Chapter 3: Low vision

Contents

  1. The importance of visual field for defining, categorisation and other aspects of low vision
    Branka Eškirović, Yugoslavia
  2. Toys as a material for diagnostics and sensory training
    Ligita Geida, Latvia
  3. Illumination and Low Vision
    Rosalia Holzschuh Fresteiro, Spain
  4. How to classify paediatric low vision?
    Lea Hyvärinen, Finland
  5. Problems of people with low vision in different stages of Russian system of special education
    Alexandre Issakov, Russia
  6. Neuropsychological testing and observation as part of an interdisciplinary assessment of partially sighted children with reference to advising in connection with the child starting school
    Elsebeth Mortensen, Denmark
  7. Observation of motor function carried out at observation courses for integrated 4-6 year old partially sighted children before they start school.
    Susanne Paulsen, Denmark
  8. Assessment of intact low vision in a child through observation and testing
    Jette Pedersen, Denmark
  9. The Objectives of Visual Training
    Vasile Preda, Romania
  10. How can we support visual functioning of young children with multiple impairment?
    Markéta Skalická, Czech republic
  11. Development of Efficiency in Visually Functioning Students with very Limited Field of Vision - Case Analysis
    Hanna Smolen, Poland
  12. Visually impaired children
    María Jesús Vicente Mosquette, Spain

lecture
3.1

The importance of visual field for defining, categorisation and other aspects of low vision

full text of lecture 3.1

Branka Eškirović, Yugoslavia

Address:
Faculty of Defectology
Visokog Stevana 2, Belgrade, 11000 Yugoslavia
Fax: +381 11 183 081
E-mail: handicap@Eunet.yu

Special importance in the model of visual function of low vision children is attributed to: visual acuity for near and distant vision, condition of the central and peripheral vision field, motility of the ocular apparatus, contrast of the figure and background, frequency and duration of object observation, light, experience, attention, learning and motivation. Visual acuity plays the decisive role in definition and categorisation of low vision. Many authors indicate that visual field should be given a more important place in this respect. The fact that few information on the characteristics of visual perception of low vision children of different levels and different kinds of visual field defects are available is an additional problem.

The aims of the study:

  1. to determine the incidence of the visual field defects in low vision children;
  2. determining significant differences in visual efficiency of low vision school children in educational process with respect to the degree of visual field defect;
  3. determination of specific aspects in solving the visual tasks for the teaching process in low vision children with visual field defect of different severity; 4) determination of the role of visual field in defining and categorisation of low vision based on conclusions related to realisation of the former aims.

The study is a part of the project investigating visual efficiency of low vision children in educational process. The study was conducted in the course of academic 1996/97 year by B. Eškirovia (1998), based on a sample of 72 school children with low vision. The sample was composed according of the following criteria:

  1. visual acuity on the better eye with correction ranging from 0,05 to 0,4;
  2. age 6 to 13,5 years;
  3. normal neurological and psychological findings. In the study was observing and evaluating the performance of subjects completing 18 groups of visual tasks contained in the LOOK AND THINK CHECKLIST, created by E.K.Chapman, M.J. Tobin, F.H.Tooze, and S. Moss. The study of visual field was carried out in 49 children on Goldmann' s perimeter.

Among other conclusions of the study we herein point out that more or less severe visual field defect was registered in all students. Key words: low vision, schoolchildren with low vision, definition of low vision, categorisation of low vision, visual efficiency, visual field.


lecture
3.2

Toys as a material for diagnostics and sensory training

full text of lecture 3.2

Ligita Geida, Latvia

Address:
Strazdumuiza Boardine School - Training centre for blind and partially sighted children
Juglas str. 14a, Riga LV - 1024, Latvia
Fax: +371 7532046
E-mail: LigitaG@parks.lv

The basics of successful development of blind and partially sighted children are early diagnostics of visual impairment and work on the developing of saved sensor systems. It is shown by different already existed tests that the evaluation of visually impaired children is more effective if toys are used as a test material, because they are most interesting and understandable for kids. Since materials for well-known tests, like H. Barraga's or
L. Hyvarinen's, are quite expensive for our country to buy them for every special group of visually impaired children, we made a project in collaboration with local firm that is working on producing toys.
This project included a series of toys for primary diagnostics of functional vision and toys for sensory training of blind children. Essence of these toys was taken from already existing tests and toys, and we do not pretend to be discoverers. This is the possibility to make these things by our own craftsmen, to spread them between our staff working with visually impaired children and let us teach them how to primary evaluate visual possibilities of every child who can be seen as visually impaired. Group of toys for the developing of the saved sensor systems of blind children lets make more interesting and meaningful lessons of orientation and mobility.


lecture
3.3

Illumination and Low Vision

full text of lecture 3.3 (rar archive)

Rosalia Holzschuh Fresteiro, Spain

Address:
University Polytechnics of Madrid
Puentecesures 1-B, B-D, Madrid 28029, Spain
E-mail: frestei@idecnet.com

It is well-known that the displacements made in a building's interior, the illumination has a very important role, and in a special way, referring to visually impaired people. It is a very important factor to these people to detect and identify objects situated in a relatively short distance, between 1,5 and 3 m., obtaining relevant information of the environment as soon as possible when they need orientation in these displacements. This paper presents the results of a preliminary study to find out the adaptation time in lighting changes, to determine how much visual pathologies influence in lighting necessities and how to verify which illumination and colour temperatures these diseases need to orientate.


lecture
3.4

How to classify paediatric low vision?

full text of lecture 3.4

Lea Hyvärinen, Finland

Address:
Lea-Test Ltd.
Apollonkatu 6 A 4, FIN-00100 Helsinki, Finland
Fax: +358 9 420 89 68
E-mail: lhyvarin@helsinki.fi

International classification of visual impairment and disability in the ICIDH (international classification of Impairments, Disabilities and Handicaps) does not acknowledge children as a special group. In the ICIDH, visual impairment is defined based on measurements of visual acuity and visual field. These visual functions cannot be measured in young children using techniques that are used in the assessment of adult persons. When visual acuity is measured with single symbols or with grating acuity tests, the values are not comparable with the adult values. Thousands of children do not receive early intervention because of the present testing tradition. To classify paediatric visual impairment we need to develop assessment of functional vision and define the vision related functions that are important at different age levels.
In infancy, vision is critical in early interaction, visual communication between the parent and the infant, in development of motor functions, spatial concepts, object permanence, language etc. Thus the basis of evaluation should be whether or how much visual impairment affects these different areas of development. In pre-school age visual impairment may affect development of social contacts, because visual communication is the dominant way of communication in toddlers and important also later. It changes the way of learning and may require use of techniques typical to blind persons in some activities. In school age, if we assess the functions in the four main areas of activities where vision plays an important role:
communication, orientation and mobility, activities of daily life and in sustained near vision tasks and give 1 point to techniques typical to blind persons, 2 points to techniques typical to persons with low vision and 3 points to techniques typical to normally sighted persons, we have a variation of 4 points (blind techniques in all four functional areas) and 12 points ( sighted techniques in all four functional areas). Five or six points would mean profound low vision, 7-8 points severe low vision, 9-10 points moderate low vision and 11 points mild low vision. Twelve points would mean no reportable low vision but would not exclude the need of low vision services or modification of learning techniques.


poster
3.5

Problems of people with low vision in different stages of Russian system of special education

full text of poster 3.5 (rar archive)

Alexandre Issakov, Russia

Address:
Moscow School for the Blind Children
Yasnogorskayastreet, 13/2-418, Moscow, 117463, Russia
Fax: +7 095 423-68-88
E-mail: aisakov@rosmail.ru

People with low vision have different psychological and physical problems for every period of their life. These problems can be solved for the period, but sometimes they cannot. Thus the overcoming of these problems can become very difficult after. When the low vision child is in preschool age, he or she has problems with the use and development of the rest of vision. In school the problem of Braille learning and the necessity of it appears immediately. Should low vision people learn Braille or not? On the hand it is a safe-line for the future, but those who reads Braille by eyes, spoils vision rapidly.
Another problem is orientation in space. Should we appeal to contrast markers, inclusive design etc., or have to adapt to the environment ourselves? Cultural life is a problem too: many low vision people know about such things as theatre, ballet, painting and architecture only theoretically. What things should we teach low vision children to prepare them for the full life? And of course the problem of employment. There are not so many professions which are available for low vision people and we should begin to prepare them for the professional activities as early as possible. Sometimes the problem is a lack of information about the "normal" world; some people do not know "normal" letters after the studying in residential school and are not able even to sign a paper. Communication is an important problem too: young visually impaired people should be psychologically ready for communication with their future employer.


lecture
3.6

Neuropsychological testing and observation as part of an interdisciplinary assessment of partially sighted children with reference to advising in connection with the child starting school

full tetx of lecture 3.6

Elsebeth Mortensen, Denmark

Address:
Refsnaesskolen
Kystvejen 112, DK-4400 Kalundborg, Denmark
Fax: + 45 59 57 01 01
E-mail: elsebeth.test@mail.tele.dk

The content of the lecture will be presentation of the psychological part of the interdisciplinary observation of partially sighted children, 4 -6 years of age. There will be a brief presentation of the possibilities and limitations of the psychological tests being used. Tests contributing disclosing visuo-perceptual circumstances will be emphasised. Video presenting test proceeding will be presented.

Characteristic problems observed within this group of children will be accounted for. A relatively detailed description of how the children's difficulties effect our proposal concerning teaching of the child, partly current training areas, partly on the longer term assessing which kind of teaching the individual child will benefit from, will be presented.

Finally the importance of the relatively early assessment of the cognitive resources and limitations in the individual child in connection with the further development and teaching of the child will be evaluated, just as the importance of early advisory service to parents and professionals will be examined.


lecture
3.7

Observation of motor function carried out at observation courses for integrated 4-6 year old partially sighted children before they start school. Co-operation between Educator, Psychologist, Physio- and Occupational therapist.

full text of lecture 3.7

Susanne Paulsen, Denmark

Address:
Refsnaesskolen
Kystvejen 112, DK-4400 Kalundborg, Denmark
Fax: + 45 59 57 01 01
E-mail: refsnaesskolen@vestamt.dk

Video on observation of about 3 - 6 partially sighted infants will be presented. Basis will be an individual child. Seen from the video recordings, possible sensory integration problems that the child might have will be described.

A questionnaire completed by the parents before the course will be presented. This questionnaire means that we as therapists can carry out a more qualified observation of the child.

In order to understand how the child is functioning in the daily life at home, the observation is supplemented by video, recorded in the home, based upon Movement Science theories.

Apart from their visual handicap many visually impaired children have sensory motor difficulties. These motor difficulties might have their basis in the visual impairment, but can be caused by other things and be intensified by the visual impairment. Sensory integration difficulties might cause learning difficulties in sighted children and certainly in visually impaired children. The visual impairment is not the reason why a child cannot learn how to read or to sit still in the school.

In order to make the visual impaired child as ready for starting school as possible, all severely visually impaired children in Denmark are offered an interdisciplinary assessment. Interdisciplinary work is important, as a child should be seen as a whole person. Interdisciplinary work enables us to handle all the difficulties a child might have.


lecture
3.8

Assessment of intact low vision in a child through observation and testing

full text of lecture 3.8

Jette Pedersen, Denmark

Address:
Refsnaesskolen
Kystvejen 112, DK-4400 Kalundborg, Denmark
Fax: + 45 59 57 01 01
E-mail: jetteped@yahoo.dk

There will be a brief presentation of the course, during which the observations are carried out, specially emphasising the part of the course where it is possible to observe how the children use their intact vision in social interaction, mobility, daily living skills, when playing, in motor activities and when sitting still.

Examples on how we check visual possibilities and limitations in the child as to "reading" pictures at different levels, working with preschool materials and different kinds of games. Apart from that use of computer when testing the vision is described.

Finally there will be a brief presentation of the formal vision tests being used when assessing vision at short and long distances.


lecture
3.9

The Objectives of Visual Training

full text of lecture 3.9

Vasile Preda, Romania

Address:
"Babes-Bolyai' university Cluj-Napoca
M. Kogalmiceanu, nr. 1, 3400 Cluj-Napoca, Romania
Fax: +40 64 191906
E-mail: vpreda@hiphi.ubbcluj.ro

Visual training represents a specific objective fundamentally important for a good development of the instructive-educational and corrective-compensatory activities employed with visually impaired children. It ensures the most adequate integration at school and the most efficient professional and social integration of visually impaired children. Visual training takes into account the ophthalmologic and psycho-pedagogic diagnosis and the prognosis of every case. Visual training aims at the activation and mobilisation of all visual possibilities, realising-at their maximum-the interrelations between the real functional capacity of foveal vision and of the peripheral vision, stressing the development of: the oculo-motor exploratory strategies; the perceptive schemes; the visual perception skills; the visual attention; the motor-visual co-ordination; the operative and long-term visual memory; the capacity of perceptive structuring of spatial representation, and of the specific visual operational judgements. There are very strong interactions between the psycho-physiological and psychological components.

The visually impaired children who practised visual training exercises for a proper period of time, have a better organized visual exploration. The individualised choice of methods and techniques of visual training and the motor structuring of graphical space must take into account the nature, the degree and the dynamic of visual impairment.


lecture
3.10

How can we support visual functioning of young children with multiple impairment?

full text of lecture 3.10

Markéta Skalická, Czech republic

Address:
Low vision centre university hospital Motol
Antala staska 31, 14000, Czech Republic
Fax: +420 2 2482 6858
E-mail: p.skalicky@era.cz

Children with multiple impairment are recently more and more referred for assessment of visual functions and for services for children with visual impairment. These children need not to have serious ophthalmic diagnosis and still their visual behaviour has features of serious functional problems.
What can we do for these children?

  1. Step: Careful multidisciplinary assessment of the cause of the impairment: ophthalmologic assessment of the eye, pathways and neurological assessment of brain, metabolic disorder etc.
  2. Step: Assessment of visual functions using objective and subjective methods suitable for small and multiple impaired children (testing of motility, visual attention, fixation, visual acuity - detection, resolution, recognition, visual field, contrast sensitivity, colour vision, light and dark adaptation, light sensitivity).

    Observation of visual functioning as following, grasping, eye hand co-ordination etc. in its regular environment.
    Assessment of the developmental level of the child, his motor functioning and requirements for positioning is important as well.
    It is important to use experience and observation of the parents of the child who know the child best.

  3. Step: Design plan for environment adaptations and stimulation and training activities based on the multidisciplinary assessment of the child. . Explain parents the results of the assessment and reasons for planned adaptations and activities. Since there is little experience with support for children with cortical visual impairment, it is challenge for parents and counsellors to promote skills available and compensate for those, which cannot be developed.
  4. Step: Support for the parent or other caretakers in their activities with the child.

There is need for lot creativity and flexibility in searching for proper stimulation of the child, attracting his attention using other senses to support the visual functioning and avoid over stimulation.
In this presentation I would like to share some experiences made by early intervention counsellors, share experience with using specialised material: using three dimensional objects, photos of these objects, using special video programs and computer programs for vision stimulation and vision training.


lecture
3.11

Development of Efficiency in Visually Functioning Students with very Limited Field of Vision - Case Analysis

full text of lecture 3.11

Hanna Smolen, Poland

Address:
Laski, the School for the Blind
Zakk. Dla Niewidomych W Laskach,
05-080 Izabelin, Poland
Fax: +48 022 7522 105

In this paper I would like to share my experience in work with visually impaired students living in the Institute for the Blind in Laski. Most of them are one-eyed with an additional serious damage of this eye used in everyday life. Cases when ophthalmologists could measure acuity, yet field has not been measured with traditional methods. Since 95 % of students who are treated have enormous depletion in the vision field, not only central but also peripheral, I have been interested in issues related to rehabilitation of these subjects. Moreover, it is interesting to notice that manual dexterity of children working in tactile technique since the earliest age develops differently than in those who came to our school at older age with their school skills. This results in learning to write and exploring their surrounding.

Place of depletion in the vision field determines orientation and independent moving. I wonder why some children, treated as congenitally blind and subconsciously using remaining vision have problems with utilizing tactile techniques in situations, in which they cannot manage using their sight. Even though they are guides for their blind peers in the daylight, at night when sight is too weak, they become helpless and need guides themselves. Questions arise, what should be trained in such cases? What skills should be focused on? How long should they be improved?

I will analyze students I have been working with for five years. I will demonstrate their achievements and difficulties that have not been solved.


lecture
3.12

Visually impaired children

full tetx of lecture 3.12

María Jesús Vicente Mosquette, Spain

Address:
O.N.C.E.
Calle Prado 24, Madrid 28014, Spain
Fax: +34 91 429 31 18

Action programs for children with visual impairments have characteristics which differentiate them from those catering to adults.

Firstly, there is the first and fundamentally important stage between 0 and 3 years of age. The cerebral development of children is greatest in this period. Actions capable of determining the child's remaining level of sight are necessary at this stage. Then, each child's sensory development program is worked out according to his/her capacities. The child's visual potential should be developed as much as possible and then integrated to the rest of the senses to guarantee the child's balanced development as an individual.

A qualitative and quantitative change is produced in the development of a child and its needs between the ages of three and six. This is the stage in which the child's basic learning code is to be established. This requires a very precise functional evaluation of the child's sight. There are tools designed to provide us with this information. On the basis of the information they provide, a training program is worked out to enable the later incorporation of optical, non-optical and electronic instruments to improve the child's use of his/her sight.

Reviewing what we can do, what instruments we have at our disposal and who should carry out the tasks at each stage is the main aim of this paper.


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