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IN - SIGHT

HIGHER LEVELS OF VISUAL FUNCTIONING IN PARTIALLY SIGHTED CHILDREN.

AN ASSESSMENT PROCEDURE.

 

IDA E. EKKENS

VISIO, Royal Institute for the Education of Blind and Partially Sighted Children

Amersfoortsestraatweg 180, 1272 RR, Huizen, THE NETHERLANDS. 

 

Abstract
This paper outlines the content and uses of In - Sight, an assessment procedure concerning higher levels of visual functioning in partially sighted children.
How categories and items, related to classroom tasks, were selected will be described as well as why In - Sight is being developed. Registration of data will be mentioned.

Introduction

The Royal Institute for the Education of Blind and Partially Sighted Children,
(KIOSB) is developing a standardized assessment procedure to screen higher levels visual functioning related to classroom tasks. Why? Because instruments available sofar are mostly meant for children who are just beginning to use their limited vision. However, many children score well on these, excellent, tests. The question then arises which relevant data should be obtained when demands on visual functioning increases.
How can observations of higher visual functioning be structured? Can a visually handicapped child come close to the visual versatility of children who have no visual impairment?
To try and answer questions like these an analysis was made of visual components, within the eye-hand radius, which are of importance in an educational setting, emphasizing the variability and complexity of classroom tasks.

Target group

In - Sight is meant for visually handicapped children, six to twelve years of age, with normal learning capacities. The procedure is not meant for 'low vision' children with no more than some usable residual sight. The procedure has been developed with teachers in mind but can easily be used by other profressionals.
In - Sight is geared to the Progress Monitoring System for Visually Handicapped Chidren which has been set up by VISIO/KIOSB. This system not only screens visual functioning but all the senses, as well as motor proficiency, cognition and emotional development.
 

Purpose

The objective of In - Sight is to assess progress of visual functioning over a number of years, keeping in mind the skills of a child with normal vision.
The changing visual context determines the level of visual functioning within each of the twelve categories.
Primarily the procedure aims to assess what a child can do with residual vision. Many children can do surprisingly more than initially expected.
Secondly In - Sight will register what the child can not do, as yet.
When the child performs well on In - Sight, it can be expected that all work to be done in the classroom, within the eye-hand radius, should be possible without too much of a problem.
The level of visual functioning is measured by the use of variables, gradually becoming more complicated as the child grows older.
The scores, together with specific points of observation, will provide extensive information about weaknesses and strengths of the child at a given age.
Based on these findings it becomes clear what can be asked of a child in an educational setting. Appropriate adaptations can then be made to facilitate visual functioning and suitable prescriptive teaching can be considered.

Method

In - Sight rests on many years of practical experience screening and training visually handicapped children. Based on this experience, prerequisites for effective visual functioning related to classroom tasks were brought into perspective.
Subsequently these findings were incorporated in the selection of categories.
Then each category was divided into a number of items. An item - diagram was made for each of the given categories, in order to make it possible for the user of In - Sight to see at a glance which aspects of visual functioning can be assessed. In addition a matrix for structured observation was devised, because it is felt to be essential not only to know what a child can do with residual vision but also how he goes about a given task.
In order to register data to be utilized, specifications were made for the lay-out of a protocol-form and score-sheet. Next to instructions on how the items should be administered, the reason why a particular task is important for teaching purposes has been explained. Hopefully this will give teachers relevant background information, thus encouraging 'diagnostic teaching'.
To make In - Sight 'fun to do' for children, materials of interest to them, such as animals, dolls or cars, were chosen. The work-sheets to be looked at were made by a graphic designer, according to specifications.
Last but not least an extensive guide for the evaluator was written. In this guide the rational and history of the development of In - Sight are furnished as well as how and when the instrument can and should be used. A short explanation of each category has been added.
A 'resonance group' of experienced teachers and child psychologists provided much appreciated feedback, focusing on the basic concepts of the procedure.

Contents

In - Sight contains twelve categories of visual functioning, each divided into items, graded according to difficulty. The choice of these items was made from a practical point of view namely: which visual skills does a child need in the classroom within the eye-hand radius?
The instrument was divided into three levels of visual functioning, related to chronological age, resulting in as many age-groups. Each age-group received one of the three colours that make up the Dutch flag:
- RED: six to eight year old children,
- WHITE: eight to ten year old children,
- BLUE: ten to twelve year old children.

In - Sight includes about a hundred items. This is felt to be necessary because it involves higher levels of visual functioning, taking into account a large number of variables and the age of the children concerned.
Some categories have more numerous items than others because of their particular relevance to learning. Which categories? Perception of detail, visual discrimination and visual-spatial perception. This does not mean that the other categories, such as 'how to look', colour and contrast, part-whole relationships, figure-ground perception or picture interpretation are unimportant. And of course, two dimensions (2D/3D), visual-motor skills, perception of symmetry and visual closure are also an integral part of In - Sight.
Information to be obtained from recommended observations is structured under three headings, each with a number of points visable in the observation matrix.
- chooses spontaniously, for instance 'viewing distance or angle'.
- completing visual task, for instance 'ignores part of work-sheet'.
- psychological factors, for instance 'fear or protest'.
Observations are not supposed to be valued but should just be noted.

Visual memory was deliberately not selected as one of the categories but included with the observation - matrix, because it is felt to be of importance to all categories at hand and therefore must, in this case, not be considered seperately.

Uses

In - Sight is not meant for 'low vision' children, using the term 'low vision' as: 'residual vision of children who are diagnosed as functionally blind'.
A guideline can be: children who are or will be able to read print are suitable to be screened using In - Sight. Children reading braille are not suitable. However, children deserve the benifit of the doubt. In addition it should be remembered that visual functioning does not always develop in a logical sequence.
In - Sight can be used in a number of ways.
1. Extensive version. This means all items within a certain age - group (red, white, blue) will be screened.
2. Shortened/'Flash' version. A suggested selection of the extensive version.
3. Impairment related: loss of visual field; lowered contrast sensitivity; disturbed perception of colour; nystagmus; diminished perception of detail; short viewing distance; interpretation of visual information.
4. Progressive diseases. To determine the effects on visual functioning.
5. Late admission to the school. Possible choice: lower than the age of the child would justify.
6. Repeated screening. After a period of visual training.

Difference

In - Sight differs. In what way? The twelve assessment categories are more or less the same as the ones used internationally. But the chosen items within these categories are clearly different. How? Consider for instance the category perception of detail, probably the most important component of visual functioning. To decide on the items for this particular category, a number of questions were asked:
- When is perception of detail necessary?
- Which factors can influence perception of detail?
- Which variables of detail perception determine flexibility of skill?
As an answer to the first question a few examples: detail as part of a given whole; on a large surface; around a horizontal or vertical axis.
Next some examples related to the second question: conditions of low contrast (colour or black/grey/white); embedded detail with possible crowding effects; details without meaning.
Finally the third question: recognition of detail despite altered appearance or distracting factors; noticing details that are missing on the basis of visualization.

The items for all of the twelve categories were determined in similar fashion, always keeping in mind the variability and complexity of classroom tasks.

Conclusion

Effective use of vision will remain an important issue. The makers of In - Sight pursue a worthwhile 'tradition' by adding a valuable assessment procedure to the ones already available. Allthough some lines of thought obviously differ, the assumption that the use of residual vision can go far, does not.

References:

1.Barraga, N.C. & Morris, J.E. Program to develop visual functioning. American Printing House for the Blind. Louisville, Kentucky, 1989.
2. Blaksby, D.C. Visual Therapy. A theoretically based intervention program.
Journal of Visual Impairment and Blindness, 1992.
3. Corn, A.L. Instruction in the use of vision for children and adults with low vision: a proposed model. Re - Viuw, 1989.
4. Frere, S. Light box Activity Guide. Level I, II and III. 1983.
5. Steendam, A.L. Cortical Visual Impairment in Children. Royal Society of New south Wales, 1989.
6. Tobin, M.J. How non - visual modalities can help the young visually handicapped child to succeed in visual and other tasks. British Journal of Visual Impairment, 1996.

April 1997

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