Strategies for Assessing and Teaching Students with Visual and Multiple Disabilities

Chapters:

1. Introduction
2. Understanding How Sensorimotor Stage Learners Acquire Information
3. Assessing Sensory Needs of the Learner with Multiple Disabilities
4. The Levels of Sensory Response
5. Strategies for Progressing Through the Learning Stages
6. Creating Attainable IEP Goals
7. Moving from Function to Symbols and Meaning

CHAPTER 1: Introduction

SMITH: Cognitive development is a process. And we used to think of capacity for learning being something that was innate and static. You could measure it, that's what it is, that's what it was for the rest of your life.

What we know now, mainly as a result of research in cognitive psychology and neurobiology is that that's not true. Cognitive development is a process. And what every person in the field of visual impairments needs to be aware of is the incredible significance of visual impairment on cognitive development.

And it's because of the fact that the first step and the process of cognitive development is the acquisition of sensory information. Learning begins with acquiring sensory information. If a person can't acquire high quality sensory information, the learning process stops right there.

So after sensory information is acquired, the next step in the process is storing that information, and then retrieving it when you need it, and using it. That's what learning is. That's cognition. No sensory intake, no gathering information through sensory channels, no cognitive development.

A long time ago, Jean Piaget talked about cognitive development in terms of global stages of cognitive development. And most people are aware of that. But a lot of people haven't thought about the impact of that in reference to sensory efficiency.

So the first stage of cognitive development, the skills that, typically, developing children learn from birth to about two years old, is what Piaget called the sensorimotor stage of development. And here's what happens at that stage in regard to learning. The primary behavior of learning at the sensorimotor stage is exploring.

NARRATOR: In a photograph, we see an infant engaged in an exploratory interaction with a simple toy. The infant has a plastic ring with several large, colorful, key-shaped objects attached. The infant has the ring in his mouth while one hand grasps the keys.

SMITH: And what the sensorimotor stage learner, the typically developing infant or toddler does, is that they are attracted to the things in their environment. Anything they are attracted to, they go and immediately find out two things about it.

What is it like, what does it smell like, what does it taste like, what does it look like, what does it sound like, what does it feel like when I touch it, so they're busy answering the what is it like question. And then they ask the other major sensorimotor question, what does it do. And with that knowledge, what is it like and what does it do, they develop the basic concepts that make them able to understand the world that they live in.

So that's my goal. That's every teacher of the visually impaired's goal. That's every educator's goal. For any individual who is at that stage of development, regardless of how old they are chronologically, what they need are the sensory experiences that allow them to make sense of the world they live in.

 

CHAPTER 2: Understanding How Sensorimotor Stage Learners Acquire Information

SMITH: The primary sensory system at the sensorimotor stage is always touch, and vision becomes, through that period of development, more and more important as time goes on, but even as vision becomes more important, touch remains either more important or as important.

There's a wonderful new wealth of information about where tactile learning starts before — for object recognition where tactile skills need to start, and it's from the research of two people in our field, Klatzky and Lederman. And what they did was they looked at what tactile learners do with their hands to inquire enough tactile information to recognize an object.

And it turns out there are six basic things tactile learners do with their hands in order to recognize people, objects, and their environment. The six exploratory procedures that Klatzky and Lederman identified are lateral movement, just back and forth movement of the fingers, or, if hands are not available, the same thing can be done with the lips and the tongue, or, for that matter, with the toes or foot.

Static contact for temperature is another one, and that's just leaving the hand or the mouth or the foot on something long enough to get information about its coolness. And temperature information is a very important part of object recognition.

So another one is unsupported holding, and that's just holding something in space, which can be done in any of the modes. And that gives information about weight. Another one of the tactile procedures is enclosure.

It's done best with two hands, but it can be done — you can get good information with one hand if the learner can't use both hands, and that's information about global shape. Another one of the procedures is pressure, and that's for information about density, find out if the object is hard or soft.

And the last of the six procedures is called contour following. And contour following is taking the tip of the tongue or one finger and actually following around edges and different internal detail characteristics of an object.

NARRATOR: In a photo, we see an infant girl who is visually impaired, on her back, grasping a toy in her hands. The girl stares at the toy, a blue plastic ring with several large, brightly colored shapes attached.

She holds one of the shapes, a red disk, in her right hand. She is employing all six tactile exploratory procedures in getting sensory feedback.

SMITH: This is why the role of a teacher of the visually impaired is even more important than it might be otherwise for an individual at this stage, because in the education community, a teacher of the visually impaired is really — other than an occupational therapist — the only educator who really knows about the tremendous significance of the tactile sensory system and how to facilitate learning with that system. Teachers of the visually impaired know about that because of braille, pre-braille, they know about tactile learning.

So what we do for the sensorimotor stage learner is apply the significance and the importance of tactile learning to the learner who is learning about his own body, objects in his environment — people, objects, actions, and places. That's the curriculum of sensory motor level learning. And all of those things need to be learned about visually and tactually. The TVI has to ensure that the information intake in those two sensory systems is highly efficient.

 

CHAPTER 3: Assessing Sensory Needs of the Learner with Multiple Disabilities

SMITH: I've developed a product for the American Printing House for the Blind to be available to teachers to help them address the needs, the sensory motor needs of learners of any age who are at that stage of development, and the product is called a sensory learning kit. And it is available to teachers to help them do two things, assess the needs of the sensorimotor stage learner with a visual impairment and to apply the teaching strategies that have been shown to be the most highly effective for individuals at that stage of development.

So one of the tools in the sensory learning kit is the sensory response record. So in the sensory response record, the primary assessment items used are objects. So objects that have strong auditory qualities are presented, objects that have strong visual properties are presented, tactile properties, olfactory properties, gustatory properties.

And the teacher watches the learner's response to the presentation at each learning media item, assesses it, first of all, in terms of whether the response was a positive or negative one, because only learning media items that elicit a positive response can be used for instruction at the sensorimotor stage.

There are neurological reasons for that. You can't maintain attention and you can't engage intentionality in cognitive processing without items the learner perceives as attractive. So there's a lot of emphasis on finding attractive learning media.

NARRATOR: In a photograph, we see the contents of the sensory learning kit that Millie Smith developed. Items that can be used to evoke a response in sensory motor learners.

These items commonly elicit a positive response, but TVIs and parents are encouraged to introduce and use other objects to which tactile learners respond positively.

SMITH: A teacher looking at the tactile sensory system will present something like an object that vibrates, and assess the learner's response to that kind of tactile input.

If it's a positive response and if it's a strong positive response, then an object that vibrates becomes a topic for an instructional activity. The teacher looking at the visual system might take an object like a mirror, and see if, when the mirror is presented, the learner has a strong positive response to the light refraction and the movement reflected in the mirror.

If it does, then the mirror can become a topic for an instructional activity. A teacher looking at the auditory system might present something like, sing to the student, human voice, and see what the response is. Or a musical instrument.

Items are presented, several, at least five, in each sensory system. The learner's responses are assessed in terms of positive or negative, and also strength of response, both positive and negative. Items that get a strong negative response are never used for instruction. Items that gets a strong positive response are used as topics for instructional activities.

 

CHAPTER 4: The Levels of Sensory Response

SMITH: In the sensory learning kit there are four response levels, based on how the learner interacts with the media.

There's attention level. Did the learner just quietly pay attention to thesensory input as it was presented by the teacher?

Second, did the learner try to interact with the learning media? That's called the exploration level. It's very exciting when learners are at that level, because what they're trying to do is interact with the media and get more information about what is it like. That's called exploration, and that's the primary behavior for learning at the sensorimotor stage.

The third level is function, and that's when the learner not only tries to explore the object by touching it, looking at it, tasting it, smelling, usually they do everything they can do with it to get as much information about it as they can, or you hope they do.

Then the next level of graduation is function. So when you design an instructional activity with a highly attractive learning media object, what you're going to do is start at their present level, which might be attention, and target your skills at the next level up, exploration.

NARRATOR: In a video clip, a TVI is presenting an object to a young girl who is visually impaired and multiply disabled. The TVI uses a flashlight to draw the girl's visual attention to the object, a plastic bottle with dry beans inside.

The girl sits upright in a wheelchair, supported by a harness. Once the girl demonstrates attention to the bottle, the TVI holds the bottle within the girl's reach, and she begins to explore it with her own hands, eventually holding the bottle on her own and shaking it vigorously.

She is exploring it tactually as well as receiving auditory feedback from the sound of the beans in the bottle.

[RATTLING BEANS]

SMITH: So you're going to try to move that learner from paying attention to something they find attractive to interacting with it and exploring it and getting more sensory information about it.

If their present level performance is at the exploration level, then you're going to target skills for them and their instructional activities at the function level, where you're trying to teach them what the object does.

An example of that would be if a learner pays attention to me when I bang a spoon on the tabletop, they're interested in the sound that they're hearing. And that's good, because we have to start with attention.

If I can get attention with banging the spoon, then what I see is, can I get the learner interested in exploring the thing that made the sound? Can I get them interested in exploring the spoon? So what I'm going to do is, I'm going to start off with that spoon, with that learner that I want to move from attention to exploration by coming underneath his arm and banging the spoon.

He's going to feel that I'm doing something with that object. What I want him to do is become interested enough in what it is that I'm doing with something, that he brings his hand down and feels what's in my hand. He begins to explore that object.

So I use what it is he pays attention to as the motivation when I gave him access that the object that's making the sound to feel what that object is. So then I'm beginning to explore.

If a sensory motor learner has a severe motor impairment, they can't use their hands for exploration, what I'm going to do is present that object up on the side of the face.

And what I want to happen in that case is for the learner to move his mouth toward the object and explore it with his lips and the tip of his tongue. What is that thing that's making that sound like? What is it like?

Now, he still doesn't know it's a spoon.

One of the highest level skills you're looking for, what you're trying to teach at the exploration level, is imitation.

So if I can get that learner to imitate with that object what I'm doing with that object, then the next place I want to go from there — well, at that point, he's banging. He's making the noise, and that's hugely significant.

But I don't want to stop there either. Just like we never want to leave the learner just staying at the attention level, a learner who achieves exploration level goals, we don't want to leave him at the exploration level. We're trying to move him ahead to the function level.

So here's when an interaction with an object becomes function. If at some point I can facilitate learning, I can create an instructional activity that allows this learner to understand that a spoon is not a banger. One of the things it does is bang, but when I move into function, I want him to know that a spoon's not a banger. It's a tool you use to eat with. So with the function stage, that's what I'm going to teach.

 

CHAPTER 5: Strategies for Progressing Through the Learning Stages

SMITH: The instructional strategy that's highly effective for sensorimotor stage learners is the sensory motor routine. The sensory motor routine is an instructional activity that's designed precisely to meet the needs of an individual learner.

So a sensory motor routine for one learner at this stage of development is going to be absolutely unique to that learner, and it's based on that assessment we do of his sensory learning characteristics.

In order for an instructional activity for a sensorimotor stage learner to be consistent, it has to be designed so that everything that happens within the time span from when instruction begins until it ends, happens exactly the same way every time.

That's why it's called a routine, and that's a research-based neurological need, that's not just a preference. It's dependent upon how long they can maintain attention. It's dependent on how much sensory information they can take in, assimilate, and organize neurologically in a given time span

It's dependent upon how many objects they can deal with within one activity. Can they can explore one spoon in an activity, can they explore three or four spoons? It depends on how long or how well they can interact with the object they're trying to explore. It takes a whole team of people to design that kind of instruction.

It won't be successful unless the TVI can contribute information in the design of the activity related to sensory efficiency.

It won't be effective unless the physical therapist can contribute accommodations for the activity that create access to the objects for the learner.

It won't be successful unless the occupational therapist can contribute accommodations for sensory issues like complexity.

It won't be successful unless a speech language pathologist can talk about what kinds of communication modes need to be in place for the learner engaged in the activity so that they can tell you when they want more of something, when they want less of something.

Otherwise you get into frustration and withdraw from the activity and learning ceases. So the communication pieces, the access pieces that are part of the work of occupational physical therapists, and the sensory efficiency pieces that's the domain of the TVI, all of those things have to be accommodations that are built into the instructional activity in order for learning to occur.

NARRATOR: In a video clip, we see an example of a sensory motor learner who uses a routine to complete a complex task. An adolescent girl who is blind and multiply disabled is sitting at a desk at snack time.

Her calendar sits in the upper left corner of the desk. Her TVI has introduced a blender canister, and together they will make a fruit smoothie for her snack.

With some assistance, the girl pours apple juice from the pitcher into the canister. Next, using a hand-under-hand technique, the TVI places a cup of pineapple pieces on the desk.

As the foil cover of the fruit is peeled back, the girl rocks back and forth and waves her hands excitedly, perhaps smelling the pineapple as well as anticipating the next steps.

Together, they add the contents to the canister and the TVI screws the canister base with the blender blades into place the TVI briefly presses the canister down to engage the motor and then stops, waiting for the girl to place her hands on the canister.

The motor is then reengaged. As the smoothie is being blended, the girl leans in and places her forehead on the vibrating canister, a sensation she apparently enjoys. When the girl removes her hands, the TVI removes the canister and places a plastic drinking cup on the desk.

After the girl drinks some of her smoothie, she is asked if she wants more. She signs that she would like more, so together they pour the remainder into her cup for her to drink.

Finally, the cup is placed into a small basket, signaling the end of snack time.

SMITH: When a sensorimotor stage learner is introduced to an unfamiliar object — and it's our job as educators to make sure that they are introduced to unfamiliar objects — our job is to make sure that their development of knowledge about the world around them consistently includes more people, more objects, more actions, more places.

We need to make sure that they do encounter new objects and expect that when they encounter an unfamiliar object, person, action, or place, they are going to go back to attention, work their way up to exploration, and then achieve function again.

And the good news is, the more that happens, the more sensory motor routines they have, and the more they happen, the more new objects they encounter, the length of time it takes them to move through that sequence with a new object or a new person or a new action or a place get shorter and shorter and shorter. They literally become more efficient learners.

 

CHAPTER 6: Creating Attainable IEP Goals

SMITH: One of the difficulties that teachers have encountered in regard to using the goals in the IEP as an accountability tool for showing that learning has occurred for sensorimotor stage learners is that it's very difficult to write attainable goals for the learners who are, what I think of as the most fragile learners.

Those who have the most difficult and complex challenges to learning. So it's very, very important to think about what should be in those learners' IEPs so that we can actually document for them that learning has occurred.

So in the most challenging situation, I think of those learners who are medically fragile and who spend a great deal of their time in what neurologically, we call extended states. And extended states are where learners are before they achieve attention.

I talked about the SLK levels of learning being attention, exploration, and function. Well, there are many of our learners who we have to do an intense intervention to get them from extended states to attention.

There are four extended states. There's sleepy-drowsy, and our medically fragile learners who take a lot of medications for different things, seizure disorders, whatever it might be, gastrointestinal distress, you name it, it's a struggle for them to move from an extended state to attention. We have to have ways to facilitate that.

On the other end of the spectrum, there are those learners who are fussy and agitated most of the time. And those are also extended states. We have to have ways of facilitating movement for them from those extended states to the neurological state in which they can maintain attention, because that's where learning occurs.

That state where learning occurs, we call attention or alertness. So our job is to move our learners who are sleepy and drowsy up to attention alertness, and our learners who are fussy and agitated, maybe engaging in things like self-injurious behaviors, or very, very intense self-stimulatory behaviors like hand in mouth, things like that, down to attention alert. Is that something that can go in an IEP? Can that be an IEP goal?

NARRATOR: We see one of the initial interactions between the girl and the TVI at the beginning of this activity period. The girl has recently arrived from another classroom.

The TVI has placed the music cassette in a black tray to present to the girl, but she is distracted, chewing on a pink face cloth that she uses to self-soothe.

The TVI gently removes the cloth from the girl's mouth and attempts to draw her attention to the cassette, moving it around within the girl's visual field. Eventually, the girl's gaze settles on the cassette.

She is now in the state of attention.

SMITH: For a learner whose present level of performance is extended states, one of their IEP goals — it shouldn't be their only one, but one of their IEP goals absolutely has to be to achieve attention. So the second goal for the attention level — the learner graduated from extended state to attention. The first one is to achieve and maintain attention, the second one is to anticipate the second of two closely associated events.

I'm going to participate in a hand motion routine. And in the hand motion routine I'm going to learn lots of different things. But one of the things I'm going to learn is that after I smell lotion, somebody is going to touch my hand. And I don't startle and I have a seizure when it happens because I can anticipate it. Pretty important goal.

So at the exploration level, our goals become more sophisticated, but they're still in the IEP, and they're incredibly important. I, personally, think of the exploration level as pre-pre-braille.

 

CHAPTER 7: Moving from Function to Symbols and Meaning

SMITH: We have to introduce the third question for the learner.

The first question for the learner was what is it like.

The second question for the learner is what does it do. Sensorimotor stage questions. The pre-operational question that begins to be a part of learning in the transition in end of sensorimotor to the beginning of early pre-operational.

The third question is what's its name. So in thinking about helping learners design instruction, for learners who are in that transition from sensorimotor stage, what is it like, what does it do learning, to that 18 months to about three-year-old, late sensorimotor, early pre-operational learning, there were two things that had to be addressed.

Addressing those became a new product, and the new product is called SAM, symbols and meaning. SAM, symbols and meaning is designed to teach two things. It's designed to answer the what is its name question, and it's also the time to expand concepts.

NARRATOR: We see a photograph of the items included in the symbols and meanings kit available through the American Printing House.

The SAM guidebook provides strategies for developing a strong sensory foundation for concepts about people, objects, actions, and places, so that symbols referring to them are more meaningful to the child.

SMITH: Now we're talking about developing concepts for, concepts about, and understanding the language used to name common objects, and an ever-widening variety of objects, including those that become the things that are more commonly in environment.

At this stage, what we want is for the learner to develop an incredibly important word. We want the learner to develop coherence for his world. And believe it or not, this is a research-based word. There's a lot of work going on regarding coherence right now in neurobiology and cognitive psychology.

Coherence is the feeling that you understand what's happening in your environment. Individuals with sensory loss and additional disabilities, far too frequently are in environments where they have no coherence.

They hear things happening, they see things happening but their vision is impaired, they aren't sure what it is.

They touch things, or even worse, people are constantly coming and touching them they don't know what's touching them or why it's touching them.

They live in an incoherent environment. The result of experiencing too much incoherence — and this is the neurobiological piece of the research — the result of experiencing too much incoherence is withdrawal. Role

So if we want our learners to understand the environments that they're in, we have to use the strategies and techniques that are in the product called SAM to create coherence for what's going on in their worlds.

So the ability of an individual with visual and multiple impairments to continue to learn in more complex environments, which they encourage at this stage of development, depends on their ability to create coherence in that environment.

What we're going to do is we're going to establish a direct sensory relationship for what they hear by having them touch the object that makes the sounds they hear and engage in the action with the object that produces that sound. So that's one SAM strategy.

The other thing that's incredibly effective at creating coherence is having the ability to understand what is going on and what something is by having somebody tell you. That's called receptive vocabulary. Receptive vocabulary.

So SAM teaches two thing. Concepts for what's happening with objects, what people are doing and what's happening with objects in the environment, concept development.

The second thing SAM works on is receptive vocabulary, so that when somebody is sharpening a pencil in another part of the room, somebody can say to you, pencil sharpening, and the learner goes, oh. I've got coherence for that.

I don't have to be worried. I don't have to worry that it's going to move like the vacuum cleaner and come over here closer to me and then I don't know what it's going to do. The world can be a very scary place without coherence.

Receptive vocabulary in SAM — and there's a specific teaching strategy for doing it — is called joint attention. Here's why a lot of the language used by learners at this level of development becomes limited functional language.

There's a kind of a pervasive phenomenon among learners with visual impairments and cognitive challenges called echolalia. And what that means is, they enjoy saying words and they say a lot of words, but that doesn't necessarily mean they understand the meaning of the words that they say.

SAM teaches teachers to establish meaningful words by having joint attention not established through vision, but established through touch. If you give the learner a word for an object or an action while both of you are paying tactile attention to it, then you run much less risk of developing echolalia. Joint attention is the key piece.

SAM has procedures and strategies for making sure that receptive vocabulary can be developed meaningfully. At that point, you can increase coherence dramatically. Something happened in the room, and you have words, you have receptive vocabulary for people and actions and objects, and you can say, Susie sharpen pencil. And then the learner goes, Oh yeah, I understand now.

The learner can only have coherence for Susie sharpens pencil, the receptive vocabulary piece of it, if he has also been taught the concept of pencil sharpening. So that will only have coherence if the learner actually has the experience of developing a concept for pencil sharpening by going to the pencil sharpener, holding the pencil, and sharpening it.

That's also part of what gives the words meaning. The sensory tools for object identification never change, regardless of the level of the stage of cognitive development the individual is in.

A college graduate who goes into a biology lab for the first time has to use all of his sensory learning skills to identify the new objects he encounters in that environment. It isn't a product of cognitive disability either. Gifted learners have to use all those sensory strategies to identify the objects they encounter. So the sensory strategies never go away.

NARRATOR: Perkins offers an online class based on Millie Smith's teaching strategies for sensorimotor stage learners. More information is available at perkinselearning.org.