Assessment of vision functioning in multi-disabled and visually impaired children for early intervention planning

Focus Area: Early Intervention

Topic: MDVI

Marketa Skalicka

Low Vision Therapist

Early Intervention Center in Prague

Association for Early Intervention  

Hastalska 27, 110 00 Praha 1, Czech Republic

phone: +420/603354796

skalicka.marketa@quick.cz

Early intervention can start only after discovering of the needs of the family and thorough assessment of the child's needs.

Home visitor  who in responsible for intervention in the family needs to know :

1) what is the child's general health state

(what additional impairments the child suffer from, if he needs special medication which can influence his sensor and motor alertness and activities)

2) what are his/her physical/motor limitations, what kind of exercises the parents have to perform and what is the best positioning of the child to be able to perform his/her vision abilities

3) what is his/her cognitive developmental level

4) what is his/her diagnosis of visual impairment, what are the remaining  functions available for his/her visual functioning and how he/she can utilize his/her vision in his/her functioning in the daily life.

After we had studied the system of admittance assessment provided by our colleagues in Sensis in Grave, the Netherlands, we developed our system of assessment of the child when applying for EI services. The system of assessment has being used in the EI in Prague for one year. We have another 6 centers around the country where the system has not been used yet.

A) Each child whose family apply for the service is visited by home visitor, who see the child first in his/her home environment. He/she discuss with the parents their expectations about the services and  EI services which can be offered to them.

The parents together with the child are invited for the complex assessment to the EI Center in Prague.

B) In the Center the family meets a team of  three specialists (low vision therapist, physiotherapist, psychologist) and the home visitor who visited the family.

The meeting lasts 1.5 hour.

At the beginning the home visitor introduces the team members to the family.

Then the family is asked for medical reports and introduction of their child, what are the child's skills, what are  his/her vision, motor abilities, eating, play activities according the parents' experience.

Then the low vision therapist provides assessment of vision functions and functioning in assessment room, the physiotherapist observes the child during the vision assessment. It takes about 20 minutes.

Then physiotherapist provides motor development tests in the play room and low vision therapist observes the child during that time. It take also about 20 minutes.

Then the parents with the child come back to the meeting room together with the home visitor while the team meets to discuss the observations of the child s condition and makes the decision about the acceptance of the child for the service and global plan for the intervention and the time of the next assessment.

If there is expectation of the child's quick progress the intervention is  offered for a limited period. If the child seems to have severe impairment the intervention is offered for the full period (up to the age of 4 years for child with visual impairment, up to the age of 7 for multi-impaired child).

After the team meeting the specialists say their conclusion about the assessment and recommendation for the nearest period of intervention to the parents: low vision therapist in the area of vision stimulation, vision training, environment adaptations, the physiotherapist in the area of positioning, exercises, special aids, feeding training etc.

All observations, conclusions and recommendations are written down and sent to parents.

Home visitor makes the appointment with the family for the next visit.

If the assessment shows that the child does not need special intervention for visually impaired children or the child is in the age when the intervention would last for a very short time, the team recommends another suitable service.

The procedure and the recording of the  assessment of vision functions and vision functioning contains following items:

a) Information from the parents (their observations about the child s vision functioning in the familiar environment, visits to the eye  doctors, therapy, prescription of glasses)

b) Assessment conditions (lightening)

c) Course of the assessment (child's mood, child's position during the assessment, time of the direct work with the child, activities done with the child, toys, aids used during the assessment)

d) Assessment of vision functions and functioning:

- does the child use both eyes, does he/she prefer using one particular eye

- special head posture

- sensitivity to the light or better vision in twilight

- pupillar reaction: slow, not equal on both eyes

- reaction to the sudden movement in front of the eyes

- does the child use glasses

- did the child use glasses during the assessment

glasses: right eye                                    left eye

1) eye movements (nystagmus, strabismus, non-coordinated eye movements, smooth coordinated movements, convergence to the near)

2) visual attention (change of the breath rhythm, in movements of the body)

to: light, shiny object, contrast colored object, faces ...

3) localization and fixation

indicate object, its size, distance of the object, length of fixation

4) following  moving object (follow over central line, move eyes and head, only eyes) indicate object, its size, distance

5) shift of the attention

indicate object, its size, distance

6) vision acuity:

resolution:

Lea Gratings Test: binocular, monocular, with and without correction

recognition:

LH Symbol Tests: distance (binocular, monocular, with and without correction)

LH Symbol Test near: (binocular, monocular, with and without correction)

BUST Test: distance     ""

                    near            ""

7) Color vision

indicate used material

8) Contrast Sensitivity:

indicate used material

Hiding Heidy test:                                      distance

9) Visual Field

10) Visual Sphere (indicate in what distance the child fixates certain object)

11) Scanning in the near space, on the desk (looks for one, two, more object on the desk), indicate object, its size, distance from the child, distance between the objects

12) Eye/hand coordination

- follows the hand during activity

- looks first, then grasps without eye control

- search things only by touch

13) Recognizes objects

indicate objects, its size, contrast distance,

14)  Recognizes photographs, pictures of real objects

indicate material used, size, contrast, distance

15) Recognizes geometric shapes, pictograms, symbols separately:

indicate material used, size, contrast, distance

16) Points details at the picture, chooses or matches symbols, pictograms in the group (crowding)

indicate material used, size, contrast, distance

Conclusion:

(The child dominantly uses vision, hearing, touch, integrates senses ...)

Plan of vision stimulation and training skills:

Time period:

A) Skills to be trained:

B) Recommendations for environment adaptations, for use of special toys, aids, recommended activities

The plan for the stimulation is discussed with the home visitor. He/she can consult it with the low vision therapist when he/she needs. The parents can come for the center based individual stimulation program according to their possibilities and need. Some of them come regularly every month.

Problems we can see in our assessment work:

1/ How to distinguish which problem comes from the visual system and which from the cognitive developmental delay in young premature babies

2/ How to assess the central visual impairment in the age under one year

3/ How to define the severity of the visual impairment of the children with multiple neurological impairments in early age