Visual Impairment

What is the Legal Definition of Blindness and Low Vision?

 Legal Blindness – vision of 20/200 or worse in the best eye, with the best possible correction OR field of
vision limited to no more than 20 degrees (does not equate to total blindness)
 Low vision – vision of 20/70 to 20/200 (also called partial sight)
 Visual acuity – how sharp visual images are perceived
 Visual field – the scope of what one can see without turning the head or moving one’s eyes
What is the IDEA 04 Definition?
 Visual impairments including blindness are defined as “vision that, even with correction, adversely affects a
child’s educational performance. The term includes both partial sight and blindness.”
What Else Should I Know About the Definitions of Blindness and Low Vision?
 Legal definitions emphasize visual acuity and residual vision.
 Teachers should be concerned with how well a student can use residual vision and the impact on
educational performance.
 Students with low vision may be able to use printed materials (for example, large print books).
 Students with blindness may need to learn through means other than printed materials.
 Individuals with the same visual acuity can function differently in the same classroom.
What are Some Causes of
Blindness and Low Vision?
 Optical defects
 Refraction – focusing light as it passes through different components of the eye
 Refractive errors are more common and include:
 Astigmatism – focusing problems whether stimuli are near or far; usually present at birth; may cause
headaches, nausea or tired eyes
 Hyperopia – can see better at far distances than close up
 Myopia – can see better at close range than at distances
 What are Some Causes of
Blindness and Low Vision?
Ocular Motility Defects
 Nystagmus – eyes move abruptly in continual jerky types of involuntary motion; may cause the
student to tilt or turn his/her head to try to see better
 Strabismus – any deviation in the alignment of the eyes as a result of muscle imbalance or
neurological condition
 Amblyopia – suppression of images which causes a blurred image in either or both eyes (“lazy eye”);
can lead to permanent vision loss if untreated

What are Some Causes of

Blindness and Low Vision?
 External eye problems can affect the orbit, eyelids and cornea
 Growths, thinning, or inflammation of the cornea can lead to problems with vision, pain, and tearing of the
cornea
 Internal eye problems can include Retinopathy of Prematurity (a possible complication of premature birth
 Cortical visual impairment – vision loss associated with brain damage
What are some Possible Characteristics of Students with of Blindness or Low Vision?
 Intellectual Characteristics: The ability to see may have little or no effect on one’s general intelligence.
 Play and Social Interaction Skills: These may be delayed.
 Language and Concept Development: Language does not appear to be significantly affected for many
students. Association of words with concepts and understanding concepts may be difficult without hands-on
experiences.
What are some Possible Characteristics of Students with of Blindness or Low Vision?
 Academic Achievement: When considering achievement, assessment methods should be considered.
Students with blindness or low vision can succeed in academics at the same rate as their peers.
 Perceptual Abilities: Visual perception may be significantly affected and include orientation, mobility, and
wayfinding
 Psychological and Social Adjustment: These areas may be affected including social isolation and negative
reactions from peers
What Should I Teach Students with Blindness or Low Vision?
  Regular curriculum + expanded core curriculum to address their needs specific to their vision loss
 Expanded core curriculum may include skills needed in the core curriculum at a greater depth than sighted
peers or skills sighted peers would not need
 Self-advocacy and self-determination skills
How Should I Teach Students with Blindness and Low Vision?
 In general, students with blindness and low vision should learn the same information as general education
students although more time and accommodations might be needed.
 Counseling to deal with reactions from others
 Possible teaching of care for prosthetic eye
 Adaptations for color or visual discrimination problems
 Responding to traffic signals, etc.
 Provide a copy of teacher’s notes
 Read aloud
 Supply audio tapes/CDs of print materials
 Use hands-on models and manipulatives
What Types of Instructional Technology Can be Used?
 Use programs to magnify computer screens.
 Scan materials for access.
 Provide Braille if the student uses it.
 Always use captioned videos.
 Use of a guide dog may be needed.
 May scan in materials and use a synthesizer that reads the text to the student
 Voice recognition software applications
What are Some Considerations for the General Education Teacher?
 Request large print materials in advance.
 Get training on the use of optical devices and software.
 Encourage student relationships and interaction.
 Support emotional and learning needs.
 Provide daily cues.
 Consult with vision specialist regularly.
 Use tactile materials.
 Reduce glare on materials.
 Speak in normal tones.
 Tell the student when you are leaving the room.
 Maintain high expectations and give regular feedback.

Hearing Impairment
Hearing impairment refers to a defect or damage to the hearing mechanism which may occur in any part of the ear.
It leads to hearing disability or loss of hearing which may range in severity from mild to moderate to profound.

Classification of Hearing Impaired:

• Based on degree of hearing loss-
– Mild (db 26-40)
– Moderate (db 41-55)
– Severe (db 56-70)
– Profound (db 71-90)
– Near total deafness (db 91 and above)
– Total deafness ( No Hearing)
Time of onset
 Congenital: present at birth
 Acquired: obtained after birth
 Adventitious: acquired after birth
Time Course
 Acute: sudden onset/short duration
 Chronic: long duration
 Sudden: rapid onset
  Gradual: changes slowly over time
Time Course
 Temporary: limited duration
 Permanent: irreversible
 Progressive: advancing
 Fluctuating: changes in degree over time
Number of Ears Involved
 Unilateral: Just one
 Bilateral: Both
“The ear is not as sensitive as normal in detecting sound”
 Types:
 Conductive
 Sensorineural
 Mixed
Conductive Hearing Loss
“Caused by an abnormal reduction or attenuation of sound as it travels from the outer ear to the cochlea”
Sensorineural Hearing Loss
“Caused by a failure in the cochlea to transduce the sound from the middle ear to neural impulses in the VIII Nerve.”
Mixed Hearing Loss
“A loss with both a conductive and sensorineural component.”

Causes of Hearing Impairment-

• Long-term exposure to environmental noise
• Genetic
• Disease or illness
• Medications
• Physical trauma
Care and Training of Hearing Impaired-
Parent’s responsibility –
• Early identification of hearing impairment
• Timely referral of cases.
• Acceptance of the impaired child.
• Sharing responsibility for training of the child.
• Encouraging the child to use hearing aid regularly.
• Preparing the child for integration in the school.
• School’s responsibility-
Three methods of training deaf children-
1. The Manual method
– Finger spelling
– Sign language
[Link] Oral method
– Lip reading
– Auditory training
3. Total communication method.
Role of teachers in managing hearing impaired children-

• Advise parents for medical treatment of the child.

• Attend short term training to know and adjust with the implications of the handicapped.
• Develop positive attitude.
• Keep auditory and visual distracters to the minimum.
• Ensure proper seating arrangement in class.
• Ensure use of the hearing aids.
• Encourage questions.
• Adapt curriculum to needs of the child.
• Give opportunities of equal participation in class.

Understanding Students with Communication Disorders

Speech Language Disorders
• Speech disorder
• Language disorder
• Receptive language disorder
• Expressive language disorder
Phonology
• Use of sounds to make meaningful syllables and words
• Encompasses the rules and sequencing of individual speech sounds (phonemes)
• Study and use of individual sound units in a language and the rules by which they are combined and
recombined to create larger language units.
• Phonemes are the unit of sound such as /s/ or /b/ , they do not convey meaning.
• Phonemes alter meaning of words when combined (e.g., sat to bat).

Phonological Deficits
• Frequently appear as articulation disorders.
– Child omits a consonant: “oo” for you
– Child substitutes one consonant: “wabbit” for rabbit
– Discrimination: child hears “go get the nail” instead of mail
What is Morphology?
• The system that governs the structure of words
• The smallest meaningful unit of speech is called a morpheme
• Adds plurals, inflection, affixes, and past tense markers to verbs
• For example: changes “swim” to “swam”
Syntax
• Study of the rules by which words are organized into phrases or sentences in a particular language.
• Referred to as the grammar of the language and allows for more complex expression of thoughts and ideas
by making references to past and future events.
Syntactic Deficits
• Lack the length or syntactic complexity (e.g., “Where Daddy go?”).
• Problems comprehending sentences that express relationship between direct or indirect objects.
• Difficulty with wh questions.
Semantics
• The larger meaning component of language.
• More than single words, includes complex use of vocabulary, including structures such as word categories,
word relationships, synonyms, antonyms, figurative language, ambiguities, and absurdities.
Semantic Deficits
• Limited vocabulary especially in adjectives, adverbs, prepositions, or pronouns.
• Longer response time in selecting vocabulary words.
• Fail to perceive subtle changes in word meaning: incomplete understanding and misinterpretations.
• Figurative language problems.
Pragmatics
• Knowledge and ability to use language functionally in social or interactive situations.
• Integrates all the other language skills, but also requires knowledge and use of rule governing the use of
language in social context.
Pragmatic Deficits
• Problems understanding indirect requests (e.g., may say yes when asked “Must you play the piano?”).
• May enter conversations in a socially unacceptable fashion or fail to take turns talking.
• Difficulty staying on topic.
Speech Disorders
• Articulation disorder
– Substitutions
– Omissions
– Additions
– Distortions
• Apraxia of speech
Voice Disorders
• Pitch
 • Duration
• Intensity
• Resonance
– Hyponasality
– Hypernasality
Fluency Disorders
• Interruptions in the flow of speaking
– Hesitate
– Repeat themselves
– Use fillers such as “umm”
– Stuttering
Organic Causes
• Nervous system
• Muscular system
• Chromosomes
• Formation of speech mechanism
• Hereditary malformation
• Prenatal injuries
• Toxic disturbances
• Tumors
• Traumas
• Seizures, Infections diseases
• Muscular diseases
• Vascular impairments
Strategies
• Supportive teaching
• Complementary teaching
• Consultation
• Team teaching
Augmentative and Alternative Communication
• Integrated groups of components that supplement the communication abilities of individuals who cannot
communicate effectively through gestures, speaking, and/or writing
A communication disorder is an inability to understand or use speech and language to relate to others in
society. This can be divided into four areas:
 Language - this involves listening, speaking, reading and writing
 Articulation - the pronunciation of sounds and words
 Voice - the sound produced by vibration of the vocal cords
 Stuttering - a disruption in the normal flow or rhythm of speech
Characteristics of language impairments
Language disorders may be receptive, expressive, or both.
Language disorders may be related to another disability or may be a specific language impairment.
 Phonological disorders – difficulty in discriminating differences in speech sounds or sound segments
 Morphological difficulties – problem using the structure of words to get or give information
 Syntactical errors – problems involving word order, incorrect structure, misuse of negatives, or
omitting structures
 Semantic disorders – problems using words singly or together in sentences
 Pragmatic disorders – problems in the social use of language

• Two types of speech and language disorders

– Organic: caused by an identifiable problem in the neuromuscular mechanism of the person
– Functional: those with no identifiable origin
• Speech and language disorders can also be classified according to when the disorder began.
– Congenital: present at birth
– Acquired: occurs well after birth
• Prevalence
– Of all students receiving special education services, about 19.2% receive speech and language
services.
 • Adapting Instruction
– Ask varied types of questions
– Expand student utterances
– Augment or alter classroom language by providing statements that explain a student’s nonverbal
behaviors
– Allow students opportunity to practice public verbalizations
– Keep in mind the need of some students for AAC systems
• Augmenting Instruction
– Repetition of the curriculum
– Visual supports
– Direct instruction in social skills
Physical disabilities are difficulties associated with sitting, standing, getting into position, moving, communicating,
using and manipulating classroom tools and materials and self-care.
• Orthopedic impairment means a severe orthopedic impairment that adversely affects a child's educational
performance. The term includes impairments caused by a congenital anomaly, impairments caused by
disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy,
amputations, and fractures or burns that cause contractures).
• Mobility impairments range in severity from limitations of stamina to paralysis. Some mobility impairments
are caused by conditions present at birth while others are the result of illness or physical injury.
• IDEA uses the term orthopedic impairments, but educators typically use the term physical disabilities.

• Typically refers to a large group of students who are very different from each other

• The term may be used to also include students with:

• Severe and multiple disabilities

• Other health impairments

• Traumatic brain injury

• This focuses on three types of physical disabilities:

• Cerebral palsy

• Spina bifida

• Spinal muscular atrophy (a type of muscular dystrophy)

• Cerebral palsy
• A disorder of movement or posture, due to damage in the brain
• Four types
• Spastic
• Athetoid
• Ataxic
• Mixed
• Causes
• Prenatal
• Perinatal
• Postnatal
• Other associated conditions
• Possible mental retardation
• Speech and communication problems
• Spina bifida
• Malformation of the spinal cord
• Three common forms (see p. 347)
• Spina bifida occulta
• Meningocele
• Myelomeningocele
 • Causes
• Occurs in early pregnancy
• Mothers using regular supplements containing folic acid reduce their risk of having a child
with spina bifida.
• Other associated conditions
• Usually does not affect intelligence
• Depending on location of defect, may cause incontinence or other urinary and bowel
problems
• Muscular dystrophy
• A group of nine hereditary muscle-destroying disorders
• One type is spinal muscular atrophy
• Instead of destroying muscles, specialized nerve cells called motor neurons are attacked.
• Can result in paraplegia
• Causes
• Autosomal recessive disease; both parents must carry the gene responsible
• Can affect both males and females
• Other associated conditions
• Scoliosis
Methods and Strategies
• Accessibility to physical environments
• Access to the general curriculum
• Participation in extracurricular and other school activities
• Occupational therapists are often valuable
• Movement patterns
• Posturing
• Use of necessary adaptive devices
• Ecological inventory
• Identifying important environments for participation
• Identifying sub environments
• Identifying skills possessed, skills needed, and supports available and needed
• Continued monitoring

• Students who use wheelchairs, calipers or crutches, or who tire easily, may find it difficult moving about
within the constraints of lecture timetables. Absence or lateness may be a result of the distance between
teaching venues, so at the end of a lecture you may need to recap any information given at the beginning.

• Check that academic activities which take place off-campus (such as industry visits, interviews or fieldwork)
are accessible to people with a mobility disability. Consider supplementary laboratory practicals, films or
videos as alternative options to field trips

• Students with a mobility disability may sometimes wish to use their own furniture, such as ergonomic chairs
or sloped writing tables. Extra space may need to be created in teaching rooms, but this should be done
unobtrusively.

• Some students with back problems may prefer to stand in lectures or classes, rather than sit.

• Some students may need to use a tape recorder or note-taker in lectures. Extra time is involved in processing
information acquired in this way. It is common practice in some departments to routinely tape all lectures.
This is a practice which will assist a variety of students, including those who may be absent from time to time
because of their disability.

• Students may need extensions to deadlines for work involving locating and using library resources. Provide
reading lists well before the start of a course so that reading can begin early.

• Academic isolation may be an issue for students who are unable to participate in some class activities. One-
to-one sessions with a tutor may help fill this gap in participation.
Quadriplegia refers to the loss of function to arms, legs, and trunk. Students with quadriplegia have limited or no use
of their arms and hands and often use motorized wheelchairs.

Paraplegia refers to the loss of function to the lower extremities and the lower trunk. Students with paraplegia
typically use a manual wheelchair and have full movement of arms and hands.

Learning disabilities are neurologically-based processing problems. These processing problems can interfere with
learning basic skills such as reading, writing and/or math.

They can also interfere with higher level skills such as organization, time planning, abstract reasoning, long or short
term memory and attention.

Causes

• Genetic influences. Experts have noticed that learning disabilities tend to run in families and they think that
heredity could play a role. However, researchers are still debating whether learning disabilities are, in fact,
genetic, or if they show up in families because kids learn and model what their parents do.

• Brain development. Some experts think that learning disabilities can be traced to brain development, both
before and after birth. For this reason, problems such as low birth weight, lack of oxygen, or premature birth
may have something to do with learning disabilities. Young children who receive head injuries may also be at
risk of developing learning disabilities.

• Environmental impacts. Infants and young kids are susceptible to environmental toxins (poisons).

• "Specific learning disability" means a disorder in one or more of the basic psychological processes involved in
understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to
listen, think, speak, read, write, spell or to do mathematical calculations, including conditions such as
perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia and developmental aphasia. The
term does not include learning problems that are primarily the result of visual, hearing or motor disabilities,
of mental retardation, of emotional disturbance, or of environmental, cultural or economic disadvantage.