Publications Archive

Information Exchange: The First Five Years

Summary: Education of visually impaired children with severe learning difficulties

• Assessing visual response
• Ideas for occupying and involving mentally handicapped children who have little or no sight
• Classroom management
• Light stimulation of the visual cortex in SLD special needs children (with healthy eyes)
• Vibration and the multi-handicapped child
• The mannerisms of blind children
• Approaches to curriculum (I)
• Approaches to curriculum (II)
• ‘Deaf-blind’ children
• Blind children – with reference to those who are also profoundly handicapped in other ways – some thoughts
• Some of our needs (mine, and my teacher’s)
• Curriculum [A letter from Lilli Nielsen]

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By and for those concerned with children and young people who have severe learning difficulties and little or no sight

Supported by RNIB

'Information Exchange', created by teachers of visually and multi-handicapped children, was first published as a newsletter in 1980. The newsletter was designed to meet an area of very special needs, and it quickly grew in size and in circulation to become a termly magazine written by and for all who are concerned with the education and upbringing of multi-handicapped children with little or no sight.

This publication comprises a collection of major articles that appeared in ‘Information Exchange’ in the five years to 1985. The idea originated from the large number of requests we received at RNIB, for reprints of these articles. Each article carries a date: we believe this is important as ideas develop and situations can change quickly in education.

Thanks go to all the authors who gave permission for their articles to be reprinted here, and to Tracy Winstone, Liz Poole and Jane Pickerden who have assisted with the typing and production of the final manuscript. Special thanks are due to Sally Silverman who has inspired and led the editorial team of IE for more than a decade. So much of what appears here is due to Sally's energy and enthusiasm in generating ideas and provoking thought amongst those educating and caring for multi-handicapped visually impaired children.

At RNIB we were pleased to provide administrative, secretarial and some editorial support to the IE team during the early years, and to assist the magazine as it grew and developed. Now, the magazine has its own, independent editorial board again and we wish them well for the future.

Louise Clunies-Ross
RNIB Education & Leisure Division
January 1991

Assessing visual response

By David Bethell, then Peripatetic Teacher of the Visually Handicapped, Walsall and currently Statements Officer, Walsall

When an adviser for visual handicap first goes into a school, the first question is often:

'What can this child see?'

You may well be responsible for a child who doesn't seem to you to have normal visual responses - he doesn't pay attention to things that would seem to be visually attractive, or he doesn't reach out well, or he stares at light but little else, or he won't hold eye contact, or follow movement with his eyes, or he waves his fingers continually close to his eyes, etc. He's generally thought to have very bad sight, but you don't know how bad, and you're not sure what special programmes he needs or how, if at all, you should adapt your methods for him. What do you do?

1. Collect all information about him that's already available:

a) Find out what the ophthalmologist, paediatrician, or other medical specialists have said about his sight. It may be inconclusive or even inaccurate, but it is the opinion of a skilled person and can be invaluable. If you don't understand the terminology of a diagnosis, get it explained to you in practical terms. If you can get hold of an orthoptist to see the child, her opinion may be the most useful of all the medical ones.

b) Also check out physiotherapists' reports, possible effects on vision of the drugs he may be on, opinions of previous teachers, parents' views about his sight, and so on. Then, if you're still in doubt, proceed as follows.

2. What you can do yourself:

There's no real substitute for a full, formal assessment of visual ability by qualified medical people. Unfortunately, this is only sometimes or even rarely available. If you can't get it, try the procedure suggested below; but remember, you are only trying to observe a child's visual behaviour and use of sight as a help to your teaching. You are NOT able to make any sort of quasi-medical diagnosis, or to label the child as 'blind' etc.

And - we think this is most important - do remember that these children are often at their best in a calm, warm, secure, comfortable, familiar and affectionate situation, one which is intrinsically supportive and motivating. This isn't always easy to reconcile with the fairly precise, controlled work one may have to do with them - eg. working with isolated stimuli in a distraction-free environment - but to put these children into unfamiliar, unnatural, 'guinea pig' situations is probably unkind, possibly unethical, and almost certainly self-defeating, because the child cannot show his true ability in such circumstances.

a) Lookinq at a child's eyes and .qaze:

In SLD children, visual impairment is often caused by brain damage rather than by ocular defects, but check eyes and gaze anyway.

Look at the child from the front, try to hold eye contact (a penlight held between your eyes may help). Normal eyes are more-or-less equally proportioned and clear, and their gaze is straight and steady. They move smoothly and in unison across, up, down, diagonally and around. They fix without flutter. They converge on an object brought very close (bring a small bright object slowly to within a few inches of the child's eyes, then slowly withdraw it). They blink if a rapid movement is made close to them ('menace' reflex - flick your fingers a few inches away from the child's eyes) and the pupils constrict or dilate according to the intensity of the light (observe pupils when you bring a child from shade into sunlight).

Eyes which appear clouded, weeping, inflamed, disproportionate, squinting and which do not fix steadily, or have random, jerky or unsynchronised movements, or which lack pupillary or menace reflexes, may not give full visual acuity (fineness of sight) or full field (area or arc of sight). For instance, unsteady or 'dancing' eyes often mean a loss of acuity, and a strong squint or other sign of dependence on one eye alone may well mean a loss of visual field and of some of the ability to perceive three-dimensional 'depth' and to judge distance. Complete lack of pupillary and menace reflex might suggest a serious sight loss. However, DON'T jump to conclusions; even children with obvious ocular abnormalities may have good sight, so try again to get qualified medical opinion.

b) Observinq and recordinq a child's visual responses:

Before a child can make good use of his sight, even at the most basic level, he must be ableto:

• give visual attention;
• fix (i.e. look steadily at a particular object or part of one);
• track (follow a moving object with eyes and/or head, across, vertically, diagonally, around);
• change focus (converge, or accommodate - alter the focal length of the eye by changing the curvature of the natural lens inside it);
• shift fixation (by so-called 'saccadic' movements, i.e. rapid jumps from one fixation point to another - different from tracking movements).

Normal infants develop these abilities automatically, but visually handicapped SLD children or others with a visual handicap may not have them in full, or at all. Of course, they're bound up with other areas of development - the perceptual ability to distinguish figure from ground, the concept of object permanence helping to motivate visual searching, motor development in eye/hand co-ordination and so on.

You can tell a great deal about a child's visual behaviour by watching him carefully in an ordinary classroom situation, but if you want to make your findings a little more precise, try this method of observing and recording visual responses: (but again a warning: you can only observe how a child is using his vision and to what sort of visual stimulus he responds best; you cannot, from this, make absolute statements about his field, acuity, etc.)

Make an A4 size stencil of the rough visual field diagram shown below:

• 

In the corners leave space with headings for child's name, teacher, date; details of the visual target or' stimulus used (colour, shape, size, movement etc.); the range; the level of background contrast and lighting; and general comments on the child's response. Then remembering our earlier caveat about sympathetic situations, find a quiet corner with a table and two chairs where you have some control over the lighting - an anglepoise on the table, perhaps, but watch the hot shade - and get a helper to sit at the table with the child in her lap, or sit the child at table if he prefers it.

Beforehand, get together a few objects of different shapes, sizes and colours, some bright, some less so, or perhaps a torch with different colours (Pifco Tricolour available at Boots is good). Face the child, with a copy of the diagram handy, and present objects to him according to the scheme below:

• Try to get visual attention with a fairly big, bright object, well contrasted against background, held still (or revolving on itself) close to the child, centrally and a little to each side, first at eye level, then lower. - Where the child gives visual attention, mark a large 'O' on your diagram or record ‘nil response’. Record details under other headings.
• Similarly for fixation: try a smaller object, vary the range (close examination range of a few inches, normal working position, arm's length, across the room, are more functional than so many centimetres or metres). Hold it still, and if the child looks steadily at it, record a fix with an 'X' in the corresponding part of the diagram (you might like to use a new one for every trial you make).
• Similarly for tracking; move an object horizontally, slowly, and not far off centre at first; alter lighting, contrast, object size and range, motion to be tacked etc., and record an arrow to approximately the direction and length of the arc followed. Walk across the room and use yourself as the object if you like. Gradually increase difficulty of task.
• Similarly for other visual skills; for saccadic movement you might need a small screen in the middle of the table from behind which objects can appear/disappear, and you could record with a dotted line between the Xs. Reaching out can be recorded with an arrow with a circle round its tip, and other symbols can be used as needed.

If you do this sort of thing for a few minutes a day for some weeks, you will build up a record of the sort of visual stimulus - if any - to which a child will respond. If you analyse the diagrams you have collected, you will be able to say with some certainty what visual skills a child uses, and what conditions encourage him to look - preferred colour, size, shape of object, lighting and contrast conditions, range, orientation, etc. This can be a great help to you in planning how and what to teach him.

There's nothing hard and fast about the sort of procedure suggested; you may like to modify it or devise an alternative. Of course, frequent short sessions with one or two items and skills are better than long spells. Finally, remember it's an observation, not a test.

Old favourite: if you want to find out how acute a child's close vision is (and close vision and distance vision are often at different levels), go to Tesco or a similar store and get the small size and large size cake decorations called ‘hundreds and thousands’, a pack of Smarties, and another of the giant size Smarties, if you can find them. Use these on the table top in front of the clhild, and if you vary the level of contrast afforded by the background, you have a graded range of stimuli. They're better than the graded plastic balls used in e.g. the Stycar Test (available from NFER Nelson, perhaps better left to the orthoptists and SMOs who often use it) because they can be eaten with impunity! Of course, only for those who reach. And another: black on yellow often gets a visual response, and spirals and symbolic faces of the Mr. Men are often attractive.

To sum up, even if you can't get any formal medical assessment of a child's sight, you can watch the way he uses it and, by careful recording over a period of time, can establish a kind of visual baseline for him. Then you have some data on which to base decisions about teaching methods and programme content, and if any sort of visual training is to be undertaken, you have a point from which to start.

So, observe, record and don't give up - even the smallest bit of vision can be used and can become central to a child's development.

Reference

NFER: National Foundation for Educational Research, The Mere, Upton Park, Slough SL1 2DQ

Issue 2, March 1981

Ideas for occupying and involving mentally handicapped children who have little or no sight

A Collection of Ideas and Information for Parents, House Parents, Nursing Staff and Teachers)

By Linda Hargreaves, then Teacher of the Visually Handicapped, North Yorkshire and currently Teacher for the Visually Impaired in North Tyneside.

Your house or flat can make the best possible classroom for your child - the kitchen, bathroom, bedroom and garden contain lots of possibilities for learning!

You have probably found that your child will need to be told what you are about to do around the house and then he or she will benefit from being as closely involved in that activity as possible.

For example, tell him 'I'm going to turn the hoover on now, you listen and tell me (or raise a hand) when I've stopped'.

Warnings that sudden noises are about to happen (spinner or the washing machine, hammering) may help to prevent startled responses.

Sound Sequence Stories: once your child has become used to everyday sounds around the house then great fun can be had by building up a 'sounds sequence story'. What are the first sounds we hear in the morning? Alarm clock, running water, kettle, school bus beeping its horn etc. These home sounds could be put on a cassette recorder and a little bedtime "sound story of Richard's day" could be made. Maybe brothers or sisters would like to do this for you!

There are lots of everyday household activities which visually handicapped children of all ages and degrees of handicap could help you with:

In the summer a physically handicapped blind child sits on the grass and helps gather together the cuttings after Dad has mown the lawn.

After shopping let your child sit with you as you unpack the basket. The shape and weight of an onion is so different from a tin of beans!

When you are washing up, then perhaps he could have his own bowl too, with one or two unbreakable items in it. If this would cause too much splashing then a wet cloth and a tupperware container or yoghurt pot to wipe would help him feel involved. Songs often seem to help: try singing 'This is the way to wipe the dishes on a Tuesday morning' (tune of 'Here we go round the Mulberry Bush').

When you are busy in the kitchen maybe your child could handle and sort some blunt items from the cutlery box. These are often shiny, make a nice noise and if he has the opportunity to handle them, then later he will be able to help you to lay the table. These early experiences could make all the difference to your child's social skills when he is an adult.

If you are baking, let him have some off-cuts of pastry to squeeze, poke, roll or pat. Some children will enjoy being helped to use a simple cutter and will be proud if they can bake their own jam tarts. For younger and more handicapped children, the feel and texture of the pastry or play pastry will be the main enjoyment and an 'end result' isn't needed.

There are lots of recipes for play pastry. Here is just one from Roma Lear's book "Play Helps":

Play Pastry:

2 cups plain flour

1 cup salt

2 tsps cooking oil

enough water to bind

food colouring to add interest

This mixture will stay fresh in the fridge for about a week (in a plastic bag). Flour, by itself, is cool and soft to play with; it does make quite a mess.

There are so many things you do in the kitchen which are of educational value to your child. Let him feel how cold a packet of fish fingers is when it comes out of the freezer and then, how warm a cake is soon after it has come out of the oven, It is by bringing these sorts of experiences directly to your child that he will discover the variety of smells, temperatures, textures and sounds within his surroundings, and can then start to put them into some kind of order.

When you have to leave your child to occupy him or herself:

Ideas can be difficult to find, the television may not be appropriate for many and too much radio or constant music from the cassette or record player is not helpful in encouraging children to become selective in what they pay attention to. (The ability to develop selective listening skills is so important for a visually handicapped child, e.g. to know where he is in a building, or later to cross a road).

Music Boxes: it is certain that many of your children have enjoyed these (even if the tunes do get on our nerves at times!). They can be very helpful for some children, especially if they have a plastic bangle attached to the end of a drawstring so that the child has a better chance of operating it himself. Some of the wind-up ones are a little difficult. Hestair Kiddicraft make the 'Melody Man'. When you pull the cord it activates the tune and the eyes move from side to side. They also produce 'Tuneful Tim' which is similar to 'Melody Man'.

A certain tune could be used to indicate to the child that a particular routine is about to happen: e.g. bedtime. Or a small (e.g. Fisher Price radio box) music box could be started and put on the child's own chair to help him begin to locate where his own place is around the table. This idea has been used very successfully in a classroom situation to help a blind child find his place within a group of children for our morning 'conversation time'.

Many of the newer music boxes have moving parts which turn as the tune plays and these can be very useful for encouraging the use of any residual vision which the child may have. Sometimes the small plastic shapes could be removed and shiny foil from pie tins or red cellophane biscuit inserts could be attached instead as these would be more likely to attract attention.

If your child sleeps in a cot then there are lots of interesting items which could be attached to the sides to provide interest and stimulation if he wakes up very early or has a nap during the day. These could include herb pillows with different smells, either homemade or bought from some Health Food shops or Department stores. Feely Cushions (see page 111 Roma Lear's book 'Play Helps'), can be lots of fun, an old cushion could be transformed into a Humpty Dumpty shape and then different textures sewn on to him. If you sew on a couple of rings then these could have different objects attached to them every week, e.g. bells, rattles, tinsel. Many younger physically handicapped children feel quite safe propped up in the corner of a cot to play for short periods and the sides mean that toys can't roll far away.

Have you seen these?: (N.B. Some of the toys mentioned below may not now be available but the principles hold good).

Tweety Bird .... a toy suggested to us by a teacher in Walsall. It is a brightly coloured bird which will bounce on a wire making intermittent tweety sounds. It performs for a long time and will help to motivate reaching and looking.

Giggling Ghoul .... this is a brightly coloured hanging toy which makes a laughing sound when the child reaches and swipes at it. Available from Woolworths.

Father Christmas Brooch .... also from Woolworths. When a string is pulled, his face will light up.

Thinking of Christmas .... if you have time, keep an eye open for useful light stimulation toys, coloured torches etc., which are around at this time of the year and then disappear. Xmas lights; there are some available now which rotate and even play a tune! These could be used now and then kept as a light stimulation toy for your child during the long summer holidays!

Keep out some of the shatterproof Christmas balls as well, as many visually handicapped children will love to handle them and hold them up to the light.

Glow Stars .... from the Discoveries Catalogue available from Discoveries, Harrington Dock, Liverpool, L70 1AX, Tel. 051-708-8883. These stars are very small but very effective, they are made from a safe non-toxic material. They are automatically recharged from ordinary light and will fluoresce in the dark for about 45 minutes.

A couple of parents we know of have put these stars on their child's bedroom walls and ceiling and have found that their children enjoy seeing the Glow Stars slowly fade after their lights have been turned out.

Glow Giggly Ghosts are also around in some toy shops and may be better for some children, as they are larger.

Other Homemade Ideas:

Activity Centres: There are lots of plastic Activity Centres on the market now and these are very useful as the moving parts won't fall off and get lost. However, the most interesting ones for children are often homemade. It is often the case that commercially produced activity centres have too many activities and a child will just play with a few in a selective way. (Maybe an older brother, sister or cousin could ask to make one as a project in school woodwork class, or grandparents could be asked).

Glue or screw a series of objects (probably not more than four to six) to a solid board which can then be clamped to a table or cot, or held in place with BluTac or Dycem non-slip matting. The objects could include:

a) a matchbox with a sweet inside to be pulled and pushed open

b) a zip pocket with a toy or sweet inside

c) a light switch

d) a door bell could be wired to a ring

e) there could be a series of four doors all with different ways which the child has to open them, a lock and a key, a latch, a bolt or button catch, a different texture or small object could be behind each door.

For more details of this kind of Activity Centre and for other ideas write off to the National Toy Libraries Association, 68 Churchway, London NW1 1LT. Ask for "Do-it- Yourself" and for a publications list, as they will all be relevant and helpful.

Wrap up a favourite toy (especially a sound-making one) in layers of paper, shake the parcel so that the child knows that there is a reward inside and is motivated to tear the paper off, he can then have fun playing with the torn up newspaper.

Provide the child with a rummage box:

Make a shute out of cardboard (inside kitchen foil, or clear tubing as sold for wine-making, or piece of plastic drainpiping), tie a string around the middle and hang up within the child's reach. The child can then post toys, cars, balls, in one end and listen for them falling out at the other end. Line the tube up so that the objects fall into the box or a metal bin which will give added sound and the objects can easily be collected for posting again.

Cat doors also make interesting posting boxes (!) and may be worth putting in even if you don't have a cat.

A simple wooden stand could be made and be put close to the child. Ideas will have to be thought of to prevent it falling over: an old fashioned clothes horse could be attached by large hooks to a sturdy cupboard or to a wall. A variety of interesting toys and objects could be hung on elastic and changed often. Bells, rattles, crumpled paper, Christmas streamers, strange bags of polystyrene pieces, milk bottle tops threaded through cotton. Many children will benefit from moving their bare legs and feet through these objects as well as their hands. Save the Christmas sweet wrappings! These can be mounted in slide frames or left on their own to hang by the window or from the wooden frame.

Blocks of polystyrene are very good to collect (electrical shops selling TVs often have plenty to spare), cover with a variety of materials both visually attractive and interesting to feel. It is very lightweight and easy for the child, with little strength in his hands, to push around and explore.

Feely Aprons:

If your child is unable to reach out and use his or her hands very much, then you might consider this idea. You may already have a basic play apron or large bib which could be adapted. The idea is to make the apron stimulating and interesting for the child when he makes the smallest movement with his fingers. Sew on about four to six small curtain rings, then with ribbon or elastic attach small bells, beads, lavender bags, pot-pourri sachets or fancy buttons. If these are tied to the curtain rings they can be interchanged for variety and also removed when you want to wash the apron. Pieces of fur, velvet, sequins and little pockets with velcro fastenings could also be added.

Stairs and Steps:

These can cause anxiety to parents and teachers alike, but they can provide hours of fun and exploration to the child, not to mention good exercise and a sense of achievement when they are mastered!

Many of our more modern Special Schools are designed on one level and have no steps at all and, so it is in the home that experiences with steps and stairs can take place most readily.

Children often approach stairs on all fours and will want to feel for the top step with their feet. Bare feet may be safer than shoes, certainly safer than socks, giving the child a better chance to locate his position through touch.

A box or basket of clothes or shoes can keep many children occupied, happy, and will provide a meaningful resource for learning. Dad's shoes are larger and heavier than sister's, new shoes smell so nice. Which are his own?

When you want your slippers from the bedroom then maybe your child could see if he could find them and bring them to you, this is a very real part of 'Mobility Training' and an activity of value to your child.

You may well have found that at birthday or Christmas times your child is more interested in exploring the colourful wrappings and containers than he is in the plastic toy or furry animal inside. This will often be the case, and you are certainly not alone in finding this. These materials are often more rewarding and meaningful to the child with poor sight.

Parents and older brothers and sisters will often make the very best swings and climbing frames, cutlery boxes, the best sorting trays and bread bins, the best early discovery toys.

An Evening Out:

It could be a great experience for some visually handicapped children to be taken out after dark. Bonfire night is a good opportunity, isn't it? Many parents may be planning to take their children out to town centres on evening this Christmas to see the lights. Is it possible to make this experience available to our children who are in hospitals, too?

Reference

'Play Helps: toys and activities for handicapped children' by Roma Lear, London, Heinemann Health Books, 1977.

Issue 4, December 1981

Classroom management

by Steven White, then Peripatetic Teacher working in Huddersfield with multiply handicapped visually handicapped children. Steven White is currently Deputy Headteacher of a S.L.D. School in Halifax.

A. Some Considerations

Children learn to see, and this learning not only depends on the actual process of increasing the use of this sensory mode (vision) but also is greatly influenced by the experiences and learning opportunities to which the child is exposed.

Learning to see is a two-way process, and the extent to which the child's vision develops to its maximum potential has much to do with the amount of environmental visual stimulation the child receives.

Visual training is important for all severely and profoundly handicapped children who make limited use of all sensory information. If there is any vision, then it is worth developing. Planning for the child must include ample opportunities to experience and learn to interpret visual stimuli. It is important to remember that his use of vision will largely be dependent on two factors - how much actual sight he has and the extent to which it is developed. Over the last few years, there have been important findings concerned with use and development of vision in the 'blind' child. One of the most important is that 'blind' children with residual vision who have had no training in 'learning to see' can, with proper instruction, learn to see better. How much the child will finally learn may depend to a large extent on motivation, which is our problem.

B. The Classroom

Lighting:

The best lighting set-up is when the light source is behind you - it can be behind either or both shoulders - and is directed onto the table. In this way, what the child is looking at will be lit, but he will not have light glaring into his eyes, as he would if the light source were in front of him.

Small high-intensity lamps can prove useful for close work as long as the light is directed onto the table where the child is sitting.

When a table or reading lamp is being used, remember that if the ceiling lights are off there will be a sharp contrast. Experiment using lamps at different heights and angles to see if this will increase the child's visual awareness.

White ceilings will improve the level of illumination, as will pastel-coloured walls.

To avoid glare from floor and furniture surfaces, they should be matt finished.

Be aware of the contrast and lighting in your room. Light on dark/dark on light - experiment for individual children.

The use of dark room, or areas within the classroom can be useful for visual training areas and stimulating for all children in the class.

Curtains and blinds can achieve an overall effect in increasing and decreasing light source.

Small rooms with ultra-violet lights are now being used in a number of S.L.D. schools. Ultra-violet light causes certain materials to become fluorescent, thus intensifying the visual stimulus they give. This effect can be used directly in vision training and in a variety of programmes which require visual attention, discrimination and hand/eye co-ordination.

By using a small room, or even a blacked out Wendy House within the classroom, a stimulating effect can be achieved.

A number of conditions and safeguards have to be met before using ultra-violet lights which involves both medical and technical expertise and considerations. (The fluorescent light itself should be long-wave as short-wave burns!).

The use of ultra-violet at Briarwood Special School, Bristol:

A wall about six feet by nine feet is covered with black material (matt black paint) and ultra violet light is directed at it. There is a pulley system so that cut-outs painted with fluorescent paint can be moved backwards and forwards across the screen. Other stationary cut-outs can be pinned to it. The Briarwood system was electrically operated and the children were able to control it themselves, but it could certainly be done mechanically.

C. Classroom

Equipment Around the Room:

Try blindfolding yourself and your assistant and walking initially around your room and then throughout the school. Some appreciation of the problems facing our children may be realised.

Avoid reflective and shining surfaces when working on purely visual work. To limit reflection or shine use matt finishes.

If the child has useful vision in only one eye, then work that side with the child -make sure visually presented tasks are initiated from this direction.

Have a familiar corner, covered with textures (perhaps corrugated paper which could be painted with fluorescent paint) or shiny surfaces so that the child becomes familiar with one place. If you need a shiny background surface for visual attraction use the gold or copper foil paper.

With "blind children" make sure presented toys and equipment are made stable on the work surface (especially if the child is unattended), soap stickers or sellotape 'sticky fixers' are very useful for this. They can be used to put equipment, toys, etc onto the wall or on vertical surfaces so that the child is working on a different plane. (This encourages the children to sit more upright instead of bending over the working tasks).

Textures on sitting chairs and wheelchairs again make 'places' in the classroom more familiar.

Guidelines around the room and in the corridors can aid mobility. A furry line along the corridor can encourage children to feel the wall and aid mobility. Textures under the feet can be used.

For the non-ambulant profoundly handicapped children a prone board with attached table can give the child a new position to work and move from. Visual responses also vary when these children are moved from various positions - prone, upright, sitting etc.

Various 'areas' within the classroom can serve different purposes and can be used by all children, not just the visually handicapped child. A certain area can be stimulating by using foils - gold or copper. Articles can be hung from the ceiling, or you can buy pegged hangers and attach various objects which dangle. Objects can be attached by string, elastic or by using the magnetic attachments (as used on cupboard doors) with metal objects like spoons.

Wall coverings can be magnetic boards or attached with drawing pins, sellotape, 'blutac' teazle graphs, or use a cork-tiled poster area.

Woolley Wood SLD School, Sheffield, have devised their own tactile language scheme which involves various wooden shapes representing words. The children can build-up sentences both by 'reading' and 'writing' with these shapes. Many of the children in the school have progressed to Grade One Braille. For further details write to:- The Headteacher, Woolley Wood S.L.D. School, Sheffield, South Yorks.

For more able children, with some vision, the Partially Sighted Society produces sheets of paper with bold and well-spaced lines for writing aids. Partially sighted children need large, clear pictures, good spacing between lines, words, letters and good quality paper without glare or gloss. Such equipment as easels, copystands, blackboards and typewriters may be considered.

Tape recorders and cassette players are useful for language and 'listening' work. Putting various tactile clues onto the buttons, the child can then operate the machine himself, i.e. rough and smooth buttons, switch and cassette player on or off.

Q.E.D. (Quest Educational Designs) Ltd., 3 High Street, Gosport, Hants, tel. 0705- 581179 produce electronic aids, including easy-to-work touch-pads which can be fitted to ordinary cassette players, so that a simple touch will start and stop them.

D. Space and Place

Children with a mental handicap who have the multiple handicap of visual impairment need their own 'special' place in the classroom and their own 'special' space.

There is the place where they sit to complete skills and tasks. There is the space where they escape to a hide-away place, as children need a den and 'escape' there. These dens can be made up of anything but must give the idea of a space which is close, but not enclosed. This space can be used for play activity.

Soft play areas with foam wedges and cylinder cushions are ideal:- a carpet with texture squares stuck or sewn onto the top of the carpet, provide an interesting base. If you use wooden structures, tactile surfaces can again be used. One of the barrels used in the playground activities could be used and the physically handicapped child can be put in it with a number of attractive toys. Instead of the barrel, a box/cardboard hole can be made or even a reinforced cardboard box -try the local electricity shop for fridge boxes.

E. Activity

There are some good mobility ideas in a leaflet produced by Linden Lodge School for the Blind, London, which is available from the RNIB.

Activities for two children to one teacher can be carried out by rearranging seats away from the tables, e.g. Music and Movement.

Set the children at right angles to you - maybe to the front and one to the side. The child facing - put his feet on yours. The child to the right and also, maybe, to the left - put their legs close enough to touch yours. Singing rhythm and movement can be 'transmitted' - three ply.

Songs, rhythm, can be good teaching aids, include songs on a variety of themes - days of the week, weather, naming parts on the children's bodies, facial features, hands, fingers, feet, etc. A wide variety of ideas for songs and poetry are in two excellent books:-

'This Little Puffin' (Nursery Songs and Rhymes) - compiled by Elizabeth Matterson (Puffin" 1969)

AND

'The Young Puffin Book of Verse' - compiled by Barbara Ireson (Puffin: 1970).

F. Basic Educational Curriculum

Barraga (1976) in her book 'Visual Handicap and Learning - a Developmental Approach' (Wadsworth Publishing Co. Belmont, California) identifies a basic educational curriculum in general terms which seems relevant for our children:-

1) Human Interactions and Relationships

Pleasurable personal contacts, acceptance and trust of teachers, peers and others, recognition of self and others as human beings.

2) Sensory Awareness and Stimulation

Exposure to sounds, odours, tastes, textures and visual stimuli, discrimination and recognition of differences and likeness.

3) Physical Movement and Activity

Body awareness and control (co-active movement with teacher): object manipulation and manual dexterity: exploratory movement in environment.

4) Self-Care and Daily Livinq Skills

Self-care skills of eating, dressing, etc, handling utensils and materials, social play and interaction with others.

5) Lanquaqe Development and Communication

Expression of needs and response to language; word-object or word-action association; psycho-drama, story telling and role-playing (records, tapes etc) following basic commands and instructions, meaningful language expression.

6) Work Attitudes and Language Development

Assigned work duties, personal and group responsibility; use of bus and public transport.

7) Physical Education and Recreation

Physical exercise, adapted games, swimming, arts and crafts, leisure skills.

Obviously these are very very general but I think it is worthwhile considering what we are actually teaching our children and what are target behaviours, overall objectives and aims. Socialisation and living skills would be important areas on which to concentrate, as the more social skills the child has, then the more self-independence he gains. The teaching of social skills lends itself very well to a task analysis approach, whereby the skill you ultimately want the child to learn is broken down into smaller gradual stages. The skill can then be taught, whether by starting with the first stages and building up to the ultimate stage (taking off his socks) or by backward chaining whereby the last step or stage is taught first, (i.e. putting a jumper on) - you would start with the child having his arms and nearly all his head through the jumper so that he only needs to pull it fractionally before achieving the first stage. The next stage would be his head a little further out of the neck of the sweater and so on until you work back to the child putting his arms then his head through the sleeves and neck of the jumper - this approach has the advantage of the child being able to appreciate the overall aim (putting the jumper on) and can be easily rewarded and prompted through the whole process.

G. Task

Try working out the various stages involved in taking your socks off or washing your hands, e.g. here is one on washing your hands:-

1. Locate the basin

2. Find the plug and put it in the sink

3. Find the hot tap and turn on

4. Find the cold tap and turn on

5. When there is sufficient water in the basin, turn taps off (most difficult stage)

6. Wet hands

7. Locate soap

8. Rub soap between palms of hands

9. Put soap down

10. Rub palms and fingers

11. Rub back of left hand with right hand

12. Rub back of right hand with left hand

13. Rinse hands in water thoroughly

14. Pull plug out

Remember your N.T.A., Nursery Nurse or helper are V.I.P.s - any considerations of room management must incorporate them. If you have one visually handicapped child in your classroom, then perhaps your assistant will spend more of her time with this child than with the rest of the class. Difficulties do occur in trying to fully 'occupy' the child when he/she is not in a one-to-one situation and at times 'occupying' proves impossible. Materials have to be adapted so that the child can participate in group work along with his sighted peers. Simple conditions such as: sitting the visually handicapped child next to you so 'contact' with the child is never lost; always using appropriate language even if there is no apparent response. Observe the responses to see if the child is using a different mode of communication.

Kinesthetic Sensory Development

The purpose of materials chosen for this area is to encourage movement. Some of our children are ambulant, while others are almost totally dependent on teachers to aid any type of movement. Increased movement facilitates tactile exploration, and the development of tactile exploration increases the likelihood that children will attempt to move in an effort to reach attractive objects and toys.

Items Responsive to Pressure and Weiqht:

Waterbeds and lilos, foam rubber pieces, pillows, mats, tyre inner tubes, trampoline.

Items Propelled by the Child:

Balls, pull toys, beanbags.

Items moved by mechanical assistance or limited person assistance:

Punching bag, wind-up toys, ball on end of rope, rocking horse, furniture.

Items that move children through space (with initial push by adult or by power supplied by child):

Swings, hammock, inclined boards, slides, tricyle/bicycle, pedal cars.

Other suqqestions

Footprints taped to the floor can be fun to walk on and often create interest. Texture footprints can be used with children in bare feet to explore their immediate environment. In the same way, lines of texture coverings can be stuck along the lengths of corridors, sides of classroom walls, to encourage mobility. A string of Christmas lights or disco 'tube lighting' along a dark strip of wall will always catch a child's eye. Place colourful strips of tape, fluorescent and shiny materials at eye level around the classroom.

Arrange an obstacle course on the floor to walk around or through. The objects used can be large or small; motivate the child so he will want to go through the course. A flashlight to 'lead' him or an RNIB bleepball, or a reward at the end may help.

Label things around the room. Cover the door handles with fur or velvet for recognition. Put different textures on to the child's chair so that he becomes familiar with his 'own' chair. You may find it more helpful using a three-dimensional object like a tube or brush to indicate the chair. Once this is established, move the chair into different positions so that the child with little vision has to explore the classroom environment.

If the child has some useful residual vision, try wearing very bright clothes when you are encouraging mobility, i.e. yellow rain mackintosh; bright knitted gloves. Most boutiques now sell fluorescent pink/yellow/red socks which may help the child with a ‘putting on' or 'taking off' of socks programme.

Sometimes industrial and commercial goods have far better educational value than toys in catalogues or in toyshops. Shiny baking tins, colanders, etc are very useful for object containers, which are important prerequisites for further learning of the relationship between different types of objects - screwing, taking out, pulling apart, etc.

Reference

Partially Sighted Society, Queen's Road, Doncaster DN1 2NX

Issue 5, March 1982

Light stimulation of the visual cortex in SLD special needs children (with healthy eyes)

by Mark Mabon, then teacher of the visually impaired in Manchester. Mark is now working in New Zealand.

This is based upon work undertaken in Manchester during 1978-82. The work concerns the use of different types of light to stimulate the visual pathways existing between eye and brain, in profoundly handicapped, developmentally young, children who are diagnosed as being blind. The work originally was, and indeed still is, practical in its orientation.

A brief outline of the thinking behind the light stimulation programme is appropriate here. The solution to the problem was thought to be a body spatial awareness programme.

A body spatial awareness programme could not be constructed for Special Needs children with a developmental age of less than six months. So there was still a gap to be filled for the Special Needs child whose development lay between 0-six months. This gap was to be filled eventually with a programme based upon the use of light.

Light was selected because it was decided that as there is usually little or no expressive/receptive language, often a hearing loss as well as the visual defect, plus a multitude of other handicaps, all adding to the child's isolation, it was possibly the only means of communication available to use. This rationale initially sounds confused - if a child is diagnosed as being cortically blind, then what is the point of using light to promote contact? There are several answers:

1. Usually there is some residual vision in 80% of all cases of blindness - even registered.

2. Being subnormal, the children, in most though not all cases, are diagnosed subjectively, not objectively. For example, very few brain scans are done on SLD children. The assumption is that if the child has SLD and healthy eyes, yet does not function visually, then the brain damage extends to the visual cortex and hence the child is cortically blind.

3. Even if the visual cortex is damaged, there is evidence that a more primitive sub-system might be capable of responding to certain forms of stimuli, especially moving lines of light.

4. Some compensatory mechanism might come into play if stimulated - this is an area where more and more evidence supports the view that the brain is far more adaptive than thought of to date.

The next question begging an answer then is 'Why, if there is, in some form or other, some capacity for sight, it is not used?' The contention behind the answer to the question is one for which there is very little, if any, proof. The author admits only to intuitively based speculation. This speculation runs contrary to all established thinking on the link known to exist between movement and the development of vision. Basically, the contention is that the profoundly multi-handicapped child born with healthy eyes originally (though not in every case) has the potential for the development of sight. However, having no concept of centre line and no spatial awareness, yet having a large degree of movement imposed upon it (the child) from without (over which the child has no effective control), vision is shut down to reduce sensory input - thereby decreasing the disorientation caused by having no fixed points of reference.

As the child grows and the experience of movement and of being handled increases and becomes more familiar, the child could possibly tolerate visual input, but is unable, having elected at a very early developmental stage to be non-seeing, to use whatever potential for vision was originally present. This is where light stimulation or, to be more precise, the use of different forms of light as a means of stimulating the visual cortex, comes into play.

Initially, all the equipment used was primitive. This equipment is still used in the early stages, both of assessment and stimulation. For example, a piece of hardboard 2 ft x 2 ft with 0.5 inch holes with 2 inches between centres, can be made with ease. The holes are covered with coloured paper in rows of primary colours; green, red, blue, yellow ...... Holding the board one way and using, say, a torch as a source of light, produces a line of all the same colours. The boards can be used to monitor either horizontal or vertical tracking responses. Once the board has been turned from the position where all the colours line up, i.e. through 90 degrees, the lines running horizontally will be a mixture of the primary colours originally selected.

Boards

• 

These boards, as is all the equipment used, are usually presented to a child in a dark environment. There is usually sufficient 'leakage' of light to permit the child's eye movements to be noted and recorded. The teacher or assistant, who knows a child well, will also be able to note changes in behaviour. These changes are usually associated with shifts in attention, and can be used as some indication of whether the child is responding in any way to the presented stimulus.

Other simple forms of stimulation involve the use of what are called 'target fans'. These are about the size of an adult face, oval in shape, made of luminous card with a spiral drawn freehand on the surface, the entire thing mounted on a stick to act as a handle.

Fans and slides

Luminous Card: "Target Fan"

The purpose of the spiral is to confuse the eye - a baby, for the first few weeks of life, cannot focus (accommodate). The vision is fixed somewhere around lm in distance. A baby knows when an object comes near because it goes out of focus. Conversely, when the object is withdrawn it goes back into focus. By moving the Fan slowly, so as not to cause movement of air around the child's face (and thus promote a response) either towards or away from the child's possible field of vision - present from all directions, i.e. up/down, across, towards/away, and note any pupil responses. (These fans work better under ultra violet light as surface contrast is increased. (Please refer to the note about Health and Safety regarding ultra violet light usage at the end of this article).

Other simple methods of light stimulation involve the use of a slide projector. The slides described here can be made with great ease and produce some interesting results. At present 15 slides are employed to produce light stimulation. They are presented, initially at a distance of 1 m and if no response is noted after several presentations, the distance is decreased in stages, to nose tip. The slides, projected on a wall-screen in front of the child (but also to both left and right of centre) are made up of bits of plastic 'gel' (the kind of material placed in front of stage spotlights to give them colour). The first slides are of strong primary colours, red, blue, green, yellow ..... Then the colours with shapes cut out of them - holes, lines - anything (use a sharp knife or a lighted cigarette to produce the lines and holes). Then irregular shapes on a red background. Next regular shapes on a green background and finally, and by far the most successful slide usually, a primitive face on a blue background.

• 

N.B. All of these slides are shown both in and out of focus.

Other useful slides to use are those that project lines of white light, ranging in number from one to a complete slide of lines (known as fine and coarse gratings and available from some suppliers of scientific equipment). If used, these slides are presented both in and out of focus to simulate movement, and the single and two, three, four lines slides are most effective when rotated through 360 degrees (remember that it is the movement of an object that attracts the seeing mechanisms of the brain first - not the object itself).

A further use of a spiral is to make one on a moving L.P. size disc and place it on a moving turntable. The responses to these forms of visual stimulation can be recorded (see attached record sheet - Light Stimulation Record). On the record sheet there is a section for colour glow objects (U.V.).

Ultra-Violet Lighting

This section applies to those who have access to a Iong wave ultra-violet light source. Basically, all the U.V. light does is to increase the possibility of a response to certain forms of presented stimuli by enhancing contrast. A portable desk top U.V. lamp in a wooden case is suitable if there is no existing light fitting in a suitable room, when a U.V. tube can be located (they will fit into any ordinary fluorescent light fitting, all you have to note is the length of the existing tube). These portable units are usually 20" long X 12" high and 12" deep. See below:-

• 

The interior of the 'box' is painted matt white (matt black was subsequently found to be even better) and their main advantage is that they allow close contact with very bright objects in everyday classroom lighting conditions. They can be used to promote visually directed reaching in those children capable of reaching and eye location in those not so capable - also tracking exercises can be undertaken using these U.V. boxes. (Today, some large stores sell battery-powered UV tubes.)

Finally, outside of a specially constructed light booth (see attached sheet for details of 'light booth') any source of moving coloured light is of value. There are some very inexpensive disco lamps producing excellent visual stimulation and usually found in local 'cheap jack' stores. On a more advanced level, boxes containing moving rows of coloured lights are very useful in producing and holding visual attention. These 'Twinkle Boxes', in some cases, can even be operated by the children themselves, using specially made switches linked to control boxes, thus a child has the opportunity to operate upon a part of the environment!!

Projector Image

The projector produces various images depending on the user's selection. The image used by the author consists of rotating lines of primary colours fixed around a black centre.

• 

Rotating lines of primary colours (Author’s selection)

This image is ideal for stimulating a visual cortex and 'we' have Special Needs children who, using the same kind of switches mentioned above (these include touch, sound, suck, wave, pressure and tilt operated devices) will switch the image, making it rotate. In some 'cases, a Special Needs child will even make two switching operations, one to switch the image on, the second to make it move.

Since this article was written, new and very exciting equipment has become available. See Rompa catalogue available from ROMPA, P.O. Box 5, Wheat Bridge Road, Chesterfield, Derbyshire S40 2AE Tel. 0246-2117777.

Issue 7, December 1982

Appendix 2: Light Stimulation Record

Name:

Equipment (see instructions)	Date	Exposure Times	Response	Other Factors
1.Targets (U.V.)
2. Slide Projector
3. Disco Projector
4. Colour glow objects (U.V.)
5.Record Deck

Keynote: Under Item 1-5 on original form, 10 responses are recorded.

Appendix 3: Note on light booth

(Formulated by Mrs. Johnson, ex-head of Special Needs, Mellands. Now head of a Special School, Manchester)

The light-stimulation booth has at least four basic applications. It offers an environment in which a variety of stimuli can be carefully controlled and recorded, so that research into practice can be well designed. It provides an excellent facility for the development of visual assessment techniques. It allows controlled visual stimulation programmes to be designed and carried out for both children with immature, undeveloped vision, and for those with more specific visual handicaps. Finally, it gives opportunities for severely handicapped children to learn to manipulate their environment in order to produce specific rewards in the form of sensory stimulation.

It is at least likely that severely retarded infants will suffer deprivations in environmental stimulation for several reasons. Many of them will be comparatively inactive babies, 'good' babies, and will not perhaps demand parental attention as a normal baby would. They will also fail to reward parental attention by smiling or cooing, and it is likely that gradually such parental attention will tend to become less and less. Since these children remain much longer at the stage of infancy, they will in fact continue to need environmental enrichment much longer than normal babies, as they will be unable to effect changes in their environment for themselves.

If one takes up a basically hierarchical view of development, then the failure of a child to develop one sensory modality will affect co-ordinations between that modality and others, and the results of this retardation will inevitably compound the primary retardation. A substantial body of research supports the view that environmental encounters of many kinds markedly enhance the speed of development in the infant's sensory-motor systems (Altman & Das 1964, Volker & Greenough 1972, Levines and Lewis 1963 and - again - White & Held). Other workers in this field have shown that very specific forms of visual stimulation produce optimal results at certain developmental stages, or under certain conditions. For instance, the beginnings of human perception are specially sensitive to moving stimuli, and - most markedly - to stimuli in the outer peripheral edge of the visual field. Also, at the onset of visual development, the infant does better with monocular than binocular vision (Epstein 1964), and babies under six months of age show no sign of discriminating colour. The light booth enables a visually enriched environment to be specifically applied, tuned to developmental age and also to individual difference. (See Fantz 1962 for work with patterned surfaces).

In the light booth, we can study with some degree of accuracy which forms of visual stimulation prompt responses, and which indeed will act as rewards for subsequently learned skills.

NOTE: The booth measures 8' X 6' X 7'6"

Appendix 5: Hand/eye co-ordination check list

It was considered that a separate quick reference scale of visual ability was advantageous with regard to gaining some knowledge of a child's use of vision as an indicator of cognitive ability in developmental terms.

Age in Months	Auditory Responsiveness	Date
0.1	Responds to sound of bell
2.2	Searches with eyes for sound
2.6	Glances from one object to another
6.0	Looks for fallen spoon

Age in Months	Visual Responsiveness	Date
0.1	Momentary regard of red ring
0.2	Regards person momentarily
0.4	Prolonged regard of red ring
0.5	Horizontal eye co-ordination: red ring
0.7	Horizontal eye co-ordination: light
0.7	Eyes follow moving person
0.8	Vertical eye co-ordination: light
1.0	Vertical eye co-ordination: red ring
1.0	Following moving light with eye
1.2	Circular eye co-ordination: light
1.2	Circular eye co-ordination: red ring
1.3	Free inspection of surroundings
1.6	Turns eyes to red ring
1.6	Turns eyes to red light
1.9	Blinks at shadow of hand
2.0	Turns eye to moving finger or light
2.3	Eyes follow pencil
2.4	Follows pencil torch 90 degrees R/L slow tracking 11" from face
2.5	Regards cube
3.0	Follows or watches a dangling toy
3.0	Looks from one object to another
3.1	Follows ball visually across table
3.2	Head follows dangling toy
3.2	Head follows vanishing spoon
5.8	Attends to scribbling
10.0	Looks at pictures in books
11.0	Looks at people in books
18.0	Can scribble in circles and straight lines
23.0	Recognition of small details in pictures
24.0	Can copy a line - sometimes
24.0	Can copy horizontal and vertical strokes in scribble
24.0	Draw a circle
24.0	Can recognise pictures in favourite book (and photographs of favourite people)
27.0	Can copy a circle

Age in Months	Visually Directed Reaching	Date
3.1	Reaches for dangling toy
3.8	Inspects own hands
3.8	Closes on dangling ring: Right hand (R) Left (L) None (N)
4.1	Reaches for cube
4.4	Eye hand co-ordination, reaching
4.6	Picks up cube - check hand preference (R) (L) (N)
5.0	Persistently reaches - Eye/Hand co-ordination in reaching for small objects
5.2	Lifts inverted cup
5.4	Reaches for second cube
5.7	Picks up cube directly
6.0	Reaches and picks up objects immediately

Age in Months	Visually Manual Behaviour	Date
1.7	Reacts to paper on face
3.8	Inspects own hands
4.5	Watches own hands
4.6	(Grasps mobile, picks up one inch size toy/object)
4.9	Recovers rattle in crib
5.0	(Eye/hand co-ordination in reaching for small objects)
5.2	Lifts inverted cup
5.4	Sustained inspection of ring
5.4	Exploitive string play
5.5	Transfer objects hand to hand
5.7	Pulls string: secures ring
5.8	Lifts cup with handle
6.0	Sustained inspection of objects
6.0	Looks for object that has rolled out of reach
6.0	Reaches and grasps objects
6.3	Reaches out and picks up objects immediately
6.5	Manipulates Bell: interest in details
6.9	Look for objects which have rolled out of reach
7.0	Turns to look when object falls on floor
7.1	Pulls string adaptively: secures ring
9.0	Uncovers a toy seen hidden by a cloth
10.0	Waves "bye-bye" (imitation)
11.0	Finds objects seen hidden in box
11.0	Points with index finger
12.0	Points to near object when wanted
14.0	Removes an object from a bottle
18.0	Points to outdoors (distant objects)
18.0	Builds tower of 3 (after demonstration)
23.0	Throws ball into basket
24.0	Builds tower of 6 (after demonstration)
24.0	Imitates actions

* See programme planner for blind and partially sighted children of lower ability including severely learning disabled children (SLD), available from: Shawgrove School, Cavendish Road, West Didsbury, Manchester M20 8JR. Cost £2.00, Cheques/postal orders to Shawgrove School Fund.

Safety Note

The main theme article refers to the use of ultra violet light. Its use is a very interesting idea, but please be aware that it is potentially dangerous. There is a report available from HMSO about its use in the work situation; this was compiled in America and adopted by the U.K. There are three types of U.V. lighting, and exposure to any can be dangerous. Discussions regarding the need for safety standards and requirements related to its use in education have taken place and this is now receiving the attention of the Health and Safety Executive, 25 Chapel Street, London, NW1 5DT.

There is a need to establish a precise code of safety standards. Once these are laid down, ideas can and surely will be developed, using this light with fluorescent material with the children. Obviously, we do not suggest that you use it before these safety standards are written down for us to follow. Both the Health & Safety Executive and the Department of Education and Science are aware of its value as a teaching aid.

Preliminary Thoughts

Try to find out what assessment of vision has been carried out with each child. Useful questions to ask yourself:-

a) Does the child react to sunlight with his/her eyes and how? For instance, some children's eye lids will flutter when the sun's light falls on their faces.

b) Does the child's vision react to daylight?

c) Does the child's vision react to electric light?

d) Does the child's vision react to a lit gold disc?

e) Does the child focus on small shiny objects?

f) Does the child focus on other objects?

g) Does the child follow many objects?

h) Does the child react to colours?

i) Does the child use hand-eye co-ordination and how?

j) What vision stimulation/training has been carried out?

k) Have any visual aids been prescribed for the child (e.g. glasses)? If so, how are they used?

l) How does the child use vision to search for objects? What objects, how and where?

Issue 7, December 1982

Vibration and the multi-handicapped child

Many parents and teachers are aware that their children with a severe sensory loss can often be fascinated by vibration in all its forms. We often comment on how a child will love to sit with his or her cheek close to the washing machine or will spend periods of time making throat noises or repeating mouth-blowing games against his fingers.

In the two articles that follow, Elizabeth Carrington, Tim Williams and David Byrne show us how we can make use of this enjoyment and motivation in our daily teaching.

A. Vibration for the multiply handicapped child

By Elizabeth Carrington, then Senior Physiotherapist, York.

Why vibration?

Vibration provides a source of interest and fascination for many multiply handicapped children, some of whom may be entirely dependent on the sense of touch where vision and hearing is either damaged or unable to function due to a delay in sensory development.

Several workers have put forward the idea that there is a developmental sequence of responding to sensory stimuli. Initially, the dominant senses are those of smell, taste and touch, i.e. the near senses. Maturation takes the child to the next stage where the distance senses become dominant, first vision and then hearing. Children with delayed or retarded development may stick at the stage of near sense dominance for some time before they mature sufficiently to be able to make use of their potential for seeing or hearing. If they are tested at this time they may be unable to respond and will appear blind or deaf. Clearly there are children who are truly impaired but it is only through the work of teachers and therapists, who are involved with parents in devising programmes of stimulation for young and handicapped children, that an assessment based on observed function can be made.

Application of sensory stimulation should be child specific and related to the child's preference rather than the parent's or teacher's choice. If a child enjoys using his near senses, vibration can be used to enlarge that level of sensory experience with the advantage that it can be structured to help the child to learn in a way that taste and smell games cannot.

Will my child like vibration?

Perhaps your child already likes sources of vibration at home, e.g. the spin dryer, the vacuum cleaner. At school, the back of the piano provides inquisitive hands with wonderful rhythmic vibration. Other sources which your child may already enjoy include clockwork toys, your voice felt through your chest or throat, a trampoline which is stamped on or banged whilst the child is lying on it and a large beach ball treated in the same way

Preference for these types of games will give you a clue but the best way is to try a hand-held vibrator. Turn it on at a low level and move it slowly over the child's body whilst he is either relaxing on the floor or sitting comfortably. If you do not get any adverse reaction you can turn up the intensity of vibration until you reach maximum. Some children need very strong sensory inputs applying before they are able to attend. The Niagara equipment (see-below) will give you a stronger burst of vibration than will a battery-operated model. For many children vibration is extremely pleasurable, but ongoing interest is more likely to be maintained in those children who are unable to see or hear.

What will I see?

1. Stilling and attending

2. An expression of awareness

3. An increase in gross limb movement, e.g. arm waving and kicking, in a severely physically handicapped immobile child

4. Smiling and perhaps laughing

5. Reduction of anxiety and crying

6. Vocalising

7. Alteration in behaviour, e.g. cessation of mannerisms such as eye poking, finger flicking, etc.

Points to watch

1. Avoid vibrating over bony points if a child is thin and is not wearing much

2. Don't vibrate over fragile skin

3. If you cause a startle reaction, turn the intensity of vibration down to a low level

4. Try not to vibrate directly over a spastic muscle with a local application, e.g. hand unit at a high intensity. You may increase the spasticity and make movement more difficult. Where children have physical handicaps in addition to sensory impairment, they will probably be in contact with a physiotherapist who would advise.

5. If your child has very unsteady balance and is ataxic, or has involuntary movements as in athetoid cerebral palsy, vibration may well be disliked as it tends to enhance motor inco-ordination in these conditions. It is best to let the child show you his own feelings about vibration rather than pre-judging the issue.

What else will vibration do?

The effects of vibration are many and are of interest to parents, teachers, therapists and psychologists:-

1. Sensory effects

2. Motor effects

3. Behavioural effects

Sensory

a) Felt by the skin and received by the brain as a pleasurable sensation

b) Reduction of pain, swelling and the stiffness connected with swelling

c) Improvement in circulation in the skin

d) Sensation of vibration increases the child's body awareness and can be helpful in drawing attention to a previously 'neglected' limb

Motor

a) Gentle vibration has a relaxing effect and will reduce the tension in spastic muscles, when the vibrator is placed on them. Vibrate for 10-20 minutes. Effect can last up to four hours

b) Very strong vibration has a stimulatory effect and will cause the vibrated muscles to contract. This may be very useful if your child cannot make the muscle work by himself. When you stop vibrating the muscle, it will relax.

c) If your child has difficulty in coughing and keeping the chest clear of secretions and is perhaps awkward to tip up and clap in the usual way, a vibrator pad under the chest can be helpful in clearing the secretions.

Behavioural

a) Creation of pleasure

b) Catching attention

c) Increased motivation to attend or to move.

d) Vibration has been shown to be a most powerful reinforcer. It acts as a reward for completing a task and may accelerate the learning process. It may be more pleasurable than the child's self-stimulatory mannerisms (which perhaps need reducing so the child can explore a wider world) and can be used to change behaviour. Your child's teacher and/or psychologist will devise learning programmes to do this where it is appropriate.

e) It represents a method of communication with children who cannot speak or hear and who may also have limited mobility.

f) Progression up the sensory hierarchy. Children who develop responses to vibro-tactile stimulation can sometime transfer these abilities to their visual or auditory channel.

g) Training of self-help skills, balance and mobility in deaf blind children.

h) Relaxation of spasticity, in the profoundly physically handicapped, prior to personal care procedures. Comfort is increased.

i) Smiling and movement in an otherwise immobile child will be enjoyed by the carers as well. Vibration can help you to get into closer contact with your child.

NB: Beware of the child who has a tantrum so that he can calm down on the vibrator. Don't leave a child on a vibrator pad for long periods of time or it will no longer be a rewarding experience.

Practical examples of use of vibration

1. General body stimulation with a hand unit to make your child smile, laugh or listen to the altered sound of his own voice if you vibrate over the throat. He may want to put his hands round the vibrator and lead your hands. Use this initiative to play a reciprocal game where you vibrate over your throat whilst singing and then the child reaches for the vibrator and pulls it towards himself for his turn.

2. Having established interest in vibration, your child may be motivated to reach out, find and follow the moving vibrator. You may be able to persuade him to attempt a new movement. The teacher or psychologist will help you to structure the vibratory reward so the child has to work progressively harder to obtain this. Vibration can be altered in intensity, duration and quality. It can be continuous or pulsed.

3. Some vibratory equipment is designed to encourage a particular motor skill, e.g. balancing. For the blind child with delayed motor development, vibration is useful in helping to develop a feeling of mid-line and equilibrium. A balance platform is available which vibrates when the child is evenly balanced on both feet in standing. Correct sitting and kneeling can be trained in the same way. Vibrating walkways, which consist of a series of carpet-covered pressure switches, are used to reward forward stepping and give the child a lot of feedback about the position of the feet.

4. Potties, which vibrate when the child performs, are useful aids to toilet training for deaf-blind children.

5. Selection of the preferred type of vibration, i.e. strong, weak, intermittent, continuous, can help hand skills and perceptual development. Pressure switches which activate a selection of small vibrators mounted on a board, under a table or in a mat on the floor, provide interesting choices.

6. Children who find it difficult to play may be more interested in toys which contain small battery-operated vibrators.

7. The metal strip on the vibrator pad (* see equipment) is useful. Try encouraging a child who can grasp, to place the rattle onto the metal strip and listen to the sound it makes. For those who are unable to shake a rattle spontaneously, the vibrator will do the work.

8. Basic movements in your child's repertoire can sometimes be used as a demand signal for 'more vibration'. For example, putting two hands together may be possible but not used purposefully. Try putting the child into an undemanding posture such as lying on his back, or sitting comfortably with good support. Help him to put his hands together and give a short burst of vibration (count about six) from a pad underneath him, as a reward. Eventually you may find that the child begins to initiate putting his hands together himself in order to obtain more vibration. You have a demand signal - 'more please'. Sometimes movements that represent actual signs from a communication system such as Makaton will be physically too difficult, but alternatives can be found for some children.

These examples represent just some of the ideas which are being developed to help children with profound handicaps.

What sort of equipment is available?

Niagara Therapy UK Ltd., Colomendy Industrial Estate, Rhyl Road, Denbigh, Clywd. 0745-813666

Large pad

Hand Unit

Battery-operated disc

Polymodulated pad (intermittent vibration)

Mr C Black, Vibro-Medico, 20 Church Road, Hadleigh, Essex SS7 2DQ. 0702-557966

Niagara equipment marketed for schools and hospitals - as previously

Plus

Reward Balance trainer

Vibrating steps and slide

Walkway and crawlway

Reward trainer - platform with potty

B. The uses of mechanical vibration on the teaching of children with multiple handicaps

By Tim Williams, then Senior Clinical Psychologist and currently Divisional Psychologist (Children's Section) W. Berkshire Health Authority, and David Byrne, then Teacher in Charge, Mary Sheridan Unit, Borocourt Hospital, Wyfold, Reading.

In this contribution we will attempt two types of description of the uses of vibration. Firstly, we thought that there was a need for a readily digestible review of the published papers on the topic of the use of mechanical vibration. Secondly we thought that it might be helpful if more people knew about the uses to which we have put mechanical vibration at the Mary Sheridan Unit at Borocourt Hospital and also the ways in which we have used vibration in the assessment of profoundly handicapped children. Before considering the published literature on the uses of vibration, I would just like to set out the use of what may seem to be a rather unpromising technique into some kind of context.

Mechanical vibration is just one type of sensory stimulation that can be used to change the behaviour and hopefully the rate of learning of children. It is also possible to use sound, lights or even odours to help the children learn. It is relatively rare to use one of these sensations in the absence of another. This js particularly true of vibration, since the movement of the vibrator inevitably also generates some sounds. However, these are relatively low frequency sounds and as such do not correspond to the sounds made when playing music. Vibration should therefore be thought of as just one in a whole range of techniques that can be used to help children learn.

Surprisingly, there is also a theoretical basis for suspecting that vibration could be used to help children learn. Schachtel (1959) proposed that very young infants were most aware of events that happened very close to them and that they used the relatively primitive senses of smell and touch. Only later do children learn to rely on the distance receptors (eyes and ears) to learn what is happening outside themselves. In brief then, he believes that children begin by learning through changes of feel and smell, and only later do they develop an awareness of the senses of sight and hearing. If this theory is true, then the most handicapped children will tend to respond to touch and smell rather than sight and sound. Since these latter are the methods by which most human beings communicate and hence teach, it is possible that methods using touch and smell might be more effective.

Finally, there are also commonsense reasons for thinking that vibration could be used to help children to learn. This is particularly true of children with multiple handicaps such as the deaf/blind or the visually and mentally handicapped. For these children there are fewer ways in which information can be gained about the environment. In addition, it is often the case that those children with nervous system damage show abnormal reactions to sensory stimuli and the use of vibration may represent the only way to inform the child of changes, and hence teach him about new activities.

Review of published work on the uses of vibration

In this section, we intend to try and bias our comments towards a strictly practical slant, so that it should be possible for teachers and others to find out what is involved in choosing to use vibration for children in their care. We will therefore start by discussing the types of vibration that have been used, and how to assess whether a child is likely to benefit from its use. We will then go on to consider the uses to which vibration has been put.

Assessing what sort of stimulation a child responds to best should be one of the first tasks in working with the child. Many blind multiply handicapped children will be frightened and ill at ease if it is their first time in a new setting and they will often need reassurance. If the mother or father, or someone familiar with the child is there, it is worth observing carefully how they manage to soothe the child. Do they hold the child at all? Do they stroke him? Do they talk to the child or do they perhaps rock the child gently? Often, of course, the parents will have a number of different ways of looking after the child, but it is worth seeing if the components can be separated out. For instance, does the child respond to the first touch from the mother, or does she have to pick him up? If the child does seem to be responding to touch, then it is probably appropriate for the teacher to consider the use of vibration in the teaching programme.

Five studies have been reported in which methods of assessing the usefulness of vibration are described. Two of these deal entirely with psychotic or autistic children. However, the principles remain the same for all children. The first stage is to find out what the child does without any rewards. Then arrange things so that the child can switch on vibration or light every time he moves his arm or makes a "please" sign or whatever response has been chosen. Three of the studies use a lever to switch on either vibration or light or some sort of sound (Ferrari & Harris, 1981; Byrne & Stevens, 1980; Rincover et al, (1977).

Since Byrne and Stevens refer specifically to visually impaired, multiply handicapped children, it is worth looking at their results more closely. Essentially, they found that there was a significant relationship between the scores of the children on the Fairview Self-Help Scale and their responses to vibration or light as a reinforcement for lever pressing. Specifically, the more able children tended to have preferences for light rather than for vibration. However, there were a few children who behaved very differently from the others in that they preferred vibration although they were quite able. From the practical point of view, this means that one cannot assume that less able children will automatically prefer vibration, although in many cases this will be true. In particular autistic-like children often prefer vibration while being advanced in other respects.

More recently Hogg (1983) has investigated the effects of music, praise, or vibration on a multiply profoundly handicapped child. This study illustrates the careful attention to detail that is required if a useful assessment is to be made. The only behaviour that the child showed spontaneously was turning the head. Every time head-turning was seen, it was recorded. Although Hogg was able to use an electrical recorder, most people should be able to use paper and pencil to record this. One can then draw a graph of the number of responses for vibration or sound or praise and compare them. Hogg recorded the child's behaviour over many short periods, as did Byrne and Stevens (1980). This too is important since it increases the chances that the differences you observe are the true ones. Short sessions are important because in that way the child does not become tired and hence will continue to respond to the stimuli.

It is possible therefore to describe an assessment as consisting of a number of short sessions in which the children are given the opportunity to work for vibration, or some other possible reward such as praise or music. There should be a number of these sessions; up to about 10 with each type of reward. The behaviours of the child need to be carefully recorded and then drawn up on a graph so that it is easy to see how well the child responds for each type of reward.

Teaching and Treatment Using Vibration

In this section we will briefly consider how vibration has been used both as reward for performing certain activities, but also how vibration has been used to improve the chances of learning anything at all. These two uses may be distinguished by the fact that vibration may be given as a form of stimulation of behaviour, in other words before the behaviour, or vibration may be given as a form of reward or reinforcer after the behaviour. We shall start by considering vibration used before behaviour occurs.

In theory at least vibration could be used both as a signal that something was about to happen or it can be used as a method of initiating or enabling behaviour. In practice only the latter use appears to be described in the literature. Jones (1979) describes the use of vibration both as an enabling method and as a method of eliciting changes in behaviour. It has long been known to physiotherapists that the use of vibration enables greater mobility of the joints of both cerebral palsied and normal people. The paper by Jones also describes the use of vibration to prevent recurrent chest infections in a profoundly handicapped child. While the prevention of infection undoubtedly improves the physical condition of the child and hence the probability of learning, my concern is with the greater range of activity that may be possible with vibration-induced joint mobility. In the case described by Jones, the vibration induces almost double the extension seen when the person is resting. Enabling movement in this way allows not only for easier care of the child but also more opportunities for learning adaptive responses. It is not yet clear whether there are long-term effects, although Jones (1980) reports some improvements in another case that lasted beyond the period of vibration. It should be noted that the whole body of both people was vibrated, thanks to the use of a vibrating chair and a vibrating pad.

Jones (1980) also describes the facilitatory effects of vibration in the sense that vibration may cause a child to be more active. For the particular case described, very short periods of vibration (two minutes) caused movements of the head, fingers, eyes, neck and vocal chords. Myrvang (1973) also describes similar facilitatory effects on a profoundly handicapped child, although it is not clear from her paper that any of the children were visually handicapped.

Before using vibration to facilitate or to cause voluntary movements, it is important to ensure that no undesirable or potentially harmful movements are elicited. For this reason it is recommended that a physiotherapist be consulted.

Vibration as a reward

The use of vibration as a means of teaching new behaviours, rather than enabling behaviour to occur has been more thoroughly investigated. Vibration may be used either to increase or to reduce the rate of occurrence of certain behaviours.

Myrvang (1973) reports the use of vibration as a reinforcer for four profoundly handicapped children in order to increase the rate of vocalisation. Ten 15-minute training sessions resulted in an eight-fold increase in the number of vocalisations. The use of non-contingent vibration (an important control) resulted in only a five-fold increase.

Jones' (1979) paper again provides further clear evidence of the effectiveness of vibration as a reward. In this study he taught a blind physically and mentally handicapped girl to hold a cup for up to 70 seconds at a time. Jones reports that subsequently this girl learned to explore certain objects, and to hold her spoon at meal times.

Lest these results seem to present too one-sided a story, a study by Hogg (1983) demonstrated that vibration was ineffective in promoting head-turning in a profoundly handicapped child.

Goodall et al (1982) report the use of vibration and social reinforcement to teach four children with visual and multiple handicaps to place shapes in a form board. However, some children still failed to learn the task. Another paper by Goodall & Corbett (1982) recorded the effects of sensory stimuli on stereotyped behaviours. No increases in stereotyped behaviour were found with vibration, and in fact for some children, stereotyped behaviours decreased.

Mary Sheridan Unit Experience

Thanks to the generosity of Niagara Therapy we have been able to experiment with the use of vibration, and as a result we feel able to offer the children much greater opportunities for learning. A few examples of the type of learning that may be achieved should suffice to indicate the type of work we do.

Ideally, when children are assessed at the Mary Sheridan Unit, we check whether they will learn to press a switch or make some other voluntary movement in order to obtain sensory reinforcement. Although all children admitted for assessment are tested, this is often done informally rather than through the procedures outlined in the first part of this account. Vibration is often found to be the most effective reward for the multiply handicapped child admitted to the Unit.

At the same time, as we establish that a child will work for vibration, we also carry out a thorough assessment of the child's needs. This forms the basis for a teaching programme in which the goal and the rewards are clearly specified.

We have used vibration to teach walking, standing, toileting, elements of sign language and manipulative skills. One of the children who was deaf and partially sighted (rubella handicapped) learned to reproduce 20 signs from the Paget-Gorman sign system by being systematically rewarded with vibration for closer and closer approximations to the correct hand movements. In order to get her to do the signs, her hands had to be held for a lot of the time that this type of teaching was going on. In its turn this required one-to-one and as a result it could only take place during very short sessions of about 10 minutes at a time.

Another younger child, also deaf and partially sighted due to maternal rubella, was taught 'food', 'drink' and 'please', using the same methods. However, in addition to producing the signs, he also showed less interest in his otherwise constant eye poking.

Perhaps our most effective use of vibration has been for teaching standing and walking. This has been achieved at least in part due to the development of automatic apparatus which only vibrates if a step forward is taken. Steps backwards or small jumps do not receive any vibration. In this way we have taught a number of children, some of whom were physically handicapped, to take forward steps. The basis of the device is a long wooden platform with pressure-sensitive switches incorporated under a carpet. Thanks to some electronic circuits, the pressure switches are only activated in one direction. When used for teaching walking, handrails are provided which slot into the platform. However, it can also be used to teach crawling if it is made into a tunnel with an inverted U-shaped top. We have also used a set of steps and a slide on the same base unit to teach climbing. This apparatus has not been sufficiently evaluated for us to claim any great superiority of effect.

In conclusion, we would like first of all to say that although vibration is a useful and adaptable tool, both for eliciting behaviour and for rewarding it, it should not be considered the universal panacea. Some children will not be motivated by vibration any more than some children respond to praise. It is very important, therefore, to assess what a child responds to before drawing up teaching programmes, or buying expensive equipment. Even when vibration has been shown to be effective with a child, we often train the child to accept social rewards as well. This is done by ensuring that both vibration and a cuddle or praise are given simultaneously. In this way the cuddle or praise becomes motivating for the child. Therefore, we are able to use more normal rewards with that child, with all the advantages that go with them.

Equipment

Any object that "buzzes" probably vibrates. Hence it is possible to use electric toothbrushes, old electric razors (not Phillips type) or electric facial massage kits as small handheld vibrators. As far as more powerful vibrators are concerned, the Niagara Therapy vibrators are supplied by Vibro-Medico at 20 Church Road, Hadleigh, Essex SS7 2DQ. There may be other sources of such equipment since some of the reports in the literature imply that they have built their own vibrating motors. For further ideas on equipment it is recommended that one should read the article by Woods & Parry (1981) and Goodall et al, (1981) where a number of developments are described.

Select Bibliography

'Mentally Handicapped Children's Responses to Vibro-Tactile and Other Stimuli as Evidence for the Existence of a Sensory Hierarchy' Byrne & Stevens

Apex, Journal of British Institute of Mental Handicap vol. 8 no. 3 December 1980

'Sensory Stimulation and Stereotyped Behaviour in Rubella and Severely Handicapped Children' Goodall. E.

Conference for Provision for the Deaf/Blind - National Association for Deaf/Blind and Rubella 1981

'The Uses of Mechanical Vibration with the Severely Mentally Handicapped' Jones. C.

Apex, Journal of British Institute of Mental Handicap vol.7 1979 & vol.8 1980

Issue 9, July 1983

The mannerisms of blind children

By Heather Jones and Roger Hinds, then RNIB Education Advisers. Heather has now retired and Roger Hinds is Manager of the RNIB Specialist Employment Unit.

You have only to watch a politician or a member of your family to realise that we all have mannerisms. There are, however, certain behaviours common the world over to those born with little or no sight which can become so obsessive that they interfere with the learning situation or actually cause damage to the head or eyes. Eye poking, gyrating on the spot, head-banging or shaking, biting the hands, are a worry to parents and teachers. The following notes were put together following a day's discussion between Mrs. Heather Jones, Senior Education Adviser for the RNIB and Roger Hinds, a member of the Information Exchange team who has had very little vision since birth. There are no programmes to reduce undesirable behaviours: the aim is to initiate a change of attitude in the care-giver at the detailed planning stage of such a programme. What are these mannerisms? We are not thinking so much of hyperactivity or tantrums, fits or tics or compulsive muscle activity.

Eye-Poking

This occurs in some blind and weak-sighted children developmentally at the time the hands have found the face and mouth. Presumably, without vision-created desire to reach for objects and people out there in the world, and without visual-monitoring of manual reaching and grasping, the youngster finds his reward in stimulating his own body. He must get some primitive visual stimulation from poking and moving the eye-ball. Abler children can confirm this and talk of seeing colours or a silver ring in the poked eye. One can hardly design a programme to eliminate such a pleasure without offering a substitute, and it must be understood that the intervention must take place close to the child's face and eyes and the hands must be slowly lured away out into the nearby space. Music, glitter, another human being, all have a place, depending upon the needs and the circumstances of the individual case.

Finger-Flapping

Again, such behaviours have their origin at the time when the hands fail to move out into space from the mouth and eyes. It is as if the finger movements are dictated by the eye's need to see movement or changes of light/darkness patterns. There also seems to be an element of creating airflows on the face. In our experience, such finger-flapping can indicate the presence of a little vision, except that the habits may have been formed at an earlier age before the loss of sight. Where there is a little sight, intervention must offer, again close to the face, a vision-stimulation programme which has bright colour, movement and changing light intensities as its ingredients so that the needs of the retinal cells are satisfied. Perhaps the TV screen and appropriate animated colour pattern from the micro can play a part here. Teachers of the visually handicapped, however, have a vast range of ingenious toys and apparatus to offer you.

Other Light-Play

There are many records of children seeking out particular places where they play with sun-beams or other chinks of light by moving their heads or bodies somewhat repetitively and strangely. Some are simply drawn to look up at the light, at the window or in the ceiling. Such habits derive from a time when their weak vision was only able to feast on such light-sources and they could not, or cannot, see further visually-rewarding detail in their environment.

The Dangers

Obviously, it is in no way desirable to look directly at the sun or a strong light but it is agreed by the experts that no harm will come to the eyes if looking is encouraged greatly in ordinary circumstances. Our children need to sit close to a TV screen which may need to be clear and coloured. The point about the odd light behaviours is that they are socially unacceptable and, if repetitive, they preclude new vision learning situations. All issues of Information Exchange contain tips on vision stimulation, and we are beginning to gather suggestions for activities for the totally blind child. The golden rule is that people, in their willingness to romp and closely interact, are the best toys and learning aids.

In brief

The following points seemed worthy of a mention for those readers who are new to blind or weak-sighted children:

1. Intelligent blind people have similar mannerisms but can be aware enough to eradicate them or at least keep them private. The behaviours are in evidence throughout the world and are more likely in "deprived" conditions. No one should be blamed, least of all parents.

2. It is not wise to think in terms of a cure, although an enriched environment close to the face at the time of origin could form the best prevention. Some of us have found that worse behaviours can follow a shallow attempt to eliminate a mannerism without adequate substitution for what could be a biological need.

3. Scientific Exploration - we felt that it is vital to give children the benefit of any doubt and bear in mind that any seemingly odd behaviour may well serve a scientific exploratory function for that child, even at a primitive level of development. A few examples will illustrate what we mean:

Hand-clapping, clicking of the tongue, apparently inappropriate vocalizations etc. may be serving the purpose of echo-location; i.e. the child may be sounding off the walls about him and judging his whereabouts in space.

Head positions may appear odd but the child may be just getting himself into the right position to see best what he wants to; he will not be aware that he looks odd. If sight is confined to the bottom or to the sides of the eyes, the head will need to be eccentrically held high or to one side. This type of deviant posture is often in fact labelled "eccentric viewing".

With growing awareness of his own identity as a person amongst others, the blind child can demonstrate a reduction of mannerisms.

As with so much of our knowledge of human beings, we will learn most by observation: only by keeping detailed records of when and where and the time and the place of the behaviours, will we begin to understand their function and origin for the child. If there is a real problem, a specialist teacher of the visually handicapped and/or a psychologist can help you with the wider perspective.

References

Jan E. et al. (Eds) 1977: Visual Impairment in Children and Adolescents. Grune and Stratton, New York.

Baumeister A.A. and A.A. 1978: Suppression of Repetitive Self-Injurious Behaviours by Contingent Inhalation of Aromatic Ammonia. The Journal of Autism and Schizophrenia vol.8.

Burlington D. 1972: Psychoanalytic Studies of The Sighted and the Blind: International University Press.

Issue 10, December 1983

Approaches to curriculum (I)

By David Bethell and Judy Bell, then Peripatetic Teachers of the Visually Handicapped, Walsall. David Bethell is currently Statements Officer, Walsall and Judy Bell is Team Leader for Visual Impairment in the Wolverhampton Special Needs Support Service.

1. Is there an accepted, proven curriculum for SLD children?

We think not. They have only been considered 'educable' since 1970, and since then we have tended to offer them a mixture of care-giving, 'rich' environments that are intended to stimulate but leave a good deal to maturation and chance, and the use of 'behavioural technology' in getting them to learn specific skills. We recognise the importance of the environment, we agree that the behavioural approach has proved very powerful and useful in raising children's skill levels and controlling their behaviour, and we know that there is a whole range of exciting new work being done in the SLD field. However, most people would agree that we have not got a fully developed SLD curriculum yet, and that there are many shortcomings in what we offer these children. We make some suggestions about this in the next sections.

2. What are the main goals that the SLD curriculum should help a child reach?

We would argue that a curriculum for these children should have two main aims: to help them to some understanding of the environment, thus some control over it and some degree of autonomy; and to help them respond and relate as individually as possible to other people. We are not convinced that the present tendency to stress the mastery of specific skills - a stress on products and outcomes that may be useful, but are not necessarily generalisable - is the best or only way to help children get an understanding of objects and events around them. Such skills may help a child get information, but they may not be enough to help him order it or solve the problems it poses. We think that skills training needs to be complemented by sustained efforts to make the patterns, relationships and procedures of the child's world more accessible and intelligible to him. And we think that the imposition of skills by behavioural techniques tends to relegate 'interactive' teaching, in which we build on the child's initiatives, to a less important role than it deserves, thus decreasing his chances, perhaps, of developing identity and autonomy, and of forming any but dependent relationships with others.

(In this connection you may like to read, or re-read, R. McConkey's article 'Education without Understanding?' in Special Education: Forward Trends, VIII:3, Sept.'81).

3. Should the goals for a visually handicapped SLD child be different from these?

We do not think so, but we should say here that we prefer to think in terms of individual needs rather than of categories of disability within the SLD range. It seems clear that for a child who has little or no sight, the goals we talked about earlier are especially relevant and especially hard to reach because he will find it extra difficult to get information about his world, and to integrate and make sense of what he does get. Of course, such a child is going to need some special compensatory skills and some special teaching techniques and emphases.

4. How can you help a child towards a better grasp of his environment and a less passive, dependent relationship with others?

We do not have a definite answer, but we would like you to consider the following suggestions.

We think that in many schools, wards etc., the SLD VH child will get some specific skills training in general areas of development and, probably, in special 'VH' skills, some therapy, some outings, and a good deal of very dedicated but perhaps rather unstimulating care. However, it is often the case that the environment and its systems, patterns and procedures are informed by the organisational requirements of the school or hospital, by skills-teaching programmes and timetables and the ticking of their record sheets, and at worst, by staff interests that are peripheral or irrelevant to the needs of the children. You may say we are exaggerating, but ask yourself honestly:

• if you taped a whole day's talk in your class, how much of it would be with the children, intelligible to them or even relevant to them?
• how often during the school day is a child given a choice of materials, activities etc. rather than having them imposed on him?
• how positively do staff or visiting adults respond to initiatives from children?
• what proportion of the activities your children are involved in are 'artificial', i.e. polish a skill and evoke a 'Good Girl' or other reward, but have no 'real life' antecedent, motivation or outcome?
• how often, and for how long is a child, especially a VH one, left uninvolved, unstimulated, immobile?
• how valid is the 'scale of importance' that you present to the child by the measure of praise or blame you allot to his different actions and responses?

Perhaps you have an entirely clear conscience, but your answers may suggest to you that you are not doing enough to make the people and events of the child's world more real, relevant and accessible to him, to use opportunities for informal learning in naturally occurring situations, and to encourage him in interaction with other children and adults.

We think, simplistically perhaps, that if a child does not have some grasp of his individual identity in relation to other people and objects, the basic patterns of time, space and causality, it is impossible for him to behave 'intentionally', i.e. he cannot hold an aim in his mind, and recall and order information so as to act to reach this aim. To enable a child to have some autonomy, we have to try to help him follow and understand at least some of the patterns, systems and relationships in which he is caught up, by, for example:

1. simplifying, routinising and differentiating the stages of all activities in the classroom, giving children active roles in them if possible, and using any means to make the connections, e.g. between cause and effect, as obvious as may be;

2. trying, by the way we talk with, touch, and present things to the child, to make it easier for him to remember and thus anticipate events in a known sequence, and so to be able to plan and act even in the smallest, simplest way to take some control over these events;

3. having a firm policy of 'interactivity', so that any contact or activity initiated by the child is followed up by a teacher or aide, who tries to build on the communication or play that the child starts, without taking control over it; and that visitors to the class do not just talk to the staff, but relate to each child individually;

4. using the routine positioning and moving of children constructively, to help them understand spatial relationships;

5. using real situations and events for informal learning and for generalising formally taught skills;

6. letting children choose whenever possible, not simply in contrived discrimination exercises, but in the natural course of the day's events;

7. cutting down on extraneous noise, adult 'chat', and other environmental 'clutter';

8. making efforts to 'explain' things that happen in terms of causation, time sequence etc., by talking them through and acting them out to involve the child;

9. making differences (and perhaps similarities) between people and between. objects more marked by accentuating appearance, voice tone, texture, smell and so on;

10. at all times, showing that affection, sympathy, appreciation and other 'affective' behaviour is as important or more so than the development of a skills repertoire.

This may seem vague and more to do with classroom management than curriculum, but what we are trying to suggest is a full-time, whole-day, carefully planned endeavour to use all the activities in which the child is involved, not just as the infrastructure for skills training and care giving, but as a continuous opportunity to practise skills, to gain some understanding of the environment - some self-regulatory behaviour, if you like - and to grow in the affective domain, which for some very disabled children may offer the most satisfying and productive experiences. Don't get us wrong; we value structured, formal teaching to precise objectives very highly. But we do think it needs to be supported and enhanced by the 'complementary curriculum' we have outlined, which, we believe, is the most effective way to use all our resourc