
As a part of O and M instruction, many children are taught to trail walls with their hands in familiar environments; this would lead them to various locations in a room etc. Full mobility being the goal of most O and M, this shouldn't be over-used as it has limited applications.
Sighted Guide:
The term "Sighted Guide" could encompass anything from the child being lead around by the hand to the use of standard guiding techniques. Sighted guides should only be used for the sake of conveniences and not as a substitute for good mobility.
Guide Dogs:
1% of all blind people use guide dogs. Dogs are not usually trained with individuals under the age of 16. Contrary to popular belief, most blind people wouldn't necessarily benefit from the employment of a dog. Dogs are not just given to people; they are first put through a rigorous training program wherein they are taught to follow commands, to practice intelligent disobedience [6], and to ignore distractions. The individual requesting a dog is interviewed at length and, if accepted, spends a month being trained with the dog. (Where can I find a school?)
Visually impaired people are only limited in their ability to learn by the quality of their adaptations. In other words, once the problems stemming from their poor vision are dealt with and the appropriate modifications made to their program, regular performance should be expected of those for whom visual impairment is the only disability.
Literacy is the ability to read fluently and understand materials in your medium (print or Braille). It is important that a child:
Large Print:
Most people who have low vision or are legally blind can read print. This may not always be the best option, but in many cases print presented under modified conditions is sufficient for good literacy. By reducing glare and maximizing contrast between print and page, many people with a good magnifying glass can read it. This is not always a practical solution, however; periodicals and journals may be published using glossy paper, or in a colourful format that makes for poor contrast. Such publications, like Reader's Digest for example, may offer a large print alternative.
There are a range of so-called "low vision reading machines," such as Closed Circuit Televisions (CCTV's), available to the visually impaired. These can be quite helpful, but the simplest useful techniques should be the first ones taught, rather than fostering undo dependence on high-tech solutions.
Braille:
Created by Louis Braille in the mid 19th century, this is system of 6 raised dots. Each Braille "cell" is made of 6 dot positions arranged in a rectangle comprising two columns of 3 dots each. A dot may be raised in any of the 6 positions, or in a combination of these positions. Braille exists most commonly in the (what is sometimes known as the) grade 1 and 2 forms. Grade 1 is essentially full words using the alphabet. Grade 2 is words and word sounds broken down into contractions. Other Braille forms include highly contracted Braille (Grade 3), the 8 dot scientific Braille, Brailled music, and Brailled math (Nemeth code).
For more information on where to learn Braille, contact your local agency for the blind or check the Grab Bag.
"Talking Books" and text-to-speech:
While talking books and text to speech are helpful to visually impaired people, these are not substitutes for literacy. Only under very unusual circumstances should these be treated as such.
General classroom modifications:
Position in the classroom- The student should be in the optimal position to clearly hear the instructor, and he should have easy access to any necessary texts. If his vision permits, he should be sitting in a place where he can see the chalkboard. He should NOT be isolated in seating area from the rest of the class (i.e.. having most of the desks towards the back of the room except for the desk of the visually impaired student).
Adaptation of printed materials - If the student requires large print, photocopies of the overhead, or copies of blackboard notes, these should be provided regularly by the instructor or the person designated for this purpose. Any accommodations made for the student should be provided on a regular basis, such as the enlargement of tests and the provision of extra exam time. In the higher grades and in post secondary institutions the student has to arrange for these modifications himself and should be taught self-advocacy.
Physical education- In general, participation in most activities is fine, but the visually impaired student should not be forced into situations that he believes are unsafe. For more information, check out Kathy Letcher's paper on Adapting Physical Education for the Blind.
Socialization- For a person with poor vision, body language isn't a cue, and initiation of conversation has to be verbal. In traditional circles, people feel that it is the job of the visually impaired student to socialize and if that fails to happen something he is doing is the cause. In reality, socialization is a two way street; the visually impaired student has to feel safe and comfortable before anything can happen, and the other students should be told that most forms of nonverbal communication are useless with him.
Equipment- This is addressed in the "aids to daily living" section.
If you're acting as an advocate for a child, or are a teacher developing an appropriate curriculum, you may find these links helpful:
Aids to daily living
Things that can be fairly easily acquired:
NOTE: Some of these are also available at agencies for the blind or there may be subsidies available for their purchase.
Specialized equipment found for the most part at local agencies for the blind:
Things one can create or adaptations one can make:
These are wide and varied, everything from taping Braille numbers to the microwave buttons to a home made template for signing one's name. Many self-made adaptations are made as a matter of course using common sense. (More on things to make)
Blind people involve themselves in a variety of recreational activities. In fact, some visually impaired people (such as mountain climbers) even make a career of athletics. The recreational possibilities for a blind person are almost as unlimited as those of the sighted person. The blind person does, however, have to sometimes deal with modified versions of the chosen sport. Such modified sports include hockey, soccer, badminton, and to a lesser degree football and baseball. For more information on recreational activities, see the links list.
By the time a person blind since birth or early childhood enters adolescence, she should already be capable or taking care of her own grooming and hygiene needs without any help. This is especially important for girls, who contend with menstruation. Primary cooking and cleaning skills should also have been established.
Table manners (including appropriate food handling), "social graces," and other arts of this nature should also have been taught by this point. In cases where a child loses vision later in life, or even as a young adult, these skills must be specifically taught and not overlooked.
Blind and visually impaired people are employed in just about every field, and most agencies for the blind offer employment/vocational services to their clients. The high unemployment rate among the blind does confirm the existence of barriers, however; both physical and attitudinal (FAQ).
In addition to educational and technical initiatives, both potential employees and employers have certain obligations.
Employers should be expected to:
Employees should be expected to:
For more information on employment, check out the off-site article list.
Limitations?
There are only two obstacles for advancement placed on a visually impaired person. Those are: a) Limitations placed on him by his visual impairment (e.g. the inability to drive) and b) Limitations placed on him by the public. Limitations that fall into the latter category are, by their nature, intolerable - or at least they should be.
[ i] The Occipital lobe is one of four lobes of the brain and is found at the back of the head. This is the part of the brain which interprets visual signals.
[1] Macular Degeneration can affect people of any age. Find out more about it in its various forms at the MD Support Site.
[2] Hand over hand is the most common method of showing a visually impaired child certain concepts. Though still widely used, there are some people who believe it is used too much. For more information on hand under hand, see this article by Andrea Story.
[3] The most common professional thought on the subject holds that furniture shouldn't often be moved in order to protect the self esteem of the child.
[4] The "kiddie cane" is now being given to some children and infants. Though proper technique (if it really exists) can't be taught at that age, a certain comfort level can be achieved that wouldn't be so obvious if the child were introduced to the cane later. Children shouldn't be using them without supervision.
[5] There is, to my knowledge, no one standard for the measurement of appropriate cane length. Some hold that a cane should reach the sternum, others say the arm pit, and others (i.e.. the National Federation of the Blind in the U.S.) say that the cane should reach the tip of the nose. It depends on individual choice.
[6] The human is the leader of the team and the dog is the guide. The person gives commands and directions and the dog follows her unless the person is in immediate danger, which is when the dog practices intelligent disobedience.
[7] The cane can also be purchased by individuals from the manufacturers.
[8] Some screen reading or enlargement programs are less expensive or are freeware. See the downloads section for more information, or see troubleshooting for tips on browsers.
© Copyright 2004 A. Hopfe and New Vision
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