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University Diploma in Primary Teaching with specialization in Pre-school Education and Therapeutic Pedagogy from the E.G.B. University School of Barcelona (1980) and from the Autonomous University of Barcelona (1987) respectively.
Between 1979 and 1986, she
worked with the ONCE performing varied functions such as Clerk and Teacher
of Typhlotechnology, and in September 1986 began working as Primary School
Teacher (E.G.B.). From September 1987 up to the present, she has been working
as Technician in Visual Rehabilitation at the Visual Rehabilitation Unit
attached to the Joan Amades Centre in Barcelona, while also acting as coordinator
for that Service.
INTRODUCTION
The Diminished Vision or Visual Rehabilitation Services are usually a place where families and professionals alike seek answers and solutions to the complex problem of the child with residual vision. Up until relatively recent times, it was extremely difficult to find an acceptable level of resources and guidance concerning the use of vision under the best possible conditions, and so expectations are usually very high.
The work performed by specialists in diminished vision should not occupy an isolated place in the area of education or in any other set of circumstances surrounding the child, but can a specialist service satisfy all the demands which are often made of it? Can we, from within our sphere of activity, provide all professionals with useful information and, above all, anticipate the future visual functioning of the child? What characteristics must the child have in order to be a good user of optical aids? Do these instruments resolve all the needs these pupils will have throughout their schooling? What difficulties do they encounter at school?
In short, does Visual Rehabilitation respond to the expectations of the child, the family and the teachers?
This paper aims to analyse the performance of the diminished vision specialist service, and to suggest criteria for the shaping of coherent lines of action.
1. AREAS TOUCHED ON BY THE DIMINISHED VISION SPECIALIST SERVICE
Basically speaking, our field of activity can be divided into two areas: diagnosis and assessment of the visual function, and the prescribing of optical aids. We shall now analyse these.
1.1. Diagnosis and assessment of the visual function
This type of assessment aims at a careful evaluation of the residual vision of the child and the way in which he makes use of it. Such subjects present a characteristically wide range of diminished vision: there are no two people with the same degree of residual vision, the same pathology, who are affected to an identical degree and share a similar evolution, and who function in the same way. This explains why the examination includes both clinical and functional assessment. As is usual in formal assessments, the examination has many limitations which can be described as follows:
- The degree of co-operation between subject and assessor as regards the collecting of information is not always the best possible, as the subject being assessed is a child.
- Teachers often have many doubts and worries concerning the visual functioning of the pupil and expect an answer which will dispel these and give them greater assurance in their ability to perform their job. With this type of assessment, we cannot claim to offer a recipe which allows the teacher to solve all the problems surrounding the child.
In order to perform a satisfactory assessment, the following are essential:
- The availability of information the teacher has been able to provide on the basis of observing the environment which is closest to the child: the school situation. There is much to be learned from the way the child acts when using the vision he has available. The response to academic work is a deciding factor: uncertainty when performing manual tasks which require eye-hand precision, the size of the letters used when writing, the pupil tires easily, irregular pattern in the use of vision, etc.
- The pupil also needs encouragement to explain the way he sees, and the things he can and cannot do.
This is the only way in which we can start out at an advantage: by combining this information with the results obtained through clinical examination of the degree of disability. The assessment is never regarded as final, since the process is always initiated on the basis of the information obtained, and requires:
- Influencing the visual functioning of the child by encouraging him to overcome the difficulties he encounters in his use of vision.
- Informing the family.
- Transferring all recommendations to the school so that the specific characteristics of daily performance by the child may be fully understood.
Assessment must be performed periodically in order to confirm results and analyse progress made in the visual functioning of the pupil.
When the child has associated disabilities, assessment becomes much more complex, because it is very difficult to determine the underlying cause of his failure to interpret objects and pictures, why he has not developed exploration and search strategies, and why he is unable to extract valid information from what he observes. The fact that he has a sight problem is frequently used - often incorrectly - to explain this.
The functional assessment of residual vision is not at all easy; levels of co-operation are minimal, the child can only concentrate for very short periods, fatigue sets in early, and the assessment has to be performed over several sessions. The results are also affected when assessment is performed outside the usual environment of the pupil.
In this respect, the conclusions reached by the teacher and the specialist through daily observation provide specific, realistic information on the functioning and visual possibilities of the child, although the fact that it is not possible to quantify them with concrete figures is a drawback. Similarly, the parents are able to observe on a daily basis the way the child functions within the different situations which occur in the home.
1.2. The Visual Rehabilitation Programme: prescription of optical and non optical aids for children
The purpose of the Visual Rehabilitation programme is to prescribe optical and non optical aids which will maximize the use of residual vision. The prescription of optical aids for children involves taking into account a series of specific factors, and does not allow for pinpointing the chronological age which acts as an exact reference for initiating the child into their use.
However, there is a series of considerations which must be taken into account when planning the programme:
- It will never be a job complete in itself. The establishing of goals to be reached by a child is very complex, as on the one hand the level of requirements is wide-ranging, and on the other, the programme must be developed gradually since it undergoes changes as the child makes his way through the education system. It should commence with the use of simple materials which permit him to perform the job in hand, and the prescriptions should be adapted in accordance with the degree of progress made.
- Teachers should assist in the defining of pupil requirements.
- The opinion of the pupil is extremely important.
Before prescribing optical aids for the child, we should:
- Examine his level of visual perception with care. It is essential for the child to have been visually stimulated and for appropriate levels to be applied, because the aids magnify the size of the object under observation and prove useless if the child is unable to interpret what he sees, and his residual vision does not act as a path of perception in the recognition and discrimination of the image being received. - The most appropriate moment appears to be when the child has learned to read and write, as he can then use these instruments for a specific and motivating purpose. However, it must be pointed out that the learning of reading and writing skills is not possible with optical aids, since these only serve to make more difficult what is already a challenging task.
- The use of optical aids requires a series of skills which are related to reduction of the field under study, such as exploring, searching, following the text, changing from one line to the next, etc.
- The introduction of these instruments into the classroom is visible proof of the existence of a hitherto "concealed" problem. This is an aspect which should be watched over: the child must be aware of and accept the differences which his handicap produces in real terms.
- The child must feel the need for assistance because if he does not, it is unlikely that he will use it.
In addition, we must raise the question of whether optical aids which are more suitable for children are available. In our opinion:
- These must be simple and easy to handle.
- It is important for them to be functional: the child should find them practical to use.
- Non optical aids should be introduced in the early stages of schooling. Folding leaf tables and bookrests are convenient to use because they allow for short-distance work to be performed with the correct positioning. Correct lighting which avoids shadows and glare is also essential.
- Any optical aid can be used with children on the condition that they enjoy its use and adapt well to it.
The environmental information which fails to be perceived when sight difficulties exist is far greater over long distances than over short ones, which is why the telescope should be one of the first aids to be applied. In addition, the blackboard and visual material (maps, colour slides, video, etc.) are used a great deal in mainstream schools, and so the monocular telescope can prove to be a great help during these activities, although we must not be led to believe that the problem will be completely solved through the use of this instrument.
- The child must be fully conversant with the optical aid he is given, know what it can and cannot be used for, and also the correct way to use it.
It is of the utmost importance for the child to use the optical aids within the classroom context. There are ways of guaranteeing that this is done satisfactorily.
- Classmates should be aware of the child's problem and know what the special equipment is to be used for.
- Teachers should assist in and encourage the use of optical aids.
- We would reiterate that the pupil must be totally persuaded as to the usefulness of the aid which has been prescribed.
The different classroom tasks which require the use of optical instruments should never be carried out under the same conditions as for a pupil with normal sight. Perhaps this comment appears to be an obvious one, but it is frequently obvious to professionals treating diminished vision but not to others in the environment, and leads to faulty information being received because it is thought that the visual aids will improve vision and normalize the functions performed by the child. The use of optical devices makes it easier to perform certain tasks, but the child must become accustomed to shorter distances, smaller fields, fixed distance, etc.
An intervention model which may be considered more suitable is shown in chart 1.
2. THE ROLE OF PARENTS AND TEACHERS
The attitude of the family and its degree of participation will affect the visual functioning of the child in one way or another.
In principle, it should be borne in mind that the family is usually very anxious and raises many questions that must be solved by the specialist service with the help of the visiting teacher. There has to be an answer to questions such as: Why doesn't the child wear glasses? Is it bad to get too close? Won't the effort of using his sight only make it worse?
Once these doubts have been dispelled, the family usually plays a prime role in encouraging the child to develop his favourite pastimes and games using the residual vision that he does possess. This aspect of the problem is highly important and can, in many instances, be resolved with optical prescriptions.
In addition, all the professionals involved should participate in the assessment and visual rehabilitation processes, as they are a key element at all times for the achievement of the goals which are set. They should make the widest possible analysis of a whole series of aspects which can modify the visual functioning of the pupil in one way or another, namely:
- Motivation. The child should have an interest in using his sight. This is a basic requirement if the child is to complete the Visual Rehabilitation programme which has been developed for him.
- The level of ability and skill necessary for using optical aids. The teacher should fix specific, flexible goals in both these areas with a view to guaranteeing successful use of the aids later on. - To incorporate optical aids into the real situation of the educational framework. It is essential for the teacher to insist on the incorporation and use of the equipment and to intervene when problems of unwillingness and negative attitudes, etc. occur.
- To help to keep the needs of the child in perspective. In this respect, it is essential to avoid subjectivity and capture with exactitude the real needs of the student.
- Another basic element is the assessment of environmental questions and the situation of the child in class.
3. CONCLUSIONS AND DISCUSSION
The Diminished Vision Specialist Services should always be available for the education of the visually impaired child, with all that this involves. They should be utilized according to the needs of the pupil, and define specific requirements which can be met by the professionals on a daily basis and by the family who is aware of the routine difficulties experienced by the child.
From a technical point of view, therefore, we consider that this type of work can provide a satisfactory response, both regarding diagnosis and assessment and the prescribing of optical aids, always on the condition that it is regarded as a resource and that the service is not a place to seek definitive answers and solutions to the complex problem of the child with diminished vision. As stated earlier, the demand for services should be the product of reflection upon the existing need for this type of intervention.
On the other hand, we consider the information we can provide to be very useful, both from the point of view of confirming the visual functioning characteristics of the child and of anticipating future functioning.
Each case should be analyzed on an individual basis when considering the use of optical aids by children and, most importantly, parents and professionals should be persuaded that the use of these instruments alone will not solve all the needs the child will experience during his school lifetime. The only way to guarantee that the child will not feel a failure and will be able to perform school tasks in the most comfortable way possible, is to allow for flexibility and to ensure the use of these instruments in the school context.
Our specific proposals for achieving the above are as follows:
- To work in close coordination and to perform joint monitoring of the process being followed by the pupil.
- To use other, parallel types of resources whenever these are required.
In short, it is essential for the child with diminished vision to use his sight to the maximum of its possibilities, for him to have access to the resources he requires for this, and for him to be in full control of his life at school and in the future as an adult, which is why we should all be aware that our actions and participation will be a conditioning factor throughout the whole process.
MODEL FOR INTERVENTION
VISUAL STIMULATION
ASSESSMENT AND DIAGNOSIS
FUNCTIONAL
PROBLEMS WHEN
PERFORMING TASKS
AWARENESS
SOLUTION TO THE
PROBLEM
. Optical aids
. Non optical aids
. Strategies
. Mobility
. Etc.
EDUCATIONAL
INTERVENTION
. Aid inclusion
. Acceptance
. Environmental modification
. Etc.
Chart 1
BIBLIOGRAPHY
- BASTERRECHA, P. and MATEY, M.A. (1994): Los programas de Rehabilitación Visual en el ámbito de la Rehabilitación Básica. (Paper presented at the National Congress on Services for the Blind and Visually Impaired.)
- VILA, J.M. et al. (1994): Apuntes sobre Rehabilitación Visual. O.N.C.E.
- BARRAGA, N. (1986): Textos reunidos de la Dra. Barraga. O.N.C.E.