Motor Development and Physical Activities for Families of Children with Visual Impairments and Blindness

By Luis Columna, Pamela Haibach, Lauren Lieberman, Margarita Fernández-Vivó, and Ibrahim Cordero-Morales

Luis Columna is Associate Professor in the Department of Exercise Science-Physical Education in the School of Education at Syracuse University.

Pamela Haibach is Associate Professor in the Kinesiology Department at the State University of New York-College at Brockport.

Lauren Lieberman is the Distinguished Service Professor in the Kinesiology Department at the State University of New York-College at Brockport.

Margarita Fernández-Vivó is Professor in the Physical Education Department at the University of Puerto Rico-Mayagüez.

Ibrahim Cordero-Morales is Professor in the Physical Education Department at the University of Puerto Rico-Mayagüez.

Abstract

Children with visual impairments have limited opportunities in the community to participate in physical activity and sports. In addition, many parents have limited or no knowledge about how to teach physical activity and sports to their children with visual impairments. The Syracuse University Fit Families Program addresses both sides of the spectrum, engaging parents/guardians and their children with visual impairments in the workshops/activities. The purpose of this article is to describe two workshops provided to parents of children with visual impairments regarding the importance of motor skill development and physical activity. This article will provide ideas for effective modifications and program design when developing a similar program for children with visual impairments and their families.

Keywords

Parents, families, physical activity, sports, motor skills, community based activities, visual impairments

Introduction

Children with visual impairments (VI) are at higher risk for developing secondary health conditions such as obesity and heart failure due to physical inactivity (O'Day, Killeen, & Iezzoni, 2004). Numerous medical conditions have been linked to obesity and being overweight, including Type II diabetes, cardiovascular and pulmonary disease, certain cancers, sleep apnea, and liver and gallbladder disease. Individuals with VI are also more likely to have heart disease and hypertension than the general population. Within the population of older people, vision impairment is associated with reduced mobility, falls, increases in hip fractures, depression, and even mortality (Crews & Campbell, 2004).

These higher incidences of obesity could be due to lower levels of health-related physical activity (Lieberman, Byrne, Mattern, Watt, & Fernandez-Vivo, 2010) and  underdeveloped motor skills (Houwen, Hartman, & Visscher, 2009; Houwen, Visscher, Lemmink, & Hartman, 2008; Wagner, Haibach, & Lieberman, 2013). The purpose of this article is to introduce the physical activity and motor development component of the Syracuse University Fit Families Program. This physical activity program promotes physical activity among families of children with VI by providing a series of interactive workshops to parents related to: 1) orientation & mobility, 2) motor development and physical activity; 3) aquatic opportunities; and 4) team sports.

Children with VI tend to exhibit motor delays and lack opportunities to be physically active in community settings (Shapiro, 2003). Because of the lack of programs providing physical activity opportunities for children with VI, parents are often responsible for entertaining and teaching games and physical activities to their children. The problem is that many parents do not know how to teach developmentally appropriate games and activities to their children in order to support and promote physical activity and motor skill development (Martin & Choi, 2008). The main goals of the motor development and physical activity workshops were to teach parents of children with VI the benefits of physical activity, the importance of motor skill development, and how to analyze motor skill performance in their child. The Syracuse University Fit Families Program is an ongoing program that addresses both sides of this spectrum, engaging parents/guardians and their children with VI in the workshops/activities.    

Fundamental Motor Skills in Children with VI

It is important to not only understand that children with VI are significantly behind their sighted peers in regard to fundamental motor skills, but perhaps, more importantly, to understand which motor skills and, specifically, which components of those motor skills are delayed in order to better improve their motor skill competence. Typically, developing children significantly improve their fundamental motor skills across childhood, yet no differences were found in younger children with VI (6-9 years) in comparison to older children with VI (10-12 years) (Haibach, Wagner, & Lieberman, 2014). Although there are no longitudinal data to support these findings, it would be expected that older children would significantly outperform younger children in fundamental motor skills. 

The severity of visual impairment was an important variable in motor skill performance with children with total blindness performing significantly behind their peers with travel vision and children with legal blindness (Haibach et al., 2014). In this article, several fundamental motor skills that were assessed during the Syracuse University Fit Families program are discussed, as well as the specific delays found in children with VI and the task analyses for these motor skills which assist parents and professionals in effectively teaching children with VI. Two of the workshops were designed to provide parents of children with VI the skills to teach and promote physical activity to their children. Each of the workshops included a morning and an afternoon session. This article describes workshops which took place during the fall of 2013 through the spring of 2015.

Morning Session Workshop 1

During the morning session, parents and children were divided into different settings.  Children’s motor skills were assessed using the Test of Gross Motor Development (TGMD) 2 (Ulrich, 2000). The TGMD 2 assesses six locomotor skills (running, jumping, hopping, galloping, leaping, and sliding) and six object control skills (throwing, catching, kicking, dribbling, rolling, and striking). This assessment was conducted by physical education teacher candidates and exercise science students who have been extensively trained using this instrument. This instrument has been validated with modifications for children with visual impairments ages 6 to 12 years (Houwen, Harman, Jonker, & Visscher, 2010). Modifications included brighter balls, a sound box, beeping balls, and wiffle balls with bells. This assessment took between 20 to 25 minutes for each participant to complete. One teacher provided instruction during the assessment, while another teacher candidate provided assistance to the child as needed (without interfering with the assessment protocol), such as additional instruction for children who were unfamiliar with the task.  

While the children’s motor skills were being assessed, parents participated in a two hour workshop regarding teaching strategies used in physical activity settings. During this workshop, parents learned about the importance of developing fundamental motor skills and, specifically, the motor skills and their respective components for which children with VI need additional instruction. While also learning a variety of games and activities, parents were introduced to the concept of task analysis to facilitate the instruction of their children by simplifying the motor skills and activities into fewer components. For example, parents were taught how to break down the skills such as running, jumping, and throwing (See tables 1-4). After each discussion, parents went to the gymnasium to practice instructing each other using specific cue words while the other would attempt the skills while wearing visual simulators. Professionals delivering the workshop provided handouts for the activities to all families, so that they could practice at home and/or share them with recreational professionals in their communities. A detailed discussion of three of the twelve motor skills (running, jumping, and catching) follows.

Running

Locomotor skills typically develop in a sequential progression starting with motor milestones such as crawling (belly on floor), creeping, and walking independently. The first fundamental locomotor skill to be developed is running, which is typically developed 6 months after walking (approximately 18 months for children with sight) (Haibach, Reid, & Collier, 2011). This skill does not appear until much later (18-36 months) for children with VI (Brambring, 2006). Running requires not only balance and coordination, but the strength to propel the feet off the ground for a brief period of time (flight phase). Speed alone does not designate the locomotor pattern as running; rather it is the presence of a flight phase. Without a flight phase, an individual is essentially not running, but walking quickly. According to Wagner et al. (2013), this is important to mention because over half (52.2%) of the children with total blindness aged 6 to 12 years of age did not run with a flight phase. The children also did not run with arms in opposition to legs, elbow bent (52.2% missed), a narrow foot placement landing on heel or toe (i.e. not flat footed) (69.6% of children with total blindness missed), or the nonsupport leg bent approximately 90 degrees (87% of children with total blindness missed). Since these children could not visually see other children running, they will need additional support and instruction in addition to what is typically provided to sighted children. Children with less severe visual impairments (i.e. travel vision and legal blindness) performed significantly better than the children with total blindness in running and were only behind on one component, the nonsupport leg being bent approximately 90 degrees

During the workshop, parents were taught about locomotor skills and the typical developmental progression. They also learned about the components to proficient running and the areas of need for children with VI. Parents were given a task analysis sheet with cue words and modifications to teach running to their child. They were also allowed to go to the gym to practice using these cue words upon each other while wearing the simulator glasses.

Table 1: Running Components and Common Errors

Running Components

Common Running Errors

  • Pumps arms in opposition to legs
  • Arms crossing the midline
  • Arms out to side for balance
  • Arms moving together
  • Keep elbows bent
  • Straight, stiff arms
  • Brief period with both feet off of the ground
  • Shuffling gait
  • Foot movement - light contact with ground, hitting between heel and mid-foot, rolling forward
  • Flat footed landings
  • Heavy steps
  • Nonsupport leg bent approximately 90 degrees
  • Minimal knee bend (>100 degrees)
  • Standing tall with head level
  • Head facing the ground
  • Slouched shoulders

Jumping

Jumping is a locomotor pattern in which an individual propels him/herself into the air, leaving the ground with either one or two feet and landing on two feet. Toddlers typically begin jumping around the age of 2 to 3 years, but proficient locomotor patterns in horizontal or vertical jumping do not develop until much later (Haibach, et al., 2011). The task analysis on jumping taught to the parents focused upon horizontal jumping. Parents were taught how to teach their children to use their arms throughout the jump and to crouch prior to jumping.

Table 2: Task Analysis for Jumping

1. Begin with Preparatory Crouch: Bend knees and hips; extend arms behind body

2. Swing arms forward forcefully and upward to full extension above the head

3. Jump forward with both feet and land on both feet simultaneously; bend knees to absorb the force of the landing

4. Thrust arms downward during landing

Table 3: Jumping Components and Common Errors

Jumping Components

Common Jumping Errors

  • Feet leave ground together and land together
  • Leaving ground or landing with one foot
  • Toes pulled off ground
  • Arms begin extended behind body
  • Arms come forward and extend overhead at takeoff
  • Arms come forward at landing

 

  • Minimal arm motion: arms at side and no preparatory crouch
  • Arms abduct
  • Arms do not extend over the head
  • Arms may even parachute to the side for balance
  • Hips and Knees begin in deep crouch
  • Hips and knees fully extend
  • Knee flexion leads hip flexion
  • Knees extend just prior to landing
  • Trunk lean less than 30 degrees
  • Leg flexed at take-off
  • Does not flex hips and knees enough
  • Knees do not extend prior to landing

Object Control Skills

Object control skills are motor skills in which an individual manipulates an object such as throwing, striking, kicking, and catching. Children who are legally blind or have travel vision have been found to be significantly behind their sighted peers in catching and kicking (Wagner, et al., 2013). Children with total blindness were significantly behind their sighted peers in all object control skills assessed: kicking, catching, throwing, striking, rolling, and dribbling. It is clear that having some residual vision benefitted the children; however, it should not be assumed that the children with total blindness cannot perform these fundamental motor skills proficiently. As previously mentioned, it is likely that these children did not receive enough instruction and feedback on these motor skills to help them enhance their locomotor proficiencies. 

Catching is generally considered the most difficult fundamental motor skill to proficiently achieve. The difficulty with catching arises from the perceptual component of tracking the ball, learning how to move to the ball with their bodies, and adjusting their hand positions accordingly. Children have difficulty tracking multiple planes until approximately the age of 8 years. For example, the assumption that lobbing the ball to a child will make the task easier is actually more difficult due to their reduced ability to track the ball in multiple planes. Children with VI must complete this very perceptual task with limited or no vision. 

For these children, choosing appropriate objects to catch is critical to their success. During this part of the session, parents were taught to choose larger, lighter balls that are brightly colored for children with some residual vision and balls with sound for children with visual impairments and blindness. A parent or teacher can construct a ball with bells by using a wiffle ball and placing multiple small bells inside. Beeping balls can be used as well, but are often heavy, making the task more difficult. 

It is also important for children to familiarize themselves with the ball(s) before catching.  For example, one may allow the child to feel the ball prior to catching. Additionally, the child may feel more comfortable with the ball and the task of catching if they are allowed to toss the ball in the air to themselves prior to catching with another. The child should also be encouraged to throw as high as they feel comfortable.

Table 4: Task Analysis for Catching

1. The catcher steps from side to side, forward or  backward to adjust body to be able to intercept the ball

2. Finger position adjusts to the position of the ball - fingers are pointed up for high balls and down for low balls

3. Hands adjust to the ball absorbing the force from the catch

Afternoon Session Workshop 1

After the morning workshop, parents were able to practice the cues and task modifications they had worked on with their children with supervision from physical education teacher candidates and exercise science students. Parents and their children were actively engaged in several activity stations addressing manipulative skills (i.e., object control), locomotor skills, and balance. The children and their parents were free to choose activity stations and could spend as much or as little time at each station as they wanted. There were seven stations including rolling, dribbling, kicking, agility, alphabet balance, and cardio stations, as well as an obstacle course which promoted balance and various locomotor skills. 

After engaging in activities at the stations, the children participated in a couple of games which promoted fundamental motor skills. One of the activities presented was called clean my backyard. This is a simple game which promotes throwing using a variety of balls. Children and their parents were divided into two sides of the gym separated by a rope with an equal number of balls on each side. The balls can vary in size, shape, color, and weight. Modified balls with sound and/or bright colors are suggested for children with VI. The goal of the game is to throw as many balls to the other side of the gym as quickly as possible so that when the time limit of 2 minutes expires, there are fewer balls on their side. 

Games and activities in which children are required to only use a specific locomotor skill such as galloping, hoping, or skipping are another fun way to encourage children to improve their locomotor skills. For example, parents can create pathways or an obstacle course. The children have to complete the obstacle course by using one of the locomotor skills presented. Parents can also promote throwing and catching by practicing at home. A common group game is to pair up children and have them toss balls back and forth, taking one step back after every successful catch.

Morning Session Workshop 2

The purpose of this second physical activity and motor development workshop was to expand upon the previously practiced motor skills. Parents and their children participated in a variety of physical activities with the purpose of enhancing their understanding of physical activities and strategies which promote activity. First, parents and their children participated in activities separately during the morning, and then, parents played the games and physical activities they had been exposed to with their children in the afternoon. Also, parents shared with their children a choreographed dance they learned during the morning session. 

Dance was added to the program/workshop to fill the needs of children with VI by providing an additional training tool to encourage movement and physical activity for the children with their parents in the privacy of their home or in the community. For centuries, rhythm and dance have been an integral part of many cultures as a form of expression and tradition. Furthermore, dance is a physical activity that can help develop and improve cardiovascular health. Listening to music has been expressed as a favorite pastime of children with VI (Robb, 2003), and is a great opportunity to get moving while listening to their favorite artist. 

During this session, parents of children with VI learned an adapted version of the choreography of the song Happy (Williams, 2013) designed specifically for their children. A simple choreography and partner formation was used to have as support and guidance when requested by the child with VI. Parents first practiced the rhythm count of the song, then the steps to the choreography, and, finally, practiced the dance in partners. While practicing the steps of the dance, cues and modifications for any or all of the steps were provided depending upon the developmental level of each child. For example, parents were told that if a child was not able to snap their fingers, or found it really difficult or troublesome, they replaced the movement with a clap of the hands, or touching any part of the body with the hand. Parents performed the dance with an adult partner with one simulating a child with VI and the other as the guide. After several attempts, parents traded roles to gain an understanding of both. 

The second activity of the morning with the parents was a modification of the game Around the World. This game is very popular and has no limit on the number of stations or marks for shooting a basketball. Once the stations are set, the player shoots from the first station and has three attempts to make it through the hoop. If the attempt is successful, then the player will move to the next station and so forth until all the stations are covered. If the attempt is not successful, the player will wait for their next turn.

Parents had the opportunity to play while assuming the role of a person with a visual impairment or as the guide for the person with a visual impairment. In the role of a guide, the parent could tell the child the distance, height, and other related comments for feedback on execution of the throw. Then, the parents traded positions to experience both sides of the game. Sound sources, such as bells hanging from the rim, hitting the rim's backboard with a stick or a buzzer, and other activity modifications were offered to the parents. A variety of different basketballs were also available; some were regular basketballs while others were lighter, smaller, and softer, allowing the child more opportunities to succeed. The distance and height of the rims were modified too, using a three ring system which gave the students more opportunities to score. The system used the legal height rim and two at lower heights, making it easier to use for less skilled children or children who did not have enough strength.

Afternoon Session Physical Activity Workshop 2

During the afternoon session, parents practiced the skills they received instruction in during the morning session, but this time with their children. The session started with the choreography first and then Around the World. The parents were very actively involved in the activities, both motivating their child while also engaging in the physical activity. During the dance, the parent stood behind their child to motivate and guide him/her when needed by touching one shoulder or the other to let the child know the direction he/she was going in the dance routine.

After completing the dance, all dyads (parents/children) played Around the World. Parents were reminded of different modifications they could implement when participating in this activity. Comments made by many parents described the ease with which adaptations could be made to include their children in their family time and the reasons why they had not thought of them before. Some of the parents had done these activities before, but never thought of making an adaptation to include their child with a VI.

Conclusion

This article presented a description of two physical activity workshops conducted within the context of the Syracuse University Fit Families Program. Parents expressed their enjoyment and increased confidence in teaching their child after participating in these workshops with one parent saying:

The first workshop that I attended, the task analysis I noticed a huge difference in my son’s confidence, and ability, and skills that we were trying to teach him, but it also gave my husband a lot more tools to be able to interact with him and have positive experiences in trying to teach him a skill. (personal communication September 3, 2014)

Another parent indicated,

I feel much more confident now, since I did attend the sports workshops.  I understand, for instance, why my daughter doesn’t throw correctly. I haven’t broken that whole process down. It’s kind of a common sense thing, but as parents, sometimes we expect the child to be able to do it automatically, and obviously they cannot. (personal communication, May 30, 2014)

The physical activity concepts and skills enabled more active participation of children with visual impairments and their families in the sports related activities and workshops. The collaboration of professionals and parents maximized the potential and enjoyment during the activities and facilitated appropriate physical activity skills throughout. 

Implications for Practitioners and Families

It is important for practitioners to create programs that meet the needs of children with disabilities while acknowledging the needs, preferences, and expectations of families regarding physical activity. Ways to elicit this information include utilizing surveys (or questionnaires), informal conversations, and, if possible, conducting formal interviews to learn more about the needs of the families. One of the needs voiced by the participating families in the programs was appropriate equipment. For that reason, as part of the program, we provided free equipment to each family related to the content of the workshops (e.g., balls, cones, bells).

This program was possible thanks to the collaboration of professionals in the field of visual impairments. To create similar programs, we recommend professionals partner with school districts and, as much as possible, to partner with universities with a physical or adapted physical education program. The selection of the speakers for each workshop is important to guarantee the success of the program. We recommend that program developers identify speakers who are knowledgeable about the topic and have experience working with families of children with visual impairments. For families, we recommend spreading the news about similar programs by talking with representatives from professional organizations who can assist in creating similar programs or discussing with physical educators or O&M specialists ideas which can be used to create similar programming.

References

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