Working together to develop physical skills in children with VI

Post date: 
Monday, 18 January 2016

Working in a special school can mean trying to make sense of a lot of different pieces of information and advice. Do you ever find it hard to make all of the strategies work together?

“What do I do when the physiotherapist tells me to keep everything in mid-line, and work towards the middle when positioning and presenting objects, but the VI teacher says I should let her look to the side and present objects on the left?”
This question, asked by a Teaching Assistant at a conference, led us to develop the Best of Both, a series of booklets for special school staff about using therapeutic approaches with children who have vision impairment and understanding each other’s practices for effective team work. In ‘Best of Both: VI and physiotherapy’, we look at how QTVIs and physiotherapists can work together to develop movement and physical skills.

What role does vision play in a child’s physical development?

Let’s take Michael as an example. Michael focuses on his Mum’s face when she feeds him. Soon he will look from side-to-side at familiar faces and interesting things. When on his tummy, he will learn to lift and turn his head to look around. Lying on his back, he will watch his hands, experiment with finger movements and manipulate toys. He will grasp and study his feet too. Visually directed arm and leg movements will become more accurate as he reaches and kicks at objects. Next he will learn to crawl, motivated by things further away. Sitting, standing, and walking are also driven by visual curiosity.
As a baby’s vision gradually develops, so too does independent mobility. Without being able to see objects and people to move towards or reach for, a baby with vision impairment is at risk of delay in developing fine and gross motor skills. They may also adopt a “head down” posture and have poor body awareness. The incentive and confidence to move in their own environment can easily be compromised if the child has little or no vision.

Working together to achieve visual and physical development

Sometimes even with the best intentions, working to solve one problem can undermine progress in another area. Consider this situation:
At home, Anya enjoys lying under her baby gym. She has a good range movement and can kick the switches hanging from the frame to play tunes. At nursery, Anya has a new work chair enabling her to sit up straight, with her head and body well supported, and her feet securely positioned. She is moved in front of a computer to watch the display on the screen. Anya would love to touch it, but the chair won’t allow her to reach forward. She tries to move her feet, but they are strapped to the footrest. Eventually losing interest, Anya closes her eyes. Staff think another child would get more benefit from the computer and move her away.
With good communication, common sense, and a little compromise, most access issues can usually be resolved, as the following examples show:
Mohammed lies over his wedge, which encourages him to raise his head, strengthening his back and neck muscles. Visually, he is aware of lights and reflective materials, but unable to see objects in a normal indoor environment.
The QTVI works with Mohammed each week and co-ordinates alternating visits with the physiotherapist. Using lights and shiny materials as incentives, Mohammed continues to raise his head, achieving both visual and physical targets.
Stuart has severe upper-visual field loss. When his head is on his chest he can see only himself. Stuart’s school teacher, QTVI and physiotherapist work together to help him develop head control.
When his head is raised he is motivated by things to look at within his reduced visual range, and when he gets tired he uses a special headband on his chair to help keep his head in a mid-line position, enabling Stuart to use his vision more effectively.
For more examples and guidance about supporting vision and movement together to achieve great results for children, or to read any of our other Best of both booklets, please visit
Written by Sarah Holton
Children and Young People's Officer - Complex Needs
RNIB (Royal National Institute of Blind People)
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