Tuesday 6 December 2022

 What Strategies do you recommend for a vision impaired child with nystagmus or ROP

For a little girl of nursery or kindergarten age (see post ROP 4/12/22) I recommend the following:

  1. Extra practice with fine motor skills to develop her 3-D compensatory skills. Activities such as drawing, threading, stacking will help her develop her skills. 
  2. Isobel will benefit from a writing slope or upright easel in class/nursery to obviate the need to bend her neck and thus avoid potential postural problems.  
  3. Adults should enhance the degree and quality of language they use with Isobel. A child with visual impairment benefits from increased description and explanation to compensate for their lack of vision. 
  4. She would benefit from extra support when in a low light environment. 
  5. In the playground Isobel would benefit from adult supervision to ensure her safety when moving across and around obstacles. 
  6. Isobel will benefit from a multi-sensory approach to her learning. She should have enhanced access to the use and stimulation of all her senses. A range of sensory experiences will ensure she learns to compensate for reduced vision in accessing information within her environment.  
  7. Isobel will benefit from a clutter-free environment. The positioning of furniture should be kept as stable as possible and moving tables and chairs kept to a minimum. The floor should be kept free from trip hazards and obstacles. 
  8. Pictures and letters presented to Isobel should be big, bold and bright and on a well contrasted background. 
  9. Attention to be paid to contrast in her learning materials. She will benefit from off-white paper, preferably a pastel colour to reduce the glare from white paper. 
  10. Isobel will benefit from enhanced lighting in her immediate leaning environment. She will benefit from a classroom that is well lit, with average ambient lighting levels of at least 300 lux and access to a directed task lamp shining over her work area to provide levels of a minimum 500 lux when needed. She should not be in the path of direct sunlight and windows should be to her back.  Blinds or curtains should be used to control the light levels. 
  11. Isobel requires extra time for tasks because her eyes are slow in changing focus due to nystagmus. She will take longer scanning a page whether it is writing or pictures. 
  12. It will benefit Isobel if an adult takes the time to talk about activities in advance with her. She needs to be prepared and able to anticipate what is coming. In cases where she may miss a visual cue an adult should prepare her in advance. When throwing a ball to her always talk it through first with her so she is not taken by surprise. 
  13. In a nursery environment Isobel will benefit from good structure, periods of quietness and calm, varied activities, a large play element in all activities, short focused activities, increased verbal description and explanation; she will benefit from extra explanation of the concepts of comparative size and distance. 
  14. Children with visual impairments may become sensitive about being different and the management of her LSA will need careful monitoring. Some awareness-raising may need to be done with her class so they understand her visual needs and to avoid teasing.  
  15. Isobel would benefit from a mobility assessment. She is unsure when in unfamiliar places and will benefit from ongoing input from a mobility trainer. 
  16. In her early days at primary school Isobel will benefit from becoming familiar with specialist equipment such as a cctv (e.g. Professional Vision Services ‘Student’) and low vision aids (monocular and dome / bar magnifier).
  17. Isobel will benefit from her own laptop and training in touch typing from an early age. 
  18. Isobel may benefit from the use of technology such as a kindle or I-Pad for access to texts.
  19. Isobel will benefit from ongoing input in her educational settings from a qualified teacher for visual impairment (QTVI). Her teachers will require initial and additional training and ongoing advice. Any LSA attached to Isobel will require support and regular training and advice and would be expected to cascade his or her training to other staff involved.
  20. The building will need an audit to check its suitability for a visually impaired child. Basic adaptations such as yellow tape to the nosings of the stairs and steps will need to be in place before Isobel starts. 

The Role of a  learning support assistant for Isobel (kindergarten age)

  1. A 1:1 supporting f/t or p/t adult will be helpful to ensure her safety 

-in the playground during breaks and playtime

-in class to check that the floor and room is clear of trip hazards and obstacles

-when moving through varying lighting conditions or low light conditions 

  1. To sit with her during circle times and group sessions where the big book is used with the whole class. Isobel will benefit from her own copy of books and an adult to point out parts of the book the teacher is showing. 
  2. To adapt learning materials especially for her including photocopying parts of pictures and texts to provide good spacing, contrast and colour – this requires advance notice and liaison with the teacher at regular intervals. A dedicated LSA will need to have time to do this. 
  3. To sit with her and point out what the teacher is writing or drawing on the board. To give extra description and explanation of what is going on around her. 
  4. A curriculum that is tailored and adapted to meet Isobel’s needs. Isobel is curious and inquisitive; she enjoys sensory play, and likes to be active. For this reason an adult dedicated to working with Isobel should be able to prepare learning materials that will meet her visual needs. At the same time because she will require extra time to complete tasks that are visually demanding and visually tiring a support assistant would be of benefit for Isobel during much of the day. That support should be scaffolded as appropriate.  

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