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Book 1 of 2

For use in kit 1-08854-00

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American Printing House for the Blind, Inc.
Louisville, KY

In keeping with our philosophy to provide access to information for people who are blind or visually impaired, the American Printing House for the Blind provides an electronic version of this book for large print and braille readers.

Catalog Number 7-08854-00
Copyright © 2012, American Printing House for the Blind
All rights reserved. Printed in the United States of America

This publication is protected by Copyright and permission should be obtained from the publisher prior to any reproduction, storage in a retrieval system, or transmission in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, unless where noted on specific pages. For information regarding permission, write to American Printing House for the Blind, 1839 Frankfort Avenue, Louisville, KY 40206-0085.

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SAM: Symbols and Meaning

Snapshot

SAM is
a program that provides strategies for developing a strong sensory foundation for concepts about people, objects, actions, and places so that symbols referring to them are meaningful

SAM is for
students with visual and multiple impairments and pre-school children with visual impairments who are just beginning to use symbols-the late sensorimotor, early preoperational stage of cognitive development.

SAM is used by
teachers of students who have visual impairments to help parents and teachers create daily learning opportunities and provide direct instruction in natural environments.

Purple square, orange star, yellow triangle, green star, light orange circle, and blue diamond

Chapter 1: Why do we need a program?

Photo of a baby boy holding a ball with one hand and his foot with the other hand. He mouths the ball and looks at his foot.

Photo Caption: Concepts about people start with knowledge of one's own body.

Making Sense of the World

In order for any person's world to make sense, a great deal of knowledge about people, objects, actions, and places must be acquired. Three questions are constantly being asked and answered.

"It" may refer to something very simple, such as "ball," or to something more complicated, such as "the United States Congress." The acquisition of information that answers these three questions is often called "concept development." A very simple definition of the word "concept" can be found in Webster's New World Dictionary. It says that a concept is an idea or thought (Neufeldt & Sparks, 1995). The idea or thought is constructed over time and, in the early stages of concept development, the building blocks are direct experiences with people and objects in the environment (Fazzi & Klein, 2002). As these experiences accumulate, learners discover patterns and mentally organize these patterns into "schemas," which form the internalized knowledge of what the world is and how it works (McLinden & McCall, 2002).

SAM Concept Categories

People: The self and others
Concepts about people start with knowledge of one's own body. Self-awareness becomes the core knowledge to which new information is attached. New information includes the characteristics of other people's bodies first and, then, more sophisticated things associated with the body like its emotional content, what it does, where it goes, its name, and how it relates to other bodies.

Objects: Tangible things
Concepts about objects start developing as soon as the blanket touches the newborn's body. Information about the physical characteristics of objects is acquired through the senses. Acquisition of sensory information leads to recognition of the object and associated information about how it is used and how it relates to other objects.

Actions: Body movements of the self and others
Concepts about actions start with random movements of the learner's own body in infancy. The actions become more intentional as certain results are associated with certain movements. Information about the actions of other people's bodies allows the learner to imitate and expand his range of options in choosing how he will interact with his environment.

Places: Where things are, contexts for groups of things
Concepts about places allow the learner to find things. Simple place concepts include things like knowing where to look or to move the hand to find the cup during mealtime. Things have to be in the same place consistently in order for place concepts to develop successfully. Place concepts build mental maps of how things relate to one another spatially. Places are also contexts-environments or surroundings-that provide meaning. A kitchen is the context that helps to provide meaning to objects like pans, spatulas, strainers, etc.

Because of the challenges they face related to acquiring information, learners with visual and multiple impairments and young children with visual impairments may live in worlds that make little sense and are, therefore, confusing and even scary. They may defend themselves by avoiding unfamiliar objects and people (Erin & Spungin, 2004). Reluctance to engage the unfamiliar is a problem because "...delays in active exploration or variations in concrete experiences will affect the rate at which the infant's (child's) intellectual capacity develops" (Recchia, 1997, p. 402).

Development Variations Due to Visual Impairment

For learners with visual impairments, typical variations in the development of meaning include the following.

Absent and Incomplete Concepts

Psychologists J.J. Gibson and E.J. Gibson describe infants discovering the world through interactions using their "sensory systems" and their "action systems" (McLinden & McCall, 2002). If a child has a sensory impairment such as vision or hearing loss, "the quality and scope of learning may be limited by reduction in environmental interactions" (Barraga & Erin, 1992, p. 31). Access to people and objects may be limited because search is not motivated by curiosity about things seen and heard. When objects and people are accessed, meaning may not develop because sensory information is insufficient or confusing.

Children who have visual and motor impairments face significant challenges as they try to acquire information about their worlds. In addition to all the variations already discussed related to vision loss, motor impairments bring with them their own variations to the sensing and action systems. The most obvious motor issue affecting the action systems is lack of access. The learner may have fewer interactions with things in her environment not only because she cannot see that something exists beyond her body, but also because, when something is seen, she cannot move her body to it in order to explore it. If the motor impairment is severe, an object only a few inches away from the hand may be inaccessible. Action systems are also impacted by limitations in exploratory behaviors after objects are accessed. Typical children have a range of exploratory behaviors. Before they can grasp, they begin exploring by mouthing objects touching their bodies and by using their fingers to explore textures by scratching at surfaces. Gradually, their hands become more involved in information gathering.

Chapter 2: Who will use the program?

The photo shows a girl squinting and smiling at the sun. The sun's light is reflected on her face.

Photo Caption: A girl expands her learning about the day's weather by feeling the sun on her face.

Cognitive Stage Development

Jean Piaget described cognitive development in three global stages: sensorimotor, preoperational, and operational. There is disagreement among psychologists about the accuracy of some of Piaget's theories about the early sub-stages of the sensorimotor stage and about the helpfulness of looking at global stages, as opposed to looking at the dynamic development of specific domains such as language (Sutherland, 1992). Even so, the Piagetian model remains the prevalent standard for defining cognitive development (McLinden & McCall, 2002).

Sensorimotor Learners

Typical children spend the first 2 years of their lives in the sensorimotor stage. They use their sensing and action systems to react to and interact with people and objects in their environments (Gibson, 1988). As a result, they develop the cognitive skills of object exploration, object permanence, imitation, causality, means-ends, and basic spatial relationships (Morgan, 1992). The Sensory Learning Kit provides activities for developing these cognitive skills. In the late sensorimotor stage, learners begin to use simple labels for things. These usually consist of one or two words that name the thing being experienced in the here and now. These labels are not fully symbolic at this stage. For instance, the word "nana" may be used to label the white round pieces of fruit in the learner's dish, but would not convey to the learner other images of bananas like the yellow, unpeeled fruit his mother buys at the grocery store. SAM begins at this early labeling stage of symbolic development.

Preoperational Learners

It is important to understand that cognitive stage development is additive. Sensorimotor learning strategies never go away, but new, more complex strategies are added as development progresses. Children become preoperational learners when they add the strategy of remembering and organizing previous experiences and use symbols that represent components of those experiences. The child can now think about things that are not being presently experienced, and she can use symbols to expedite this thinking.

"The child is no longer tied to the here and now, which is experienced through immediate sensation and action patterns. Now the child can begin to think about the past and contemplate the future" (Fazzi & Klein, 2002, p. 116).

While first words typically appear at the end of the sensorimotor stage, in the preoperational stage, symbol use becomes more extensive and more complex. Symbols, like words and pictures, become the tools of problem solving, pretend play, and social connection (Dunlea, 1989).

APH Intervention Continuum

Sensory Learning Kit

Chapter 3: How is the program designed?

One photo shows a school bus with the door open and children walking down a sidewalk. Another photo shows a residential home. The last photo shows a young girl smiling.

Photo Caption: Both school and home environments are needed to create a successful SAM program.

Collaborating with Partners in Homes and Schools

Pre-school children and learners with visual and multiple impairments learn best when their learning opportunities occur regularly and are provided by people (partners) they know and trust (Lueck, Chen, & Kekelis, 1997). The individuals who see these learners every day, parents, interventionists, and classroom teachers, are essential partners. Peers and siblings play an important role, but their role needs to be supported by a trained partner. Teachers of students who have visual impairments (TVIs) are essential to the program. They provide the foundation for good learning opportunities even though they might not see the learner frequently enough to be the primary provider of the activities. The TVI shares information about strengths and needs, helps develop goals, chooses intervention strategies, helps plan activities, monitors progress, helps make revisions, and moves partners on when it's time (Smith & Levack, 1999). This relationship between the person who has specific responsibility for addressing needs related to their professional expertise and the people who have responsibilities and expertise in other areas is called "collaboration." It is a highly effective way to make sure that learners get what they need. The TVI serving a learner in this way is not less involved, but merely involved in a special way. One of the first things that a TVI who uses SAM will need to do is to explain to parents and teachers some of the important foundations of the intervention described in the following sections.

The Game Approach

The main intervention strategy used in SAM is an activity provided in "game" structure. There are several reasons for choosing this approach.

Use of Questions

Questions are used more frequently with learners with visual impairments than with other learners (Dunlea, 1989). There are two problems with this. First, questions are more difficult for early language users. They understand simpler forms of language like commands and comments more easily. Second, if they hear a lot of questions, they tend to ask a lot of questions when comments would be more appropriate. So, "Come here." is easier than "Would you come here?" Similarly, a child who hears, "Pull sock, good!" is more likely to say, "I pulled my sock." than "Am I pulling my sock?"

Chapter 4: A closer look at what we know about concept development

The photo shows a stone-colored, small pyramid sitting in the middle of a large room. A larger white, transparent pyramid is inverted and suspended above the small pyramid.

Photo Caption: Concepts are the blocks used to construct the pyramid, and the pyramid is the schema. Knowledge expands from the bottom up like an inverted pyramid.

What Are Schemas?

The discussion so far has been mainly about concepts-ideas or thoughts-as the units from which meaningful knowledge of the world is constructed. Schema is a word that means almost the same thing, but cognitive psychologists use it to describe something a little bit bigger. A concept is a unit, or a thought, and a schema is an orderly combination of those units in a definite pattern (Neufeldt & Sparks, 1995). For instance, combining stone blocks in a definite pattern can result in a pyramid if the plan involves arranging those blocks in a cascading fashion. Concepts are the blocks used to construct the pyramid, and the pyramid is the schema. The result of combining thought units into an organized pattern is general knowledge about procedures, sequences of events, and social situations (Matlin, 2008). The biggest potential barriers to success in this construction project are

Sensorimotor level learners need a large quantity of high quality opportunities to actively explore and then use objects with sensory attributes that are very attractive. These interactions encourage curiosity, which, in turn, motivates interactions (Smith, 2005). This is the beginning of the foundation of the building under construction. At the early preoperational level, the foundation is finished by expanding the experienced objects to include common objects that may not be as attractive. Then it is time to start constructing the first floor. In these rooms, knowledge won't be limited to attributes of single objects. These rooms will be constructed to contain knowledge about how people, objects, actions, and places relate to one another in organized patterns. Primary tools used in this construction will be objects and words related to the learner's experiences as they are used to help the learner organize relationship patterns. In this way, single concepts become more complex schemas.

The circle chart shows six photos: 1) Hands opening a cookie dough mix, 2) a mixing bowl, 3) a egg, 4) vegetable oil, 5) a stir spoon in a mixing bowl, 6) a cookie. Photos 2, 3, and 4 are screened like a shadow. Photos 1, 5, and 6 are brightly colored.

Photo Caption: The screened photos represent the steps in the group cookie making activity that the student with visual impairment did not experience.

Intervention Model

Information units organized into patterns of knowledge are called schemas. The construction of schemas cannot be left to chance when a learner is not able to use vision to make sense of random experiences. In order to ensure that learners with visual impairments have the breadth of experiences required for good concept and schema development, a plan is needed. Research indicates that without vision, language and thought in young children tend to be more self-referential. It may be helpful to think of the construction of schemas in the following hierarchy (Bigelow, 1990).

  1. Concepts about the learner's own body
  2. Concepts about people, objects, and actions touching the learner's body
  3. Concepts about people, objects, actions, and places beyond the learner's body
  4. Schemas about people-object-action-place relationships in events beyond the learner's body

In this model, the first three levels of construction are concepts-thoughts about things-either touching or beyond the body. There are four concept categories: people, objects, actions, and places. Place is a unique category. It is not included until level three-concepts about things beyond the body-because it requires knowledge of clusters of things. For instance, "kitchen" cannot be understood without awareness of clusters of things found in kitchens such as stoves, refrigerators, cabinets containing pots and pans, etc. Touching one object found in a kitchen may only bring to mind thoughts about that thing (object category); but, if touching that object brings to mind thoughts about a cluster of related objects found in the kitchen, the concept evoked is the place "kitchen." The final level is the organization of these units of concept information from several different categories into a pattern of knowledge about an event. This is a schema.

   
Photo Caption: A refrigerator and a microwave oven are part of a "kitchen cluster." 

In summary, the development of schemas begins with the acquisition of sensory information. For typical learners beyond infancy, vision is the overarching modality because it provides access to distance media, simultaneous events, and whole/part relationships (Dunlea, 1989). Learners with very limited vision must have different strategies for developing schemas. They too start with the acquisition of sensory information, but their strategies are primarily tactual and auditory. A successful intervention model for these learners must take into consideration how this kind of sensory information will impact the development of concepts and schemas.

The inverted pyramid is a good way to think of the information being constructed by early preoperational learners. Knowledge expands from the bottom up and becomes more inclusive and more complex as it ascends.

Chapter 5: Gathering sensory information

The photo shows people at a carnival in front of the cotton candy vendor.

Photo caption: Through vision, hearing, and smell, we access information about things beyond the body.

Concepts and Schemas Start With Sensory Information

Units of understanding-sometimes referred to as concepts-are collected through experiences, stored in memory, and eventually become a schema. This process always starts with the acquisition of sensory information. This is true throughout all levels of cognitive development. A formal operational learner developing a concept about algebraic equations starts with visual information in the form of written graphic symbols. At the late sensorimotor, early preoperational stage of cognitive development, the primary sources of sensory information are people, objects, actions, and places. When those people, objects, actions, and places get symbolic labels, the learner is on his way to being able to think about things he is not currently experiencing. A preoperational level concept has been developed. Next the learner begins to develop schemas by organizing those concepts into patterns of knowledge.

Chapter 6: Information about people, objects, actions, and places beyond the body

A photo of an airborne motorcycle, a photo of a growling dog, and a photo of a fire engine.

Photo Caption: People experience some degree of stress whenever they hear something that they can't identify.

Distance Sensory Information

Sensory information is the foundation for the development of concepts about people, objects, actions, and places beyond the body. Typical learners rely upon their distance sensory channels-vision, hearing, and smell-to develop these concepts. Learners with visual impairments use distance sensory information too, but in a very different way. When vision is very limited, information from the distance channels becomes meaningful only after it is paired with near sensory channel information. This means that touch has a unique role in concept development (Huebner, Prickett, Welch, & Joffe, 1995).

Tactual Bridging

Many of the variations in concept development that become challenging for learners who have visual impairments have to do with acquiring information about things beyond the body (Hughes, Dote-Kwan, & Dolendo, 1998). When a visual impairment is present, touch plays a unique role in gathering distance sensory information. Using touch to obtain information about things beyond the body sounds like an oxymoron. Tactual means touching the body, so how is this modality used as a way of gathering information about things beyond the body? In fact, it can't unless there is a bridge linking near and distance sensory input. For the primary tactual learner, distance sensory information about a thing can be meaningful only if it creates a bridge that connects the current distance experience to the memory of near tactual experiences with the same thing. Impaired visual information may be more confusing than helpful unless it is bridged to tactual experience in memory. Hearing and smell provide no information for anyone about their sources unless bridged to previous experiences pairing those sensations with vision or touch.

Smell

The sense of smell alerts one to the presence of airborne particles that emanate from objects that are an inch or a few miles away. The olfactory processors in the brain are especially sensitive to smells that convey dangers like fire, noxious gases, and putrid food. Smells also stimulate appetites (Reeves, 2001). Nevertheless, anyone relying primarily on olfactory information for knowledge about his world ultimately would have very shaky concepts. Olfactory characteristics of an object allow learners to identify that object only if the smell is associated with other sensory characteristics of the object experienced previously. For example, the smell of hand lotion does not call to mind the lotion container or the act of lotion being rubbed on the hands unless those experiences are paired with the smell.

Hearing

Hearing supplies information about sound. It tells the listener if the sound is high pitched or low pitched, loud or soft, sharp or muted, fast or slow, continuous, or intermittent (Reeves, 2001). It supplies no information whatsoever about what is making the sound. In order to know the source of the sound, it must be paired with visual or tactual information (Fazzi & Klein, 2002). A dog's bark is just a sourceless, random, and possibly threatening noise that seems to come from a certain space unless the learner has seen a dog bark, or touched a dog that is barking, sometime previously and can associate that experience with the sound he hears.

One characteristic that makes human beings especially unique among animals is that human babies are born with an amazing appetite for listening to speech sounds and an ability, from birth, to discriminate very fine differences in the qualities of those sounds (Dunlea, 1989). They don't know what the different sounds mean, but they find them fascinating. Very early on, they learn that certain pitches and tempos mean certain things. For instance, when Mom's voice is flat and even paced, she is probably talking on the phone or to Dad and there is no reason to get excited. But, when the pitch of her voice goes up and down musically and the tempo changes from slow to fast and then back to slow again, the baby knows her mom is trying to engage her and good things are about to happen.

When the auditory sensory channel is used as a learning modality for concept development about things beyond the body, environmental sounds are the primary information source for objects and voices are the primary information source for people. Voices yield important information for all sensorimotor and early preoperational learners. The learner uses voice to recognize people, to predict what they are going to do, to find out where they are, and to soothe and entertain himself (Rowland, 1984). Words are part of what voices convey and some of the individual words and phrases uttered by those voices may be useful if they spark an association with a concrete referent.

Tactual Learners and Overdependence on Auditory Information for Distance Learning

Sometimes, hearing is identified as the primary sensory channel for learners without vision or with very limited vision at the sensorimotor and early preoperational levels of cognitive development. This is especially likely to be true if these learners have multiple impairments including severe motor impairments. Assessments may indicate accurately that hearing is the primary information gathering modality used during observations. Often, these learners do spend a great deal of their time listening. The question is-should they? Is the quality of information obtained almost exclusively through the auditory sensory channel sufficient for good concept and schema development? Attempts to facilitate auditory learning about things beyond the body usually involve the teacher or family member using language to describe and explain. Using this approach, a teacher may assume that the learner with a visual impairment is receiving the same level of instruction as other students when he can label sounds such as the recorded animal sounds in the unit on farm animals. In fact, given this kind of instruction, the learner develops a variation in his concept of something like "chicken" that is quite inferior to that developed by his peers. For him, a chicken is a sharp, intermittent, high-pitched sound. Period. The teacher may hand him a stuffed toy chicken to associate with the sound. In this case, he learns that a chicken is a small, soft, fuzzy, and inanimate object that smells like cloth and somehow goes with that sound. He is probably very confused as he assimilates this information and tries to accommodate it with his knowledge of meat eaten at meals or of characteristics of live birds. This is not good learning. There is only one way for auditory information about things to be useful for concept development. That is to see and/or touch the real thing making the sound. Either vision or touch must be the primary sensory channel until the learner has developed sophisticated linguistic abilities.

This is a photo equation: A photo of a hand playing a digital recorder + a photo of a toy chicken + a photo of chicken nuggets with ketchup + a photo of a child touching a live chicken.

TVIs are sometimes told to encourage teachers and parents to talk to learners about what is happening beyond their bodies as a way of providing information about what the learner may be hearing. This is a highly effective strategy if the learner is a sophisticated user of language and can simultaneously integrate what he hears in the environment and what he is being told. Most late sensorimotor and early preoperational learners are not sophisticated users of language and have some difficulty paying attention to two competing sources of information simultaneously. Therefore, this is not an appropriate strategy for them if the goal is to give them information about what is happening. That is not to say that partners should not talk to learners when they are doing things nearby. This kind of talk may have another important function. It lets the learner know he is not alone and that his partner is connected to him even when not touching him. Partners must decide what they want. If they want to reinforce the social bond, they should talk. If they want the learner to know what is happening, they should give the learner the opportunity to touch what they are touching by either bringing the experience to him or taking him to it.

Fear and Unknown Sources of Sounds

Environmental sounds can be very scary when they have no known source. A child who experiences the loud sound of a vacuum cleaner and has no idea what is making that noise can get very scared when the noise seems to move around unpredictably and sometimes appears to be coming closer. Fire alarms, car horns, mixers, blenders, hair dryers, hair clippers, lawn mowers, and a host of other things would be perceived as threatening by anyone surprised by those sounds without knowing their source. To understand this, most people only have to remember how they felt the first time they traveled on an airplane and, while seated and just beginning to relax a little after takeoff, heard the landing gear retract. The truth is that people experience some degree of stress whenever they hear something they can't identify, even in much less threatening circumstances-the "things that go bump in the night" phenomenon. A learner with visual impairments has that experience very often and not just at night. For a learner who is young or multiply impaired, the only way to make a sound less threatening is to get information about its source by seeing and/or touching. The white-knuckler on an airplane can relax after the person next to him tells him the sound he heard was just the landing gear retracting because he is a sophisticated language user. An English speaker on an airline with passengers who all speak an unknown language would continue to expect the bottom to fall out of the plane until he figured out by visual observation that no one else was worried. Late sensorimotor and early preoperational learners with visual impairments are not sophisticated language users and many of them can't see the expressions on other people's faces.

The SAM flash drive contains a folder of common sounds perceived to be threatening by many learners. It is included in SAM so that these sounds may be associated with their sources in a carefully controlled, less intense activity.

Impaired Vision

Vision, when it works well, gives more detailed and complex information about people, objects, and actions at a distance than any other sensory channel (Chen & Downing, 2006). Impaired vision can be a useful tool for gathering information beyond the body and should be used to the maximum extent possible. Especially at the late sensorimotor and early preoperational stages of development, information gathered through an impaired visual channel is more meaningful if it is paired with touch experiences (McLinden & McCall, 2002).

A variety of conditions can compromise the learner's ability to use vision effectively for gathering distance information. For the purposes of this discussion, these conditions are divided into three broad categories-uncorrectable acuity loss, field loss, and cortical visual impairment (CVI). There are many other conditions, such as ocular motility problems or photophobia to name only two, that affect the quality of distance visual information.

Imagine three people seated around a table: one is reading a newspaper, one is writing on a pad of paper, and one is filling saltshakers. A person with acuity loss, standing about 12 feet away from the table, will experience the scene differently than a person with field loss or CVI who is standing at the same distance. No two learners' experiences will be the same.

Different Visual Experiences
Acuity Loss  Sue sees a large object and at various points around that object, the upper parts of three people. She recognizes torsos, arms, hands, and heads. She knows one person has dark hair, but cannot distinguish facial characteristics or expressions. She knows that two of the people are moving their hands, but cannot identify the small objects they are touching.  
Field Loss  Jim sees a person seated at a table reading a newspaper. When he moves his head, he sees a person writing on a pad, but can no longer see the person reading the newspaper. He is unaware that there is a third person at the table.  
Cortical Visual Impairment  Tom sees a confusing mass of color and movement that is incomprehensible and somewhat threatening. He looks away from the complex-visual target and focuses on a more familiar and simple, near-vision target.  
 

These examples are three of an infinite number of possibilities. Specific knowledge of each individual's visual functioning is necessary in order to know what he might be experiencing. Certified specialists in the field of visual impairments assess the functional visual abilities of learners with visual impairments in order to obtain this knowledge and share it with other team members.

Chapter 7: Bridging near and distance sensory information

A young girl wears a fire fighter's helmet and feels the outside of it with her hand.

Photo Caption: Pairing a real-life, touching experience with a sound is a good teaching method.

Challenges for Tactual Learners

A learner who does not get high quality information from her visual channel will rely primarily on touch for gathering the sensory information that will be the foundation of her knowledge of her world. Here is the problem. Smell, hearing, and impaired vision are the only distance senses available to her and none of them provides sufficient information for good concept development. This will be a challenge because she will not be able to access information about people, objects, actions, and places beyond her body in a meaningful way without help.

The primary tactual learner must have a way to bridge the gap between her near learning (touching and tasting) and her distance learning (seeing, hearing, and smelling) so that the information from these separate modalities is combined to provide high quality information about things beyond her body. Two stages of development create the desired result. First, the learner must have experiences that allow her to pair touch with the smell, sound, and sight-to the extent possible-of things as they touch her body (Huebner et al., 1995). Second, she can use the smells, sounds, and sights she has associated with her touch experiences alone for gathering meaningful information about things beyond the body. Making sense of experiences beyond the body can be greatly expedited by the use of symbols (objects and words) to label sources of distance information after basic sensory foundations are in place (Fazzi & Klein, 2002).

Direct Experience

Chapter 8: Information about people-object-action-place relationships in events beyond the body

The photo shows a family at the kitchen table. They are all smiling as the younger of two sons blows out the candles on his birthday cake.

Photo Caption: Blowing out candles on a birthday cake is an event.

Complex Concepts and Schemas

An event is a complex concept. The learner's ability to understand what happens in an event, like the blowing out of the candles on a birthday cake at another person's birthday party, depends on being able to put together many different pieces of information about related things. The organization of these pieces into a pattern forms a schema. The basic foundation for understanding is the accumulation of hundreds of pieces of sensory information related to people, objects, actions, and places that are part of the event. Language is another important source of information helpful to the acquisition of information about events. Once the sensory foundation is established, words about those experiences can expand meaning (Chen & Dote-Kwan, 1995).

Information about events is constructed by progressing from simple concepts to more complex concepts and, eventually schemas. So far, discussion has been limited to simple concepts at the first three levels of basic concept development-the learner's own body; people, objects, and actions touching the body; and people, objects, actions, and places beyond the body. For the most part, these have been single-referent concepts and single-category concept clusters.

To help the learner make sense of her world at the fourth level of complexity-people-object-action-place relationships in events beyond the body-the development of multi-category schemas is required. For a primary tactual learner, this level will rely even more heavily upon the use of symbols and distance sensory information for bridging. Words become an essential bridge. But, once again, words are not helpful unless they are grounded in tactual experiences at levels one, two, and three.

Review and Clarification of Terms Used in SAM

Sensory Bridging, Concepts, and Schemas

Development of meaning in single-referent concepts, cluster concepts, and schemas is based in experiences that provide high quality sensory information. Construction of a concept begins with experiences of things as they touch the learner's body or as the learner uses his body to touch them. As information from distance sensory channels is associated with these touch experiences, the learner begins to understand the world of people, objects, actions, and places beyond his body. Meaning is expanded through the use of symbols-objects used in communication contexts, and words. Symbols expand meaning only if each symbol is grounded in sensory experiences of its concrete referent.

The following descriptions provide an overview of the role of sensory information in the development of concepts and schemas. Two kinds of concepts are included-single-referent concepts and cluster concepts.

Single-referent Concepts

The simplest way to think about a concept is to think about one thing at a time. This is true whether the thing is the body itself, something touching the body, or something beyond the body-the first three levels of concept development. Thinking about a thing is often triggered by a symbol. For instance, touching an object or hearing a word may be a trigger. Distance sensory information, a sound or smell, associated with the referent may also trigger thoughts about it. If the link between the memory of touching the thing itself and those associated pieces of distance sensory information (sensory bridges) is a strong one, the thoughts about the thing will be rich and meaningful.

Examples of Single-referent Concepts 
Category Touching body Beyond body bridges
Person: Mother  The learner feels a mass, covered by soft tissue. There are lots of curves. Voice sounds and warm air are associated with the area surrounded by long hair. Appendages produce very nice sensations when applied to the learner's own body. Very strong feelings of comfort, safety, and attachment are associated with being touched by this thing.  The sound of the voice of the person described in "touching body" triggers thoughts of all those experiences. Later, hunger, feelings of loneliness or joy, or smells of certain foods may trigger Mother thoughts. 
Object: Toilet  The learner feels a mass with a hard, smooth, curved surface. It is cool and sometimes can be cold. There is a moveable surface attached to a more stable surface, both with a hole in the middle. Sitting over the hole without clothing is required. A loud, roaring noise is associated with this thing periodically.   The sound of a flush or of the toilet seat being lowered triggers thoughts of all related experiences. Later, pressure on the bladder or bowel or certain smells may trigger toilet thoughts. 
Action: Push button  After riding the partner's hand while the button on the music player is pushed, the button is found and pushed by the learner. Sound results.  The sound of the click made by the button triggers thoughts of activating the music player. 

Cluster Concepts

While the learner is building these simple single-referent concepts, he is also becoming aware that single-referent concepts tend to be experienced in predictable groups. These can be thought of as cluster concepts. Everything in the cluster has to be experienced as described above in order to have meaning. That is why each thing in the cluster is a single-referent concept. But, it is a single-referent concept clearly associated with other single-referent concepts. This is significant because experiencing one thing in the cluster calls to mind all of the other things associated with it. Cluster concepts are the beginning stage of schema development.

Examples of Cluster Concepts 
Category Touching body Beyond body bridges
Person:
- Mother
- Dad
- Brother
 
Sitting with Mother while she reads a story brings to mind similar experiences with other family members.  The sound of a brother's voice overheard on the school playground causes the learner to think of his family. 
Object:
- Toilet
- Toilet paper
- Toilet paper holder
 
After the sitting experience, paper is pulled from a cylinder attached to a wall. Shortly after pulling, a paper-like substance touches the bottom. The learner is not sure how the paper got there.  The sound of the toilet paper roll turning triggers thoughts of experiences with toilet and paper. 
Action:
- Load CD
- Push button
 
Putting a cassette or CD in the player affects the button-pushing outcome. Push button results in sound only when cassette loading happens first.   The sound of familiar music or of noises made by the player triggers thoughts of loading and activating. 

Schemas

Schemas are more complex than cluster concepts. Like cluster concepts, they require thinking about several things at once, but they also require thinking about how those things relate to each other in current and past events. The word "event" is key to understanding the significance of this kind of concept development. In an event, several things interact dynamically over time. Some single-referent concepts have a simple dynamic aspect such as discovering how an object is used or how a person usually behaves. The dynamic aspect increases dramatically in events. The level of complexity of an event is determined by how many people, objects, and actions are included in the interaction and by how long the event lasts. The toilet and toilet paper cluster described previously involves two single-referent concepts each having a dynamic "use" component-sitting and pulling. The toileting event is much more complex. It includes the space around the toilet and everything it contains, the presence of other people and what they are doing with those things, and the sequence of actions that happens in that space with those things from the beginning to the end of the event. There are many referents, and knowledge of how each interacts with the others is essential to the development of the schema. Most events will contain some symbols referring to things touching the body and some, usually many more, to things beyond the body.

Since events increasingly involve interactions with peers, they are highly social in nature. Understanding and enjoying events is essential to the social development of young children with visual impairments and students with visual and multiple impairments. Learners who are overwhelmed by the sensory input in complex events and who are unable to make sense of it are more likely to self-select less complex and less social activities (Hughes et al., 1998). The learner who sits by herself playing with the buttons on the music player may not be choosing this activity because she loves music or "is stuck on cause and effect," but because it feels much safer.

The following are examples of simple schemas as they might develop at the early preoperational stage.

Examples of Schemas 
Event Touching body Beyond body bridges
Breakfast  The learner feels the food in his mouth, the utensils held in his hand, the surface of the table or tray as he intentionally moves his hand to find items used during the meal, the chair he is sitting in, and the people and objects in the kitchen he touches as he moves to the eating area.  
  • The smell of food
  • Sounds of people doing things
    • - preparing food
    • - setting the table
    • - unfolding napkins
    • - pouring liquids
    • - passing serving dishes
    • - chewing
The sources of these smells and sounds are unknown to the learner unless they have been paired with touch experiences previously. 

 
Toileting  The learner feels his clothing as he pulls his pants down, the toilet seat as he sits on it, the paper as he unrolls it and wipes, and his clothing again as he pulls his pants up. He may also feel doors, the tank and handle, sinks and counters, and other things, depending on his level of participation. 
  • Smells of soaps, cleansers, etc.
  • The sounds of the activities of other people in the space
    • - doors opening
    • - water running
    • - towels being pulled from dispensers
    • - blow dryers, etc.
Sources of these smells and sounds are unknown to the learner unless they have been paired with touch experiences previously. 

 
Circle Time  The learner feels the carpet square upon which he is sitting. 
  • Teacher's voice
  • Peer's voices
  • Music
  • Sounds of
    • - pages turning
    • - tapping on charts
    • - Velcro ripping as symbols are moved
  • Movement of peers' bodies
Sounds and words used to refer to visual media like number charts, printed words, and pictures are meaningless unless they have been paired with touch experiences previously. 

In each of these examples, knowledge of the space in which the event takes place becomes an important part of developing a meaningful schema. Understanding breakfast requires that the learner explore the area in which breakfast takes place, usually a kitchen. Then the learner must have an opportunity to find out what other people are doing in that space. The learner who eats the cereal placed on the table in front of him does not really have a schema about breakfast if he has no idea that Dad is drinking orange juice in the chair next to him, his brother is going to the refrigerator to get yogurt, and Mother is toasting a bagel for herself at the counter next to the stove. Without a chance to tactually explore what is going on, the learner will never figure out that those crackling noises Dad makes aren't related to something he is eating but, rather, the newspaper he is reading. When the learner has had meaningful experiences of going to the refrigerator and getting food items, he will be able to use the sounds his brother makes as he gets his yogurt as a bridge to information beyond his body. He will understand that his brother is interacting with the refrigerator. The learner does not have the luxury of thinking about his breakfast experience in isolation. Sensory information about what his brother, mother, and dad are doing is coming to him simultaneously. In the face of all that, he is still supposed to think about eating his own cereal. He is more likely to be able to do that if he understands what is happening around him.

Chapter 9: Troubleshooting Guide

The photo shows a boy and his female teacher facing each other and holding both hands together, as if dancing.

Photo Caption: The information in the Troubleshooting Guide is not comprehensive. Behaviors and causes which lend themselves to this format and which are addressed in published materials easily obtainable by partners are included.

Barrier behavior

Why

Caution! Extended states-sleepy, drowsy, fussy, and agitated-occur related to both biological and behavioral influences. Manipulation of arousal states is complex and requires collaboration among team members with specific areas of expertise. The two examples given above are only examples of what may be involved for a given learner. No assumptions should be made without careful assessment. For instance, fear can cause learners to shut down and appear drowsy; boredom can cause agitation.

Try

Resources

Barrier behavior

Learner engages in self-stimulatory behavior a great deal of the time

Why

Sensory input is needed to either calm or stimulate the learner's central nervous system

Try

Resources

Barrier behavior

Learner responds to others by scratching, biting, spitting, pulling hair, tearing clothes, etc.

Why

Try

Resources

Barrier behavior

Learner does not interact with available learning media

Why

Try

Resources

Barrier behavior

Learner pulls hand away when touched

Why

Try

Resources

Barrier behavior

Learner throws or drops objects placed in his hand

Why

Try

Resources

Barrier behavior

Learner limits self-initiated interactions to one or two favorite objects

Why

Try

Resources

Barrier behavior

Learner has one or two actions, like licking or banging, that he performs with all objects

Why

Try

Resources

Barrier behavior

Learner is unaware of activities of others

Why

Try

Resources

Barrier behavior

Learner becomes upset when something unusual happens

Why

Try

Resources

Barrier behavior

Learner refuses to transition from place to place

Why

Try

Resources

Barrier behavior

Learner does not sustain or complete activities on his own

Why

Activities are done differently each time; completion is arbitrarily determined by another

Try

Provide routines and games with clear beginning and ending steps and a consistent series of intermediate steps

Resources

Barrier behavior

Learner talks to himself using language consisting of repetitions of previously heard phrases and sentences-sometimes whole stories

Why

Try

Resources

Barrier behavior

Learner does not follow simple verbal directions

Why

Content of language not meaningful

Try

Make sure learner has solid concepts in place for vocabulary used

Resources

SAM: Symbols and Meaning

Barrier behavior

Learner gives arbitrary incorrect answers to questions

Why

Try

Resources

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Appendices

The photo shows a woman holding a girl on her hip. Using the hand-under-hand technique, they pat a horse.

Appendix A
Learning Strategies for Tactile Defensiveness

Jennifer Stocker, MHS, OTR/L

References

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Bundy, A. C., Lane, S. J., & Murray, E. A. (2002). Sensory integration: Theory and practice (2nd ed.). Philadelphia, PA: F. A. Davis Company.

Dunn, W. (1999). Sensory profile. San Antonio, TX: The Psychological Corporation.

Fredericks, C. M. (1996). Basic sensory mechanisms and the somatosensory system. In C. M. Fredericks & L. K. Saladin, (Eds.), Pathophysiology of the motor systems: Principles and clinical presentations (pp. 78-104). Philadelphia, PA: F. A. Davis.

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Williams, M. S., & Shellenberger, S. (1996). How does your engine run?® A leader's guide to the Alert Program® for self-regulation. Albuquerque, NM: Therapy Works.

Williams, M. S., & Shellenberger, S. (2001). Take five: Staying alert at home and school. Albuquerque, NM: Therapy Works.

Wilson, B., Pollock, N., Kaplan, B. J., Law, M., & Faris, P. (2000). Clinical observations of motor and postural skills. Framingham, MA: Therapro.

Young, P. A., & Young, P. H. (1997). Basic clinical neuroanatomy. Baltimore, MD: Williams & Wilkins.

Jennifer Stocker is an Occupational Therapist at the Kentucky School for the Blind. She is trained in Pediatric Neuro-Developmental Treatment and certified in the Sensory Integration and Praxis Test.

Appendix B
Impact of Cerebral Palsy and a Visual Impairment on Object Manipulation and Object Use

Jennifer Stocker, MHS, OTR/L

In summary, the ability to learn about objects is a complex multiple system process. One must consider the large amount of possible variations in functional vision as well as positive and negative manifestations of cerebral palsy. Not to mention that one square inch of skin contains 20,000,000 cells, 78 nerve fibers, 1,300 pain receptors, 19,500 sensation receptors, 160-165 pressure receptors, and 100 sweat glands each containing, 20 blood vessels, 78 heat receptors, 13 cold receptors, and 65 hair follicles (The Wolfe Clinic). All of which may be impacted by cerebral palsy. When helping a child diagnosed with a visual impairment and cerebral palsy to learn about objects for the purpose of a specific function:

References

Adams, M. A., Chandler, L. S., & Schuhmann, K. (2000). Gait changes with cerebral palsy following Neurodevelopmental Treatment Course. Pediatric Physical Therapy, 12, 114-120.

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Arndt, S. W., Chandler, L. S., Sweeny, J. K., Sharkley, M. A., & McElroy, J. J. (2008). Effects of a neurodevelopmental treatment-based trunk protocol for infants with posture and movement dysfunction. Pediatric Physical Therapy, 20, 11-22.

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Erhardt, R. P. (1994). Developmental hand dysfunction: Theory, assessment, and treatment. Austin, TX: Pro-Ed.

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Fredericks, C. M., & Saladin, L. K. (1996). Clinical presentations in disorders of motor function. In C. M. Fredericks & L. K. Saladin, (Eds.), Pathophysiology of the motor systems: Principles and clinical presentations (pp. 255-292). Philadelphia, PA: F. A. Davis Company.

Girolami, G. L., & Campbell, S. K. (1994). Efficacy of a Neuro-Developmental Treatment Program to improve motor control in infants born prematurely. Pediatric Physical Therapy, 6, 175-184.

Greene, D. P., & Roberts, S. L. (2005). Kinesiology: Movement in the context of activity (2nd ed.). St. Louis, MO: Elsevier Mosby.

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Karem, M., Livanelioglu, A., & Topcu, M. (2001). Effects of Johnstone pressure splints combined with neurodevelopmental therapy on spasticity and cutaneous sensory inputs in spastic cerebral palsy. Developmental Medicine Child Neurology, 43, 307-313.

Lane, S. J. (2002). Structure and function of the sensory systems. In A. C. Bundy, S. J. Lane, & E. A. Murray, (Eds.), Sensory integration: Theory and practice (2nd ed.). Philadelphia, PA: F. A. Davis.

Nicholson, D. E. (1996). Motor learning. In C. M. Fredericks, & L. K. Saladin (Eds.), Pathophysiology of the motor systems: Principles and clinical presentations (pp. 238-254). Philadelphia, PA: F. A. Davis.

The Wolfe Clinic. (2004, September). Skin deep. The Wolfe Clinic News, I, 3. Retrieved August 13, 2008, from http://shopthewolfeclinic.com/store/newsletters/2004/september_01/pdf/Sept_03_2004.pdf

Urdang, L. (Ed.). (2000). The Bantam medical dictionary (3rd ed.). New York, NY: Bantam Books.

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Jennifer Stocker is an Occupational Therapist at the Kentucky School for the Blind. She is trained in Pediatric Neuro-Developmental Treatment and certified in the Sensory Integration and Praxis Test.

Appendix C
Tactual Learning With Limited Hand Use Due to Motor Impairment

Millie Smith, M.Ed, TVI

Most teachers of students who have visual impairments (TVI) have heard the following aphorism. "If the eyes don't work, the hands become the eyes." Neurologists confirm the truth of the statement. They point to images that show regions of the brain normally dedicated to processing visual information given over to tactual processing in individuals without sight. In the case of braille readers, a huge portion of the cortex is dedicated to processing input from the index finger alone (Pascual-Leone & Torres, 1993). But what happens in the brains of individuals without sight who have severe motor impairments? In other words, what does the brain process if both the eyes and the hands don't work?

To answer this question it is helpful to remember what the brain is trying to do with the information it processes. It is trying to help its owner make sense of the world. Young learners discover what is in their worlds and how it works through use of their "sensing" and "action" systems (Gibson, 1988). Making sense of the world without the ability to gather information visually or haptically-through active touching-is a formidable task. Learners who cannot use their hands to explore objects may develop knowledge of their worlds based primarily upon auditory information. Auditory input alone doesn't make much sense.

Imagine two children hearing sounds coming from a music player. Both children are blind. Joe has no motor impairments. Beth has severe cerebral palsy. When Joe becomes curious about the sounds he is hearing, he moves toward them until he discovers a box. He leans down and puts his ear against the speaker. "Yes," he thinks, "this is the thing that makes the sounds I hear." He explores the box with his hands. He finds some buttons on the front of the box. He presses one and the box goes silent. He presses the same button again and the sounds come back. He finds other buttons that change the sounds. He learns that this thing has a name-CD player. When Joe hears someone say "CD player," he thinks of the box with the buttons. When he is exploring his grandmother's house and he comes across a box about the same size with buttons on the front, he recognizes it. "Oh," he thinks, "Grandma has a CD player too."

Beth's experience is very different. She hears the same sounds. She would like to find out from where the sounds come, but she cannot move toward them. Someone puts something (an adaptive plate switch) next to her head. When her head presses against the hard, smooth surface, the sounds stop. When her head presses the surface again, the sounds start. This confuses Beth because the sounds don't seem to be coming from the surface. She is additionally confused when the same surface seems to affect other things in the same way-blowing air, lights, etc. She understands that pressing some, but not all, hard, smooth surfaces make things stop and start. Sometimes she doesn't want to press these surfaces because she isn't sure what will happen. She wonders from where the sounds, air, and lights come. When she hears someone say "CD player," she thinks they must mean the surface or the sounds she hears. She isn't sure.

TVIs know a lot about visual impairments and about how to teach compensatory skills. Touch is the most essential compensatory strategy for children who are blind. How does the TVI facilitate the use of touch to the maximum extent possible in learners who have very limited vision and hand use? The facilitation technique used most frequently is passive touch. Teachers put the learner's hand on an object, or put an object in the learner's hand, and move the learner's hand over the object. Even though the learner's hand is moving, this is still passive touch because the brain activity related to ideation, motor planning, and muscular execution of the movement is occurring in the teacher's brain, not the learner's. If the hands are fisted or otherwise unavailable, teachers often move the object over skin on the arm or back of the hand. Passive touch yields poor quality information.

Problems with passive touch

  1. Manipulating the learner's hands is invasive. Some learner's may perceive this as unpleasant or threatening. Avoidant behaviors may result. These may include things like pulling the hands away, biting, pinching, and dropping or throwing objects (Miles, 2003).
  2. Passive touch does not stimulate receptors in the learner's muscles and joints. Without the resulting combined tactual and proprioceptive input, information about spatial relationships, dimension, weight, and exact shape is unavailable (McLinden & McCall, 2002).
  3. Passive touch gives information about density (hardness), temperature, and texture. The input may be experienced as pleasurable or unpleasant, soothing or exciting, but information received passively, limited to these three properties, would be unlikely to result in recognition of the object providing the input (Chen & Downing, 2006).

Active touch (exploration) is required for object recognition. In active touch, movement is the learner's idea. He plans the movement and executes it to the fullest extent possible. How is this kind of touching, haptic perception, impacted by cerebral palsy? According to Blanche and Nakasuji (2001), the following factors must be considered.

Active touch deficits related to cerebral palsy

  1. Sensory and motor deficits are present, including sensory processing and motor planning disorders.
  2. Loss of tactual sensation is common and may be due to injury to an area of the central nervous system or impairment of peripheral nerves.
  3. Tactual deficits in the hands are more common in children with spasticity than in children with athetosis.
  4. The intensity of the tactile deficit is not related to age or cognitive abilities.
  5. Tactual processing deficits are common in children with hemiplegia.
  6. Tactual and proprioceptive deficits most often include deficits in tactile discrimination, pressure sensitivity, directionality, two-point discrimination, haptic exploration, and grip force.

Imagine Beth at her birthday party. She helps tear the wrapping off of her gift and a lump is placed in her lap. She wants to find out what it is. She can't see it. It doesn't make a sound, have a unique smell, or taste. She can do some haptic exploration of the object, but the quality of the input is impaired. If one of the typical children at Beth's party was blindfolded and put in a heavy arctic parka and thick gloves, he would get about the same quality information that Beth gets. Beth can tell that the object is hard and fairly smooth. She isn't sure how big it is or what shape it is because she can only touch part of it with one hand. She knows that it is a present from her sister and she doesn't want to hurt anyone's feelings, but it really isn't very interesting to her. She has no idea that it is a Barbie® doll. When she is told, "It's a Barbie doll," she recognizes the words and she knows that those are important words to her sister, but she doesn't understand why her sister would be excited about the lump in her lap.

Beth's TVI wants to help Beth use active touch to explore and recognize objects. In order to do that, she will have to consider each of the following questions.

How do I make a variety of objects available for exploration?

How do I facilitate exploration?

How do I make a variety of objects available for exploration?

Learners with visual impairments and limited hand use need help accessing objects. Partners are responsible for determining three things: content, format, and context.

Too often access is limited to only the first content area in this list.

How do I facilitate exploration?

Typical children use very predictable strategies for exploring objects. Gibson (1988) and Bushnell and Boudreau (1993) describe three phases.

These behaviors are extremely important. Ruff, McCarton, Kurtzberg, and Vaughan (1984) found a relationship between manipulative exploration at 9 months and later cognitive functioning; and they suggest a causative relationship between lower levels of manipulation and the emergence of cognitive deficits.

From 5 months on, exploration of objects is haptic and visual. Ruff, Saltarelli, Capozzoli, and Dubiner (1992) found that infants explored novel objects by mouthing followed by looking. Exploratory mouthing decreased with age as visual examining increased. The implication for children with low vision and severe motor impairments is that they must have access to objects in such a way that they can mouth and look at the same time. Exploratory environments designed with accommodations for motor and visual impairments are rare. The active learning environments developed by Dr. Lilli Nielsen provide wonderful haptic accessibility to the mouth and hands (Dunnet, 1997). But, children who have cortical visual impairment, in particular, may experience difficulty with the "mouthing followed by looking" procedure described by Ruff et al. in exploratory environments containing high levels of visual and cross-modal complexity (Roman Lantzy, 2007). Often, TVIs design learning environments to maximize visual regard of shiny, brightly-colored objects. But, teachers need to remember that visual regard alone is not sufficient for object recognition. Even in infants with typical vision, explicit exploration does not start with looking. It starts with touching followed by looking. At about 4 months, infants use vision to detect targets. This curiosity about "something out there" stimulated by vision is vitally important, but it does not answer the question, "What is it?"

When vision is not available to be used with touch for exploration, object recognition depends on haptic perception alone. In 1987, Lederman and Klatzky described the specific hand movements related to the detection of certain properties of objects. They called these hand movements "exploratory procedures" or "EPs." Bushnell and Boudreau (1993) related Lederman and Klatzky's EPs to the development of manual motor abilities in the three exploratory phases referred to earlier. The material in parentheses after the EP is Bushnell and Boudreau's elaboration. The information about phases refers to manual exploration only. Infants develop knowledge of properties orally at earlier ages (Ruff et al., 1992).

Property Exploratory Procedure & Hand Motion
Texture  Lateral motion (Phase 2: Scratching or rubbing) 
Hardness  Pressure (Phases 1 and 2: Kneading, squeezing, and poking) 
Temperature  Static contact (Phases 1 and 2: Withdrawal of hands after contact) 
Weight  Unsupported holding (Phase 2: Waving, banging, transferring from hand-to-hand) 
Global Shape  Enclosure (Phases 1 and 2: Clutching, grasping, holding) 
Exact Shape  Contour following (Phase 3: Holding with one hand while following edge with fingers of other hand) 

(texture) 

(hardness) 

(temperature) 

(weight) 

(global shape)
(volume) 

(global shape)
(exact shape) 

McLinden (2004) in a study of nine children with visual and multiple impairments found that while the learners performed some exploratory procedures like those described by Klatzky and Lederman, they displayed additional behaviors. For instance, one learner rubbed an object across his lips and another tapped beads placed in her clinched hand against her teeth. McLinden points out that these may have been exploratory procedures related to gathering information about texture, density, and temperature. Bushnell and Boudreau (1993) postulate that certain properties of objects, like weight and exact shape, cannot be detected until the motor skills related to the exploratory procedures develop. Learners of any age with severe motor impairments that prevent them from developing the motor abilities to grasp, lift, transfer, and manipulate also miss out on the corresponding detection of properties of objects. This is a very significant fact given Klatzky and Lederman's later findings (2008) in their work on haptic perception in individuals with low vision. They found that object recognition is dependent upon the ability to detect several properties of objects in exploration carried out over time using a variety of EPs related to the unique features of the object. Learners with severe motor impairments are simply getting less haptic information and, if they are dependent on haptic perception alone because they have a visual impairment, are going to face extreme challenges in developing the concepts that are essential to early cognitive development.

The TVI can facilitate exploration by designing instructional activities with three variables in mind: time, space, and mode.

Time

Under the best of circumstances, the amount of information the hand can gather simultaneously is limited to the part of the object it is touching at the time. Gathering information about the whole object "involves taking a number of tactile samples over time" (Davidson, Abbott, & Gershenfeld, 1974, p. 539). When children, like Beth, have deficits in tactile discrimination, sensory processing, and the motor ability to execute exploratory procedures, even more time is required. One of the major reasons children with visual and motor impairments fail to obtain information about objects in their worlds is that they are simply not given enough time. If Beth is rushed through activities so that she can stay on schedule or keep up with her peers, she cannot possibly have the opportunity to engage in quality exploratory procedures that would lead to recognition of the objects that are part of her activities. Beth needs to participate in activities with her peers, but she also needs exploration time.

Strategy: Make exploration activities a regular part of the learner's day. Design these activities so that the content, format, context, and pace supports learning according to assessed needs. As often as possible, choose object content that will help with the recognition of objects used in activities shared with peers.

Space: Positioning and modifying

In order to explore, young learners must be positioned so that they can touch and see simultaneously to the maximum extent possible.

References

Blanche, E. I., & Nakasuji, B. (2001). Sensory integration and the child with cerebral palsy. In S. Smith Roley, E. Blanche, & R. Schaaf (Eds.), Understanding the nature of sensory integration with diverse populations. (pp. 345-364). Tucson, AZ: Therapy Skill Builders.

Bushnell, E. W., & Boudreau, J. P. (1993). Motor development and the mind: The potential role of motor abilities as a determinant of aspect of perceptual development. Child Development, 64, 1005-1021.

Chen, D., & Downing, J. (2006). Tactile strategies for children who have visual impairments and multiple disabilities: Promoting communication and learning skills. New York, NY: American Foundation for the Blind Press.

Davidson, P. W., Abbott, S., & Gershenfeld, J. (1974). Influence of exploration time on haptic and visual matching of complex shape. Perception and Psychophysics, 15, 539-543.

Dunnet, J. (1997). Nielsen's Little Room: Its use with a young blind and physically disabled girl. Journal of Visual Impairments and Blindness, 91, 145-50.

Gibson, E. J. (1988). Exploratory behavior in the development of perceiving, acting, and the acquiring of knowledge. Annual Review of Psychology, 39, 1-41.

Klatzky, R., & Lederman, S. (2008). Object recognition by touch. In J. J. Rieser, D. H. Ashmead, F. F. Ebner, & A. L. Corn (Eds.), Blindness and brain plasticity in navigation and object perception (pp. 185-208). New York: Lawrence Erlbraum Association.

Lederman, S. J., & Klatzky, R. L. (1987). Hand movement: A window into haptic object recognition. Cognitive Psychology, 19, 342-368.

McLinden, M. (2004). Haptic exploratory strategies and children who are blind and have additional disabilities. Journal of Visual Impairments and Blindness, 98, 99-115.

McLinden, M., & McCall, S. (2002). Learning through touch: Supporting children with visual impairments and additional difficulties. London: David Fulton Publishers.

Miles, B. (2003). Talking the language of the hands to the hands. D-B Link, The National Information Clearinghouse on Children who are Deaf-Blind.

Pascual-Leone, A., & Torres, F. (1993). Plasticity of the sensorimotor cortex representation of the reading finger in braille readers. Brain, 116(1), 39-52.

Roman Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and intervention. New York: American Foundation for the Blind.

Ruff, H. A., McCarton, C., Kurtzberg, D., & Vaughn, H. G., Jr. (1984). Preterm infants' manipulative exploration of objects. Child Development, (55)(4), 1166-1173.

Ruff, H. A., Saltarelli, L. M., Capozzoli, M., & Dubliner, K. (1992). The differentiation of activity in infants' exploration of objects. Development Psychology, 28, 851-861.

Millie Smith is a private consultant who works with students who have visual and multiple impairments. She retired from the Texas School for the Blind and Visually Impaired. She is the author of the Sensory Learning Kit.

Appendix D
Supports for Learners With Visual and Motor Impairments: Facilitating Participation in Play and Games

Tristan Pierce, MIA

All children learn through play. Psychologists and educators deem play pivotal to the lives of children; however, prior to the 1980's, little research existed on the play of young children with disabilities (Buchanan & Giovacco-Johnson, 2009). Young children learn through their hands and manipulative play is beneficial to the development of hand skill. When working with children who have special needs, parents, teachers, and caregivers need to use materials that are developmentally appropriate and provide needed supports so the learner's body is adequately supported; this allows not only for the learner's hands to be free to play, but it allows for her concentration to focus on hand movements as opposed to trying to sit up or hold her head up. Consider environmental modifications to make the activity/goal more successful for the learner. Reward the learner with encouragement and praise. Success encourages the learner to repeat and strive for better performance. All infants, toddlers, and older children who have disabilities, whether visually impaired or not, develop arm and hand skill by playing with construction toys and tactile media (e.g., sand, beans, playdough). Adults often view play negatively because they define it as simply having fun, but play is more than a creative urge; it also functions as a foundation for learning (Elkind, 2008). Today, educators feel the pressure and need for standardization and accountability, but it is important to remember the value of play as both an assessment and an instructional tool to support a child's development and learning (Pizzo & Bruce, 2010).

Toni Linder with Susan Dwinal and Anita C. Bundy (2008) provide a very detailed outline of keys to intervention by developmental age in their chapter titled, Facilitating Sensorimotor Development: Strategies for Improving Arm and Hand Use, in Transdisciplinary Play-Based Intervention (TPBI2). Within that outline, it says that by the end of 36 months a typical child shows a stronger hand preference; by the end of 48 months the child uses a tripod grasp on crayons and can stabilize paper when coloring; by the end of 60 months the child can reposition a crayon in one hand following grasp, and when drawing, movement comes from the fingers rather than arm and hand; and finally, by the end of 72 months the child can "walk" the fingers down the crayon to get it in position for coloring. For a child with a visual impairment and cerebral palsy, these incremental steps may take longer to achieve.

Yoshi is 5 years old, has glaucoma and cerebral palsy. Her mother and father created a series of Yoshi Stories. When it is story time, Yoshi's parents, grandparents, and siblings pay close attention to Yoshi's posture and physical supports. They know Yoshi cannot comfortably use her hands without proper support for her head and torso. Each Yoshi Story has a set of manipulatives to follow along with the story. When reading "Yoshi is an Artist," her paper and crayons are positioned so Yoshi does not have to lean to reach them. She wears her pencil/crayon holder (orthosis) when coloring. Her reader provides verbal support when Yoshi draws, "Yoshi, you draw good circles!" When new items are introduced within a story, Yoshi is allowed ample time to explore each item using hands, feet, nose, or mouth. Yoshi's favorite story is "Yoshi Goes Swimming." She gets to sit in her little pool in the back yard, splash in the water, and explore all the toys in the pool. It makes her mother laugh, Yoshi's favorite sound.

Yoshi's entire family provides physical support, verbal support, environmental modification, and allows extra time for Yoshi to explore and process new information.

Teachers and parents introduce to typical children activities that use scissors in supervised situations between 48-60 months (Linder, Dwinal, & Bundy). Keep in mind that learning to use scissors is not a deal-breaker for a young learner who has severe motor impairments to be successful. Other play-based, success-oriented activities are valid substitutes for cutting with scissors (Haynes, 2009).

Robbie has optic nerve hypoplasia and cerebral palsy. When very young, Robbie used a plate switch with LED lights to operate toys. In kindergarten he used his platform communicator for making choices and matching activities. Now in grade school his teacher thought he should be able to use the same hand manipulation technique to cut paper for his art assignment. She thought this would be a good reach-grasp-release routine to strengthen arm and hand use. Using a digital recorder, she recorded the snipping sound of the table-top mounted push scissors. She applied reflective tape to the handle of the scissors. With her supervision, she let Robbie explore the scissors using the backs of his hands and his knuckles. With her assistance, Robbie placed a piece of paper in the scissors. She said, "Cut paper, yes." Using the hand-under-hand technique, she assisted Robbie in pushing the top of the scissors down. Robbie heard the snip sound. After several times, the teacher helped Robbie place the paper in the scissors and repeated, "Cut paper, yes." Robbie pushed the scissors down by himself. The digital recording of the "snip sound" became Robbie's sound bridge for cutting paper. Robbie's teacher spoke with his mother who continued the activity with Robbie over the weekend to make holiday decorations.

Using a hand movement that was familiar to Robbie, his teacher added audio to the routine (sensory sound bridge) and provided an environmental modification (adapted scissors and reflective tape). She used consciously chosen words that conveyed a command.

When a child demonstrates a stronger arm and hand preference, Linder, Dwinal, & Bundy (2008) suggest play that encourages the child to roll and toss balls. By 48 months, the child should be able to throw a small ball at least 3 feet and play catch with a large ball. These early skills need to be practiced and incorporated into more advanced games as the child grows. Standard 1 of the National Physical Education Standards states that the student demonstrates competency in motor skills and movement patterns needed to perform a variety of physical activities. State standards provide more precise direction. For children using wheelchairs, hand mobility is extremely important when playing sports; it can even determine how a ball is kicked.

Carmen's physical education teacher was not happy that Carmen couldn't participate in her 4th grade class's unit on kickball. Her state's Performance Standards state, "that by the end of grade 4 students will demonstrate progress toward the mature form of all locomotor (movement) patterns and selected manipulative and nonlocomotor skills such as throwing, catching, and kicking" (Wisconsin Department of Education, 1997). She consulted Carmen's TVI who collaborated with the district's adapted physical education specialist. Carmen's PE teacher explained the principles of power wheelchair kickball to the occupational and physical therapists. After referring with Carmen's doctor, it was decided that she could play. Carmen's wheelchair tray would remain on during game time, and she would be secured in her wheelchair to ensure she maintained a proper upright sitting position, and that she would wear a helmet. To begin, the physical therapist temporarily removed the tray from Carmen's power wheelchair and placed an electronic sound ball in her lap. Carmen was able to feel the roundness of the ball on her thighs and stomach. Her PE teacher helped her explore the shape further with her arms and the backs of her hands. They experimented with letting the ball roll off Carmen's lap so she became accustomed to hearing the ball bounce. The next day they bounced the ball from a short distance until Carmen showed recognition of the sound and requested the ball. Later, from the same distance, her PE teacher bounced the ball, stopped, turned the ball's sound on low volume, and resumed bouncing the ball. Once Carmen understood the sound was a sensory bridge for the ball and practiced locating it, she was ready to learn how to catch, throw, and kick. Peers in her class took turns practicing the skills with her; she soon was ready to play kickball. A box was fitted to the footrest of her wheelchair with which she kicked the ball. When it was Carmen's turn, she activated the forward motion of her wheelchair with her hand in a manner that when the box made contact with the ball, it rolled forward. The classmate who caught the ball bounced it 20 times to allow Carmen time to run to first base (Lieberman & Cowart, 2011). Everyone counted along and Carmen knew she would make it before they reached 20.

Carmen's PE teacher consulted with specialists prior to implementation. Through task analysis (step-by-step process), the PE teacher and classmates taught her to recognize the ball and to catch, throw, and kick it. The environmental modification allowed Carmen to sit in a proper upright position. An equipment modification was employed by the use of a sound emitting ball. The rule modification of counting to 20 allowed Carmen extra time to maneuver her wheelchair. The fun of the game and Carmen's continued improvement allowed her to experience success while playing with her peers.

When speech is not available to a child, and cerebral palsy prevents reach-grasp-release as a manipulative option, switches and alternative communication devices are tools that can allow the child access to language and literacy.

Ira is nonverbal, has no light perception, and uses a wheelchair. He was invited to a classmate's birthday party. One of the games played was Where's the Birthday Bird. All the children wore blindfolds and were given a balloon. The string on Ira's balloon was tied to his wheelchair. To start the game, the Birthday Boy removed his blindfold and moved to a location of his choice in the yard and began to sing the "Happy Birthday" song. All the children began to try to locate the song bird. The child who reached the singing Birthday Bird first won the bird's balloon and he or she became the song bird for the next round. The object of the game was to gain as many balloons as possible; the winner having the most balloons. When it was Ira's turn to be the singing Birthday Bird, an adult helped him move his wheelchair to a distant location and he turned on his switch-adapted cassette player and played the "Happy Birthday" song. Although Ira did not win the game, he did win two balloons to take home.

With just a couple of modifications (tying the balloon to the wheelchair and using a prerecorded song), Ira was able to participate and enjoy the party game with his friends.

Linder with Bundy (2008) address the skills of eating and dressing in Facilitating Sensorimotor Development: Strategies for Improving Sensorimotor Contributions to Daily Life and Self-Care. Their keys to intervention by developmental age state that the typical child, by 60 months, needs little assistance with sweaters and socks when getting dressed. When eating, continue to introduce new foods and include the child in all aspects of the meal. Adults teach children what to eat and wear. They teach them how to eat and dress appropriately for the situation. Linder and Bundy stress that adults should make eating and dressing fun, encourage participation and independence, and reward the child's accomplishments. Games can be a great conduit for learning. Always design games for children with visual and motor impairments in a way that the game tangibles are presented in an easy-to-access manner.

Tina and Fay are twins who have mild cerebral palsy and low vision. They wear school uniforms but get a choice of gray, green, or white socks and button down sweaters. Each article of clothing has either a large black "T" or "F" on the label. A few weeks before starting the 1st grade, their mother began playing a game with them using elements of Go Fish and Yours and Mine, calling it Tina's and Fay's. They played every day the week before school started. To begin Tina and Fay each had their own basket each containing six items: green sweater, white sweater, gray sweater, green socks, white socks, and gray socks. The girls took turns going first. When Tina selected her gray sweater, Fay would select her gray socks. When it was Fay's turn, she selected her white sweater and Tina selected her white socks. After matching all the items together, their mother would place a green sweater on the tray alongside a pair of green socks and white socks. The girls would take turns selecting the associated (sweater to socks) and matching (green to green) items. When the first day of school arrived, their mother laid the clothing selections on the tray on top of the dresser. The girls successfully chose their matching socks and sweaters. Their mother told them how proud she was of them and their father exclaimed how beautiful they were in their uniforms. Eventually their mother moved the items to the top dresser drawer, laid out in the same manner, and the girls continued to wear their coordinated clothing throughout the school year.

Tina's and Fay's mother made learning fun by creating a game. She made the items easily accessible by using baskets and trays. Both parents praised the girls for their accomplishments.

Peterson has severe myopia with achromatopsia, low muscle tone, and very limited voluntary movement ability due to cerebral palsy. He can follow the movements of hands. Every day at lunch the students are given a choice of three fruits. Coordinating with the cafeteria staff, Peterson's teacher, Miss Gena, began playing Do It Again with him. Peterson's basket contained an assortment of whole fruits often served in the cafeteria. Miss Gena took the banana out of the basket, held it close to Peterson's face, and said, "banana." As Peterson touched the banana with his cheek, Miss Gena said, "Do It Again?" With a popping sound, she began peeling the banana and said, "Peel banana." Miss Gena held the banana within a few inches of Peterson's face; she let him smell it and helped him hand-under-hand to feel the first section of the banana peel fold down. Miss Gena repeated the procedure until all the sections of the peeling were removed. Each day a new fruit was explored. Every morning Miss Gena goes to the cafeteria and gets one of each of the three fruits being offered that day. She lays the fruits on the tray, holds it up to Peterson's face, and says, "Peterson's banana" or "Peterson's grapes." Peterson directs his gaze at the fruit and leans his cheek to touch the correct fruit. Peterson is still working on this, getting it correct about 60% of the time. Miss Gena hopes by the end of the year that Peterson can select from the three fruits while in the cafeteria going through the food line. The cafeteria staff agreed to have a tray ready for Peterson with the three choices laid out. Miss Gena taught Do It Again to Peterson's mother so she can continue the game at home.

Peterson's teacher also utilized a game to teach him about a variety of fruits and the independence of choice making. To help Peterson identify the banana, she incorporated the use of smell, hearing, and touch. The game became a pre-lunch routine that Peterson played every day. Recruiting the assistance of the cafeteria staff was vital to Peterson experiencing a successful outcome.

Beth is a 5-year-old girl. She is busy learning about her world with the help of her family members, her kindergarten teacher, her teacher of students who have visual impairments, her speech language pathologist, and her occupational and physical therapists. Beth's visual abilities are limited to light perception only. Her motor and haptic perceptual abilities are limited by cerebral palsy. Beth has good head control but requires support for sitting. She can move her right hand at the wrist about 3 inches and can extend the index finger of her right hand with facilitation. Both hands are fisted and splints are worn to help prevent contracture. She has deficits in tactual discrimination, sensory processing, and haptic perception due to central nervous system impairments and peripheral nerve damage. Beth's sister, Jenny, gave her a Barbie doll for her 5th birthday. Jenny was disappointed when Beth seemed to ignore the object. Pam, Beth's mother, wanted to find a way to increase Beth's interest in her toys. She discussed this with Beth's educational team. They decided to give Beth a chance to explore her new Barbie doll with carefully provided support. They placed Beth in her side lyer, left side down. They stabilized the right shoulder and forearm with folded towels so that the right hand lay comfortably about 6 inches from Beth's face. They removed the splint from the right hand and provided some deep pressure and joint compressions to relax the hand. This was followed by one of Beth's favorite tactual games, Body Buzz. When Body Buzz finished, they placed the Barbie doll next to the hand so that it touched the side of the hand. After observing for about 3 minutes and seeing no hand movement, they picked up the doll and placed its shoulder next to the corner of Beth's mouth. Beth immediately turned her head to the doll and brushed her lips over the doll's arm, neck, and head. She drew back when she encountered the hair on the doll's head, but continued to explore the arm. When she got to the end of the arm and discovered the hand, she used the tip of her tongue to probe the crevices between the doll's fingers. Beth's TVI said, "Fingers," as she did this. The TVI then touched Beth's fingers and said, "Fingers," again. Beth laughed. They put the doll back on the mat touching Beth's hand. Beth moved her head to the doll and continued exploring it with her lips and the tip of her tongue using her hand to stabilize it as she did this. Beth enjoyed exploring other toys in this same arrangement. As she developed knowledge about the objects available to her, she developed favorite toys. These were always objects with smooth, hard surfaces, indentations, and-best of all-moving parts. Her favorite toys were not typical toys. The most exciting things to play with for her were her mother's colander and spaghetti spoon, her dad's key chain, Jenny's Guess Who and Count Four game boards, and cassette tapes (the holes and little wheels). The speech language pathologist was thrilled when Beth was able to move her mouth to the named object when two objects were placed on the mat in front of her face. In this way, Beth was able to demonstrate that she knew the names of each of her favorite toys.
Once Beth had several favorite objects, the team decided it was time to expand her knowledge about those objects. They played the game Yours and Mine with Beth using a hanging array. A swing arm clamped to the back of the side lyer supported a bar in front of Beth's face. Three objects were tied with elastic to the bar so that they hung at mouth level. The two outer objects were accessible with no more than a 4-inch move of the head up or down. Beth's game partner, Jenny, showed her a colander similar to her familiar toy. As Beth explored it with her lips and the tip of her tongue, Jenny said, "Jenny's colander." Jenny then moved the objects in the array so that they made a sound and said, "Beth's colander." Beth smiled and moved her head to her colander and touched it with her lips. Later Jenny enjoyed playing variations on What Do and Go Fish with Beth using the hanging array.

In these games, Beth learned that the cassette goes with the cassette player and she was able to show that she understood what object was associated with the sound of music playing by touching the cassette in her array when Jenny played music and asked her "What do?"

Summary

A variety of intervention strategies and modifications were described in the stories. All the learners have visual impairment and cerebral palsy, but each child is different and play interventions and games must be tailored to the individual needs of each learner. There is one constant and consistent strategy in all of them-team participation. Yoshi's entire family knew the appropriate way to have story time using the story tangibles. Robbie's teacher recruited his mother to tag-team on weekends to keep the knowledge and skills Robbie learned during the week sharp over the weekend. Carmen had a magnificent team; her TVI, the PE teacher, the Adapted PE Specialist, the occupational and physical therapists, her doctor, and all of her classmates. Ira benefited from adults who planned games at the party that allowed Ira to participate. The game Tina and Fay played not only had their parents as team members, but they had each other. They each played a dual role, learner and teacher. Peterson's teacher recruited the cafeteria staff for school days and his mother for weekends. There was a reversal of roles in Beth's situation; her parents recruited Beth's educational team to participate and all were open to the strategy of Beth using her most accessible way of gathering information, her mouth.

Photo Caption: Team Ira

Research shows that the development of play and communication skills are linked for young learners who are deaf-blind or have visual impairments with additional disabilities. Classroom teachers and parents can use play techniques and strategies to reinforce the development of communication (Pizzo & Bruce, 2010).

For further understanding on arm and hand use, plus other aspects of sensorimotor development, review the reference list and SAM Appendices B, C, and G. To enhance the learning experience while playing SAM games, read Linder's TBPA2. This guide is thorough, well written, and very enjoyable to read. It includes a chapter titled, Strategies for Working with Children with Visual Impairments.

References

Buchanan, M., & Giovacco-Johnson, T. (2009). A second look at the play of young children with disabilities. American Journal of Play, 1(2), 41-59.

Elkind, D. (2008). The power of play: Learning what comes naturally. American Journal of Play, 1(1), 1-6.

Haynes, D. (2009, June 16). Teaching receptive and expressive communication skills to persons with severe and/or multiple disabilities across the age span, Kentucky Deaf-Blind Project Summer Institute EDS 558-022, Louisville, KY.

Lieberman, L., & Cowart, J. (2011). Games for people with sensory impairments. Louisville, KY: American Printing House for the Blind.

Linder, T. (with Bundy, A.). (2008). Facilitating sensorimotor development: Strategies for improving sensorimotor contributions to daily life and self-care. In Transdisciplinary play-based intervention (2nd ed.) (pp. 141-161). Baltimore: Paul H. Brookes.

Linder, T. (with Dwinal, S., & Bundy, A,) (2008). Facilitating sensorimotor development: Strategies for improving arm and hand use. In Transdisciplinary play-based intervention (2nd ed.) (pp. 69-91). Baltimore: Paul H. Brookes.

Pizzo, L., & Bruce, S. M. (2010). Language and play in students with multiple disabilities and visual impairments or deaf-blindness. Journal of Visual Impairment and Blindness, 104, 287-297.

Wisconsin Department of Education. (1997). Wisconsin's model academic standards for physical education. Retrieved from http://www.dpi.state.wi.us/standards/pdf/phyed.pdf

Tristan Pierce is a project leader in the Research Department at the American Printing House for the Blind in Louisville, KY. Seasonally she is a swim coach for students who have visual impairments and blindness. She also works part time with adults who have intellectual disabilities.

Appendix E
Functions of Echolalia for Very Young Children With Vision Impairment and Blindness

Zoe Larsen Morgese, MA, CCC-SLP
JC Greeley, TVI, O&M

Vic sits happily on the couch and presses his fingers into his forearm. He says,
"Squishy finger.....ring!
Squishy finger.....ring!"

Mama comments to herself,
"Squishy finger RING...where on earth did that come from?"

Vic repeats,
"Squishy finger...ring!
Squishy finger...ring!"

Mama locates Vic's daily note from his teacher and reads it. "Ah-ha Vic! You have been working on the brailler! Now I understand."

The above example shows one of the landmark traits of young children with low vision or blindness: persistent and sometimes excruciating (for the listeners) echolalia. The term "echolalia" refers to the verbal repetition of previously heard words, phrases, and sentences. In the above scenario, Vic is home with his mother after a day at preschool. During preschool, Vic had scribbled on the brailler and enjoyed pressing the keys until the bell rang at the end of a line. Now at home with his mother, through his favorite learning sense, hearing, Vic is reliving the pleasant time and practicing what he learned. According to language expert Porges (1998), the ears are used to remember things. The ears-what a child hears and understands-are essential to determining the meaning behind a child's echolalia. And there is more to offer as well-read on.

The echolalia of a child with vision loss reflects many of the same characteristics of the echolalia of a sighted child. However, echolalia by the child with vision loss, especially one with no vision, may be more extensive, used for longer periods of time, and used for more functions than the sighted child. Echolalic responses are almost always communicative, reflective of a child's understanding, and serve a meaningful purpose. The echolalia noted in young children with visual impairment is an effective and positive step in the sequence of communication development.

References

Andersen, E. S., Dunlea, A., & Kekelis, L. S. (1984). Blind children's language: Resolving some differences. Journal of Child Language, 11, 645-664.

Brambring, M. (2007). Divergent development of verbal skills in children who are blind or sighted. Journal of Vision Impairment & Blindness, 101,12.

Cutsforth, T. D. (1951). The blind in school and society. New York: American Foundation for the Blind.

Fraiberg, S. (1977). Insights from the blind: Comparative studies of blind and sighted infants. New York: New American Library.

Peters, A. M. (1994). The interdependence of social, cognitive, and linguistic development: Evidence from a visually impaired child. In H. Tager-Flusberg (Ed.), Constraints on language acquisition: Studies of atypical children (pp. 195-220). Hillsdale, NJ: Lawrence Erlbaum.

Porges, S. (1998). The Listening Project, Brain-Body Center, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL. Retrieved June 10, 2008, from http://www.psych.uic.edu/news/porges.htm

Riddlej. (2007, October 16). Life with little children [Online forum]. Retrieved April 7, 2008, from WordPress Web site: http://littlechildren.wordpress.com

Semantic Pragmatic Disorder Support Group. (2007). Echolalia. Retrieved April 7, 2008, from http://www.spdsupport.org.uk/echolalia.html

Suggested Reading

Andersen, E. S., Dunlea, A., & Kekelis, L. S. (1993). The impact of input: Language acquisition in the visually impaired. First Language, 13, 23-49.

Berk, L. E. (1994, November). Why children talk to themselves. Scientific American, 78-83.

Brandsborg, K. (2002). Blindness and autism: What is the relationship between blindness and autism-like difficulties in children? Paper presented at the 11th International Council for Education of People with Visual Impairment World Conference. Retrieved April 7, 2008, from http://www.icevi.org/publications/ICEVI-WC2002/papers/03-topic/03-brandsborg.htm

Field, E. I. (2005). Suggestions for caregivers of children with echolalia. Chapel, Hill, NC: Early Intervention Training Center for Infants and Toddlers with Visual Impairments, FPG Child Development Institute, UNC-CH.

Fraiberg, S., & Adelson, E. (1973). Self-representation in language and play: Observations of blind children. Psychoanalytic Quarterly, 42, 539-562.

Hatton, D. D., Bailey, D. B., Burchinal, M. R., & Ferrell, K. A. (1997). Development growth curves of preschool children with vision impairments. Child Development, 68, 788-806.

Landau, B., & Gleitman, L. R. (1985). Language and experience: Evidence from the blind child. Cambridge, MA: Harvard University Press.

Peters, A. M. (1994). The interdependence of social, cognitive, and linguistic development: Evidence from a visually impaired child. In H. Tager-Flusberg (Ed.), Constraints on language acquisition: Studies of atypical children (pp. 195-220). Hillsdale, NJ: Lawrence Erlbaum.

Urwin, C. (1983). Dialogue and cognitive functioning in the early language development of three blind children. In A. E. Mills (Ed.), Language acquisition in the blind child: Normal and deficient (pp. 142-161). London: Croom Helm.

Zoe Larsen Morgese is a Speech Language Pathologist and JC Greeley is a Teacher of Students who have Visual Impairments and Certified Orientation & Mobility Specialist. Both work at Anchor Center for Blind Children, an organization serving children birth to 5 years with visual impairment and their families. Anchor Center for Blind Children is based in Denver, Colorado.

Appendix F
Emotional Glue-Making Meaning Stick

Linda Hagood, MA, CCC-SLP

Teaching is both an art and a science. The ideas and strategies in this book focus on the technology, or the "science" of teaching as described by the developmental psychologist and researcher Piaget, who gives many cognitive and rational reasons for the need to connect meaning with experience. Helen Keller's quote, however, reminds us that intuition and feeling, as well as thinking and concrete experience, are essential components of education.

Recent research in the area of social cognition shows that what every grandmother knows may be true: Emotional connection is an important foundation for learning. Children who have high "emotional IQs" are more likely to grow into adults who have the cognitive flexibility and perspective-taking skills that are important for academic and vocational success (Gibbs, 1995; Goleman, 1995; Hobson, 2002). Without important visual cues, the child who has blindness or visual impairment is at a disadvantage in the area of social and emotional development (Sandler & Hobson, 2002). The child who has blindness or visual impairment may not receive information such as facial expressions, the use of body positioning in communication, or the give and take nature of nonverbal turn-taking routines. She may miss incidental learning about relationships that sighted children obtain through their eyes-

Even the more accessible auditory and tactile modes of input can be confusing if they are not paired with visual information. Blind children are often uncertain and feel awkward about how to interpret and use tone of voice, volume, and touch to convey feeling.

Children learn these social-emotional skills best, as well as many other important symbolic and cognitive skills, when they are emotionally engaged with their partners. Most of us learn our ABCs, our "times tables," and how to read our first words within engaging social contexts (e.g., singing a song together, reciting for a supportive partner, or looking at a book as our parent reads to us). Through the "emotional glue" generated by interactions with our partners, these skills "stick" in our minds. The emotional glue is so strong that the information is permanently embedded. Compare this to information we learn in isolation (e.g., dates of important Civil War battles, procedures for solving quadratic equations, or the capital letter abbreviations of all of the states). Most of us would have a difficult time recalling these facts, which we learned while studying alone or saying them back to ourselves.

How can I tell if we're connecting?

This seems easy enough, until you interact with students who have hard-to-read faces and bodies, and insufficient language to give you clues. A good starting place for reading the child's responses to you is the conventional one-"Find the Smile." When getting to know a child, or beginning a relationship, the initial goal might be to "find the smile," rather than achieve compliance or performance of specific behaviors. This can be tricky. The smile is not always a reliable cue to the child's mood or feelings about the interactions. Many kids, especially those with "quirky" nervous systems, smile or even laugh when they are anxious or upset. Some children smile unintentionally, while others never smile, even when they are quite content and engaged with another person. So it is important to be a careful observer of your student, and to observe how he communicates his feelings about being with you or the activities you have brought to him.

For some students, body orientation is a good cue. The student who turns toward you rather than away from you may be saying, "Okay, I like to play with you better than being alone." The student who reaches toward you or the object that you offer may be conveying a message of acceptance.

Participation is another important way that students can tell you they understand the activity and are willing and interested in connecting with you. Don't expect immediate participation. For many students, new activities signal challenge and trigger avoidance. A student who has built a trusting relationship with his teacher or parent may be more willing to watch a new activity passively at first than to flee the area; however, true active participation may occur only after repeated passive exposure to a new game or activity. When using hand-under-hand support to introduce the child to the activity or materials, does the child willingly follow your hand; or do you have to "reconnect" with her frequently to maintain the physical support?

Some students have highly idiosyncratic signals for connection and avoidance-one student communicated pleasure and enjoyment by wiggling her feet. This was not apparent to the teacher until the student's sister commented on it.

Last, but not least, remember that YOU are 50% of the connection! Pay attention to your own "emotional barometer" and notice how you are feeling during your time together. Do you laugh and smile during the activity? Do you wish the activity was longer, or do you keep looking at your watch and wondering when you can stop? Do you feel it was worthwhile to have spent the time playing with the student? Sometimes, do you feel amazed that you are actually paid to do this job because it is so much fun?!

Emotion Meter 
Number  Emotion  Feels like a 
100  Out of Control   thunderstorm  


90

80
 
Mad   shark  


70

60
 
Upset or Getting Silly   dragon  


50

40
 
Worried or Excited   alligator  


30

20
 
Relaxed or Happy   fish  
10  Sleepy   

References

Bailey, B. A. (2000). I love you rituals. New York: HarperCollins.

Baliss, M. (2006). Emotional intelligence and clear communication. Retrieved March 6, 2008, from: http://parenting.families.com/blog/emotional-intelligence-and-clear-communication1

Denham, S. A. (1986). Social cognition, prosocial behavior and emotion in preschoolers: Contextual validation. Child Development, 57, 194-201.

Gibbs, N. (1995). The EQ factor: New brain research suggests that emotions, not IQ, may be the true measure of human intelligence. Glencoe Understanding Psychology, Unit 5, Article 1. Retrieved February 13, 2008, from Time Web site: http://www.time.com/time/classroom/psych/unit5_article1.html

Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ. New York: Bantam Books.

Gutstein, S. (2007, February). Relationship development intervention. Workshop presentation. Austin, TX: Texas School for the Blind and Visually Impaired.

Hagood, L. (2008). Better together: Building relationships with people who have visual impairment and autism spectrum disorders (or atypical social development). Austin, TX: Texas School for the Blind and Visually Impaired.

Hobson, P. (2002). The cradle of thought: Exploring the origins of thinking. London: MacMillan.

McGehee, L. (2007). Les McGehee plays well with others. Austin, TX: Dalton Publishing.

Prizant, B. M., Wetherby, A., Rubin, E., & Laurent, A. C. (2006). The SCERTS® model. Baltimore: Paul Brookes Publishing Company.

Ridgeway, D., Waters, E., & Kuczaj, S. A. (1985). Acquisition of emotion-descriptive language: Receptive and productive vocabulary norms for ages 18 months to 6 years. Developmental Psychology, 21, 901-908.

Sandler, A. M., & Hobson, R. P. (2002). On engaging with people in early childhood: The case of congenital blindness. Clinical Child Psychology & Psychiatry, 6, 205-222.

Linda Hagood is a Speech-Language Pathologist who previously worked at the Texas School for the Blind and Visually Impaired. She is currently employed at the Central Kitsap School District in Silverdale, Washington.

Appendix G
Using SAM Items

Tristan Pierce, MIA

Appendix H
The Game Planning Worksheet: Getting Started and Moving Forward

Millie Smith, M.Ed., TVI

Glossary

American Sign Language Manual (hand) language with its own syntax and grammar used primarily by people who are deaf

Action system Movements used in exploratory procedures performed to gain information about the properties of objects

Active participation Physically taking a role in a group activity, routine, or exertion

Active touch Independent exploratory manipulation carried out with the hands, feet, or mouth: reached out and touched the soft cloth

Acuity loss (uncorrectable acuity problems) The decreased ability of an eye to distinguish object details and shapes

Athetosis A constant succession of slow, writhing, involuntary movements of flexion, extension, pronation, and supination of fingers and hands, and sometimes of toes and feet

Causality The nature of the relations of cause and effect

Chatter Spontaneous, random language used for social rather than instructional purposes

Cluster concept A small group of things in one category typically experienced in close proximity in both time and space

Clutter reduction Removing some (but not all) items from a field of vision

Cognitive development Field of study in neuroscience and psychology focusing on a child's development in terms of information processing, conceptual resources, perceptual skill, language learning, and other aspects of brain development and cognitive psychology

Concept development The acquisition of information that answers questions about what something is, what it does, and how it relates to other things

Concept formation Strategy which requires a learner to compare and contrast groups or categories that contain concept-relevant features with groups or categories that do not contain concept-relevant features

Concrete referent A thing that can be touched, pointed to, or done

Contrast enhancement Using color and complexity reduction to make an object stand out from its background: background red and object yellow

Cortical visual impairment Functional defect Impaired vision due to bilateral dysfunction of the optic radiations and/or visual cortex

Distance senses Vision, smell, and hearing

Distributed trials Repetitious responses that have a little space between them during which something different happens for a short time (your turn/my turn)

Dynamic symbol form Words; one of two foundation level tools used to build symbolic skills

Dyspraxia A neurological disorder of motor coordination usually apparent in childhood that manifests as difficulty in planning unfamiliar motor tasks

Echolalia The immediate or delayed repetition of words spoken by another person without comprehension of word meanings

Empty words Words without meaning due to lack of experience with concrete referents

Event An occurrence during which many referents from different categories interact in a prescribed way over a distinct period of time

Experiential memories Remembering an event/activity in which one participated

Field loss (visual) Lack of space or range within which objects are visible to the immobile eyes at a given time

Fingerspell Different positions of fingers used to represent letters of the alphabet

FM system A communication system for improving speech comprehension in difficult listening situations; a radio microphone is worn by the speaker that transmits wireless signals via frequency modulation (using very high frequency) to a receiver that is worn by the listener

Hand-over-hand The placement of a partner's hand over a learner's hand to help the learner understand the movement of a fine motor activity

Hand-under-hand The placement of a partner's hand under a learner's hand to explore an object together or guide a learner through a fine motor activity or task

Haptic perception The process of recognizing objects through touch. It involves a combination of somatosensory perception of patterns on the skin surface (e.g., edges, curvature, and texture) and proprioception of hand position and conformation

Hearing impairment deafness Full or partial decrease in the ability to detect or understand sounds

Imitation Advanced behavior whereby an individual observes and replicates another's

Kinesthesia The conscious awareness of bodily position, weight, or movement of the muscles, tendons, and joints

Learning modality The sensory channels used for processing and storing information: primarily visual, tactual, and auditory, but also, olfactory, gustatory, proprioceptive, and vestibular

Motor impairment A loss or limitation of function in muscle control or movement or a limitation in mobility

Near senses Touch and taste

Object exploration Use of sensory channels to gather information for detection of properties, identification, and discovery of potentials

Object permanence The knowledge or recall of an object even though it is not there at a given moment

Passive touch The action of being touched either by an object or by another person; to touch an object but with no independent exploratory and manipulative use of the skin

Piagetian model Model of cognitive development, first described by Jean Piaget in three global stages: sensorimotor, preoperational, and operational

Praxis The ability to plan new movements. It is a practical and applied knowledge to one's actions

Preoperational stage The developmental stage identified by using symbols, like words and pictures, as tools of problem solving, pretend play, and social connection

Proprioception The unconscious awareness of joint position

Referent Object, person, action, or place being referred to when a symbol is used; the symbol represents its referent; person, object, action, or place referred to by a symbol

Schema Knowledge of the relationship of things from several categories to each other as experienced in events beyond the body over time

Self-awareness An awareness of one's own personality or individuality

Sensorimotor stage Stage of learning defined by Jean Piaget during which typical children, 0-2 years of age, learn about their worlds through exploratory play by sensing and acting on objects

Sensory attributes Properties of objects that induce one to see, feel, hear, taste, smell, and move

Sensory channels (distance/near) Distance channel receptors are activated by attributes of things without being touched; near channel receptors are only activated when touched

Sensory defensiveness To have an aversion to things that induce one or more senses; a flight or fight reaction to sensation that unaffected individuals would consider non-threatening

Sensory impairment To have a lack of or a diminished capacity to use one or more sense

Sensory information Knowledge of the world acquired through sensory experiences

Sensory overload Activates the sympathetic nervous system used to prepare individuals for emergency situations; may cause nausea, dizziness, flushing, pallor, sweating, withdrawal, anxiousness, restlessness, and sleep disturbances

Sensory shutdown Neurological reaction to sensory overload resulting in unresponsiveness

Single-referent concept Thoughts about one thing

Social touch A combination of active and passive touch that promotes attachments and emotional relationships

Somatosensory system Pertains to the general somatic senses: somatic pain and temperature, touch, vibration, limb position, and motion sensibility

Spasticity Stiff, jerky movements caused by tight muscle groups that limit movement

Spatial relationships Knowledge of the relationship of the positions of parts of the body to each other, the body to objects and people, and objects and people to each other

Symbol Something that stands for or suggests something else by reason of relationship, association, convention, or accidental resemblance; objects and words used to represent their referents

Tactile symbols (tactual or tangible symbols/tactile graphics) Arbitrary or iconic objects or graphic forms used for communication and literacy

Tactual discrimination The ability to detect features and properties of objects through touch for the purpose of identification and comparison

Tactual/Tactile defensiveness A subset of sensory defensiveness that only involves touch

Visual impairment Any uncorrectable degree of vision loss, ocular or neurological, that limits a person's ability to perform visual tasks

Word bridge A spoken word used to trigger thoughts about sensory experiences with things stored in memory

Zone of proximal development The gap between what the learner can do without help and what he can do to achieve a goal he desires and understands

Acknowledgements

Field Testers

The American Printing House for the Blind extends a special thank you to the following professionals who contributed their time and expertise to the evaluation of SAM: Symbols and Meaning. These individuals stayed focused on this project for a full academic year; many incorporated SAM into their learner's Individual Education Program (IEP).

Anonymous, Teacher and Speech Language Pathologist, Huntsville, TX
Leslie Daniels, Special Education Teacher, Fruitland, ID
Patti Eswein, Students who have Visual Impairments, Braselton, GA
Yvette Hoisington, Students who have Visual Impairments, Alvin, TX
Ramona Lee, Special Education Director, Fruitland, Idaho
Melinda Loyd, Students who have Visual Impairments, Sherman, TX
Barbara McElyea, Students who have Visual Impairments, Johnson City, TN
Anita Medley, Students who have Visual Impairments, COMS, Olive Branch, MO
Joyce Olson, Students who have Visual Impairments, Genoa, NE
Suzan Patillo, Itinerant Visually Impaired Program Chairperson, Grayson, GA
David Presley, Students who have Visual Impairments, Clarksville, TN
Gina White, Special Education Teacher, Caldwell, ID

Photography

Anchor Center for Blind Children, 107, 154, 155, 158
APH Archives, 68, 109, 111, 129
Michael Bicknell, 82, 87, 181
Janie Blome, 3
Robin Bush, 47, 48
Drew Carlsen, 22
Mark Cookman, 45
Meredith Cooley, 138
Michael Drewell, 33
Rita Gale Lane, 29
John Linahan, 43
Colleen MacDonald, 112, 121
Jim Manka-Taylor, 59
Barbara McElyea, 9, 123
Kathy Morrison, 35
James Moses, [BIG], 137, 138, 143, 150
Kathy Neufeld, 55, 181
Mike Peters © 2009, www.mikepeters.com, 66
Tristan Pierce, front cover, 9, 17, 22-23, 25, 40, 55, 67-68, 71, 101, 121, 135, 165, 175-179, 181, 191, 201
Erica Rucker, 39, 55,
Lesley S., 119
Danie Shaughnessy, 16
Larry Smith [BIG], 9, 27, 181
Ann Travis, 1, 12, 15, 36, 83, 120
U.S. Census Bureau, 25
Monica Vaught-Compton, 19, 84
Camille Workman, 153

Illustrations

[BIG], 68
Breanna Burton, 163
Yoshi Miyake, 61-63, 122, 172

Videography

Michael Bicknel, TSBVI - Bag Story (Abraham), Clue, Do It Again (Matthew), Do It Again (Cassie), Finger Tag (Leo), Finger Tag (Matthew), Mystery Voice, Show Me Who, Simon Says, Slap, Sounds Like , Yours and Mine (Abraham)
Scott Blome, APH - Go Fish (Patti)
Donnie Bott, [BIG] - Bag Story (Butter's Bath Time), Box Story, Scavenger Hunt
Kendra Doty, TSBVI - Clue
Stephanie Lancaster, APH - Go Fish (Patti), Binder Story
Marcela Meza - Whoopee Clothes
Sherry Pollen - Body Buzz
Larry Smith , [BIG] - Hot Potato, What Do, Yours and Mine (Jerrita)


SAM icon of geometric shapes in a basket

Guidebook

APH logo

1839 Frankfort Avenue
Louisville, KY 40206
800-223-1839
www.aph.org
info@aph.org

Catalog No. 7-08854-00 Use in Kit No. 1-08854-00