Blind and Multiply Handicapped

Blind and Multiply Handicapped

(back) (contents)
Blind and Multiply Handicapped
by Doris M. Willoughby
Editor's Note: The following
article is an excerpt from Chapter 12 of the Handbook for Itinerant and Resource
Teachers of the Blind and Visually Impaired. Written by Doris M. Willoughby
and Sharon L. Duffy in 1989 and published by the National Federation of the
Blind, this excellent resource book is as valuable to parents as it is to professionals.
The book is available from the NFB Materials Center for $23 (shipping and handling
included). To order, send check and request to NFB Materials Center, 1800 Johnson
Street, Baltimore, Maryland 21230. Calls for information or credit card purchases
are taken between 12:30 p.m. and 5:00 p.m. Eastern Standard Time at (410) 659-9314.
Although the term multiply handicapped has been
largely replaced by the term multiply disabled, I have elected to make no editorial
changes in when and how those terms are used in this document. Regardless of
terminology, the content of the following material can stand up to the toughest
scrutiny for soundness in philosophy, attitudes, and practical application.
However, I have replaced referecences to the federal special education law (at
one time commonly known as P.L. 94-142) with the current designation, IDEA (Individuals
with Disabilities Education Act).
When a student has more than one disability,
it is extremely important to examine the situation individually. Each disability
should be carefully analyzed, both separately and as it may interact with the
other disability or disabilities.
Either or both of two opposite errors on the
part of educators (or medical personnel) may cause unnecessary problems: (a)
the assumption that anyone with a multiple handicap necessarily will have great
difficulty in education and in life; and (b) failure to consider how two disabilities
may interact and interfere with customary compensations for each. The former
error is the more common.
Lori has a moderate problem with asthma. She
also wears a brace on one leg, and climbs stairs slowly. If she were not blind,
relatively little fuss would be made over these problems. An asthmatic child's
teachers are advised of any restrictions, and medicine is kept available. The
child who walks with a brace may have adapted physical education. However, if
the child is also blind, some educators may immediately assume that she cannot
achieve normally in any respect an exaggeration that is unconscionable and in
conflict with IDEA. Or, the student and her family may believe any and all problems
are due to the various handicaps.
Michael is not so fortunate as Lori. He is barely
able to walk, cannot control his hands well, and has a moderate hearing loss
in addition to blindness. Michael clearly needs a great deal of special help.
Nevertheless, it should not be categorically assumed that Michael couldn't do
anything in a regular class at the usual pace.
Each Situation Is Different
Look for clear reasons whenever a child is not
keeping up with his age group and work hard to develop the abilities he has.
Be sure that an expert in each disability is on the scene, working cooperatively
with others. The team approach (with the parents always included) really shows
its value with multiply handicapped children. Different specialists working
alone can ruin one another's efforts. Two or more disabilities can interact
in ways that may not be obvious without consultation. For example, the teacher
of the blind may not realize that even mild cerebral palsy can cause much difficulty
with typing. At the same time, the occupational therapist may not realize the
importance of typing to a blind child, and may fail to explore ways to make
it possible. If various specialists work closely with one another and with the
parents, they can find an appropriate approach to each need.
Regardless of the severity of problems, expect
progress and work toward it. Virtually everything in this Handbook is applicable
whether or not the child has other handicaps. Methods and ideas need merely
to be adapted for the other disability.
Other chapters in this book explain that alternative
techniques (methods which do not rely on sight at all) often are not taught
to students who should have learned them. This problem may be even more common
with multiply handicapped children. For example, children regarded as having
low general ability are sometimes not taught Braille at all, even though they
actually could benefit greatly from a vocabulary suited to their needs.
Carefully analyze priorities in working toward
independence, and seek the best means available for meeting them.
When any child has a behavior or adjustment
problem, it can be hard to determine the precise cause. If the child has one
or more disabilities, it becomes especially complicated. Does Matt have tantrums
because he is at the age of the terrible two's, because of losing more sight,
or because of the neglect he suffered before he was adopted? Does Elaine cry
so easily because her heart medications need adjustment, because some classmates
teased her about blindness, because of the tensions of the teen years, or for
some other reason?
Knowledge about specific problems can be very
helpful, but sometimes it is impossible to be sure of the cause(s). It is often
best to deal with the behavioral difficulty and not worry about the cause. Whatever
the cause may be, the student still needs to learn more appropriate behavior
Beware of the tendency to blame everything on
blindness. Because of public attitudes, parents and others tend to believe that
blindness is more devastating than almost any other handicap. A typical result
is the incorrect belief that the blind child with, say, mild mental disability,
cannot succeed nearly as well as others with mild mental disability. Another
common result is preoccupation with futile attempts to develop a very small
amount of sight, to the detriment of alternative techniques and general skills,
which have much more potential.
Blindness and Physical Disabilities
A physical disability may be a problem so slight
that it shows up only in certain sports, at one extreme, or near-total paralysis
at the other extreme. This seems obvious, but is often ignored by unwise generalizations.
Mild orthopedic problems generally should be
accommodated wherever the student would be otherwise. Consider these examples:
A five-year-old has had surgery to straighten
his foot. He has trouble running and climbing stairs. But none of this rules
out his starting to use a long white cane. The cane is, in fact, increasing
his confidence on stairs.
A twelve-year-old uses leg braces and walks
with difficulty. Her class schedule is arranged so that she need not walk a
long distance in a short time. However, except for Adaptive Physical Education,
no alterations are made in the classes themselves.
A first grader has very little use of his right
arm. He cannot read Braille with conventional two-handed motion. However, his
teacher is helping him develop his own style, and he is moving right along in
the Patterns books. His Perkins Brailler has the adaptation for one-handed use.
Any problems involving the hands will usually
affect typing skill. Consult an occupational therapist. Adapted fingering patterns
exist to accommodate missing or useless fingers. If a child with poor muscle
control keeps striking unwanted letters, the occupational therapist can add
a keyboard shield, so that each key is in a small depression. Exercises can
develop finger strength and coordination.
Although some physical disabilities affect how
the hands move in reading Braille, general procedures usually need not be changed.
As long as some fingers are usable, Braille can be learned. Do not assume, furthermore,
that a physical disability necessarily slows down pacing it depends on the individual.
Even if the sense of touch is believed to be damaged, it may develop surprisingly
well with constant practice.
Physical education is most often affected by
a physical handicap. Work closely with the Adaptive P.E specialist for the best
arrangement of regular and/or modified activities. Don't let the student be
left out of archery because the Adaptive P.E. teacher doesn't know about audible
goal locators (devices which make a sound at the target or goal) and failed
to consult you. Don't let the student be excluded from all running because you
don't know how to teach him and you failed to ask for help. Also be sure everyone
is using the same language a bowling rail for the blind is totally different
from the bowling aid for people in wheelchairs.
If the student can walk fairly well, and has
the use of at least one hand, then he can learn to travel with a long white
cane. A mild orthopedic handicap should have little effect on how quickly the
student learns to travel well. Even some people who appear to have poor balance
will walk better with a long white cane, as they no longer need to shuffle their
feet and fear obstacles ahead. (Of course, the long white cane cannot actually
improve balance as such.) A greater physical involvement may cause more difficulty,
but need not rule out cane travel.
One student had an artificial leg. She blamed
her inability to keep in step on that handicap, until the teacher explained
that all students, with very few exceptions, have difficulty keeping in step
at first. Once this was explained, the student mastered this aspect of travel
as quickly as everyone else.
Even for people using wheelchairs there is increasing
use of white canes. One-handed steering of the chair is necessary, to leave
the other hand free for the cane. A telescoping cane may be desirable for storage
on the chair. Even limited independent mobility can be very important for employment
and personal freedom.
Height may not be commonly thought of as a physical
handicap, but it can be. Very short stature can prevent reaching drinking fountains,
locker shelves, etc., and make it hard to find a suitable desk. As the student
moves along in school he will have trouble with foot pedals in sewing, high
tables in science, etc. Often a simple aid such as a footstool is sufficient.
However, for extremely short stature a specialist (Adaptive P.E. teacher, physical
therapist, etc.) should be consulted. He/she may have suggestions not readily
thought of by others, and will lend weight to requests for special furniture.
In the case of very tall stature, as occasionally occurs with early-maturing
children, desk size is the main consideration.
With any extreme, give careful attention to
the student's feeling of self-worth teasing is common from other students and
even adults. Note that abnormal growth hormones can cause early puberty, or
delayed or incomplete puberty.
Blindness and Hearing Loss
A mild hearing loss need not keep a student
from learning in essentially the usual ways. It is very important, however even
more so than for the sighted child with a mild hearing loss that careful attention
be given to the compensations he does need. When a sighted hard-of-hearing child
(or a sighted child with normal hearing who is temporarily disadvantaged by
poor acoustics) cannot hear the teacher well, he will nevertheless receive visual
cues. The blind child who cannot hear the teacher well may be totally at a loss.
Work closely with the audiologist to examine
the environment. Sometimes even a minor change in furnishings can make a great
deal of difference. Especially helpful improvements include:

Carpeting
Acoustical ceiling tile
Dropped ceiling
Cork or other absorbent material on walls

If hearing aids are needed, urge that binaural
hearing (in both ears together) be emphasized, even though this may mean two
aids instead of one. Otherwise the child may hear a sound but not be able to
tell where it is coming from a disastrous problem for a blind child. Develop
and use the hearing in each ear to the maximum extent possible. Also note that
the type of aid called CROS (Contra Lateral Routing of Signals) makes it possible
for one ear to hear sound as coming from two directions, thus encouraging sound
localization.
Different hearing aids amplify particular frequencies
to varying degrees. The importance of environmental sounds to a blind person
may be relevant in the choice of an aid.
In some cases an auditory trainer (actually
a specialized FM radio) may be worn by the child for greater amplification.
Used with a special microphone worn by the classroom teacher, it helps eliminate
extraneous noise. A switch selects reception for the teacher's microphone only
or reception for the classroom in general.
A hearing loss can make it difficult to orient
oneself to traffic and other environmental sounds. It can interfere with using
the sound of the tapping cane to locate doorways, parked cars, hallways, etc.,
as one passes them. Nevertheless, try to help your student develop these skills,
rather than assuming it is impossible perhaps it is possible to some extent.
Also note that the identification aspect of a white cane is especially important.
Headphones may be helpful in listening to recorded
material.
Lew Needed Help
Lew was visually impaired; however the preschool
teacher had said he could see all of their materials OK. He also had a hearing
impairment, but his speech communication was good. It was expected that he would
do well in regular kindergarten. However, he failed to learn the names of the
alphabet letters, often ignored the teacher's directions, and generally had
severe difficulty.
Ms. Pirtle, the itinerant teacher of the visually
impaired, believed that not enough attention had been given to the hearing impairment.
She insisted that a teacher of the hearing-impaired attend the spring IEP conference.
I wonder if Lew should have a Phonic Ear, commented
Ms. Pirtle (using the brand name for one kind of auditory trainer). Sometimes
we think he really doesn't hear the teacher's directions. And I wonder if he
really hears the difference between the letter names b, d, and so on. His vision
really isn't good enough to see gestures clearly or do any lip reading at all.
We usually don't suggest a Phonic Ear for children
with this much hearing, replied the teacher of the hearing-impaired. But you
may be right. Let's put it in the IEP as a trial arrangement.
In first grade with his Phonic Ear, Lew's achievement
and adjustment improved rapidly. He quickly learned the letter names, now that
he heard each one reliably. He no longer needed repeated explanations and reminders.
Impressed with this improvement, the parents also decided to agree to include
Braille in the next IEP; Lew had great difficulty seeing ink print letters near
the end of the day.
I didn't realize, said the teacher of the hearing-impaired
at the next meeting, how much the low vision interfered with the compensations
which other hearing-impaired children make almost automatically. Because Lew
could see pictures and letters at close range, almost everyone had made this
error. Lew himself, never having experienced good hearing, had no understanding
of the problem. (If asked, Can you hear me? he would usually answer Yes, not
realizing what he had been missing.)
Deaf-Blind Students
If the student has very little hearing, and
also little or no vision, a specialist in the education of the deaf-blind should
be involved. Detail about the education of the deaf-blind is beyond the scope
of this book. However, the importance of three key skills will be pointed out:
Braille, typing, and mobility.
Braille is vital for all the usual reasons,
plus several others. Talking books and live readers are not usable. It is difficult
to keep up with the news when one cannot use the newspaper, radio, or TV; the
American Brotherhood for the Blind doing business as the American Action Fund
for Blind Children and Adults publishes the Hot Line for Deaf-Blind,
a weekly Braille newsmagazine.
Although manual sign language can be used by
the blind (in a version contained within the hand of the listener), written
language is essential for spelling, grammar, and precise meaning. Standard English
may actually be a second language as compared to the sign language used.
Furthermore, for the deaf-blind Braille is a
major channel for personal conversation. The Tellatouch, manufactured by the
American Foundation for the Blind, enables almost anyone to communicate with
a deaf-blind person. By using either the keys of a regular typing keyboard or
keys like a Perkins Brailler, the speaker can raise pins to form Braille under
the listener's fingertips. The Tellatouch is probably the most versatile and
efficient communication aid for the deaf-blind. The keyboard can be used by
almost anyone, with virtually no training necessary; the listener need only
know standard Braille, or even just Grade I Braille; and the device is not extremely
expensive.
Another device is a glove with the letters of
the alphabet printed in locations, which the wearer has memorized. The speaker
touches letters in turn, to spell out a message.
Newer devices, much more complex and expensive,
may enable conversation in either direction or even over the telephone.
In communicating with a sighted person who is
not present, typing skill is valuable for the deaf-blind as well as others.
In addition, the deaf-blind person whose speech is not easily understood will
find a typewriter to be a handy, inexpensive way to communicate in person.
A person without sight and hearing may be limited
in mobility. However, there is no reason why a deaf-blind person cannot use
a cane at school, in the workplace, and elsewhere with appropriate arrangements.
General Health Problems
When a medical condition affects a student's
general health, a primary problem is deciding how much to expect. Can tension
bring on an attack or seizure? Does the health condition truly limit stamina
or general ability? If so, how hard do we dare to press for achievement in school?

Solid decision-making is based on a clear medical
statement from a doctor, usually with interpretation by the school nurse. Ask
the nurse for written specific guidelines, to be distributed to all teachers.
(Example: One student was severely bothered by heat, but the school was not
air-conditioned. Every fall and spring there was much debate as to how much
he couldn't stand. The boy took advantage of this by avoiding assignments. Finally
the nurse analyzed the temperature at which he began to have real trouble, and
a thermometer was placed in each of his classrooms. When a room reached the
problem level, the boy took his work to the air-conditioned office for that
class period. On very hot days he worked at home. In no case was the boy excused
from assignments.)
A policy of written guidelines also prevents
phantom diseases. One girl was thought to have mononucleosis, but actually was
overdoing her musical activities. Another girl, after fully recovering from
a severe infection, had to fight for years a reputation of being sickly. Blind
children, whom society tends to believe are frail anyway, are especially vulnerable
to such misjudgments.
It is wise to check about food prohibitions
for all students, especially those with health problems. Any child may have
allergies. The diabetic child has a very strict regimen. Don't forget that small
treats are food too.
The Emotionally Disturbed Child
Too often, the emotional problems of a blind
or visually impaired person are blamed on the visual disability itself or on
irrelevant factors, when the real problem is inadequate skills or incorrect
assumptions about blindness.
Carol achieved excellent grades in high school,
and received an award as an outstanding blind student. After graduation, however,
she became more and more frightened at the prospect of college and a job. She
became afraid to leave the house alone.
Carol talked with a psychiatrist, who believed
that she had a typical reaction to the trauma of blindness, and concentrated
on helping her adjust to restricted circumstances. Later a second psychiatrist,
while counseling Carol to build up her confidence, strongly urged her to attend
the adult Orientation Center for the blind. Finally Carol agreed. She also joined
the National Federation of the Blind and met successful blind people from all
walks of life. Soon she was delighted with her improved practical skills, and
came to realize that it is respectable to be blind. No longer feeling that blindness
meant inferiority, Carol went on to college a few months later.
Carol's high school teachers had helped her
to achieve well academically, but had not succeeded in teaching her real self-respect
and confidence as a blind person.
Fortunately Carol lived in a state with an exceptionally
good adult Orientation Center. In many states she would have received little
positive help after high school. The National Federation of the Blind, however,
provides a positive influence throughout the country.
Some blind children, of course, really do have
emotional problems as such. Consult the psychologist or other expert if a student
is destructive toward himself or others, loses or gains a great deal of weight
without medical explanation, or has major behavioral changes (examples: increased
withdrawal and avoidance of personal contact; increasing aggression; increased
avoidance of responsibility; marked indifference to personal appearance or to
things in general).
As with any other multiple disability, specialists
must work together. The psychologist might be unaware of the real problems of
blindness, just as you may not know how to treat serious depression.
When a blind child truly has psychological problems,
it is no less important that he be taught good techniques and positive attitudes
regarding blindness. He does not need the additional burden of believing that
blindness means inferiority. Whenever a blind child seems to have severe behavioral
problems always consider all of these possibilities:
(a) a true psychological disorder
(b) low expectations due to an exaggerated view
of the limitations of blindness
(c) lack of skills (mobility, social interaction,
etc.) or the opportunities to use them
(d) two or more of these together
Following are several examples of apparent psychological
problems, which turned out to be something else. In each case, if the described
solution had not worked, psychological causes should have been investigated.
(Caution: Often in such cases, the problem related to blindness is handled poorly,
and a psychological cause is still wrongly assumed.)
A seventh-grade girl seemed withdrawn, not talking
with any of her classmates. A sympathetic classroom teacher found that she knew
almost no one, and lacked experience in making friends. This teacher coached
her in how to get acquainted. She also recruited three girls to go to lunch
with her.
A partially sighted tenth grader refused to
go shopping or walk to the pizza
shop. If she did go out in public, she clung
to someone's arm. I'm afraid of crowds, she said, and the psychologist wondered
if she had agoraphobia (extreme fear of open places). Finally her parents realized
that the girl could not really tell the difference between a step-down and a
mere change in pavement coloring. Also, they realized she really could not judge
traffic motion. They insisted that the mobility teacher give her cane travel
instruction with sleep shades, even though he had said this was unnecessary.
After a few weeks the girl was shopping happily all over town, with newfound
freedom and confidence.
A third-grade boy continually poked and pushed
his classmates. The counselor found that, like the seventh grade girl above,
this boy did not know how to make friends. Also, some of the boys had teased
him about his heavy glasses. The counselor included this student in group counseling,
to help him make some real friends and to teach him social skills. This small
group often played together at recess, providing an additional opportunity for
normal social interaction.
An eighth grade girl, rather thin, never ate
lunch at school. By 2:00 p.m. she was tired and listless. The nurse feared she
had an eating disorder.
I'm just afraid I'll make a fool of myself,
the girl finally confided. Those school lunches have gravy and soup and whatever,
and I know I'll make an awful mess. And don't tell me to bring a sack lunch.
My mom doesn't have time to make one.
The nurse arranged several sessions of eating
hot lunch privately with coaching. She also helped the family teach the girl
to pack her own sack lunch.
His behavior is bizarre, said the first grade
teacher. He waves his arms in circles, just any old time. And he keeps poking
his fingers in his eyes.
The resource teacher explained that these habits,
while very undesirable, are not unusual in blind children and may not mean psychological
disturbance. The psychologist helped the teachers work out a behavior modification
plan, with simple rewards for avoidance of these habits.
An eleventh grade girl was very unhappy. Everyone
assumed that this was because of losing more and more sight. Finally, however,
her mother realized that the breakup with her first real boyfriend was the current
crisis. Several heart-to-heart talks revived interest in school dances and other
activities. At the same time, the counselor and the resource teacher reexamined
the program of alternative techniques to cope with decreasing sight.
A senior boy seemed deeply depressed. The psychologist
found a strong fear of spending life in a rocking chair, like an elderly blind
neighbor.
Although this boy had met some other blind people,
he had never really talked with them about their jobs. It was arranged for him
to visit two blind people at work and to receive cassettes from Job Opportunities
for the Blind. Soon he was happily examining several career choices at the Community
College.
He must be autistic, said the kindergarten teacher.
If you leave him alone, all he does is whirl around and around.
The itinerant teacher redoubled her efforts
to teach the child cane travel for increased mobility. She urged the kindergarten
teacher to correct him sternly whenever he started whirling. If it's a class
session, insist he sit down and pay attention, just as you would any other child.
If it's free play, move him physically to something interesting, such as the
clay table or the swing, and insist that he do something constructive.
Pseudo-diagnosis of supposed psychological problems
is very common, due to the mistaken belief that blindness necessarily causes
psychological difficulties, and due to inadequate teaching of techniques and
skills. However, as with any student, a psychologist should be consulted if
solutions such as those above do not work, or if the behavior is dangerous.
Always consider also whether a medical condition (possibly undiagnosed) might
be affecting behavior.
Mild Mental Disability
Most students classified as mildly mentally
disabled can lead an essentially normal life, and do not appear obviously different.
Regular social interaction and integration into some regular classes are appropriate.
Modification is usually necessary for heavily academic work.
For the older student, emphasis is placed on
vocational skills for appropriate jobs. Often high school students have a part-time
job in the community with school supervision restaurant work, farm work, cleaning,
stocking shelves, etc. These students reasonably expect to marry, to raise families,
and to hold jobs in competitive employment at a level appropriate to their ability.
In short, they blend into the general population.
Mild mental disability is generally defined
by a score of 55 to 70 on an intelligence test. Those scoring slightly above
this are often called slow learners and may need somewhat similar help.
There is no reason why mildly mentally disabled
blind students cannot learn the same alternative techniques as others Braille,
cane travel, typing, abacus, etc. Extra explanation, practice, and repetition
may be needed, but basically the education of a mildly mentally disabled blind
student is similar to that for others.
However, mislabeling a visually impaired child
is a common problem. Sara had always been regarded as mentally disabled. However,
when a new itinerant teacher started an assertive program of alternative techniques
(despite previous assumptions that Sara could not benefit from them because
of retardation, or did not need them because she had some vision), Sara bloomed.
By graduation, it was obviously doubtful whether Sara really was mentally disabled
at all.
Blindness aside, there is much controversy as
to whether intelligence tests really measure general ability. For blind students
there are additional problems with such tests, as discussed in the chapter on
testing. As provided in IDEA, no single test should be used to classify a student.
Use more than one measure, including general behavior and achievement.
Moderate Mental Disability
This degree of disability is generally defined
by a score of 40-55 on an intelligence test. These students have difficulty
with social conventions and life skills, and have very low ability for academic
work. The student generally can learn to dress himself, eat normally, and handle
most self-help skills, but some supervision will probably always be needed.
(For example, a person may learn to dress himself and to do laundry, but not
be able to handle repairing or replacing garments.)
Typically, moderately mentally disabled persons
achieve partial self-support in sheltered employment. Some, however, do hold
regular competitive jobs.
Many blind students with this degree of disability
read Braille with a limited vocabulary, just as their sighted counterparts do
in print. If there is uncertainty whether reading instruction is appropriate,
a good indicator is the degree to which the student can grasp concepts. Can
he make comparisons? Draw conclusions? Carry on a logical conversation? If it
seems at all reasonable, reading instruction should be attempted. Even a few
symbols can be useful for labeling, for simple messages, etc.
For pre-reading skills, provide materials similar
to those used with preschool children. If the student is really beginning to
read, someone who knows Braille should work directly with him.
Most moderately disabled persons are able to
learn cane travel, sometimes doing better than one might expect. Without a cane,
the person is more limited than is really necessary.
For older students, independent living skills
and vocational education are emphasized. Instruct the student and/or his teacher
in alternative techniques for such things as:

Personal cleanliness
Cooking
Laundry and very simple mending
Housecleaning
Shopping
Industrial janitor work
Sorting and assembling
Collating, stapling, etc. (You may need to explain techniques
for keeping track of which papers are which. They may be boxed, labeled, kept
in a certain place, etc.)

The role of the resource/itinerant teacher of
the blind will depend on the student's age and individual abilities. If a skill
such as cane travel or Braille were being intensively taught, you would work
directly with the student. But if much repetitive practice is needed, someone
else will probably help in between your lessons. Often you will mainly provide
information to other teachers and to the family.
Severe/Profound Mental Disabilites
These students have intelligence scores of under
40. Many will never walk. A sheltered living situation will be needed in adulthood.
Lessons for a Severely/Profoundly Handicapped
Student
When a student is mildly mentally handicapped,
working with him is basically the same as with others, but at a slower pace.
Working with a school-aged student who is moderately handicapped is much like
working with a preschooler or kindergartner, though there usually are complicating
problems. But when a teacher is first asked to work with a severely/profoundly
handicapped individual, it may be very hard to imagine how to proceed. This
chapter will offer a number of suggestions.
Unless you are employed by a special school,
your role probably will not usually include direct instruction. Daily contact
is necessary to achieve rapport. Progress occurs at a pace so slow as to be
outside many teachers experience. Academic work is not appropriate. For these
reasons the itinerant/resource teacher of the blind will most often provide
suggestions and materials. But in order to do this one must understand what
the program for such a student is like.
Why is it so important for that boy to shake
a rattle? I once asked a friend who worked at the State Hospital-School. Is
his hand coordination so poor?
That is part of it, she replied. He can't do
much with his hands yet. But our main goal on this is to get him to sit at a
table. If we can get him to sit up and rattle something, then he'll be in a
normal position instead of sprawled. This will also help him hold his head up.
And if he gets used to really sitting at the table, consider all the things
that can lead to eating more normally, putting objects in containers, even starting
to work a simple puzzle.
My friend was helping me think about early developmental
skills. It can be hard to think in those terms when the chronological age is
12.
Following are some typical skills, which (with
much more specific wording) may be in the IEP:

Turn head toward something interesting
Reach for an object on command
Recognize familiar objects
Distinguish between colors
Roll a ball
Place a ball in a box
Follow a simple command, such as Stand up
Wash hands
Wash face

For the severely/profoundly handicapped student,
it is necessary to break skills down into very small steps, each of which must
be taught by much repetition. Consider a sequence for a student learning to
wash her face:
(1) Reach for washcloth
(2) Pick up washcloth
(3) Find faucet
(4) Turn on water
(5) Hold washcloth under water
(6) Wring or squeeze cloth
(7) Put cloth to face
(8) Move cloth around on face
This sequence actually is only a part of the
procedure, because after each new step is learned, all steps to that point must
be practiced before adding another. Also, the above sequence does not include
soap. That may need to begin with: Examine soap and understand it is not to
be eaten.
Teaching a severely/profoundly handicapped student
to wash her face, with daily lessons, can easily take many months.
Most Blind Students Do Not Need This
Breaking a task down into small steps, as above,
is necessary for students who have great difficulty. To a lesser extent, breaking
a task into smaller steps is also done routinely by all teachers.
Blindness in itself does not require more of
this kind of thing than is necessary for sighted students. However, unfortunately,
some publications seem to make that very assumption. For example, A Step-By-Step
Guide to Personal Management for Blind Persons gives incredibly detailed
directions for taking a bath e.g., As towel gets damp, shift to a dry section.
This widely circulated book ought to be entitled: A Step-By-Step Guide to
Personal Management, for Blind Persons With Special Learning Problems.
Its text should carefully explain that such
detailed help is not needed for the vast majority of blind persons. In this
way the book could be helpful for those who really need it, without encouraging
the false belief that all blind persons are unable to follow ordinary directions
or grasp general concepts.
In 'To Man the Barricades' (see References),
Kenneth Jernigan explains in detail the severe damage caused by the assumption
that all blind people need the help which is appropriate for those who learn
very slowly.

Helping Teachers Make Lessons Appropriate
In teaching a skill to a severely/profoundly
handicapped student, it is usually necessary to move the student through it
physically many times, gradually giving less and less help. For example, at
first the teacher might hold the student's fingers on the washcloth and raise
the student's arm to the face; later the teacher might just touch the fingers
and raise the child's arms slightly as a reminder. This is called physical prompting
and is especially important with a blind student.
Emphasis should be on skills for functioning
as independently as possible in an appropriate (very sheltered) environment.
You may need to provide ideas for alternative
techniques, and to help teachers realize that planning for a blind student is
basically the same as planning for other students. Ask, What is she doing now?
and What would you be doing if she were sighted? Teachers of the mentally disabled
will know what is appropriate for each developmental level, and how to break
things down into small steps. After some consultation and experience, they will
usually be able to plan their own modifications for a blind student. Give plenty
of encouragement and compliments for the teacher's work.
Let us return to the list of typical skills
and note how they can easily be made appropriate for a blind child:
Turn head toward something interesting:
Use an interesting sound. If there is some sight, sometimes use a flashing light
or a bright-colored shiny surface.
Reach for an object on command: Associate
a sound with the object, or use something very bright if that is appropriate.
Recognize familiar objects: Make sure
the objects are consistent and easily distinguished tactually.
Distinguish colors: If the child has
quite a bit of sight, this may be achieved with bright, clear colors. Distinguishing
textures is an appropriate alternative.
Roll a ball: Use a ball that makes a
sound. Provide plenty of appropriate feedback (for example, the teacher might
clap his hands when the child rolls the ball a certain distance.)
Place a ball in a box: Use a stable container
that will not move around easily. Help the child to examine the ball and the
container with her hands, before she tries to put the ball in.
Follow a simple command: such as Stand
up. Use physical prompting.
Wash hands or face: Washcloth, soap,
faucet, etc., can all be found by touch. It is helpful if (at least at first)
such things are always in the same place in relation to the student. Help the
student examine and understand each thing (including the water itself) before
starting to work on what to do with it. For example, help her to turn on the
faucet with one hand while her other hand is underneath, so that she feels the
stream come on.
Keeping Vision In Perspective
Avoid being pushed into overemphasizing visual
development. On the one hand, especially with the younger child, it may be hard
to tell how much he really can see, and therefore some effort to develop the
use of his sight may be warranted. On the other hand, parents and teachers often
overdo the visual emphasis, in a futile attempt to improve vision that is not
really there, and with the erroneous idea that better vision would bring better
general ability.
Encourage everyone to note what (if anything)
interests the child visually. Will he turn toward a light? Does he respond to
the general room lighting being turned on or off? To a flashlight? To shiny
surfaces? To blinking lights? To lights of certain colors? Red and green are
often favored. Also, black light may be especially effective (a kind of ultraviolet
light which cannot itself be seen by the human eye, but which can give interesting
fluorescent effects).
[Caution: Some lighting effects, especially
blinking lights, may bring on seizures in certain children.]
If the developmental level is early infancy,
remember that development of the use of vision will not exceed mental and physiological
development.
For a child with very low awareness, it may
help to pair something visual with something else to which the child already
responds, and gradually encourage the child to notice the visual attraction
alone. For example, if the child already responds to music, a bright red ball
might be shown each time the music is started. This may help the child learn
to respond just to seeing the ball.
Keep vision in perspective by working to develop
all senses. This approach helps to determine the child's general ability as
well as his visual ability. Emphasize the integration of sense that is, how
the senses work together. Any child with useful sight (including the fully sighted)
requires practice in order to know what visual information means. After he has
felt a ball many times, he comes to understand when his eyes are seeing a round
object.
Following are a few typical activities that
help develop the sense of touch, smell, and/or taste, along with vision if it
is present:
* Peanut butter is placed on the fingertip and
may be licked off.
* The child examines various textures (velvet,
corduroy, hay, feathers, etc.) and gently rubs his arms and legs with each.
* Cornstarch is moistened to form a ball with
interesting characteristics. When held in the hand it melts, but upon leaving
the hand it coagulates again.
* Water play has endless possibilities.
Conclusion
What kind of educational setting does this student
need? In answering this question, carefully consider which disability most affects
education as a whole. If mental ability is essentially normal, then the regular
curriculum is appropriate, with only as much special help as is genuinely needed.
If the student is severely mentally handicapped, then the mental disability
and not the blindness is most relevant; a setting appropriate for severely mentally
disabled students is preferable to one for merely blind children.
Placement should always be decided on an individual
basis, however. Rigid categories are not an appropriate way to plan education.
The following chapters in this book are especially
relevant for students with more than one disability: Early Childhood, Orientation
and Mobility (Under Age 8 and Special Problems), Teaching Braille (Second Grade
and Below), Dealing With Medical Matters, Placement Options and Decisions, and
Working With Other Agencies and Organizations. See also References.
Many people with multiple handicaps complete
their education, raise families, and succeed in vocations of their choice. Treat
each student as an individual, emphasizing the strengths he has, not permitting
him to be regarded only as part of a vague lump called the multiply handicapped.
(back) (contents)