Facilitating_Movement.htm

Facilitating Movement and Navigation in Blind Pre-Schoolers: A Positive, Practical Approach

Daniel Kish, M.A. / M.A.

Hannah Bleier, M.A.

Sandra Moser, M.A.

Presented at

California Transcribers and Educators of the Visually Handicapped (CTEVH)

and

Association for the Education and Rehabilitation of the Blind and Visually Impaired

1998 Conferences

I. INTRODUCTION

A. Background

1. Affiliations:

a. Hannah Bleier worked for 3 years exclusively with preschoolers as the Orientation and Mobility Specialist for the Blind Children's Center in Los Angeles California - (800) 222-3567.

b. Sandy Moser has worked regularly with preschoolers for 6 years as an Orientation and Mobility Specialist for the Blind Children's Learning Center in Tustin California - (714) 573-8888 Ext. 117.

c. Daniel Kish served as Orientation and Mobility Specialist and Youth Outreach Coordinator for the Blind Children's Learning Center for 5 years working regularly with preschool and school aged children. He is now the Executive Director of World Access for the Blind where he maintains a case load of all ages. He can be reached at: (866) 396-7035.

2. Together, we've put in over ten thousand hours with kids under 6 years old. Many of you have had more or less experience than we have; we're open to suggestions, input, and sharing.

3. All three of us have Master's in Special Education, and Daniel Kish's second Master's is in developmental psychology. All three of us graduated from the California State University O&M training program.

4. Daniel is totally blind from infancy. Many have regarded his mobility skills to be highly refined and effective, but he did not receive regular, formal mobility until the age of 12. Fully mainstreamed from the beginning, he learned most of what he knows simply by doing what other kids did.

B. The need for early movement and navigation facilitation: Many school districts and agencies won't provide or fund movement instruction to very young children. Three to five years is often the cut-off. We assert that a child is never too young to benefit from professional O&M training. We feel that movement and navigation should start when blind and visually impaired children begin walking (if not before), or from the point at which qualified professional judgment acknowledges that the child should be walking.

There are many developmental advantages of early training. Many spatial concepts and motor patterns (such as gait and posture) become well formed in early childhood. In addition, the earlier a child learns to move safely and effectively, the more quickly and fully she can acquire critical knowledge about the world and develop appropriate conceptual and movement schemes. She can also form the idea early in life that she can act to acquire what she wants or needs - developing an active rather than passive approach to environmental interaction. She learns to act upon the environment, not merely react to it. Obvious issues of safety arise when a visually impaired child begins to ambulate. Do we not all agree that a visually impaired child must do what he cannot see - must learn through movement what cannot be visually learned? If the visually impaired child is to develop along normal lines toward conventional achievements by typical avenues of exploration, then the child must be properly encouraged to exercise techniques that ensure these avenues are traversed safely.

C. Many O&M instructors have raised questions about how to work with pre-schoolers. Since over 90% of the blind population has always been comprised of adults, the traditional university O&M curriculum includes relatively little information about how to work effectively with pre-school age children. Understandably, many O&M instructors feel confused and uncomfortable when called upon to work with a pre-schooler. Some of them try simply to teach the traditional O&M curriculum at a slower pace. This doesn't work, because the traditional O&M curriculum was designed to teach blinded veterans. Teaching pre-schoolers using that model frustrates the instructor and gives the child a stressful and negative first experience with O&M. Both instructor and child will feel like failures, because the instructor has started out with inappropriate expectations. We argue that the traditional instructional model is no more appropriate to use with preschoolers than teaching spelling before language, or mathematics before the child learns to count.

D. For all, particularly the very young, the nature of the surrounding environment dictates the quality of learning. Certain elements must be in place in order to optimize learning. Just as we need proper levels of oxygen to optimize respiration and adequate nutrition to optimize metabolic processing, so the very young need certain environmental conditions to optimize learning. We discuss these conditions in the following sections.

II. THE IMPORTANCE OF A POSITIVE, PRODUCTIVE RELATIONSHIP

A. "If we do what we've always done, we get what we've always gotten." (Jack Canfield) Learning (i.e., growing) only takes place when something new is added to our situation. Everyone seeks balance. Whenever something is added, we are temporarily thrown off balance until we handle the new element. This process of "handling" may be called "learning." The process of incorporating and assimilating new elements brings understanding of them. With understanding comes return to balance. While we are imbalanced, we tend to experience psychological insecurity. Insecurity is, to some extent, part of the learning process. Therefore, we learn best when we feel fundamentally secure about ourselves and our lives, because we can better tolerate the temporary insecurity that results from the imbalance inherent in learning. With the very young, fundamental security comes from many sources including and especially good rapport with the teacher. The young one must trust, like, respect, and feel respected by the teacher. This allows him to gain the fundamental security needed to grapple with the inevitable insecurity brought about by the introduction of new material to be learned. Without good rapport, the young one is too caught up in fundamental insecurity to be able to rebalance himself in the face of new material. This material will, therefore, not be easily learned under such circumstances.

Just as the quickest way to a man's heart is through his stomach, so the quickest way to a child's heart is through fun. The bottom line for instructing a young child is that the child MUST be willing to participate. Providing instruction in a context that the child enjoys is perhaps the most effective method of helping a child open up to new material and to develop an acceptance of novel stimuli and new situations. When something is fun, the child will almost automatically feel secure and be readily able to apply his internal resources and abilities most effectively to grasp new material.

B. Building Rapport. If you go into a pre-school classroom for the first time, go over to your student, introduce yourself in a friendly way, pull her out of the classroom and try to lead her through the traditional first lesson in cane travel, the child will most likely throw a tantrum the likes of which you have never seen, or will shut down completely, depending on his or her personality. It may take you weeks to get her to talk to you at all or be near you without screaming.

We know the importance of building rapport with adult clients. We might spend the first session with them listening to them tell us their concerns and learning about who they are as people. But pre-schoolers are usually unable to express their concerns verbally. Also, adults tend to just expect children to do what they're told to do. So we might not realize that, in fact, building rapport with very young children is essential if the child is to learn anything from us. We may be able to overpower a child into executing or ceasing behaviors as we desire, but we cannot muscle a child into learning. We need to spend much MORE, not less, time building rapport with pre-schoolers because of their inability to communicate their needs verbally.

The fact that pre-schoolers are too young to communicate their movement concerns doesn't mean they don't have any. We must learn what their concerns are, and to do this, we must spend a lot of time observing them.

C. Observation. Observation is one of the most important keys in working with pre-schoolers. To observe effectively, we need to pay a lot of attention without making quick judgments about what we are seeing. Remember, observation is active. We are collecting information we can use to establish the child's needs and to meet them effectively. Spend time in the child's classroom carefully observing how he moves without interfering in his movement or trying to change it. Pay attention to details about the child's movement. Watch the child play. Observe how he relates to other children and other adults. Observe what interests the child, what the child likes or dislikes, what scares him or makes him feel safe, what makes him angry and what makes him happy. Observe how the child uses his senses of hearing, touch, smell, taste, and remaining vision. Also observe the quality of the child's movement. Is he reluctant to move? Eager to move? Does he move with or without caution? Does he seem fearless or fearful? Observe any actions the child is already taking to facilitate her own movement. Does she put her hands out in front of her body when she is exploring? Does he seem aware of objects before touching them? If so, does this awareness seem to arise from visual or auditory means? Does she remember where an obstacle is after she bumps into it once, or does she keep bumping into the same obstacle? Does the child use sound to help him get where he wants to go? Does he seem to pay more attention to some sounds than to others? Does he seem disoriented by the many sounds in his classroom?

Talk to the teacher and teacher's aide about their perceptions of the child. Talk to the child's parents about their perceptions of and concerns for the child. Consider what they say carefully, and see if what they say seems accurate to you. Be open to others' feelings and opinions about the child's movement needs, but don't allow others' remarks to over-rule what you observe. Trust your own observations.

You will get a lot more information about the child by observing him in his everyday school or home setting than you will by pulling him outside or into a room by himself and testing him using a checklist. It is a good idea to take several sessions just to observe. If you can, go at different times during the child's school day to get a more complete picture of him. Make sure you don't have three observation sessions during a period of time when the child is sick or having some other temporary difficulty that strongly affects his behavior. You can let the child know you are there if you like, but don't disrupt the child's normal day in any way. It is a good idea to take notes immediately after your observation sessions so you don't forget important details. Wait until after your observation sessions to take notes, because while you are looking at your notebook you can't be watching the child.

With young children even more than older students, it is very important to remember to keep observing them carefully even after these initial observation sessions end and you begin teaching them. Pre-schoolers are changing and growing in every way at an amazing rate. Continuous careful observation while teaching is essential to planning and updating an effective program for them. Continue to note big and small changes in the child's movement and behavior. When you begin teaching the child, you may still occasionally want to schedule a session where you back off and just observe the child in the classroom or on the playground. This is a good thing to do if you are stuck about how to solve a teaching problem; if you step back from the problem and just observe the child for a session, you may get a fresh perspective.

D. Being with the Child, Serving the Child, and Gaining Trust. Many early childhood studies show that the most important factor in a child's learning is the quality of the emotional bond that the child has with the person teaching her. Such a bond may not be necessary in working with adults, but it's crucial in working with kids. If the child does not feel safe and comfortable with that person, the child will have great difficulty learning anything from that person. So, since we want the child to learn from us as O&M instructors, we need to spend time helping the child feel safe and comfortable with us. Some people might feel that this is too "warm and fuzzy," and that what the child needs is "a firm hand." There is a big difference between "a firm hand" and structure. Children need a lot of structure to help them feel safe and comfortable. This means they need to know what the rules are and what happens if they break the rules, and they need to be able to count on the fact that the rules will not change for some reason they can't understand. Often what people really mean by "a firm hand" is that they demand that the child do what they say without question or be punished. Many professionals demand this of children to some degree without realizing it. If we approach a child with the expectation that she will do what we say because we are bigger and more powerful, we are coercing the child into a situation that is not conducive to learning. People may learn in spite of coercion, but they won't learn because of it. We need to remember that the educators are there to serve the student, not the other way around. We don't stop having an obligation to serve small children simply because they are small and have less power in the world than we do. Serving the child doesn't mean that we let the child take charge. It means we have appropriate expectations for the child that we have developed by getting to know her. It means providing structure and safety so that she can meet those expectations. We need to have enough confidence in what we're doing to know that we are in charge, without having to prove it by coercion.

So, we've taken time to get to know something about the child through observation, and we're ready to start building a relationship with her. The first thing we do is simple, but essential - we play with the child - with no pressure, - with no expectation. We make time to be with the child doing something the child enjoys. If all the child seems to like to do is sleep, be there to sing the child a song or tell him a story at nap time. If he likes to rock on a rocking toy and listen to music, try combining those two activities; have him come with you to his favorite rocking toy and play his favorite music while he rocks. If the child's favorite thing is to make loud noises or to run around like a maniac, go someplace with him where he can do that and have fun with him while he does. Do what you can to increase the child's enjoyment of whatever he or she likes to do. Fun is a very important motivator for learning! It's important to remember that playing means you get to have fun, too. You get to play, too. In fact, it is our experience that young children cannot hide their true feelings, and it is very hard to hide our true feelings from them. If you are bored, they will sense that, and they may become bored, too, or otherwise bothered. If you are tense, they will sense that and may tense up themselves. If you are genuinely enjoying the child's company and the activity you are involved in, the child will know that, too. So spend some time thinking about what you really like about each child and what you enjoy doing with the child. We're not saying you have to like hopping on one foot from the swing to the jungle gym, or listening to "Old Mc Donald" twenty times in a row, but maybe you can get some genuine enjoyment out of watching the child crack up every time you do these things together. While you are spending time with the child, talk to him in words he can understand about what you are doing together and what is going on around you. Pay attention to his level of verbal skill, and try to match it or talk just beyond it. If the child doesn't talk, talk to him anyway in simple words. He will get used to the sound of your voice and will become more comfortable with you. Also, he may understand much more than he is able to verbalize.

E. Traits Most Pre-schoolers Have In Common.

1. Pre-schoolers Love Repetition, and They Learn From It. When young children find something fun, they like to stick with it for a long time. That means they may want to listen to the same song every day for six months, and if you try to change to a new song, they may get very mad. It means they may want to go to the same place every lesson for a very long time. They are not doing this to be ornery. They may be doing it, because they are getting something important out of the repetition of that experience over time. Sometimes it takes some creativity for the instructor to respect the child's need for repetition without going crazy himself. Many times it is possible to keep the repeated activity, shorten it a bit, and add a new activity, or to expand the old standby in a way that will help the child learn more. It's also important to be sensitive to when the child is through with something - eventually they've learned what they need to learn and want to move on. Behavior changes may indicate boredom.

2. Pre-schoolers Learn from Making Choices. There are many standardized tests of children's aptitude, and one of the elements tested is often the child's ability to make choices. It is very ironic that we often judge children for not making choices, but then when they make them, we often tell them, "No." When we give a child a choice, we try to make sure it's a real choice. If an instructor has decided that it's important to go outside to use the cane, it is not prudent to ask the child, "Do you want to go outside?" We've already made the decision, so it's not a real question. If the child says "no" and then we make him go anyway, we have given him a choice and then over-ruled him. The child learns both that choices are not really his to make and that his wishes are not respected. This is particularly damaging to blind children who, more than sighted children, will need to learn an active approach to carving their way through time and circumstance. Instead, we may go in and say, "It's a nice, warm day outside. Do you want to go play on the swing or do you want to walk to the corner?" Then if the child says, "I want to stay inside," we can say, "That wasn't a choice. The choices are to go to the swing or to go to the corner." Depending on the situation, we might allow the child to stay inside that day and adapt the lesson to whatever he wants to do. If the child usually is eager to go outside and occasionally wants to stay in, we would probably not be justified in pushing the matter. If the child is fearful and reluctant to go outside, we might stick with the choices we gave the child, and see how we can help him feel more comfortable about going outside. For example, we might ask him directly if he is scared to go outside and have a conversation about why. If he says, "I'm scared of the dogs barking," we can promise not to let a dog hurt him. By making an attempt to find out what is going on with the child, we show him that we respect him, even if we end up insisting that we go out. The quickest and most reliable way to earn and keep a child's respect is to demonstrate respect for him. It is important to be careful not to insist the child do something he is truly not ready to do. We would do well to observe the child carefully to determine how much insistence is too much. This can be a very subtle distinction and requires sensitivity, experience, and respect for the child's growth.

3. Pre-schoolers Like to Have a Feeling of Personal Authority. We've already talked about how children need structure in order to feel safe. Within a structured environment, a pre-schooler likes to feel that he has some control over what is happening in the interaction between the two of you. For example, pre-school cane users often love it if you pretend to be lost or confused and ask them to show you how to get somewhere. (They often know we're pretending, but that doesn't matter to them; in fact, it seems to make it more fun.) We may take a stuffed animal and tell the child, "Miss Bear wants to get to the piano. Can you show her where it is?" and carry the bear along. When we do that, we've changed the interaction so that the children aren't always the ones being shown something; they can take the lead. We're telling them, "You're in charge," which isn't something they get to hear very often. They appreciate it, and they usually make an extra effort to get to our destination. When an instructor is using his own cane, children will often ask if they can trade. This is an effective way to get children interested in paying attention to tactile feedback. We needed be hung-up about whether the cane is too long. The important thing is that they keep it on the ground and in front.

4. Pre-schoolers Learn from Imitating the Behavior of Adults and Other Children. It is important to remember that if children like us, they are going to want to learn to do what we do. They will also want to learn to do what other children they like do. Many times when working with a child who is ready to begin using a cane but is not interested in the child-sized cane at all, it helps to bring in an adult sized cane with the child's cane. We allow the child to touch and compare both canes, and to help fold and unfold the adult cane. We talk about the different parts of the cane. Suddenly, because the instructor has a cane too, the child is interested. The instructor might take a walk holding her own cane in one hand and the child's hand in the other, so that the child can get an idea of what the cane is for. We have found that many children are more eager to use their canes when they know the instructor has one, too. The instructor's use of a cane can also serve as modeling of good cane skills and appropriate cane use. (If children ask why we don't use our cane during every lesson, since on some lessons we need to have both hands free, we may give them the same explanation as when they ask the same question about children with low vision - some people need to use their canes more often than other people). We've also found it useful to pair a child who is reluctant to use a cane with another child who is using a cane successfully. Mood is contagious, especially among young children. It can serve as an extremely powerful motivational tool. If one child observes another child's excitement and eagerness about walking with a cane, he is often more eager to do it, too. Dual lessons of this sort can provide very powerful and effective contexts for the learning of many skills, though such lessons may at times require a second adult present to assist in managing behavior and keeping the lesson productive.

5. Pre-schoolers Respond Well When Given Goals They Can Reach with Effort. Young children need to be given goals that are just out of their reach, that they can reach successfully if they learn a little more, go a little further, do a little more. Careful observation is essential to establish the child's current ability to do something and to create a goal that is the next logical step. Every child is different, and each child's sequence of learning is different. It is important not to hold children to any pre-conceived idea we may have of where they "ought" to be at their age. Pay attention to what they are doing, not to what you or anyone else thinks they ought to be doing, and then think about what they could do next. For example, if a two-and-a-half year old girl who is blind and has other disabilities can localize your voice and take two independent steps toward you, you might let her get very confident and comfortable with that over several lessons, and then try moving two or three steps further away. You would not move across the room right away, because you or the child's mother or classroom teacher would like her to be able to go across a room by herself now. The expectation is ultimately good and praise-worthy, but that's not where the child is now. Part of our job is understanding that ourselves and helping the child's mother and classroom teacher to understand this as well.

6. Preschoolers are almost invariably emotional, instinctual, intuitive, and physical people, and must be interacted with on those bases. They are also very logical, but their logic is not based on learned rules of conventional society. (Who's to say those are logical anyway.) It is, instead, the logic of the heart and body. Though, on the surface, many of the things that preschoolers do and say may seem bizarre and irrational, if one stops to examine the situation from their perspective, one will usually find the preschooler to be following an impeccable course of logic. For example, many preschoolers, especially blind preschoolers, don't like wet, sticky substances on their hands. They may react quite vehemently to being forced or even encouraged to handle substances such as glue, paint, clay, etc. We call this "tactile defensiveness," and regard it as a problem to be fixed. Perhaps it is to some degree, but let's think about it. Preschoolers are very physical. They love and need to use their hands; they learn through touching and manipulating the environment. This is especially so for blind preschoolers who use their hands in place of vision to understand the environment. It is so much so that anything that interferes with their sense of touch - which is a primary perceptual channel - may logically be regarded as hostile or threatening. The strong reaction that is often seen may be considered self-defensive. Such a reaction is natural when a primary sensory channel is interfered with. Don't sighted people get all bent out of shape when their vision is interfered with? Yet, we don't label this rampant behavior "visual defensiveness," and festoon sighted people with the need to deal with regular visual interference. Now, we're not saying that tactile defensiveness shouldn't be addressed insofar as it interferes with functioning, but the logic behind it, as with many enigmatic preschool behaviors, must be respected and considered.

7. Preschoolers are usually extremely perceptive of people's intentions and dispositions. We often underestimate this because of our perceptions of their level of cognitive ability, but much of what can be known about people transcends strict forms of cognitive processing. When we work with preschoolers, it is imperative that we are genuine. We must take sincere pleasure in our interaction, because the preschooler may respond negatively if we don't. That doesn't necessarily mean that we have to be all warm and fuzzy every second. There are times when a little stern insistence is necessary, but this must happen within an established context of warm and respectful rapport. It also happens that we're in our own negative moods sometimes. Here, then, is where our professionalism really needs to come into play. Either we should distance ourselves from our preschoolers until we can pull it together, or, we simply must exercise sufficient professional wisdom and discipline to keep our upset from taking over our instructional relationship with our student. That is our professional responsibility. Sometimes, one might say: "I really want to work with you today, but I need you to keep your voice down, because I'm not feeling well." If we must work with our young students under less than ideal circumstances, we owe it to them to make it clear that it isn't their fault if we're a little edgier than usual.

8. Occasional Tantrums are Inevitable and Important. If the child is throwing tantrums all the time, or even frequently, this is a signal that we may need to change how we're working with the child. Occasionally, however, tantrums are just going to happen. One reason for this is that children need to test us; they need to find out what will happen if they do everything they can to provoke us. It's one way they test whether they can trust us. Or, the child may be very frustrated and overwhelmed for reasons that have nothing to do with us. Another reason tantrums are inevitable is that no matter how hard we try as instructors to observe a child well and meet her needs, sometimes we are going to make mistakes and the child is going to get very upset with us. That's okay; that's life, full of mistakes. Children can learn from mistakes and so can we. Here are some important keys for how to handle tantrums:

a. Remain calm. Calmness can be as contagious as yawning. You may feel very angry and upset yourself when a child throws a fit. Allow yourself to feel whatever you feel; you are not a bad person for feeling angry with this child. Remember, however, that if you dump your anger on the child, you are doing exactly the same thing he is. Keep breathing. Even though it may be hard, think about what you like about the child. Remember any loving feelings you have had for him in the past. Do not resist the fact that the child is throwing a tantrum, even if he does it in front of other adults and you feel embarrassed. Allow the fact that a tantrum is what is happening now. Children seek balance. They prefer instinctively not to be ruffled or upset. Your mastery of yourself may give them the energy they need to pull it together.

b. Remove the child immediately from other children. Tantrums can really disrupt the mood of everyone else. Try very hard not to return the child to the classroom until the tantrum is over. This may be a time to postpone or skip your next student. Though the tantrum may not be our "fault," it is our responsibility to manage.

c. Stay connected to the child. It is important for the child to know that you are still there. Be sensitive to the child's personality; some children like to stay connected verbally, and some physically. We've never met a child who was helped by being left alone or isolated during a tantrum.

d. Prevent the child from injuring himself or others. Remove the child from any dangerous situation. If the child is flailing on the floor, position your body so that he does not strike his head. Get behind him and hold his arms at his sides, if he is in danger of injuring them. Make your movements as calm and matter of fact as you can. If you touch the child in anger, the child will become more upset. If the child may hurt himself or someone else, holding him in a warm embrace may help you both. Be aware, though, that he may try to bite you at first. Do not react in rage. Do not try to reinforce consequences until the child can process. If you position your arm beneath his chin, biting you will be difficult. If it is necessary to admonish the child for throwing a tantrum, this cannot be done until the tantrum is over.

e. Speak calmly to the child. Tantrums are often a response to some inner pressure the child feels, so you want to remove all pressure from him. Forget about whatever you were doing with the child before the tantrum started. Forget about telling him to change his behavior now. Remember that everyone has the right to get upset, and we all do. Adults just express it differently than children out of experience and, hopefully, emotional growth. Now is not the time to try to get the child to talk about anything or respond to anything. Acknowledge his feelings by saying something like, "Yes, you're very mad. It's okay to be mad. You're going to feel better soon." Don't reject the child for being angry at you. (Many people think that this way of handling tantrums lets the tantrum go on for too long. In our experience, tantrums have gone on much longer when we fight them, and get much more unpleasant for the child and for all concerned.)

f. If appropriate, pick the child up and hold him. It's easy to forget how young pre-schoolers really are sometimes, because they sometimes seem to be able to handle so much, and because people often expect so much of them. Try to remember that only a short time ago, they were infants, and that sometimes they may need to be picked up and held like infants. This is especially important to remember with children who were born prematurely (like children with R.O.P.), whose emotional age may be much younger than their chronological age. It's certainly not always the case, but sometimes a tantrum is a way of saying, "I need just to be held and loved for a few minutes, with no one asking me to do anything." Use your best judgment.

g. Note: Sometimes you will encounter children who have a neurological problem or some other problem that causes very intense, almost constant tantrums and self-injurious behavior such as biting themselves or banging their heads. Talk with the child's teacher and other professionals involved in his care about how they handle this behavior.

F. Communication and Bonding: For very young children perhaps more than any other type of client, the quality of bonding and communication is absolutely critical to productive instruction. It is as important as air. The bond with a preschooler must be personal and emotional for productive instruction to take place, because that is how preschoolers derive their feeling of security. Warm and frequent verbal interaction and physical contact is usually the most effective means to achieve this. This may seem unprofessional, and may arouse feelings of discomfort in yourself and among coworkers, but this minor problem in no way argues against the importance of the bond to the child.

1. Spoken Communication: Even for the very young, the sound of a voice and the words spoken can prove fundamental to growth and security. besides the development of an instructional bond, it facilitates the development of language and an understanding of what is going on in the environment. Even if the child is preverbal or demonstrates low verbal ability, he may understand much more than he can express. Even if he doesn't, the sound of your voice still acts as a positive and critical stimulus, especially for blind kids.

2. Physical Expression: Physical expressions are every bit as essential as what we say. Young children tend to receive the bulk of their security through physical contact, and blind kids may be in special need of this at times.

III. FUNCTIONALLY APPROPRIATE ACTIVITIES (QUALITY PLAY)

A. Sensory Development

1. Encouraging cane use: With preschoolers, it is not necessary and is counterproductive to try to drill the student. Preschoolers just won't put up with it. The cane must be understood as a practical tool for the preschooler to show much interest. In general, we're not much concerned about length, tips, grip, or style. Some preschoolers take a great and immediate liking to using a very long cane, so long that both hands may be required to use it. Do not be concerned about development of bad habits; the only really bad habit is lack of use. Poor use can be refined over time. The biggest concerns are that the cane tip stays on the ground and in front. Just remember, a cane is just a stick which even a chimpanzee can learn to use functionally. Here are some good tips for getting preschoolers interested:

a. Model cane use as an instructor. This is one of the most powerful. Preschoolers like to imitate people. They are much more responsive in doing something if they see others doing it.

b. Try using a very long cane if the preschooler doesn't like the one presented to him. Preschoolers often prefer the extended reach and resistance offered by a longer cane. Over time, the cane can be shortened.

c. Try using rigid canes. Folding canes have a funny way of ending up in a backpack or cubby without being used.

d. Don't resort too quickly to pre-cane devices. We haven't usually found them necessary unless the child has other disabilities that affect her ambulation or tactile processing. While a pre-cane device can be useful under some circumstances to encourage movement, they often just get in the way, and the manner of use does not usually transfer very easily to using a real cane. In general, pre-schoolers do quite well with some patience, a very long cane, and good modeling.

2. Auditory skills: Preschoolers love to play hide and seek. Neither you nor they actually need to hide. They just love to find things that make noise. This desire can be easily capitalized on in various games based on hiding and seeking or following a sound source. Also, preschoolers can be encouraged to hide the items themselves. Also, placing a ball into a spare plastic grocery bag is an excellent way to give a ball sound and bring it to life for your preschooler - much better than beeper balls. Echolocation can be encouraged out-of-doors by using a clicker toy. They love to use these things to find buildings and parked cars, and places with echoes.

3. Awareness of gradients: preschoolers often like hills, driveways, and speed bumps. Walking along the speed bump can be a great game. Also, going up and down the driveway, or even finding one's way down the cambre of a street to the curb can be a great game with very functional implications.

4. Visual Efficiency: Preschoolers may like to use low powered magnifying glasses to look at pictures or bugs. A modified scavenger hunt can also be used to encourage them to search for things. A favorite toy hidden in the bushes can be a wonderful encouragement to search.

B. "Children's work is their play."

1. Why do adults work? What do we get out of work? Optimized quality of life (growth, security).

2. Children's play serves the same purposes as adult's work. When their play is impaired, their quality of life also suffers in the areas of growth and security (self-worth).

C. Quality play builds a foundation of security and growth potential for all kids. A colleague once said that she felt guilty sometimes just playing around with her preschoolers. Yes, she worked on specific cane skills and such, but she also spent much time on swings and other playground equipment. But, wasn't it really great of her to engage her students in the development of normal and purposeful play?

1. Through quality play, kids learn basic skills that allow them, in turn, to learn more advanced skills. "Everything I Needed to Know I Learned in Kindergarten." This is true for the movement and navigation process as well.

2. If little blind kids can do all the things with their bodies and minds that little sighted kids can do, more advanced movement skills will come more easily and naturally. For example:

a. How might all the skills needed to ride a tricycle, run, or play with a ball apply to the development of specific movement skills?

(1) Orientation: The child must establish and maintain orientation using a variety of auditory, remaining visual, and tactual/kinesthetic information.

(a) Auditory information may include building lines and location, interior/exterior corner detection, echo perception of other prominent landmarks, and characteristic sounds such as traffic, noises from the classroom, air-conditioners, etc.

(b) Remaining visual information may include perception of characteristic shadowing, lines of contrast such as where concrete meets grass, visual landmark perception, etc.

(c) Tactual/kinesthetic information may include time distance development, sensation of direction and velocity, and recognition of characteristics in the playing surface such as hills, cracks, or terrain changes such as concrete to grass.

(2) Interacting effectively with dynamic surroundings: As one moves, one's surroundings become dynamic. If it is a playground full of preschoolers, the surroundings are probably very dynamic. A ball among preschoolers can be especially dynamic in 3 dimensions. The child riding a tricycle or playing with a ball learns to hone and apply his perceptions to negotiate such surroundings in a way that will apply readily to a wide variety of environments such as suburban travel, light business, mall, etc.

(3) Development of active, purposeful movement: Kids who are discouraged from or not sufficiently encouraged to move tend to develop passive movement styles that lack purpose. Successful movement skills development depends on the eagerness to move and engage the environment with purpose.

(4) Motor planning: The child learns to move his arms and legs in specific patterns in order to go where he wishes. Refined motor planning ability is fundamental to effective movement under any condition.

b. What about swinging or pushing a swing, roller skating, and climbing? These activities may seem unrelated, but the general skills that they develop are similar and very pertinent to good movement. For example:

(1) Gravitational security: Gravitational security is essential for ambulatory grace and confidence. It enables good balance and smooth accommodation to terrain characteristics. It facilitates a natural and effective gait.

(2) Synergistic movement (upper body): Here, we're talking primarily about the ability to coordinate the body in subtle and gross ways to achieve desired results. Swinging and climbing in particular require a fairly complex harmony of upper and lower body movements.

D. Normal play is critical to the development of normal behavior. Blind kids, like all kids, MUST experience freedom and productivity of movement. Any kid whose movements are constricted will develop strange physical and psychological characteristics. There is little reason for blindness to limit movement; society limits movement. How? We punish sighted kids by limiting movement: "You're grounded," "Go to your room." So effective is limiting movement that kids modify their behavior to prevent being limited. We also limit the movement of blind kids: "Stay inside," "you shouldn't be doing that." But, they haven't done anything wrong. Common results of restricting movement include -

1. Diminished movement and navigation skills. Blind kids who have limited experiences with the world in motion develop an impaired sense of space. They lack understanding of how the world fits together and how they relate to it. Such kids become easily lost, they move slowly and with exaggerated caution, and they dislike or are fearful of self motivated movement and new situations or stimuli.

2. Low overall physical capacity (low muscle tone, physical weakness, lack of aerobic stamina, and poor coordination). It just amounts to lack of practice and experience. We simply don't develop ourselves by remaining idle. We know that none of these things need be associated with blindness, because there are many blind individuals who suffered from none of them as kids. Daniel was actually one of the strongest and most coordinated kid his age. He wrestled, hiked, swam, and bicycled independently.

3. Apathy - lack of ambition and initiative. When movement is restricted, children fail to learn that they can act to obtain what they desire. First goes the will to act, then, the desire itself. Kids become passive and reactive, rather than active. They may wait or whine for things to come to them or be done for them, rather than taking the initiative to obtain what they want or need. They may also sit unproductively unless someone is present to prompt and guide their behavior.

4. Self-stimming (hand flapping, rocking, head banging, finger flipping, eye poking, etc). So necessary is movement to physical development that when it is restricted, the body seeks other avenues. Attempting to reduce self-stimming by badgering or restraining the child without providing avenues and motivations for free movement will result in psychological and possibly physical damage. Self-stimming is most easily and reliably reduced by freedom of movement and quality play. The body has neither the time nor the inclination to self-stim when it is otherwise engaged in productive activity.

5. Inappropriately strong reactions to mild circumstances (tantrums, loud voice, wild mood swings, etc). Much of children's play teaches the appropriate channeling of emotions and psychological energy. For example, consider what children do to a ball - kicking, hitting, bouncing, catching, throwing, striking, retrieving. What could be more playfully aggressive, yet, at the same time, perfectly safe and appropriate? Also, the nature of many cooperative and competitive games forces the learning of patience, forbearance, give and take, and other forms of self-management. When children are restricted from such avenues of self-expansion, they develop expressive patterns that are inappropriate.

6. Hands that remain baby smooth. Though characteristics of skin surface vary somewhat from person to person, baby smooth hands indicate hands that haven't done much. Baby smooth hands in children even as young as 8 or 9, let alone teenagers, are good indicators of the nature and degree of activity.

E. Qualities of effective functional activities.

1. Must have immediate relevance in a child's mind. The very young do not perform because they're told to, they perform when it makes sense to do so.

a. A cane may be and often is used naturally by a child to probe the environment. Tip in front and on the ground can become very natural in environments and during activities when safety depends on it. More advanced cane skills come when more advanced travel needs dictate them.

b. During assessments, it will often prove beneficial to use alternate stimuli that achieve the same objectives. For example, some kids hate stringing beads no matter how capable they are. Young kids rarely do anything they hate. In one case, we substituted keys for beads, and the child, who liked to play with keys, performed much better on that task.

c. We also must be careful to ask questions of children in different ways to ascertain their understanding. A child can't perform if they don't understand or can't process the question. We may often obtain better results by asking children to enact rather than verbalize an answer. For example:

(1) When teaching children echolocation, one can put them in a hallway nearer one wall or the other, and ask them which wall is nearer. The goal is not to test distal concepts, but to increase auditory awareness. Many young children may not be able to answer when asked in this way. However, children may be more likely to perform when simply asked to go to the wall that they can touch most easily or quickly.

(2) One instructor mentioned that a low vision student didn't seem to understand the concept of under or over when asked which of two different colored Frisbees was (under/over) which. However, this student was able to place a specified Frisbee under or over another consistently when asked to do so.

2. Must take place in environments situationally relevant to the child (home, school).

3. Must be approximately age appropriate. We use this term lightly and with reservations, because everyone, blind or sighted, mentally challenged or not, develops somewhat uniquely. On the one hand, one should avoid pushing kids too hard or too quickly. It is easy to strip a child's psycho-physical gears by pushing them to do things that they simply aren't ready to do. On the other hand, it is common to see blind kids allowed or even encouraged to lag far behind their potential. We just need to observe each child carefully and without preconceptions or presumptions to determine their real potentials. It may take some experimenting, and will necessitate some mistakes and errors in judgment, but the key is to come eventually to an understanding of where each child is, and how he can progress.

a. Helps developmental sequences to be kept straight and move forward.

b. Helps kids to develop alongside peers.

c. Age appropriate activities happen to coincide roughly with natural child interests.

F. Facilitating functional activities. Getting kids to engage in some activities can be most difficult - especially if the child has a stark history of inactivity or nonfunctional activity.

1. In general we recommend close consultation with specialists pertinent to the child including the Occupational Therapist, Physical Therapist, Recreational Specialist (adaptive P.E., etc.). If the child is having functional difficulties engaging in quality play, and if no such specialists are involved with the child, then we recommend referring the child to relevant specialists for assessment. Usually, this referral must come from the child's classroom teacher, but this referral can carry recommendations from specific specialists. It may be necessary to push the issue at the administrative level. One can insist that movement functioning will not progress unless supplementary therapeutic or instructional services are provided. Getting the parents involved is often helpful here. Supporting parents to advocate for their children is ultimately the most powerful tool, and it can be done with discretion so that one faces little personal risk. If all fails, then informal consultation with such specialists can be helpful if time permits.

2. There is one main thing that anyone working with a visually impaired child can keep in mind when facilitating quality play. That is, be sure that the style of instruction makes ample use of the child's remaining channels of learning. If the child is totally blind, he won't learn to ride a trike or swing himself by watching others. Many children have innate instincts for how to engage in such activities, but others must be shown. One can, for example, place a child in one's lap while swinging, with the child pressed firmly against legs, arms, and upper body. One can point out how one's body moves while swinging. For running or skipping, one can place the child on one's back while engaging in the activity. For tricycling, one can start by placing the child's feet on pedals, and moving the trike forward. One can then apply pressure to the child's feet against the pedals. With all these examples, it may help to place a sound source in the environment such as a radio, so that the child has a clear frame of reference in which to gain a sense of movement. Some kids won't see any reason to engage in an activity if they don't know they're moving.

3. Joint lessons can really help motivate young children toward appropriate, spontaneous, quality play. They can also motivate the instructor toward a nervous breakdown. The instructor needs to have a pretty firm idea of what he'd like to see the students get out of it, and he should know the children involved well. In general we do not recommend taking more than two children at a time younger than 5 on a lesson without additional assistance.

4. We suggest incorporating music as much as possible into lessons. Songs, instrumentation, and musical games can expand the spatial world for all children, and, perhaps, blind kids especially.

a. Tends to act as a wonderful stimulus for movement. Human beings and other mammals have used music for art, communication, and other functions since the dawn of time. And, for the most part, music is intimately bound-up with movement. Music's relationship to movement may well be an integral factor in our genetic make-up. The use of music may well have a decisively stimulating effect on the development of neural pathways related to movement.

b. May also facilitate the development of auditory processing. Emersion in music may be analogous to emersion in the acoustic environment. The world is like a huge symphony, with every note and chord holding a discrete meaning, and a key to functioning. Understanding music may well assist in developing the capacity to understand and interact with the auditory world.

G. Lesson Planning: Formal lesson plans are a big part of learning to construct and execute effective, relevant lessons. It is imperative that an instructor maintain control over the lesson and move the lesson productively forward. Prior planning helps with this. However, maintaining control over a lesson may mean something very different with preschoolers than with older children or adults.

1. Structure: It is important that the child know what is expected of them. We all have boundaries, and we all face limits to our actions. Children are still in the process of learning these boundaries and limits, and they will test. Very young children also tend to react more from inner pressures than external ones. The instructor needs to make clear to the child what these boundaries and limits are, not by being bossy or harsh, but by being consistent, predictable, and fair. The instructor may have rules and structure to help guide the learning process, but there is a difference between facilitating a child's growth, and trying to control the child. Children will not do what they do not wish to do. They may go through the motions out of fear or conditioning, but learning is greatly reduced or absent under such circumstances. One may "make" a 3 year old move a cane back-and-forth, but if the 3 year old isn't motivated internally to do so, the only thing he may learn is that movement and navigation training is "stupid," and the instructor's a "jerk." We have heard children use these terms.

2. Flexibility and Adaptability: One must bear in mind that when dealing with preschoolers, the greatest success occurs when the instructor incorporates the child's current frame of mind and interests into the instructional moment. One must learn to "go with the flow." If a child has had a poor night's sleep, or an upset in class, or is excited after an especially inspiring activity, the instructor must account for this in presenting the lesson. The child may not be very capable of conforming his mood to the instructional needs. The instructor, therefore, must work around the child. This does not mean letting the child always dictate what happens. It just means that the child's current mood and needs must be considered in the instructional moment, because the child will not likely be able to put them aside no matter how strongly encouraged or coerced. One can work one's goals and objectives into a wide variety of child-centered activities if one is able to be creative.

3. Preparation and Record Keeping: It is most difficult with preschoolers to plan a lesson formally, because one cannot anticipate what a preschooler will be inclined to learn at any given time. Further, it is impractical and unsafe to try to review plans and take notes while managing the learning experience of a preschooler or two in an open environment. We recommend maintaining a solid grasp of each child's whereabouts and progress, along with a general knowledge of the child as a person. Also, maintain a strong awareness of characteristics and changes in the surrounding environment, and let the opportunities of the moment inspire the lesson. The lessons are still governed by what the child needs to learn, but the specific activities used to develop these skills may vary according to situation and circumstance. Wait until immediately after the lesson to take notes. Even the most die-hard organizationalists have found working with preschoolers to mandate a little informality, and a lot of flexibility.

4. Timing: When planning and conducting lessons, it is vital to time lessons for maximum effect. We recommend rarely taking preschoolers away from favorite activities for movement instruction, unless the child prefers mobility. Also, waking a child up from a nap for movement instruction is a nonproductive idea for many preschoolers. They just won't perform well; many adults don't either. Speaking of adults - This issue of timing applies to the instructor as well as to the child. We must remember to schedule time for breaks, meals, etc. Preschoolers can take a great deal of physical and psychological energy. The instructor should remain centered and focused when dealing with preschoolers. A frazzled instructor will usually result in frazzled interaction.

IV. INTERDISCIPLINARY INTERACTION

A. Collaborate frequently and regularly with all members of the service team. This is especially important with multiply disabled children whose situation may involve complexities far beyond our knowledge or expertise. We must be willing to accept that we don't know it all. For the benefit of the child, we must recognize what we don't know, and seek out that knowledge for productive application. Our education didn't end with our diploma; it scarcely began.

1. Collaborating with others is a great way to learn about the whole child. Learning about the whole child is necessary if what we do is to generalize to all pertinent aspects of the child's life. It is also necessary in developing a sound knowledge base about the child.

2. Nothing is ever taught well in a vacuum, because all activities and interactions are always affected by all other activities and interactions.

a. With one blind child with a hearing impairment, the OT and O&M Specialist held very different views on the nature of the child's perception. The child wasn't responding to the OT, and the OT felt that the child couldn't hear her. The O&M was doing a lot of work with auditory orientation and knew the child could hear sufficiently well to respond. The discrepant perspectives ironed themselves out amiably when the two finally got together to work with the child.

b. With two other children on walkers, the O&M Specialist felt they could function without their walkers. The O&M is not qualified to train kids to walk, but can facilitate referral to those who can, and can work with qualified professionals to develop walking during O&M. In both cases, the children are now walking without walkers.

B. Special attention must be given frequently and regularly to the family (parents, siblings, extended family.) Family can undermine or greatly enhance what we do as service providers. Without support from the family, what we do has little impact. Most of what any child learns either comes from the family, or is heavily influenced by the family. If that context is of quality, then quality learning takes place. What we do goes 10 times further when the family is actively with us, and can be 10 times diminished when they're against us or indifferent. A child's progress can often be greatly enhanced by involving their parents and siblings in lessons of cane travel, echolocation or vision training, or play development. It helps to make family visits frequently, and to send videos home on a regular basis. Sometimes, the family has absolutely no idea what their blind child is capable of, and sometimes, neither do we. It isn't our job to be "the one" to make or break a child's development; it is our job to help others more involved with the child to be "the one." In the case of the blind child with a hearing impairment, the parents dragged their feet about getting him hearing aids. They just kept insisting that this 5-year-old couldn't talk or interact appropriately because he was blind. One day, we introduced the parents to a blind boy of the same culture and age whose level of functioning was completely normal or above. The parents were astonished, and vowed to do more for their son.

V. KIDS ARE COOL! Perhaps we would have done better to place this topic first on this handout, because we feel it to be the most essential. It is important to remember that kids are smarter, more aware, and heartier than we often realize. They often know what's best for themselves, even if they're unable to express it in ways that we readily understand. One of our primary jobs is to make all options and opportunities available to them so that they can make informed choices, rather than controlling or constraining their options. We must also remember that young children, especially blind children, may be vulnerable to long term injury resulting from poor choices that are made for them. Placing too many controls or constraints, like forbidding a blind child to climb a tree, only hampers the development of her creativity, ingenuity, and inner strength. Encouraging her to climb the tree informs the child that this and many other wonderful opportunities are available to her. Remember, if the generation following us is not better, stronger, and wiser than we, then we, the current generation, have failed in our primary duty to life.