Tuesday 20 December 2011

What is a good Christmas present for a visually impaired child?

What is the best piece of kit for a visually impaired child?

You might think of investing in a piece of kit for your visually impaired child for their Christmas present. But what is the best kit for a visually impaired child? That is like asking, how long is a piece of string? It depends on the child and their eyesight. Then there is the all too common pupil’s denial of their disability and the deliberate resistance of all forms of support. Technology is a great asset to people who are visually impaired but in school it can have the unfortunate side-effect of accentuating a child’s difference.

So let me begin with some less obtrusive and simple changes you can make, mainly when using a computer, that do not draw attention to a child with low vision. An essential piece of equipment nowadays for a visually impaired child in school and at home is a laptop computer. That would definitely make a good pressie. However even laptops in class are not too popular with children if it makes them look different. Nonetheless when considering a laptop a lightweight model is best although a net book is probably not ideal since a fairly large screen is needed. The Mac Book Air is in many ways a perfect solution but it is not cheap.

The latest operating systems (Windows 7 and Mac) have good accessibility features, particularly magnification features built in so that they do not take up any of the computer’s RAM. One of the more annoying aspects of screen enlarging programmes is the way they slow the computer down because they use up so much of the computer's memory. In my opinion separate screen magnifying software is not needed quite so much as it used to be by many visually impaired children in school simply because of the good accessibility features of the new operating systems. That does not apply to screen reading software, but having said that Apple has its own built-in screen reader, which is quite good. 

Keyboard shortcuts make it easier on all of us especially the visually challenged: we do not have to move the mouse cursor up to the menu bar and scan a scarcely visible menu bar to find what we are looking for. The most useful shortcut on the keyboard is the control (Ctrl) key used with the central mouse scroll button (if you have one). This enlarges or reduces whatever there is on the screen.

I have mentioned the high contrast option, accessed by the Windows keyboard shortcut: SHIFT+ALT+PTRSCRN. This feature can be useful for occasional use when a child’s eyes are tired and need a rest. It is especially helpful if glare is a problem to the pupil. But it does tend to make the icons large. It can of course be adjusted and fine-tuned in the accessibility settings of the computer. This should be definitely be explored.

Low Vision Aids – De-mystifying the jargon
When first hearing the name CCTV you might be excused from thinking of this as a type of camera fixed to a wall, which sends video footage to a monitor as a security device. However CCTV is used widely now in low vision contexts for enlarging near texts and accessing print from far away such as on a board in a classroom. There are many companies making them. They all have their uses, but the major drawback is the expense; they are often between £1500 to as much as £3000.

My colleague in the VI school unit uses one of the more portable CCTVs called the Eye-Pal from Universal Low Vision Aids (www.ulva.com). It folds up and can be easily carried around. The Eye-Pal scans printed material and instantly converts text to speech or sends the information to a Braille Display for the Blind and Deaf-Blind. Faster than flatbed scanners, the Eye-Pal takes only 3-7 seconds from the keystroke to speech or Braille output. Another device is the Magnalink Student from Professional Vision Services. This has been used effectively in many contexts and plugs into a laptop via the USB port. Screen snapshots can be taken of board writing. It is quite portable and reliable.

Other kinds of low vision aids include hand-held devices such as a monocular, which is effectively half a pair of binoculars. It is small and conveniently goes in the bag or is worn round the neck. It is really useful for looking at bus numbers or on the Underground at the train station for reading the times of trains.

There is even a clip-on version of the monocular, which can be worn on a pair of spectacles. All of these devices require a certain amount of confidence. A person needs to be comfortable with using them in a public place as it may draw attention to their disability.

A dome magnifier is just that, it is shaped like a dome and fits over a page of writing to enlarge and brighten a word or group of words. For some applications a bar magnifier or ruler magnifier may be more appropriate. The value of a bar magnifier is the way it enlarges (slightly) a whole line and can be helpful for a person who takes longer focusing and re-focusing when moving on to the next line of print. Some of them also have a line to aid the reader to keep their place. They are inexpensive, portable and a simple solution for many daily tasks. There are many types of low vision aids. My advice is to take the young person to a ‘Low Vision Clinic’ in a hospital. There they will have the expert advice of an optometrist who will show a variety of types available and certainly in the UK they can be prescribed on loan on the NHS. The RNIB shop in Kings Cross London has a range of magnifiers and it is worth a trip to try these out before purchasing.  They can choose their Christmas present there and then!

But all this said, I have personally become quite minimalist over the years with regard to access technology, CCTVs and the like. I have seen so much expensive equipment under-used and wasted. In addition technology moves on at such a fast pace it is hard to keep up with it. There is some sort of technology for all levels of low vision but most children in mainstream schools are actually reluctant to use equipment if it accentuates their difference. My standard advice has been usually: use computers and use an iPad or a Kindle. Certainly have a glass magnifier or monocular at hand for emergencies. All these will be acceptable to young people and more likely to be appreciated than a bulky CCTV that takes up one desk space or even a small electronic video-magnifier that does not look cool.

Recently I have come across another solution that might suit some applications. In several primary schools I have visited I started to notice a piece of electronic kit used a little like the old style overhead projector was used, to display data, sheets and pictures quickly and with the minimum of technical expertise. It just so happened that the classroom where I first saw this being used was a room where a pupil with a severe visual impairment pupil had just started.

Immediately I saw the potential of this gadget as replacing the traditional CCTV for a partially sighted child. This device was set up on the teacher’s desk linked with the computer and already being used by the teacher with the whole class; the kids in the class loved it. It was visual, exciting and very effective. So it met four of the main requirements for a piece of access kit straightaway. (1) It removed the stigma of using specialist equipment as it was regularly being used by the teacher and it did not make the user appear ‘odd’. In fact it was the reverse: it was a quite ‘cool’ gadget to use. (2) It saved space in a limited environment as it was permanently set up in a dedicated location. (3) It did the job of enlarging and freezing a page of text or images onto a computer screen or whiteboard. (4) Perhaps more important in some ways in these days of financial difficulty, it is remarkably inexpensive. As such it can easily be placed into every classroom in every school, no doubt bringing its cost down even further. It is called a ‘Visualiser’. There are different types but the actual model I saw being used was called Avermedia AVerVision CP135 Visualiser and best of all, the price in ‘www.Visualisershop.com’ is £259 plus vat. Compared with a minimum £2000.00 for a CCTV this is remarkable. So I am now recommending that every classroom with visually impaired children invest in one of these. It may not be as sophisticated as more advanced CCTVs but I guarantee it will get used! All the pupil has to do is move seats and sit at the teacher’s desk whenever they need or want to use it.

I would say in conclusion that anyone interested in technology needs to update their knowledge regularly. One way to do this is to belong to the visual impairment forums that exist in the UK and in the USA. Google the phrase ‘VI-Forums’ and you will no doubt find what you are looking for. Or spend an afternoon at Sight Village festival of access technology or the US equivalent in your own country.

Have a great Christmas - Maurice 

Monday 19 December 2011

How I see it – a student with albinism talks about herself

Distance vision
Hi, my name is T... I am short sighted, I am severely visually impaired but I don’t know the exact measure for my visual acuity. I can't see people’s faces 6 metres away. I don’t know if they are smiling or frowning. But I can recognise people I know. I have learnt how to recognise people I know by their shape. I can see my friends coming and people I know. But I can’t see a number on a bus from  more than three metres away. I can see things at a distance but I just can't see details. 

Near vision
I prefer to read normal sized print. I should really have large print but it's too much trouble. I don’t bother, it would mean I would have to carry two books around or a magnifying glass. It’s a lot easier to read normal size print even though normal print is tiring and more effort to read. But it’s worse if I’m reading from a computer because of the bright light. Light really affects me. I can’t read off a screen for a few hours but I can read a book for a few hours. Of course I do get tired reading a book; I’ll get a headache obviously after a while but I’ll take a break and I’ll go back to it. Always when I’m studying I will read and take a break then go back to it again.  But I find it too much to look at a computer screen for hours on end. I don’t like computer text, like Kindles – I like books. I wouldn’t want to get rid of my books. I used to use a magnifier a lot but I don’t any more. It’s too much bother to carry it around all the time. I have a ruler magnifier and a dome magnifier I got from the visual support at school. The ruler one I got from Waterstones. If I need them I will use them but I don’t use them very much.

What was it like at school?
For me personally I think I have been quite lucky. When I was in primary school I had a visual support worker. She supported me and gave me things I needed like enlarged print or a sloping desk.  Then in secondary school it was impractical to use a sloping desk or any other equipment because you’re moving from class to class. You couldn’t keep everything in one place. So in secondary school I had to find ways of coping. I had a friend in school and I sat next to her for the whole of high school basically and copied from her. In school most of the time you copied from the board, questions and so forth. After copying from my friend I began to learn to recognise the words from their shapes. I knew what certain teachers wrote and I knew how to recognise the title and things that they were writing, from a distance away. I got good grades at school but it was only because I studied a lot at home to catch up. I couldn’t easily study books in school because I just couldn’t read everything off the board.

What is your background?
I am from Malawi. I am 22. I have finished studying for my degree. I am now working as a TA (teaching assistant) and I go back to education next year. 

Welcome to Holland

Wednesday 14 December 2011

How can you modify electronic documents, especially PDFs?

With thanks to all at the viforum uk here is a string of answers on an important issue relating to electronic documents that I thought would be well worth publishing as it has  certainly puzzled me in the past.

Answer 1
Omnipage 17/18 is very efficient with PDF’s.  You can also export text from a PDF into Notepad, then do a ‘copy all’ and throw it into Word.  Provided your ‘Normal’ style is set to the font size etc. that you require.

Answer 2
Easyconvertor from Dolphin - not cheap but very effective and good backup/training available from Dolphin.

Answer 3
PDF Converter from Abbyy (same people who make FineReader OCR) has received rave reviews from some transcribers. FineReader is excellent at converting PDFs for hard copy if you need to change the font. Be aware that there are different types of PDF and the same methods don't always work with all of them - it depends how they were put together. Also, there is no way of knowing in advance.

Answer 4
I find Omnipage 17/18 very efficient with PDF’s.  You can also export text from a PDF into Notepad, then do a ‘copy all’ and throw it into Word.  Provided your ‘Normal’ style is set to the font size etc. that you require. 

Answer 5
Make good use of the PDF’s inbuilt accessibility options – eg colour change, magnification with reflow, autoscroll etc. PDFs can magnify far higher than Word documents and with reflow (View>Zoom>Reflow) switched on and autoscroll (View>Autoscroll) can often give far better reading experiences than magnification software. More info in the free Accessibility Essentials resource on Accessible PDFs – see www.jisctechdis.ac.uk/accessibilityessentials for how to guides and animations.

Answer 6 
There is a free download for pdfs called ‘Doxillion Document Converter’. It is worth a look, have used it a few times to convert to Word, quick and easy.

Answer 7
Omnipage does the best job but why would you want to put files for Brailling into Word? The one certain way of eradicating graphics without having to fuss with them afterwards is just to save out from Omnipage into basic text. True, many Braille transcription programs claim that, from word, they will even retain original layout such as centering and so on, but no-one has yet convinced me that this is really the case.  Whenever we Braille direct from Word through Duxbury, the layout is truly haphazard to say the least! It certainly doesn't keep wrap-around paragraphs  and that kind of thing, so I now just save out as text and alter accordingly.  Of course Omnipage will only do as good a job as the quality of the original PDF--if it's a scanned PDF that is--but that is also true of  any conversion program.

Answer 8
I scan documents to a PDF using the school photocopier which is connected to the school network.  The school IT Technicians have installed Microsoft Office Document Imaging and I convert into a word document for embossing etc using that.  It is not always very reliable when the original is not on white paper or in italics (novels, textbooks).  I would love to have Zoomex from Humanware but its expensive – I think it would be very quick and easy to convert anything, even in the classroom using a laptop and text book it can instantly convert into an audio document.  If the teacher has not given you something to prepare it can be achieved.

Answer 9
I have used Nitro PDF Pro to convert documents to word which you can then edit to your requirements.

Answer 10 
Here’s a completely different strategy suggested by a blind colleague. It works if you have an iPhone/iPad and have installed the dropbox app on it. It won’t be appropriate for all types of PDF but it’s an approach that is used (and is useful) for blind iPad users.  Once you have the pdf on your pc, upload it to DropBox. Using the iPad, switch VoiceOver on. Start the DropBox app. Use VoiceOver to read the PDF.

Answer 11
If the PDF lets you, copy the text, and save it as text file; and if not then Omnipage will strip the text out for you. If I am using Omnipage I tend to save a Word document too if there are pictures (but as the previous reply said, for the text element cut and paste from the text file into your own formatted document).  If you want an ebook, Calibre (free download) can convert it for you from the PDF, to read on their programme on the PC or a Kindle. If you want speech, you can either read it out loud directly. In the PDF file, go to the View menu and select Read Out Loud to get the reading options. Alternatively convert the text to MP3 (several ways to do this too!).
If anyone has other ideas or solutions pleeeez post your comment...

Dancing eyes – a very rare syndrome

As is my style I am sharing again my experiences with readers, in the hope that if you are a parent or teacher you can relate to some degree or find information which may be of some benefit to you personally or professionally.  

Once in a while I come across a syndrome that is really rare. This week was such a case: yesterday in fact. The little girl’s father informed me that Dancing Eye syndrome (DES) is rare:  one in ten million to be precise – is that rare or what? By sheer statistics I will not meet a case study like this one again.

Dancing Eye syndrome can have one of two different causes: it can be a result of neuroblastoma, a cancer in the brain, or it can be a virus, which attacks the central nervous system. In this particular case it was a virus. It happened that around Christmas time a couple of years ago the little girl suddenly became ill and developed a fever and within a short time she collapsed, unable to walk, had quite lost her balance and her eyes had this characteristic ‘dancing’ effect, with uncontrollable random movements. 

The little girl is three and a half years old now. I did not see on my visit any evidence now of ‘dancing eyes’; fortunately her medication has completely controlled this. She is now permanently on steroids and she is able to walk and sort of run. She still has poor balance however and that was clear. I was informed by the parents that going up or down stairs is still a great challenge.  What I did see was a wonderful little child with lots of curiosity and interest in what is going on around her. In many ways she is a normal little girl who can speak and play quite age-appropriately. She said my name perfectly with very good diction.

The little girl’s visual acuity is actually pretty good now. She is 6/12 (20/40) with the Cardiff Cards (0.3 LogMAR), which is more or less normal. She has a squint in her right eye, a convergent strabismus, which is not too pronounced. And she is slightly long sighted in both eyes – about +1.50, (better than me!). So she wears glasses for hypermetropia (that’s hyperopia for you across the Pond). No patching suggested, but a possible operation later is offered for the squint. Her hearing is good.

I thought her fine motor skills were good. She held a fork and pronged food to put into her mouth. She played well with her toys and used her fingers appropriately and accurately to pick things up from a table or floor.

However she is presently quite vulnerable to germs and viruses, as her immune system is suppressed. Mixing with other children in a nursery would be tricky until the immunity issue is sorted out. And also still being unsteady may be risky in a busy environment like a nursery or school. So there are questions about future schooling, whether it should be home schooling and so on. The levels of the steroids in time hopefully can be reduced.  

So what advice would I give for those caring for such a child? If she attends a mainstream nursery or school I would suggest the following, purely with respect to her levels of vision:

        In view of her right squint, she will benefit from
  • Extra practice with fine motor skills to develop her 3-D compensatory skills. Activities such as drawing, threading, stacking will help her develop these skillS, which are already there but can be improved.
  • While not being monocular and still having good functional vision in the right eye, she does have a slight degradation of vision in her right eye and this should be considered in respect to her seating and with adults working alongside her.
  • Adults approaching her should be aware that she sees better on her left side and has better visual field on the left side. People should approach her from this side and adults working with her should sit on the left side. 
  • She may benefit from being encouraged to turn her head to the left to see more clearly. 
  • Because the glasses also help to correct the squint she should wear them as much as possible. 

Because of her mild long sight
  • She will need to wear her glasses consistently for accessing books and texts. They will need to be regularly cleaned. She will also benefit from having a spare pair of glasses kept in the setting (if possible) in case of damage to the spectacles
  • In view of her mild long sight she may benefit from large print texts presented close to her face.

Apart from the above and in view of her visual needs alone I do not envisage any other need to adapt her environment, curriculum or learning materials beyond these minor modifications. There are significant other needs such as lack of balance which can be caused by poor vision (or disruption to the inner ear balance mechanism). However I understand that in her case this is caused by a disorder of the central nervous system and is not directly related to her vision. I do not intend to comment on her other needs as they are outside of my professional expertise. If she is home schooled some of the above will still apply. 

As always I would also  suggest the parents contact the support network for this syndrome as it is really helpful to talk to other parents facing similar challengies. Click HERE

Sunday 11 December 2011

A baby with CHARGE syndrome

Here is a summary of my recent visit to a sweet little girl we’ll call Joyce (pseudonym). Joyce is eight months old and has a diagnosis of CHARGE syndrome. So far I have only made one visit but this is how I found her responding to visual stimuli. This was a particularly useful visit as I went with two other colleagues, a hearing impairment specialist and a speech and language therapist. It is always a good practice to make such joint visits.  I post this so that the family can refer to it and in the hope that others may find it helpful. Please feel free to post a comment or suggestion.

I noticed that-
  • Joyce follows a flashing light toy that also emits sound. 
  • Joyce gave me eye or face contact at about half a metre; that is she looked towards me.
  • Joyce looked towards a white tie with black spots 3mm in size. 
  •  Joyce has colobomas to her retina, which according to the parents, affect about half the visual field.
  • Mother thinks she has upper visual field deficit but has good lower field vision. She reports that the back of the eye, the retina, is half white and half red in reflex.
  • Joyce sees details at a maximum distance of 12 inches; beyond this she loses interest and turns away.
  • Parents report that Joyce drops an object and looks for it. The speech therapist pointed out that object permanence starts at about 8months.
  • Joyce fixes on black and white patterns at 10cm. She gives a good response from the high contrast patterned cards – ‘Wee see like babies’ - Weegallery.com.
  • Joyce is interested in her hands; this is the start of eye hand coordination or hand regard. She uses both hands together. I suggested to the mother that she puts gloves on Joyce or tie something visual (and sound emitting) on her hands to encourage hand regard and develop eye-hand coordination.
  • Mother says Joyce looks at a book with lots of colours and not very thick lines.   I examined this book and noted that it would be really hard for Joyce to make sense of the pictures, as all the colours merge together. But she no doubt finds the colour interesting.  The colourful pictures may attract her but I do not think she can see the details.
  • Joyce does not smile back to a smile. This may be linked to her reduced visual acuity. However she smiles when she hears someone laughing.

Presentation of her eyes
  • Joyce has bilateral convergent squints. No patching has been mentioned, or glasses. Joyce has difficulty controlling her eye movements. No glasses have been prescribed.
  • Joyce has nystagmus (wobbly eyes) – I was told it was worse when she was 3 months old but seems a bit better now.

Additional sensory needs
Joyce also has a hearing impairment (HI) - No hearing on her left side but some on the right. For Joyce localisation of sound is a problem. This is relevant to her visual impairment because with the squint she may also have a difficulty locating objects. The combination of this difficulty in her two major distance senses will generally be a challenge to her mobility skills. 

The speech and language therapist recommends introducing objects of reference, and suggests she use an object from her routine.

Currently she is lying down a lot; it will be better to stimulate her vision when she is supported sitting upright. 

I used a shiny belt with a mother of pearl effect to gain her attention. She found it interesting and held the metal buckle for a while.

This is a summary. Maybe some of my readers might make some suggestions. Clearly Joyce needs a programme of visual stimulation to maximise her vision.

Wee Gallery for babies and CVI children

I have come across a great website with resources for babies and older children with CVI.
It’s called -  www.weegallery.com

The idea behind it is that for babies to see a picture or object it has to be in high contrast with thick lines and edges. This is what I totally recommend to all my parents and teachers of CVI children or babies. So I totally endorse this product. I have to say I have no vested interests however! I came across it recently when visiting a baby and the parents had these flash cards. Fantastic I thought – I must tell others about this. 

Here is their rationale behind the products: it is well thought out. At the earliest stage they say a baby is interested in striking and high contrast details. As the baby grows older they begin to learn the names of the animals etc. For our purposes I feel the older child with complex needs, CVI especially, will benefit from them  because they are so clear and easy to see. Here is the soft book with black and white animal pictures.

 Here are some of the cards. See how thick the lines are and how large the details.
Here are some other cards with white on black background. The cards are tested out and babies clearly show a lot of interest in them. But I suggest you use them with even the older CVI children, who need very high contrast and simple images. 

Thursday 8 December 2011

Visual Impairment and body language

People with a visual impairment miss out on a significant number of social cues. Social skills based on visual cues are the most significant skill set which challenge  many people with a visual impairment. 

Playing with Spectacles
Alfred P Poll was an optician in New York with many famous celebrities as clients. He put forward a pop psychology view of spectacles. It was his view that in many social contexts what people do with their glasses is very telling and has a distinct meaning. A chairman who removes his glasses is signalling the end of the meeting. Wagging spectacles instead of a finger is a gentle reprimand. The person who keeps unfolding and folding his glasses is indicating severe boredom. 

Julius Fast, who wrote ‘Body Language’, said, ‘as an extension of the body eyeglasses can tell us much more about the person who wears them.’I use this example to introduce the idea that visually impaired young people can have a great difficulty with reading people’s body language generally. The acquisition of social skills and social development in general are a challenge to children with visual impairments and much of it is the failure to accurately read body language cues.

Social skills
Social skills comprise a set of behaviours all people use to interact and communicate with each other. They are linked closely to a particular culture and tied to the rules of a particular society.

The Social Greeting
An adult I know recently lost the use of one eye. She told me the most embarrassing thing is shaking hands because she cannot see precisely where the other person’s hand is. So she compensates for that by holding out HER hand and letting the other person do the shaking. I was impressed this week when I met a blind lady (with some useful vision however) working at Great Ormond Street and she held out her hand to shake my hand. In point of fact I am not sure who reached out first. I only recall both hands meeting. But she has certainly learnt the skill of shaking hands as a blind person.

Establishing eye contact is a simple but very important social skill. Making eye contact does several things. It grabs the other person’s attention. It also creates a relationship with the other person. Looking someone in the eye is actually quite an intimate thing and people who find it difficult to form relationships have difficulty with it. So do visually impaired children. What you do with your eyes is a powerful social cue. Looking directly at someone can also be intimidating. I was in a meeting when someone started staring at me making me feel very uncomfortable. It was more like glaring. Not being able to establish eye contact can create misunderstandings, it can create bad feeling. But it is often harder for someone with a visual impairment to do this.

To look someone in the eye can be awkward for a different reason. If you have nystagmus and look at someone you know they can see your eyes wobbling so you then feel even more self conscious. You may turn your head away for that reason – fear of what others may think.

Suggestions to help a visually impaired youngster
A helpful way for a visually impaired child to overcome social awkwardness is to become familiar with the medical details and implications of their eye condition. This will enable them to explain how they see the world if and when they need to. It is very important for a person to understand their own eye condition but many children with nystagmus have not even heard of the word ‘nystagmus’ and would be unable to explain how they see. So it is my view that you have to demand that the eye doctor or the advisory teacher for visual impairment explains nystagmus to the child. They need to know so that they can explain their eye condition clearly and objectively to others, including teachers. Doing this accomplishes several things:

Self-advocacy puts a visually impaired child in control; it is empowering. They are now the expert as they know more than others about this topic. They become their own advocate speaking up for themselves; they are on the road to independence where they no longer rely heavily on someone else to speak up for them.

It gives information and removes fear. Fear of the unknown is the greatest single issue when you meet someone who is in any way ‘different’. If you don’t know why they look different or act different it can make you keep your distance or at the very least feel a little apprehensive. Information takes away fear. This is equally true with many teachers, who have a certain amount of fear when confronted with a child with sight difficulties for the very first time.

The more a person talks about their condition the more confident they become. Young people should be encouraged to bring up the subject as a matter of course. They should talk about it frequently like the weather. Before too long the subject of their eyesight will be an accepted part of conversation and will cause no embarrassment.

The more you talk about it the more it becomes part of the person’s identity. Teenagers and adolescents have a problem with identity. They are trying to find out who they are. A visually impaired child or young person needs to put their visual impairment at the centre of who they are. It is part of what makes them who they are. Whatever its implications, they are visually impaired. Denial becomes a difficult issue if a child will not accept they are visually impaired. Denial often takes the form of trying hard to be something they are not or trying hard to fit in with sighted peers as if they too had perfect eyesight. They might misbehave or behave eccentrically just to fit in. Accepting their disability is important in finding their personal identity. 

If a young visually impaired person talks about their eye condition positively others also come to accept it positively. In this way they receive positive feedback and a sense that they are respected. This is very important for a person’s own self esteem.

With visually impaired young people and children many social skills have to be specifically taught. Take for instance the social fact that everyone has their own personal space. It is not normally appropriate to approach very close to someone’s face. Little children who are visually impaired sometimes go up very close to another child. They are doing what comes naturally. Just as they hold an object up close and look close up at the TV so they may go close up to another child. But of course that may not be acceptable. The way to deal with it is to talk to the child and model behaviour that is acceptable.

Wednesday 7 December 2011

Portage:KIDS Home Learning

KIDS is a brilliant organisation and I have been privleged to know them for all the time I have been a QTVI. I work closely with the KIDS organisation and do joint visits to visually impaired babies. They are a brilliant group and manage to make weekly home visits to help the child to develop. Here is some information on the organisation. 

Home Learning and Portage is an early education intervention programme that recognises parents as the main educators for their child. The service is for disabled children 0-5 (mainly pre nursery stage) or whose development is causing concern. In partnership with parents they plan individual programmes for each child. Visits are made, weekly or fortnightly; toys and equipment are left for the family to work on during the week. The activities are based on the toys and equipment. They focus on encouraging the child to reach the next stage of their development. All achievements large or small are celebrated! 

KIDS is 40 years old this year! 
Celebrating 40 years of enabling disabled children and their families to enjoy their lives KIDS' vision is a world in which all disabled children and young people realise their aspirations and their right to an inclusive community which supports them and their families. 

Early Years 
The Children Centre programme set out by the government is planned to be the main way that parents and carers can access support, advice and services for their family. As part of this plan KIDS provide a range of specialist support for families with a disabled child. This support can be practical, advisory or just pointing you in the right direction for further information. They work closely with other colleagues in these Centres so are able to link you with people who can provide a wide range of other services should this be needed. 

Work falls into several areas: 
Direct work with disabled children
This includes home learning (Portage) services for very young disabled children, specialist nurseries and crèches, integrated support within Children’s Centres, short breaks for disabled children, both community based and residential, playgrounds and play schemes. 

Direct work with disabled young people 
This includes specialist youth groups (including drama groups), short breaks for disabled young people, both community based and residential, transition support and the national Youth Inclusion Network. 

Support for parents of disabled children and young people 
This includes Parent Partnership Services, parent forums, training for parents (eg Makaton), key working and our London SEN Mediation Service. 

Support for siblings of disabled children and young carers 
This includes sibling groups, young carers' groups and the inclusion of siblings in KIDS playgrounds Training, information and support for professionals and organisations This work includes the Making it Personal project; the National Development Department's Centre of Excellence, Inclusion into Practice, Training and Consultancy and KIDS eLearning teams; the KIDS West Midlands Inclusion Development Service; their Publications and Guidance and Useful resources; and work with their Partners. 

KIDS Regions: 
KIDS East. KIDS services in the East are based in Hertfordshire and Peterborough. KIDS East and West Hubs offer information and support to parents and carers of disabled children and young people across Hertfordshire. 
KIDS East Midlands. KIDS has merged with Strut in the Community who work in Lincolnshire. 
KIDS London. KIDS' London region provides a wide range of direct support services for disabled children, young people and their families. We are currently involved in the following projects: • Adventure playgrounds • Home learning (Portage) • Home-based short breaks (Respite) • Sibling support groups • Young carers support groups • Key working • Advice and information for parents • Parent Partnership Service • Mediation 
KIDS North East KIDS has a direct short breaks service located in Gateshead 
KIDS North West. KIDS work in partnership with Blackburn with Darwen to transform short break services in the local area Click here to visit the North West site KIDS South East KIDS South East supports families living in Hampshire, Kent, Medway and Bracknell Forest 
KIDS South West. KIDS South West provides services for families living in South Gloucestershire.
KIDS West Midlands. KIDS West Midlands provides services for families living in Birmingham, Dudley, Sandwell, Solihull, Warwickshire and Walsall. 
KIDS Yorkshire and The Humber. KIDS Yorkshire and The Humber provides services for families living in Hull, Wakefield and the East Riding of Yorkshire Click here to visit the 

Yorkshire site KIDS needs stars! 
Looking for a way to get involved with KIDS' work and to lend your time, skills and knowledge to a worthwhile cause? KIDS is always in need of volunteers across its regions and more information about the opportunities that you can get involved in are listed below. 

Join a Committee 
KIDS organises corporate, community and special fundraising events throughout the year. If you would like to find out more or to join a committee please get in touch with Nikki Arminio, Events & Donor Development Manager on 020 7359 3635 or Nikki.Arminio@kids.org.uk 

Company Team Challenge Volunteering 
Are you and your company looking for a challenge? To get out of the office for a day and get stuck in outdoors, making the difference where it counts? If so, then why not Volunteer for KIDS at one of our four inclusive Adventure Playgrounds across London. For more information contact ruth.caulfield@kids.org.uk 
Individual Skilled Volunteers KIDS is looking for professional painters, electricians, carpenters, architects, toy makers and plumbers to lend their skills to KIDS Playgrounds in exchange for a cup of tea and a feel-good challenge. 
If you’ve Got the KIDS Factor contact fundraising@kids.org.uk for more information. Individual Fundraising Volunteers Contact fundraising@kids.org.uk 

Individual Volunteers in KIDS Region
All KIDS Regions need volunteers so why not find out a bit more about the opportunities available below or get in touch with your regional co-ordinator to get supporting KIDS today? 

London Stars – KIDS office in London is currently not recruiting any volunteers South East Stars - contact sue.lee@kids.org.uk Stars in The Midlands - contact enquiries.westmidlands@kids.org.uk Stars in Yorkshire & The Humber - contact: ann.dixon@kids.org.uk (weekly outreach play sessions) janice.hopkins@kids.org.uk (Fundraising)

Blind people who changed history

I have just come across a fantastic resource of role models and positive images of visually impaired people who literally changed the world in different ways. It's on the Disaboom website and i hope you have a look. Here's a taste of what's there.

These famous blind people have changed and shaped the world in many areas such as music, politics, science, art and sport because they refused to allow their lack of external light perception to quench or stifle their inner light. The world has been illuminated by their courage and talent.
Stevie Wonder (Born May 13, 1950)  - American singer-songwriter-record producer and multi-instrumentalist. A list of famous blind people wouldn't be complete without this composer's name. Wonder penned such hits as "Ebony and Ivory" that aided the civil rights cause in a non-violent way.

Ray Charles (September 23, 1930-June 10, 2004) - American pianist and musician whose gritty and soulful voice shaped the sound of rhythm and blues.
Claude Monet (November 14, 1840-December 5, 1926) - Founder of French impressionist painting. By 1907, he had become quite famous, but began having serious problems with his eyesight and started to go blind.  Even though his eyes continued to get worse, he never stopped painting.  At the end of his life, when he was almost completely blind, he painted one of his most famous murals of water lilies.

Andrea Bocelli (Born 22 September 1958) - became blind at 12 years old following a football accident. He was a multi-instrumentalist and has sung with other great operatic singers such as Pavarotti.
Franklin Delano Roosevelt (January 30, 1882 -April 12, 1945) - 32nd President of the United States of America. Roosevelt had several disabilities including vision impairment.  He was one of the most popular presidents in history.

Thomas Gore (December 10, 1870-March 16, 1949) - a Democratic politician. He became blind as a child, but never gave up his dream of becoming a senator. In 1907, he was one of the first two senators from the new state of Oklahoma. He was re-elected twice more. He was famous as a member of the progressive wing of the Democratic Party.

Harriet Tubman - (1820/21-March 1913) -  a slave throughout her youth who escaped to Canada but returned to the U.S. where she helped bring hundreds of black slaves to safety in what was called the Underground Railroad.  She received a cruel head wound which led to severe vision impairment and seizures.  This did not stop her from fighting for the freedom of her people.

Marla Runyan (Born January 4, 1969) -  a marathon runner. She is the three-time national champion in the women's 5.000 meter run. Runyan was the first legally blind athlete to compete in the Olympics Games.  She placed eighth in the 1,500-meter in the 2000 Sydney Olympics making it the highest finish by an American woman in that event. In 2002 she finished as the top American at the 2002 New York City Marathon to post the second-fastest debut time ever by an American woman.

Communication and Visual Impairment

I am regularly asked to speak to a group of foster carers, some of whom look after visually impaired children. They always ask me to speak about communication and the child with visual impairment.  This has really challenged me and caused me to think hard about the whole area of visually impaired children who communicate in sometimes different ways from the rest of us. Social isolation is often a serious difficulty for many young people with a visual impairment. One reason for this is their inability to pick up on social cues, such as body language. 80% of learning is provided by the sense of vision and 90% of learning is incidental i.e. not planned. Visually impaired children miss out in both ways. They miss much incidental information in their environment and they miss out on much information because it relies on the sense of vision. But perhaps more significantly they miss out on the many opportunities that present themselves daily to create friendships with their sighted peers.

Communication in a sighted world
Our world is largely a visual world. The television is part of all our lives. Computers and I-Pads are visual media. Statistically communication is mainly visual. Research indicates that as a percentage communication is mainly visual and only a limited amount is verbal. 

a.     55% of person’s communication is non-verbal, i.e. most of our communication uses the medium of vision.
b.     38% of communication is through the inflexion of the voice i.e. the tone in which we speak.
c.      7% only of communication is accounted for in the actual words we use.

At an interview they say it is in the first two minutes of entering a room that a decision is made by an interviewing panel about our suitability for the post. In other words the way we are dressed, body posture, smiling and the general air of confidence. It is all visual. Even before we have had to chance to say anything it seems the die is cast!

Actions speak louder than words
Body language is intrinsic and essential to all our communication. There is both positive and negative body language. Making eye contact shows you are interested and curious. Nodding during a conversation, smiling intermittently, leaning forward are all good signs of a person who is paying attention to you. On the other hand if someone fidgets or taps their feet, looks away or avoids looking at you and crosses their arms when you are chatting, these are all negative signs, indicating lack of interest or attention and can be off-putting.

We use eye contact to build a relationship; we avoid eye contact to avoid a relationship. People sometimes tend to look over to the left when they are trying to be deceitful. But be careful not to read too much into body language.

Paralanguage refers to the non-verbal elements of communication used to modify meaning and convey emotion. Paralanguage may be expressed consciously or unconsciously. It includes the pitch, volume and intonation of speech. Paralanguage accounts for 38% of communication. It is the tone in which you speak. Someone asks you in all innocence, ‘How are you?’ You have had a bad day or you are feeling angry and you reply, ‘Fine!’ yet you drop the pitch of your voice and what you have said in your tone of voice is ‘I am not fine’ even though your words say ‘I am fine’. If you had raised your pitch and said, ‘Fine’ it would have meant the opposite.

How is a child with a visual loss affected by their difficulty? Such a child will fail to see the vast amount of incidental visual information that we all take for granted. It has to be pointed out verbally. It is chiefly the lack of access to information or the distortion of information that impacts on such a child. This can have a cumulative affect on a child’s understanding of basic concepts such as size, shape, proportion and distance. Conceptual development is formed during a child’s interaction with the environment.

What body language does a partially sighted child miss in school?

-       The teacher’s visual cues in the classroom - a finger pointing, crossed arms, raised hands, eyebrows lifted, smiling, frowning, calling
-       Visual cues from other children – in the classroom - laughing, a nod, a hand gesture
-       Visual cues from other children – in the playground – faces, recognising friends, a ball thrown towards them, a running child
-       Misunderstandings can develop as a result of not seeing and acknowledging a friend in the playground or street
-      Smiles, frowns, funny faces ... 
 What can we do to compensate for this?

-       Awareness raising with the teacher and the children
-      With children talk about the precise problems a person will have because they do not see clearly
-       Specific strategies can be trialled
A card shown to the child to represent certain facial teacher expressions
Seating close to teacher but also with the flexibility to turn and see other children
A low vision device to bring distant things closer
A classroom ‘buddy’ to help them see what they are missing

How can we effectively communicate with a person who is visually impaired? Above all we have to emphasise the 7% of verbal communication that we are able to use. Everything including what is going on in the environment, what is being shown on the screen it all has to be verbally described and explained in detail. If you greet a child say who you are, if there is any doubt. Use ordinary language such as ‘see you later’. Make it clear when a conversation has finished. If there is a sudden noise it may help to explain it. Basically everything visual must have a verbal counterpart. The information missed should be filled in. It is important to use the child’s name frequently also and remember to ask them questions. 

Think of all the different kinds of body language used in everyday interactions in school. I have observed drama exercises in the classroom where children were grouped in a circle and had to read the opposite person’s face and react to it. Circle times in primary schools can be frustrating for children who cannot see details or faces well. When a teacher is speaking from the front they should try to modify their behaviour where possible:

-       Approach closer to the visually impaired child without making it too obvious
-       Talk about what they doing – i.e. ‘see how I am smiling’, ‘I am raising my hand’, ‘how do you know I am angry…?’ Talk about feelings and facial expressions
-       Use your tone expressively – vary it to express emotions more than you usually would
-       If the child has a learning support assistant with them they can describe what the teacher is doing

Nor must we forget that a lot of visually impaired people find it difficult to make eye contact, either because they turn their head away to see or because they have poor central vision. Forming social relationships relies heavily upon making eye contact so perhaps this is one reason many visually impaired young people are socially isolated. 

Sometimes i get asked the very confusing question about the child with a visual impairment - 'Does she use sign language'?
I leave you to work that one out...

Sunday 4 December 2011

Review of Cerebral Visual Impairment - Working Within and Around the Limitations of Vision By Gordon N Dutton

Gordon’s paper is in my view an essential read. Did you know there is more than one vision system? There is reflex vision, which is subconscious and designed to you protect us from danger. So when a parent of a blind child says ‘can my child see?’, the answer may actually be ‘Yes – subconsciously’. Your primitive visual system senses a peripheral movement to the side of your vision and sends a message to the brain before you are even aware of it.  A non ambulant blind child may be able to ‘see’ a moving spoon approaching from the side and open their mouth. This vision is less effective if the movement approaches from straight ahead. It engages the rods spread throughout the peripheral retina. 

Then there is the higher level of vision, where information is split up into two systems, handled in different regions. These two systems are respectively a ‘where’ system, enabling movement through space; and a ‘what’ system, enabling recognition of what is viewed. Over 40% of the brain concerns vision therefore any child with damage to brain tissue can potentially have  visual problems. These can range from blurred vision and eye control to analysing visual information and moving through visual space. 

Gordon’s explanation of the visual system needs to be read and re-read. It shows how it really helps to know where the brain damage occurs. For instance the occipital lobes at the back of the brain (this is the visual cortex) receive electrical signals from the visual pathways and sort the information into all the component parts. Vision is not merely one thing. It consists of colour, detail, orientation, movement, form, distance, perspective and so on. Damage in this area may result in gaps in the visual field. For example there are children with a complete loss of vision on one side, called hemianopia. Damage in the right brain affects the left side of vision; damage to the of the cortex is affects the lower field of vision. 

What is really vital to understand is Gordon’s unpacking of the two information flows, called the dorsal stream and the ventral stream. It takes 0.1 of a second for information to reach the brain from the eyes and a further 0.1 of a second to analyse information in these two systems. The dorsal stream (where stream) connects the occipital lobes with the parietal lobes (top of the brain), the motor cortex (vertical strip of brain in the centre of the cortex) and the frontal lobes (front of the brain cortex). The ventral stream connects the occipital lobes to the temporal lobes (lower cortex). 

The posterior parietal cortex is the region where lots of information is handled at once. Like computer RAM it enables many programmes to be open at the same time and facilitates complex computing tasks. It works with the frontal cortex which makes the decisions about what to look at. Damage here can severely reduce the amount of information a child can handle at any one time. They are seeing the world more like a baby who can only do and see one thing at a time because the functioning of their parietal cortex has not developed into the sophisticated mechanism of an older child or adult. 

Read the full paper HERE

Saturday 3 December 2011

What is the difference between an optician, an orthoptist and an optometrist?

The optician may be your first port of call if you have a concern about your eyesight. People at any rate ought to have regular eye checks with an optician. Opticians make up and dispense glasses rather like chemists or pharmacists dispense medicine. According to the measurement they have been given, they will show you the range of frames and types of lenses you can have, depending on your budget. 
Optometrists usually seem to have their practice with the optician. These professionals work with the optician and they are the ones who actually measure your vision. Optometry is the science of measuring eyes. They might use just a few tests or a whole battery of tests to measure your eyes. The commonest test is the eye-chart with large letters at the top and small letters at the bottom. This is usually measured at a distance of six metres or 20 feet in the USA. In a confined space they may have a mirror to achieve the same distance or they may do the measurement at three metres (ten feet).

Then there are people called orthoptists. The orthoptist I was told years ago is the ‘squint lady’. They are doctors who treat squints. A squint is called by different names: it is sometimes known as strabismus and sometimes it is called exotropia (outward squint) or esotropia (inward squint). Squints are fairly common in young babies, with whom it usually disappears by six months of age. A squint is a condition where the two eyes are not aligned. Proper binocular or stereoscopic vision (two eyes) gives us a good three-dimensional view of the world and the ability to locate where things are precisely. If the eyes are misaligned or not straight we lose the ability to see three-dimensionally and so find a difficulty with judging distances exactly. For instance if you have a squint driving may sometimes create problems; picking up a glass may be problematic; threading a needle may be impossible! But there is one important factor about a squint that should never be overlooked. It makes eye contact very difficult. For this reason it will impact on a child’s social relationships and social skills. Other children may tease them and they may feel socially awkward. There are three solutions for a squint. The first is patching the good eye as a baby to make the weak eye work. The second is spectacles with different strengths to make the weak eye work. The third is an operation to cut the muscles and straighten the eyes. The latter is usually done as a last resort and mainly for cosmetic reasons. In other words it may be done so late in a child’s life that it does not affect vision at all. The orthoptist uses prisms to measure a person’s squint.