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Movement, gesture and sign

Summary: Sign communication for children who are visually impaired with additional disabilities

• Chapter 1: The role of vision in early development
• Chapter 2: An interactive communication programme for children who are visually impaired with additional disabilities
• Chapter 3: Objects of reference
• Chapter 4: The Canaan Barrie Signs

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Please note that this book has been updated and expanded by:

Learning together: a creative approach to learning for children with multiple disabilities and a visual impairment / Lee, Mary, and MacWilliam, Lindi. London: RNIB, 2002. ISBN 1858785316. This is available for purchase from the RNIB online shop.

Movement, gesture and sign: an interactive approach to sign communication for children who are visually impaired with additional disabilities

By Mary Lee, Lindi MacWilliam

Contributors: lain Prain, Anne Taylor, Catriona Beckett

Illustrated by: Paula Graham, Helen Herbert

Canaan Lodge Barrie Nursery

The Royal Blind School Edinburgh

Published for the Royal Blind School, Edinburgh by RNIB

Text © Royal National Institute for the Blind, 1995

Illustrations © Paula Graham and Helen Herbert

Photographers: James Fraser - cover photograph; Hilda Abdaly ; Mary Lee ; Lindi MacWilliam ; Fiona Watt; Wallie Ferguson

RNIB Education Information Service

224 Great Portland Street, London W1N 6AA Tel. 0171-388 1266

Registered charity number 226227

ISBN 1 85878 068 3

Acknowledgements

We would like to give special thanks to Richard Lee, a pupil at Canaan Lodge, who over the years has guided us in the right direction. Thanks also to the many staff at Canaan Lodge and Barrie House who have given their time and energy to this project.

Our thanks to RNIB for making this communication programme more widely available by publishing this booklet.

Finally thanks to all the people who have helped in the production of this booklet: in particular Marianna Buultjens and Paul Ennals for their support, Mary McDonald for her editorial help and Scott Lee for his ’technical' assistance.

Mary Lee and Lindi MacWilliam

May 1995

Introduction

Over a number of years, staff from specialist units within the Royal Blind School, Edinburgh, have been working to develop an approach to communication with children who are visually impaired and have additional disabilities. This booklet describes our approach and the theoretical considerations that have led to its development. It is first and foremost intended to be a practical guide for all those working with and caring for children who have similar disabilities.

One of the two units, Canaan Lodge, caters for the developmental and educational needs of visually impaired children who have a wide range of disabilities in addition to their visual impairment. All the children at our pre-school unit, Barrie House, are visually impaired and most have some degree of developmental delay. For the purposes of our text, we use the generic term, MDVI (multi-disabled visually impaired) to describe the children within Canaan Lodge. For the sake of simplicity, and since the majority of children in the unit are boys, we have chosen to use the pronoun 'he' as a general term for all children and 'she' for all adults.

Although the needs of the individual young MDVI learner are significant, they represent a relatively small, percentage of the school population, even within the special school. Because of this it is difficult for staff within individual schools to identify common patterns of disability specific to MDVI, and thus to evolve comprehensive programmes to counter the effects of visual impairment and meet these special learning needs.

Within the Royal Blind School MDVI service, we have had the opportunity to identify disability trends specific to MDVI, and to establish principles and evolve guidelines that lead to good educational practice. We have long been aware of the severe communication difficulties experienced by many of the pupils and in particular the effect that visual impairment can have on the development of successful communication skills.

The first section of this booklet deals with the effect of visual impairment on early development. The following sections describe our communication programme, which develops from the child's earliest attempts to communicate, through to the acquisition of a sign system specifically adapted for visually impaired children. Also described is the way we use objects of reference to reinforce the understanding of language. The final section consists of an illustrated list of the signs we have evolved and the ways in which we use them.

Chapter 1: The role of vision in early development

The development and integration of the visual sense takes place at such an early stage in infancy and its use becomes so instinctive, that sighted people are generally unaware of its complexity and central role in daily life. We take our sight for granted and forget the fundamental role it played in our development. There are many examples of the crucial importance of sight in infant development. Dr Patricia Sonksen of the Wolfsen Institute in London characterises vision as the 'driving' force in the early years of life, the developmentally significant years. This is the period when the key skills that govern our lives are laid down. By the age of five the basic principles of speech and language, hand-eye coordination and an understanding of cause and effect are generally well established. If we are to understand the critical adverse effects of a visual impairment on the development of MDVI children, then we must first examine the role of vision in 'normal' development.

Learning to see

Consider a six-week-old baby reaching out towards an object. There are several theoretical explanations put forward as to how the reaching for an object is refined into the swiping at and later grasping of the object. However, all these theories agree that vision plays the primary role in making the baby aware that there is an object out there to be reached for, swiped at and then grasped. Sight is then used to refine the actions, reinforcing those that are effective and negating those that are inappropriate.

Early intervention programmes with visually impaired babies always emphasise the importance of making them aware of their immediate physical, social and emotional environment. This draws our attention to the danger that with little or no sight the infant may lose his 'drive' and become introverted and thus increasingly lag behind in developmental milestones.This can be particularly so in the baby's social and emotional development where early interaction can be severely disrupted if eye contact is not available or is restricted. We are aware from personal experience of the social importance of a baby smiling and laughing with not only parents but also close family and friends. It is not only the baby, however, who needs social reinforcement, but also the parents.

Sight, as well as playing a central role in developing social and communicative skills and shaping movements into purposeful actions, helps development in other areas. For example, sight assists the reduction of 'primitive' reflexes such as the startle reflex. This never disappears-from us, but by using primarily visual cues to anticipate immediately forthcoming events, the infant becomes able to suppress the startle reflex in normal situations. The reflex remains within each of us and given the necessary unexpected auditory or physical stimuli, it is triggered.

There are differing opinions as to just how early babies develop complex visual skills. This is because conclusions have generally been based on adult interpretations of what a baby, who may not yet have mastered head control - let alone purposeful use of his hands - is doing with his sight. Mechanical movements of the eyes and preferences of looking may be observed but it is very difficult to know exactly how the baby is interpreting these visual signals.

The analogy of the eye as a camera is both simplistic and misleading. The receptor surface of the eye, the retina, can be described as an 'outgrowth of the brain', and at this level, basic codification of millions of separate visual stimuli is taking place. More importantly, however, we need to consider the interpretation of these visual signals once they have passed down the optic

nerves and arrived at the brain's visual cortex. Leonardo da Vinci clearly illustrated in his maxim sapere vedere -understand how to see - that vision is more than just seeing, it is looking - using the eye and the brain together. When a young child sees a new object, his inquisitiveness suggests a number of hypotheses to be tested. Does it make a sound if I shake it or drop it? Is it heavy to hold? Can I put it inside this box? Does it fit? Will it stand up? Does it move if I push it? What does it taste like? Is it satisfying to chew?

We might presume that with little or no sight, there would be insufficient information available to the baby upon which he could base his hypotheses and learn about the world, with the result that development will be very slow and deviate greatly from the norm. This is not the case. The human intellect is a vastly adaptable entity. With stimulation and encouragement from their parents, visually impaired babies learn to explore by using their other senses and to interact with their environment. Although initially progress is often delayed, they should eventually achieve normal developmental milestones. There may still be difficulties with some very visual skills such as complex shape recognition and their manipulation or rotation in space.

Implications for MDVI children

The development of an MDVI child whose progress has been additionally handicapped by a learning disability is likely to be significantly complicated. The greater the range of learning disability and other impairments the visually impaired child is combating, the more cumulative will be the effect upon development.

Some of the more common impairments our MDVI young learners are combating include a wide range of physical disabilities, medical complications such as epilepsy or poor general health and characteristically a severe or complex learning difficulty. Although there will be great individual differences between MDVI babies there are some common trends and implications for their development. Let us look at a common situation.

We could suppose that in the latter stages of a pregnancy there were complications and the baby was born having suffered some significant level of asphyxiation, which has severely damaged areas of the brain and particularly the cortex. Sight is diminished to a level of possible light perception and the central nervous system has been affected leaving him with poor muscle control. Most importantly the general cortical damage will affect his ability to process information and reason. Unfortunately it will often be almost impossible to assess the level of impairment accurately at this stage. Ironically it is often only when the baby falls behind developmental norms that assessment is made and for some parents the first few years are characterised by a worsening prognosis at every clinic appointment.

In our particular case the baby's general health is fine and he and his mother go home. This is the parent's first child and there is no training for parenthood; they have no norm against which to compare their baby's development. There is at first no obvious problem, the baby is breast-feeding, smiles occasionally, sleeps, moves his legs and arms and seems contented. Quite soon however the mother begins to note that her baby is passive, something is not right. There is a lack of eye contact. The smile is seen less and less often, the random movements of the limbs are declining. After initially sleeping well, the baby becomes restless and demands a great deal of physical contact. Learning and development are taking place but without having the means to communicate with his mother through the visual channel, our baby's main ways of obtaining physical comfort will be through screaming or crying. He soon learns that this is the most effective way of getting attention.

Many attempts to explore are lost in the void of space. If our MDVI baby fails to contact an object by an eighth of an inch, it is the same as missing by eight miles. The object has 'gone' when he tries to find it again, even though he has only missed by that fraction of an inch. He may, in addition, contact objects and surfaces that hurt through heat, cold, sharpness and so on. A negative pattern of reinforcement is developed whilst all the time his 'normal' peers are learning about their immediate world at a cumulative rate. The MDVI baby is often positively discouraged by his experiences from a 'normal' path of development and can instead experience frustration, fear and withdrawal from the world. It is therefore much harder for him to interpret what is happening in his immediate environment.

Many MDVI youngsters will habitually startle when touched or lifted if they are not given consistent and appropriate warnings of forthcoming events. The nappy change, the bath or being picked up, all of which should be fun, confidence building, sociable events can become frightening and confusing. Even if they are able to cope with everyday activities, MDVI children will need a lot of help to interpret sound in their environment; for example, the everyday sounds of the washing machine, radios, doors shutting, the vacuum cleaner, and - most important - speech and conversation.

For an MDVI young learner sound needs to be given substance. In normal development we learn this slowly. A toddler will not react to a parent's command if shouted from another room. The parent must come into the room so that the toddler connects person and voice before he registers the command. How much more difficult it is for an MDVI infant to learn the significance of speech. He is in danger of not 'seeing' the source of the voice and not realising its significance for him. He may not understand whether his mother is talking to him or to someone else in the room.

From the above rough sketches, we could generate thousands of individual incidents to illustrate how an MDVI child's early development lacks consistency and opportunities to make and reinforce vital connections with his world. This may lead to a lack of understanding and passivity. In more extreme cases it leads to withdrawal, frustration and aggression. In all our developmental and educational programmes we need to work alongside parents to support MDVI children's development by setting appropriate learning conditions that offer our young learners consistent opportunities on which to base their learning. Chapter 2 describes the programme we have developed at the Royal Blind School to meet these very special needs.

Chapter 2: An interactive communication programme for children who are visually impaired with additional disabilities

(Mary Lee, Lindi MacWilliam)

The communication programme is presented in four parts.

Section 1 - Theoretical background to the programme

This follows on from Chapter 1 and looks in greater detail at the effect that visual impairment has on the development of communication and how the difficulties can multiply when additional disabilities are present.

Section 2 - The programme

After many years of discussion, visiting other schools - in particular a visit to Denmark and Sweden - and a certain amount of trial and error, we now feel we have developed a communication programme that answers the needs of our children. We wanted a programme that would be flexible enough to apply to all children in the units, whatever their developmental level. We feel strongly that communication is not something that can be taught. It must be centred around the individual child, and develop as he develops through interaction with his environment. The fact that all our children are visually impaired has also had fundamental implications for the development of

the programme.

The programme itself is divided into three stages:

• movement/interaction
• natural gesture
• learning a sign system.

Our approach can be summed up by three basic principles:

• it is interactive
• it is child centred
• it is designed for the particular needs of visually impaired children.

Section 3 - Objects of reference

This section provides a short description of the ways in which objects of reference are used within the MDVI units, alongside signs and speech as an aid to real understanding.

Section 4 - The signs

A list of signs and how to use them.

Theoretical background to the programme

Mother/child interaction

As we have seen in Chapter 1, in order to understand the process of learning for an MDVI child, we must first focus on how vision and communication develop in the ordinary child. Many of the children we are concerned with function at a very early developmental level, although chronologically they may be much older. Others, although more advanced, may have failed to pick up certain specific, but crucial communication skills. As before we take the normal pattern of child development as our guide. Research since the mid 1970s has focused on the 'dynamic process of social interaction' taking place between mother and child, which begins at birth.

Theorists suggest that children are born with a sensitivity towards reciprocal human interaction. That is they possess an in-born, natural ability to communicate. Nonetheless, from the moment of birth they are dependent on the instinctive ability of their mother (not to mention father and other carers) to interpret and respond to their early communicative behaviour.

A young baby actively strives to make social contact and as a result of the consistent responses of others to his behaviour, the child learns that his smiles, gesture, movements and vocalisations produce particular effects. Complex patterns of communicative behaviour are formed between parent and baby. Research has shown that mothers are highly adaptive in their own behaviour and respond naturally in ways related to the level of understanding of the baby. The mother is constantly supporting and facilitating the child's attempts to communicate, encouraging the child to continue and expand his activities. She takes on the subordinate role and responds to whatever the child may offer, feeding it back in the form of a non-verbal conversation. Rhythm is all-important in these exchanges and mother and baby can synchronise their movements with each other with amazing precision. In time the baby is able to anticipate that others will respond to his overtures in certain specific ways. This leads on to the ability to initiate social interactions and bring the 'conversation' to a close.

Gradually, as the baby develops his skills, the interactions become reciprocal in nature and mother and baby become more equal partners in the communicative-process. (Burns 1986), (Trevarthen,1979).

These skills are the forerunners to adult non-verbal communication.

A major part of any verbal exchange is conveyed through the non-verbal channels. When people have a conversation their gestures coordinate with the same precision that can be seen between mother and baby. This coordination of movements is fundamental. Indeed the better the synchronisation between two people the more successful is the communication. Two people who have difficulty coordinating their movements with each other, may encounter problems in developing the flow of conversation.

Recent studies have shown that children with even the most complex learning difficulties do not lose their instinctive ability to communicate. Some use their abilities with great skill and build rich patterns of communication with their parents and carers. For others, however the reciprocal interaction has broken down because of the immense difficulties the disability has caused. In all cases the child's abilities can be worked with to develop and enrich their interpersonal skills and communicative ability. (Burford 1989).

The functions of language

Once the child has developed intentional communication, that is, he is aware of his own role in the communication process, then emphasis shifts from the early, fairly exclusive, mutual attention between parent and baby, to an interest in objects. These begin to become part of the communication routine. The process becomes more of a three-way interaction between child, adult and object. The infant may use an object by 'showing' it to gain the adult's attention or, conversely, he may use the adult to obtain an object, by conveying his intention through gesture or eye pointing (looking with a fixed gaze at an object to communicate interest in it). In the following months these skills diversify further and the child begins to use an ever-widening range of intentions or functions.

The functions of language form the basis for linguistic development. As we have seen, it is out of early interaction that the child develops the skills

required to be able to use language, spoken or signed. What the child does with these skills is embodied in the functions of language. These give structure to what the child is expressing; he may be seeking attention, making a request, demanding, rejecting, expressing pleasure, giving vent to feelings or simply making conversation. Even if a child never develops speech or formal sign, he may still be able to use a variety of the functions of language at a basic level. (Goldbart 1988).

Implications of a visual impairment

For a severely visually impaired child, there are particular complications in developing early interactive skills. Fundamental to the pre-verbal exchanges that take place between mother and infant is the use of the visual channel. From a very early age mutual gaze and visual exchange help in the formation of an emotional bond and a means of reciprocal interaction. Later a baby will direct his mother's attention by eye pointing. This ability to direct the adult's attention is a very important early skill and one that a visually impaired baby may miss out on. Later still more formalised pre-verbal skills develop such as gesturing, pointing and turning towards or away from an object and again these are largely absent from the repertoire of visually impaired infants, especially those who are totally blind.

MDVI children are particularly at risk during this vital pre-verbal stage. Without the appropriate support they may give up and become passive, withdrawn or frustrated and will be unaware of the extent to which they can enjoy interactive exchanges or refer to and obtain objects and activities.

Studies have shown parents of visually impaired children to be very skilful in their attempts to overcome these difficulties. Visually impaired children have a wide repertoire of facial expression and provide information for parents to pick up and respond to. Parents may accompany their children's movements and actions by means of vocalisations and movements.

Emotional feedback may be provided by the parent in a non visual way. Mutual attention can be established by observation of the child's movements in manipulating an object, this is interpreted as a sign of interest and is commented on. By these and other means, parents build up a relationship with their visually impaired infants and the children become aware that they can influence their environment. (Preisler 1988).

References

Burns R (ed) (1986) 'Social development and child rearing' in Child development: a text for the caring profession Croom Helm, London, UK.

Trevarthen C (1979) 'Communication and cooperation in early infancy: a description of primary intersubjectivity' in

Bullowa M (ed) Before speech: the beginning of interpersonal communication, Cambridge University Press, Cambridge, UK.

Burford B (1989) 'Moving in sympathy: finding optimal skills for communication with children and young adults with profound mental and multiple handicaps.' International Journal of Rehabilitation Research, Chapman and Hall, London, UK.

Goldbart J (1988) 'Re-examining the development of early communication' in Coupe J and Goldbart J (eds) Communication before speech, Croom Helm, London, UK.

Preisler G (1988) The development of communication in blind infants, University of Stockholm, Sweden.

The communication programme

The communication programme may be summarised very briefly as follows:

Movement/interaction

The first part of the programme concentrates in detail on the first most basic stages of communication. Suggestions are given for the development of the children's response to, anticipation and initiation of communicative intent. Using interactive movement, the aim is to draw out the child's innate ability and desire to communicate and to extend this repertoire of expressive gestures.

Developing natural gesture

This second part explains how children's personal gestures can be developed and used to communicate. These gestures are the easiest for the children to use since they come from within themselves.

Learning a sign system

Finally the programme provides a language model and an adapted sign vocabulary which takes into account the children's impaired vision.

Movement/interaction

The starting point for this communication approach is the child's own movement. Through individual movement sessions the adult begins to focus on the communicative aspect of the child's personal movement patterns. The aim is not to precisely replicate mother/infant behaviour, rather it is this style of communication which should be developed and which can provide the multiply disabled child with great emotional satisfaction.

The sessions

The aim of a movement session is to approach the child on his own terms, focusing on what he can do, rather than on what we want him to do, or perhaps what we feel he ought to be able to do in developmental terms. This is done by finding a quiet corner, where adult and child can concentrate solely on each other. The adult may then engage the child in simple and quite natural movement play. The aim is to form a bond of mutual trust from which the child can develop an understanding of himself and his role as an active participant within his environment.

There are four main stages in early communication, which the child may pass through:

• Response - a very basic awareness and response to what is happening.
• Anticipation - the realisation and understanding that something is about to happen because of what went before.
• Intentionality - an action made by the child to produce a specific reaction from the adult.
• Reciprocity - sequences of imitation and turn taking the basis of all communicative exchanges.

Whilst being conscious of these stages, it is important to begin a movement session with an open mind. In the sessions, the adult will pick up on whatever movements the child may make. By observing their movement qualities and feeding them back to the child by imitation, the adult shows the child that she has some understanding of what he is doing. The adult's response is intuitive and quite natural but informed by a knowledge of the likely sequence of development.

Considerations for visually impaired children

If the child has no sight then it is possible to imitate through direct physical contact, if this is accepted, or by picking up on the rhythmical quality of the

child's movements and feeding this back using sound. The adult may use vocalisation, hand clapping and body sounds in the form of shared rhythms.

The process has been described as making 'visible' the child's attempts to communicate. For example, if the visually impaired child smiles, the adult may laugh in response, often in combination with body movements and bodily contact with the child. Alternatively, the adult may use her own vocalisations, to reflect back the mood and feeling of a child's facial expressions such as excitement or anger. A movement can also be reflected back picking up on the rhythm and effort qualities of the movement. In this way the child knows that his own actions are being noticed and that he is influencing his environment.

The process

Initially the child will simply respond to what is happening in the here and now, but he quickly begins to learn that through his actions, he can influence another person and initiate a game or interaction. For example, the child taps his face his partner does it too - gradually he becomes aware that when lqe does it, something happens. He does it again, then pauses, full of anticipation to see if he was right - will his partner do it again? Sure enough, she does.

The next stage comes when the child begins deliberately to make the face tapping gesture in order to gain the adult's response. Having learnt that he can initiate interactions or 'games' in this way the child begins to develop specific gestures, which have particular meanings for himself and his partner. Put together these can make up a rich vocabulary of shared meanings to denote activities and pleasurable experiences, which form the bond or personal relationship between adult and child.

As adult and child get to know each other, the communication may become more reciprocal with adult and child responding to each other more equally. This will often take the form of a 'conversation' using vocalisations or movement, for example, a gentle rocking back and forth, with each initiating in turn.

However, whilst this is the likely sequence of events, it is important to keep in mind that it is the process of participating that is important. This kind of activity cannot be carried through with planned goals to work towards.

Case study 1

Jane is a 6-year-old child with complex multiple disabilities and severe visual impairment due to cortical blindness. She is unable to sit unsupported, but is beginning to have some semblance of head control. She can turn her head from side to side, and will kick her legs when motivated. These movements along with mouth movements and some vocalisation are her main means of communication, other than crying and smiling.

During Jane's movement communication sessions much of the adult's time is spent listening and watching, since the session is controlled by Jane. This requires close observation, so that any small movement or vocalisation is responded to. If Jane makes a movement, her partner feeds this back to her by moving the corresponding body part in close contact' with Jane's. Sound is added when imitating her mouth movements, and the adult keeps very close. Jane is now vocalising a bit, and her partner matches her vocalisation to Jane's in response. There is a strong feeling of involvement, and patterns of turn-taking are beginning to develop in these interactions.

Anticipation games can also develop, and Jane has a current favourite. It began when Jane turned her head towards her partner at a particular moment and she blew a 'raspberry' on Jane's cheek. Jane smiled broadly, and the next time she turned her head even slightly, the raspberry was repeated. This sequence happened again, and developed into a game involving anticipation, turn-taking and intention. It gives Jane enormous pleasure since she is able to control the pace and timing of the activity through her head movements.

Although it is important to stress that it is the child who should lead and direct the way the interaction develops, it is possible to include in the session enjoyable movement activities such as swings, bounces, rocks etc. The aim of this is to build up skills of recognition and anticipation and to give the child more variety of choice.

During some of her earlier sessions the adult would rock Jane backwards towards a mirror on her left hand side, gently jiggling her close to the mirror. She then tilted her up again, observing very closely for a response. Jane showed she enjoyed the activity first by her concentration and involvement, and later, as she realised that this was a repeated sequence, by smiling and vocalising.

After a few sessions she began to roll her eyes back when she was upright, which the adult took to be a request to be rocked back. This eventually developed into a very deliberate movement of her head backwards which remained a consistent gesture used to request this activity.

Jane's increasing vocalisation, and the accompanying smiling and laughing during this and similar activities show how much she enjoys controlling and directing the sessions, as well as reflecting her pleasure in the movement itself.

(The names of the children in all the case studies have been changed to protect their identities).

Skills required

One of the most important skills required in conducting a movement session is the ability to observe the child with an open mind. The adult must be able to 'read' the child's gestures and react in a similar fashion without, in the initial stages, imposing her own movement preferences on the interaction. That is, the adult must become aware of her own movement behaviour and how this may affect the child. The intuitive skills, which come so readily to us all in our everyday interactions, without even thinking, must be brought to conscious awareness. The adult must be aware of attuning herself to the child's behaviour, of supporting his efforts to communicate and of drawing him out and expanding his efforts.

Rhythm is an important element in all communication and timing and repetition may be consciously used by the adult as a means of attunement. The speed and flow of a child's movements will be a good indicator as

to mood. Video is an important tool in the process of observing and learning about a child. Watching a video with colleagues can serve to highlight behaviours, which were not immediately apparent at the time.

Often a participant will describe an interaction as having taken place because they 'felt' that was what the child wanted. This is equally valid and the cue may have been taken from the child's mood at the time, perhaps reflected by the degree of muscle tension or relaxation.

This sort of behaviour will not show up on a video and is difficult to quantify. It is dependent on the skilled observer responding with sensitivity,

Movement communication, of course, does not only take place within movement 'sessions'. It is part of the daily routine and everyday lives of the children. The observations made during a session however can be carried over into the busier daily routine and help the adult to be more sensitive to the child's needs and wishes.

Considerations for MDVI children

Children with a visual impairment are often not good initiators, and can

become very passive, particularly in movement terms. They have to learn

how to use gesture, it does not come naturally to them as it does with sighted children who learn by observation. It is necessary sometimes for the adult to wait a long time with long gaps in the interaction, to show the visually impaired child that if he wants an action to happen again he has got to do something to make it happen. Many adults find this very difficult and can in fact render the child more passive through their own best intentions. Many feel that if nothing is happening they have to make it happen by doing something else to arouse the child. This can lead to the adult dominating the activities. The child may well respond with pleasure but he is not in charge of the situation.

Many MDVI children have physical disabilities, which may result in an overlay of involuntary movements which make it necessary to observe carefully and respond appropriately only to those movements made consciously by the child. This requires careful observation of the child, trying to pick up on the child's intentional movements. This is not easy when the child's movement pattern is erratic and uncoordinated.

Alternatively the child may offer very little movement response and may appear not to possess the same striving to communicate that others do. In this case it is important to respond to every little movement the child may offer and try to expand his movement repertoire by finding out what motivates him.

From time to time with a physically disabled child, it may become necessary for the adult to change her position in relation to the child. For example, she may sit him on her knee or lie him on the floor. This enables the child to expand his repertoire of activities which he is able to initiate. This must be done with care, ensuring that the change is acceptable to the child.

A physically disabled child's initiations may at first be only the smallest movements. This could simply be a tensing of the muscles, apparent to the adult only when the child is sitting in her lap. This may be all the child

can manage but equally, depending on how much control the child has, it may be possible to encourage more definite gestures. Once an activity has been established as pleasurable and motivating, then the adult can hold back a little bit at a time, just the smallest pause, so that the child has to try that little bit harder and make his movements more deliberate in order to make his request.

Above all the sessions are fun and both adult and child gain pleasure from building up a rapport by moving together.

Summary

Within a movement session the child is learning that communication is fun and he wants to participate in the social world; movement and gesture have meaning and he can influence his environment and ask for what he wants through the use of gesture. This has obvious implications for his later possible use of more formal signs.

Further information

For further information on movement communication we recommend the following video and booklet:

Burford B, Children with profound handicaps: how carers can communicate through movement.

It was produced by The Health Promotion Research Trust, but sadly is no longer commercially available. However a number of special schools have copies and it is well worth trying to borrow a copy.

Case study 2

Laura, a child with severe learning difficulties and visual impairment, started in Barrie Nursery aged three, and now, four years on, she attends Canaan Lodge.

When movement communication started in Barrie, Laura was an introverted little girl with poor interactive skills, who showed little need or desire to be with other people. However, when she was introduced to movement activities, she gradually began to develop an interest in interacting and communicating with her partner. She liked, for example, to be picked up by her partner, holding out her arms to request this, and, sitting legs astride her partner's waist, she would use her head to indicate that she wanted to be twirled around. Then she would bounce up and down in her partner's arms to show that she wanted to be lowered to the ground. Laura was learning that interaction was fun, and that she could take charge of a sequence of events.

This new-found ability to control and direct activities, developed over the next 18 months, and her sessions began to include long sequences of interaction in which Laura would manipulate her partner through various movement patterns. Her limited residual vision is particularly stimulated by movement, and one of her favourite routines was to push her partner's arm up in the air and wait for it to fall. By altering the height to which she pushed the arm she could control the speed and timing of this routine, and the knowledge that she was in charge, gave her great pleasure.

The next stage for Laura was to learn to take the lead sometimes and to give it up at others, and to 'listen' to her partner. This was not an easy lesson for her. However, through gentle, playful interaction she learned to take turns. For example, she would initiate a game involving pushing her partner from behind so that she ran forwards then stopped. Her partner then turned and did the same to Laura. It became like a 'conversation' between them. Today Laura is still working hard at turn-taking activities both with adults and with her peers.

Developing natural gesture

As the child develops an increasing ability to understand and eventually to control interactions, attention shifts from this close relationship between adult and child, to include a greater interest in objects. The importance of vision in this situation has already been discussed, as the child uses pointing, mutual gaze and give and take games in a three-way interaction between child, object and adult. He will use movements and gestures to make himself understood within these interactions. Because vision plays such a key role in these early exchanges, these skills are slow to develop in the visually impaired child. His methods of expressing his interests and needs may well be unusual and very personal and it is important that these are carefully observed and understood.

It is vitally important therefore, to observe the child's repertoire of gestures, movements and vocalisation, and the context in which they are used. The earliest of these tend to be very basic - a mouth movement to express hunger or thirst, an arm movement to express like or dislike. These gestures can be isolated and fed back to the child. That is, they can be used by the adult when talking to the child to show him that he has been understood. Gradually the child realises that these particular movements and gestures elicit a consistent reaction from the adult, and thus he learns that he can make things happen.

Linking gesture to an object or activity

At a later stage an object or activity that is known to be motivating to the child can be chosen and this can then be linked with the gesture or body movement used by the child when playing with it. In some cases this might be a gesture which the child uses frequently and which seems to relate well to the particular object or activity.

Vocalisation is also a very early and basic means of communication, notably crying or sounds indicating pleasure. Some MDVI children enjoy playing with their vocalisations, although not, in the first instance, in any obviously communicative way. In certain cases these vocalisations can be isolated and used in the same way as individual body movements or gestures and like them take on meaning. An example of this is a 'raspberry' sound, frequently made by a certain young child, particularly at times when he was enjoying himself. Since he had also shown that he enjoyed an electric massager, the vocalisation was linked to this particular object so it became his way of requesting something he liked.

Sometimes a child's habitual, obsessive gestures have been used and have been linked to something the child is known to find motivating. Some examples of this are:

• hand waving in front of the eyes as a sign for light
• scratching a surface as a sign for guitar
• knocking for more

Experience has shown that when children start to use these gestures communicatively they are far less likely to use them, in an obsessive or ritualistic way since they have now acquired significance and meaning.

At this early stage it is important not to impose any sign on the child if it is not already a part of his natural repertoire. By using familiar movement patterns he will already be aware of how the sign is made and will only have to learn the symbolic aspect, in other words, what it stands for. Thus, it is easier for the child to understand and eventually to use the sign.

Examples of ways that natural gesture has been used:

• clap hands
• bang table
• wave both hands
• rub tummy
• rub hands
• wiggle hands
• scratching
• waving hand near face
• music
• more
• fan
• electric massager - electric massager - a favourite toy
• guitar
• light

This kind of understanding can take a long time to develop, and even children with quite good communicative ability are likely to pass through a stage where they appear to confuse signs. Although they are aware that their movements and gestures can convey meaning, they have not really understood that a specific gesture has a specific meaning. In other words they have not acquired real symbolic understanding. Since the first signs a child uses are within his own physical repertoire, it makes it easier for him to progress through this stage.

Once the idea of the symbolic nature of gesture has been established, and the idea that specific signs stand for specific objects or events, then the child is well on the way to becoming an active communicator.

The next stage is to look at ways of developing his understanding of language and of extending his ability to communicate by introducing a more structured sign system.

Case study 3

Robert is now a 14 year-old young man with complex learning difficulties. He has no sight beyond an awareness of light and dark. At the age of 8 he appeared a very frustrated boy, prone to temper tantrums. It was as if he wanted to say so much yet lacked the means to do so. His ability to communicate was not in doubt, but his understanding and desire to make contact with us far outstripped his limited forms of self-expression. There seemed to be large gaps in Robert's development and learning. This uneven development was reflected in his extreme frustration with life. On the one hand he had a good understanding and a desire to join in with activities around him, on the other hand he had a rather shaky grounding in non verbal interactions. He could make his wishes known by manipulating the adult or by placing his body in position but, due to his visual impairment, he had little understanding that specific gestures could convey meaning and be seen and understood by others.

It was decided to return to early movement activities and to Robert's personal gestures. He enjoyed these movement sessions and as the activities developed he found his own ways of directing the sessions. At the start his self-expression was mainly through whole body movements and positioning, but gradually he began to use and understand gesture. During one session, for example, he was indicating his desire to be bounced up and down by moving his trunk up and down on his partner's knee. The adult did not respond immediately, so he tried again - still no response! It was possible to tease him a little in this way since he was confident by now of his own ability to take charge. To make himself quite clear, his next request was a bounce coupled with an arm gesture up and down. From that day on the arm gesture remained his sign for this activity.

At the same time we began signing in front of Robert and working on his personal gestures used in the manipulation of objects. Robert's understanding of his role in the communication process and of the symbolic nature of gesture was gradually developing.

Robert was keen on music and especially enjoyed the keyboard and guitar. He used to tap his fingers on the keyboard in order to make the sound. Whenever the adult asked Robert if he would like to play on the keyboard, She tapped her fingers on the table. Robert quickly made the connection and adopted the gesture as his means of asking for the keyboard. Similarly Robert had a scratching gesture, which he used to explore his surroundings. He would scratch at walls as he passed them to explore their sound properties. He also used it on the guitar. In the same fashion as above, it became his means of requesting the guitar.

To the careful observer it was clear when Robert was using the gesture communicatively and when he was using it simply to explore his environment.

We showed him, by adopting his gestures into our own sign vocabulary, that they were meaningful to us.

He often liked to have the adult's hands there to make the signs with and would seek out the adult's hands before making a sign. It was his way of making 'eye' contact and knowing that the adult was listening. Over the years Robert's vocabulary has gradually increased and his intense frustration is a thing of the past. He does not have a wide vocabulary but he has a clear idea of how to contact others and make his wishes known.

Learning a sign system

Providing a language model

This section is concerned with the way in which an adult uses signing to encourage a child's understanding of language and to provide a basis from which he can then develop a signing vocabulary.

It is an essential part of this programme that the adult signs to the child as she speaks. This might appear unnecessary given that the child is visually impaired and in most cases has normal hearing. There are several reasons for this approach. Most importantly, visually impaired children who are at a very early stage of development and with an absence of visual clues, may be hearing speech but making very little sense of it. Signing helps to attract and focus the child's attention and to develop gradually his awareness of the significance and meaning of the spoken word.

To encourage the children's understanding of language and their ability to express themselves it is also of fundamental importance that they are provided with a language model, so that they become aware that signing is a two-way interaction and a real means of communication. For children who have failed to develop speech, signing can offer a new and completely different way of expressing themselves, and can also act as a breakthrough to understanding after what may be years without success.

From the very start, adults will have been signing in front of the children as they speak, 'feeding in' signs very much as speech is 'fed' into a baby. This is done with all children regardless of their level of development, not because we are expecting them to use the signs, anymore than we would expect a very young baby to speak, but so that they will be learning to associate gestures with words and meaning.

Meaningful signs for visually impaired children

One of the main challenges of developing this communication programme was how to make signing, which is after all a very visual means of communication, meaningful and relevant to children with a severe visual impairment. There was obviously a need for a sign vocabulary created with their specific needs in mind. We needed a multi-sensory approach making full use of the children's unimpaired sensory channels, notably touch and sound. It was decided therefore to start with British Sign Language signs as a base, but to adapt these signs wherever necessary so that they would give maximum auditory and tactile feedback. The initial sign Vocabulary consists of about 50 signs based on the everyday needs and activities within the children's daily routine. A full pictorial list of these and details of how to use them can be found in Chapter 4 'How to use the signs'.

For children with no sight or only light perception, signs are made close to the child so that he is aware of hand movements, which create sound and currents of air. Certain signs may be made on the child's body providing additional tactile feedback. For a child who has some sight the signing position will depend on the extent and character of his residual vision.

For example, children with peripheral vision will need signs made at the side rather than in front, as may children with severe nystagmus. Children with a loss of the left or right visual field will need the signs made on the 'good' side. Children with patchy vision or with a severe visual field loss may need to have signs made at a greater distance to enable them to take in the whole sign.

For this reason it is important that those working with the children have as clear an idea as possible as to how and how much each child sees. Signing is always accompanied by speech and only the keywords in a sentence are signed. The effect of this is to slow down and simplify the adult's speech, at the same time emphasising important words.

Learning the signs

In the early stages, the adult should be careful not to manipulate the child's hands, since this is intrusive and can be counter productive. A visually impaired child's hands are very important to him for gaining information and interacting with his environment. If we are constantly holding his hand this cuts off one of his main avenues of learning and can be compared to blindfolding a sighted child.

In addition many visually impaired children can be extremely tactile defensive and dislike having their hands touched at all, let alone manipulated. Modelling signs on such children can result in the child building up barriers both against signing and the effective use of their hands in exploration and learning.

At the same time if a child with very little or no sight is to use the signs to express himself and communicate, he will need help from an adult to learn them. So once the idea has been established that specific signs or gestures stand for specific objects or activities, a child can be invited to put his hands over the adult's as she signs. Having reached this stage of understanding children often reach out of their own accord and with their interest thus engaged they are no longer resistant to having their hands used. Moreover, with their hands over the adult's, they can remove them should they wish to do so. Gradually, by participating in the conversation in this way they pick up the signs and adopt them into their own vocabulary.

As their level of understanding increases, more direct methods of teaching can be used. This hands over method is particularly used with children who have little or no sight. Many partially sighted children while still needing the extra tactile and auditory clues are able to pick up signs visually hence the importance of making the signs within the child's visual field.

They find it easier to absorb the subtleties of the sign, and are also more likely to learn conventional gestures, such as waving goodbye and nodding for yes. At this stage children will be using both their own individual signs, and signs that they pick up from the specially adapted sign vocabulary. Only a few of these will be exactly the same as those in a standardised sign vocabulary, but it is felt that the advantages of this adapted system outweigh the disadvantages. The single most important factor is that it makes signing - an essentially visual medium - more accessible and easier for children with a severe visual impairment to learn.

Case study 4

At the same time as Laura is developing her turn-taking skills in her movement sessions, she is building on her abilities to make choices and express herself more widely. During classroom activities, Laura is able to make firm choices of what she would like to play with using her personal gestures. She is well aware of the fact that gesture can be used meaningfully and when presented with a new toy, she can quickly find a gesture to request that toy. She particularly enjoys her revolving mirror box and will imitate the hand movement used to make it revolve in order to indicate that she would like it again, Laura has sufficient sight to know that an adult is signing in front of her but not enough to be able to truly differentiate one sign from another. However she does not like her hands to be touched and will resist this quite strongly. She is aware on the other hand that signs are interesting and useful to her and she is keen to learn more. When adults speak to Laura they gently touch her arm by way of introduction, and place their hands under hers to make the signs. Laura knows that she is still in charge. She can remove her hands if she wants and the adult will not insist. Laura will leave her hand on top of the adult's just long enough to feel the sign but no longer. They are then pulled back and the adult must approach her again to make the next sign. The conversation will continue in this way with a mixture of 'hands over' signs and 'signing in front' depending on Laura's mood.

Gradually she is building up her tolerance of touch in this way and she is developing a small vocabulary of signs. Laura's motivation comes from her knowledge and understanding of communication and her growing desire to participate socially with those around her.

Reasons for departing from a standardised sign system

There is no doubt that MDVI children find some signs harder to make than others, particularly those made out in space. The main thing they seem to require is a point of contact on the body, and most of the signs we have adapted have taken this into consideration. Even children at a more advanced stage of communication when inventing their own signs, nearly always require a reference point on the body.

Totally blind children have particular difficulties. Very often their body image is poor, making it difficult for them to know which part of their body to aim for in making a sign. Similarly they often have poorly developed manipulative skills making the finer points of a sign very difficult, for example clenching the hand, or using fingers separately. Describing shapes in space they find especially confusing, as without visual or tactile feedback it is difficult for them to judge direction and distance. For these reasons the signs have been simplified as much as possible to gross gestures, and in the earlier stages any approximation to the sign is acceptable. Once the concept is established as something worth communicating about, the child can be encouraged towards a more accurate rendering of the sign.

Because the communication programme is centred around the child and aims to give him both the means and will to communicate, the first signs tend to be somewhat unconventional, reflecting the child's likes and interests. These will concern particular toys, or objects like vibromats, electric massagers or foot spas for which there are no simple signs. These objects and activities will either be included within the adapted vocabulary, or be developed from the child's own natural gesture, in the manner already explained. So in the first instance standardised signs are not always what is needed to enable the child to communicate.

This adapted sign vocabulary, therefore has distinct advantages, at least as far as the child is concerned. The disadvantages largely concern the adults, since it is more difficult for them to learn an idiosyncratic sign system, which varies from child to child. In addition there is the problem of how the children will be understood in future placements. However most of the children for whom this sign vocabulary is intended do not acquire a large signing vocabulary and many of the signs are self-explanatory given the context. It is much easier for those involved with the children to adapt to their need, than it is for the children to learn a standardised sign vocabulary. The important thing is to encourage them to communicate.

However, there may be a few children who do acquire a considerable number of signs, and for them it may be appropriate to consider changing to a standardised sign system. Once a child has reached the stage of symbolic understanding this changeover should not be a problem. It is during the earliest stages when 'inner language' is being developed that help is needed to avoid confusion. Again the example of speech development serves well. We use and assign meaning to a baby's earliest babble and later baby talk, but this does not prevent them from eventually understanding and using the accepted conventional words.

Whether a child progresses to a standardised signing system like Makaton or British Sign Language, or whether he will continue to need an adapted sign vocabulary, depends very much on the child's communicative ability and degree of sight. As yet only a few of the more able children have reached this stage and it is our experience that even children with some vision still seem to need the kind of additional tactile and auditory feedback that these adapted signs offer. It is possible that given time and the development of manipulative skills, spatial awareness and communicative ability they will eventually be able to progress to an established system.

Additional advantages of signing

Although the primary aim of the signing programme is to offer children an alternative to speech, it has also proved to be of great benefit in helping children towards an understanding of spoken language, and in developing the 'inner language' that is vital to the subsequent development of receptive and then expressive language.

This is of particular importance for visually impaired children, who often remain for a long time in the imitative or echolalic stage of language development. They may have acquired speech, but it is not always linked to meaning and can be used in a number of other ways such as getting or holding attention or filling a threatening silence, or sometimes what appears to be playing with words for the sake of it. It seems that signing can provide this link between the word and the meaning. This may partly be because the adult's speech becomes simpler and more focused, and because the child's attention is caught and held by the adult signing in front of him.

However, it does seem that there is something inherent in the combination of signing and speaking that develops communicative understanding, and encourages expressive speech. Studies over the years (Kiernan et al 1978; Walker 1982) have shown this to be so, and it is for this reason that the signing programme is used with some of the younger children. Results have been positive. For example a pre-school child who had babble but no words has progressed through using signs to using sign and speech together, and is now using speech alone.

It seems likely that as well as linking the word to meaning, the physical act of making the sign helps the child to form and internalise the concept involved.

Since in normal development gesture precedes speech, it also seems likely that introducing sign in this way will aid the natural process.

Case study 5

George, who is significantly developmentally delayed, and has some useful residual vision, could not walk and had no speech when he joined the unit aged three. However, his interactive skills were good. He loved adult company, and was adept at gaining adult attention. He enjoyed playing turn-taking and anticipation games during which he would imitate adult speech by vocalising. At the same time, his comprehension of language seemed poor, and he showed little interest in toys and objects around him, preferring an adult as his plaything.

Since George possessed such good interactive skills, the emphasis in his individual sessions was directed away from one to one activities with an

adult, and centred instead around toys and objects. Activities and routines were set up to promote choice, and George was encouraged to initiate activities and to find ways of choosing toys or games through movement,

gesture or vocalisation.

George was also introduced to signing. We tried to keep language simple and relevant to what was actually happening, and to sign key words in front of him. George’s vision was such that he was aware of hand movements being made in front of him, and almost from the start, this had the effect of attracting and focusing his attention on what was being said to him. Spoken language appeared to be meaning something to him.

Quite soon afterwards, he began to use some of the signs himself- mum, dad, finished, gym, bus, music and toilet being the first. Initially he used these in imitation, but quite soon was using them both to comment and request. Some time after this he started using the appropriate word alongside the sign, and at this stage, his acquisition and use of speech developed significantly. His vocabulary increased, and he stopped using signs, except in times of stress, or perhaps to give a word emphasis, and began to use single words on their own. He was showing far more interest in toys and his environment generally and his play skills improved. He began to name familiar objects, and request names for those he didn’t know. Eighteen months later he is now using four word sentences, but will still revert to his ’finished’ sign in situations he particularly dislikes!

In George’s case signing seemed to act as a trigger to developing the understanding and use of speech. Since his non-verbal skills were already quite good, using a non-verbal approach may have acted as a sort of bridge, helping him to make the link with verbal expression.

An important footnote

Although this programme has a developmental sequence starting with the movement/interaction sessions and continuing through to the acquisition and learning of signs from the vocabulary, this is not strictly progressive, and all aspects of the programme can be used simultaneously with all children. It is the extent to which this is developed that will vary from child to child. Some children will not progress beyond acquiring a few natural gestures, but their communicative understanding can be encouraged and extended both by the consistent use of a language model, and by movement/interaction sessions.

Some children will acquire some signs and then progress to speech, and others although communicatively and developmentally quite advanced, will continue to need non-verbal means of communication. For most of these children the movement/interaction sessions will continue to be of great benefit in building up self-concept, self-confidence and the interactional skills which are so often poorly developed in a visually impaired child.

References

Kiernan C, Jordan R and Saunders C - (1978) Starting off, Souvenir Press, London, UK.

Rogov S - (1982) ’Rhythms and rhymes: developing communication in very young blind and multi handicapped children’ in Childcare, Health and Development, Blackwell Scientific Publications, London, UK.

Walker M - (1982) ’What is the Makaton Vocabulary?’ in Peter M and Barnes R (eds) Signs, Symbols and Schools NCSE, London, UK.

Chapter 3: Objects of reference

(Catriona Beckett, Anne Taylor)

Why use objects of reference?

From an early age sighted children acquire the understanding that objects have a reference function. The young child seeing his mother get a mug from the cupboard knows ’I’m going to have a drink’. At this stage learning is taking place in the everyday situation and through play. The child gains knowledge incidentally by observing colour, shape and movements of objects and people around him. An MDVI child is unable to develop concepts in this way. He depends on others to give him clues as to what is happening, where he is and who he is with. To mirror natural development an MDVI child needs his environment to be brought within his reach. He requires opportunities to encounter relevant and interesting materials. He must learn about the properties of real objects - a doll’s cup, for example, is not meaningful to him if he drinks from a lipped two-handled mug.

How objects of reference are used within the unit

Within the structure of daily activities significant objects are routinely used. This provides incidental learning. An object which is important or found to be motivating for a child can be offered to him to feel as a reference to a certain activity or situation which is about to happen.

• mug - drink
• pad - changing
• sponge - bath
• coat - outdoors

Objects to signify particular people

Staff with whom the child has most contact can be referenced perhaps by a familiar piece of clothing or jewellery, which is always worn within the unit, for example a ring on the right hand, dangling earrings or a soft scarf.

Objects signifying place and time

A variety of textured panels and objects have been mounted on doors, hand rails and walls to indicate each area of the building. As the child explores the wider environment of the school, his attention can be drawn to these, providing points of reference beyond the classroom. For an ambulant child they are aids to developing independent mobility and further understanding of the built environment. The objects and textures chosen are reminders of the feel of each room, or the activities, which take place there:

• piece of wooden flooring - multi-purpose room
• piece of carpet - sitting room
• a single tile - shower room
• sponge – bathroom
• Cup & spoon – dining room

Different textured panels on entrance doors distinguish similar class areas. For example, area A is in velvet, B in fur and C in ribbon. Sharply contrasting textured papers are used to refer to the days of the week. This provides a way of indicating to a child that each day differs.

For example:

• bubble paper - Tuesday
• sand paper - Wednesday
• corrugated paper- Thursday

Objects signifying activities

Objects of reference are gradually introduced to meet the developing communication needs of each child. The child is systematically presented with the object immediately prior to an activity, always in context, accompanied by speech and sign. This consistent approach enables the child to make a link between the object and the activity at his own pace. The starting point is always to use real objects.

• oil bottle - massage
• bells - music
• arm band - swimming
• ball with bell – PE

There is consistency throughout the school in the choice of objects relating to activities. However, most children at some stage will attach individual meaning to certain objects. These can have a symbolic and functional reference.

• yellow box - play (I want to play)
• wind up radio - home (I play this in the taxi on my way home)
• special toy) - toilet (I play with this on the toilet)

When this association is established, the programme can be extended becoming more structured with an increase in complexity. Objects of reference may be gradually altered to become less concrete and more abstract. For example, a cup may be cut down to become a half cup and then, in time, simply the handle on its own. The arm band may become a piece of the plastic with the stopper attached and, later, the stopper only. This way children begin to learn about representation - an understanding gained by sighted children through pictures.

Development of the approach

Objects of reference offer a more able child the means to make choices, to plan a sequence of activities and to recall shared events. The child can progress at this stage to using a communication aid, such as an Intro-talker, Concept Keyboard or Echo 4, with familiar objects of reference attached. The objects will most likely be used in a reduced or more abstract form for greater flexibility.

The Intro-talker allows up to 32 pictures or tactile symbols to be attached to a machine on which corresponding words or sentences can be recorded. Thus, for example, when the signifier of an arm-band stopper is pressed, the machine will speak ‘I want to go swimming’. Similar activities can be programmed with the use of a computer and concept keyboard, where, for example, the child may press a particular texture on the keyboard, which relates to a favourite song or a visually stimulating computer graphic. The Echo 4 is worked by individual switches, which may be attached to a child’s table or wheel chair. Like the Intro-talker, words or sentences may be recorded onto it. Thus an MDVI child may be provided with a non-sighted means to access technology.

The signing programme is augmented by using objects of reference. They aid the child to make sense of his environment, denoting people, activities and places. At a later stage they may be used in combination with signing to make choices, anticipate the day’s activities and remember past ones. The progress of pupils using this programme is constantly monitored and the approach and use of materials evaluated.

References

Visser T - (1985) ’A Development Programme for Deaf-Blind Children’ Talking Sense Vol 31 no. 3, Autumn 1985, Sense, London, UK.’

Ockefford A - (1994) Objects of Reference RNIB, London, UK.

Bolt J, Ridler S - (1989) ’Educating Fatima’ Talking Sense , Vol 35 no. 4, Winter 1989, Sense, London, UK.

Canaan Lodge - (1993) Curriculum Document, Royal Blind School, Edinburgh, UK.

For more detailed information about Objects of Reference, we recommend:

Ockelford A - (1994) Objects of Reference RNIB, London, UK.

Chapter 4: The Canaan Barrie Signs

An interactive signing system for multiply impaired youngsters with visual impairment

Illustrations by Paula Graham and Helen Herbert

How to use the signs - The initial stages

The initial stages

• Sign in front of the child, key words in your sentence, using the tactile/auditory signs from our vocabulary.
• Pay attention to tone of voice and facial expression (where appropriate).
• Keep close and make the signs close to the child’s face so that he is aware of the hand movements and the sounds and currents of air they create.
• Put no pressure on the child to sign back.
• Observe carefully for any kind of reaction from the child and respond to it, for example any movement for ’yes’ or ’no’ or any signs of excitement, pleasure or displeasure.
• Certain signs can be made on the adult’s or the child’s body, so long as the child has no objections; for example, ’good’ - two taps on the chest - can be done by the adult on herself or on the child. This provides another clue to help differentiate the signs.
• Always warn the child when you are going to sign on his body, for example you can gently touch the child on the shoulder at the beginning of your conversation, to establish initial contact. Be careful not take the child by surprise.

See separate list ‘Signs which go well on the child’s body’.

The next stage

When then idea of signing has been established and only when the child understands that he can use gesture to communicate:

• Invite the child to reach out and feel your hands.
• Put the child’s hands on top of your own and continue your conversation so that he may feel your hands.
• If the child withdraws his hands, then continue your conversation, signing in front as before. When the child starts trying to use the signs himself, do not insist too much on accuracy at first, so long as the meaning is clear. Accuracy can be worked on later once the signs have been established.

The later stages

The length of time a child will receive the ’hands over’ method will depend on their rate of learning and/or degree of sight.

• When the child is ready, gradually remove adult support. For example, while waiting for a reply, the adult may lightly touch the child’s forearm to show that they are listening.
• Once a non-sighted child has learnt the signs, return to ’signing in front’. The child willl know what the adult is signing by associating her words with the sounds and air currents created by her hand movements.
• Accuracy may be worked on by moulding the child’s hands so long as the adult is sure what it is the child is trying to say.

The signs must be used in whichever way suits the individual child best.

The child may use a mixture of personal gestures/signs and learnt signs. The adult should incorporate the child’s personal signs into her own vocabulary of signs and use them when speaking to that child, thus maintaining the interactive nature of signing.

Name signs for different people in a child’s life may be invented by using characteristics of the person. For example, someone who always wears earrings might be given a name sign such as ’touch both ears’ or ’touch one ear’. The sign may be taught by allowing the child to feel the adult’s earrings and then touch his own ears, while the adult says her name.

Signing in front

Signs which go well on the child’s body

• Toilet
• Wash
• Dress
• Brush hair
• Massage
• Good morning
• Up
• Down
• Finished
• Sit down
• Stand up
• PE
• Goodbye
• Movement
• Like/want
• Not want
• Hello Mummy
• Goodnight
• Lie down
• Bed
• Ill/poorly
• Medicine
• Daddy

Hands over signing

When using the ’hands over’ method, difficulties can arise with the direction of

signs. As a rule, always make the sign on the child’s body even though it is the adult who is speaking. For example the adult says ’I am going to go out’

the go sign should be done down the child’s arm. This avoids confusion when the child comes to use the sign himself and avoids problems that could arise if the child had to learn to reverse the signs. This is a particular problem for non-sighted children.

[Description:

Wash: mime washing hands, exaggerate sound.

Wash – hair/face etc.: wash sign, then rub appropriate part of the body.

Bath: wash sign, then rub upper chest.

Brush hair: rub hair between fingers and pull along length of hair.

Shower: wash sign then drum fingers on top of head.

Undress: draw fists up body from waist to shoulders.

Dress/get dressed: draw fists down body from shoulders down to waist.]

[Description:

Hello: shake right hand of child.

Goodbye: touch fingertips of child and wave.

Stand up: rub hand up child’s upper arm then flick fingers against thumb, up high.

Up: draw hand up side of body, then flick fingers high up in air (flick fingers against thumb).

Sit down: rub hand down child’s upper arm, then flick fingers against thumb, down low.

Down: slide hand down side of body, then flick fingers down low (flick fingers against thumb).]

[Description:

Toilet: rub hands on hips in downwards direction, exaggerate sound.

Bed: clap hands beside ear, then rest head on hands.

Lie down: rub hand down child’s back and flick fingers down low.

Goodnight: rub two fingers down forehead and nose.

Sleep: use thumb and index finger, open and close them in front of eyes, hands to side of face.

Sad/crying: rub cheeks in downward strokes.]

[Description:

Good: a ‘positive’ sign, tap your chest twice with flat hand. Also: like/want/happy.

Bad: a ‘negative’ sign, child pushes own hand away from body, or adult gently pushes on child’s shoulder. Also: don’t want/don’t like.

Ill/poorly: rub forehead in circular motion, then on part of body affected.

Medicine: hold little finger inside fist of other hand.

Stop: one loud clap.

Work: tap side of one hand on side of the other hand, twice.]

[Description:

Mummy: tap fingers in palm of opposite hand, twice.

Daddy: tap on either side of chin with fingertips, twice.

School: tap fists together twice, thumbs pointing outwards.

Play: flap hands in air near child’s face (to create air currents).

More/again: bang fist twice on table top, or bang fist twice on opposite upper arm.

Finished: two slaps on the back of the hand.]

[Description:

Go: rub back of fingers along arm, then gesture away from body.

Come: ‘tap’ elbow into palm of hand, then beckon up towards shoulder, tap shoulder twice.

Me/my: place palm of hand on chest.

You/your: place palm of hand on child’s chest.

PE: tap shoulders twice, fast.

Swimming: mime swimming action (like doggy paddle) near child’s face.]

[Description:

Shopping: rub thumb on fingertips, near child’s ear.

Riding: slap sides of hands up and down.

Massage: rub back of hand with palm of other hand, twice.

Movement: (as in movement interaction sessions) touch the child’s fingertips with yours and trace a wide circle in the air.

House: cup hands slightly and tap fingertips together twice.

Friend: slap palm on back of opposite hand, then shake them in front of own body.]

[Description:

Home: ‘clap’ one hand over the back of the other, then bring both towards chest and tap chest once.

Birthday: tap shoulder with opposite fist twice.

Drink: make ‘fishy’ noise (i.e. open and close mouth noisily) and tap cupped hand on upper lip twice.

Eat: say ‘mmm’ and tap mouth twice.

Music: clap hands at shoulder height and sway arms from side to side, keeping palms together.

Song/singing: clap hands twice.]

[Description:

Dance: snap fingers and twist upper body from side to side.

Walk: stamp feet.

Bus: flat palm, draw circle on palm with side of fist.

Outing/out: bang fist in palm then gesture with thumb over shoulder.

Morning: fists with thumbs out, draw from chest out towards shoulders.

Afternoon: tap chin twice with first and second fingers.]

[Description:

Evening: cross arms across chest and pat shoulders twice.

Please: flick fingers under chin and bring hand forward in short gesture.

Thank you: tap chin once and bring hand forward in longer gesture.]

Contact addresses

The communication programme described in this book has developed with the children in Canaan Lodge and Barrie Nursery, taking account of their very varied needs. We are currently adding a further 100 signs to our vocabulary, adapting where necessary, from the original British Sign Language signs.

If you are interested in any further information about this or any aspect of this communication programme, please contact:

Lindi MacWilliam, Senior Teacher, Barrie Nursery Royal Blind School, 16 West Savile Road, Edinburgh EH16 5NQ, Tel: 0131-667 1100

Or

Mary Lee, Senior Teacher, Canaan Lodge, Royal Blind School, 43 Canaan Lane, Edinburgh EH10 4SG, Tel: 0131-452 8720

The Royal Blind School is a day and residential special school, grant-aided by the Scottish Office Education Department as a national resource.

Content author: library@rnib.org.uk

Last updated: 08/04/2008 18:38