Visual impairment and occupational therapy

Transcription

1 Visua impairment and occupationa therapy The best of both: working together to support chidren with visua impairment and additiona compex needs A series of eafets exporing ways that the QTVI (Quaified Teacher of Visuay Impaired chidren) and other professionas can achieve an effective working reationship together and ensure the best outcome for chidren with specia requirements. This eafet has been written by Catherine Southwe (QTVI, Woverhampton) and Debbie Hunt (Senior Occupationa Therapist, Woverhampton PCT).

2 The team A chid with a combination of disabiities is ikey to receive continued support from severa agencies, each to address a medica, educationa, therapeutic or socia need. Each supporting professiona wi have their own expertise, priorities, methods of working and aims for the chid. In this series of eafets we ook at the above scenario and expore ways that the QTVI can support effective team work with other professionas. We aim to discover how good communication and joint working can hep to: eiminate seemingy conficting or confusing practice for both professionas and parents avoid, or sove, practica probems co-ordinate working practice, aims and targets to ensure the best possibe outcome for the chid. Other tites in the series incude: Visua impairment and physiotherapy Visua impairment and orthoptics (cinica and functiona vision assessment) Visua impairment and speech and anguage therapy Visua impairment and specific medica needs and medication. How the occupationa therapist and QTVI can achieve the best of both This eafet expores the roes of the occupationa therapist (OT) and the QTVI in their joint working with chidren who have MDVI (mutipe disabiities incuding visua impairment). These professionas have a common aim for the chidren they support: utimatey to enabe the chidren to access activities of daiy ife appropriate to their age and environment. Activities incude independent iving skis, incusion in famiy ife and incidenta earning, education in schoo and interaction with their peer group. Their support of a chid with a visua impairment wi differ in its focus and deivery. However, there may be some instances where intervention overaps. It is hepfu for the OT and QTVI to communicate so that dupication is avoided (eg both suppying the same piece of equipment), skis are taught in a consistent way and communications to parents and others are deivered in a cohesive and joined-up manner. 2 Best of both Visua impairment and occupationa therapy

3 The roe of the QTVI focuses on the chid s earning and deveopment The QTVI: works with a chid to optimise remaining vision, where appropriate, and deveop other senses to faciitate earning provides or adapts materias and teaches strategies to hep the chid overcome probems associated with sight oss, so that deveopmenta miestones and educationa targets can be achieved advises parents and educationa settings of strategies and faciities to improve access and incusion aims to reduce any negative impact of the chid s visua impairment as far as possibe. The roe of the OT is to enabe the chid to engage in meaningfu and functiona activities Often working cosey with the physiotherapist and speech and anguage therapist, the OT: addresses issues of gross and fine motor function, sensory integration dysfunction and motor panning, in reation to the performance of functiona tasks (these are specia areas of concern for chidren who have a visua impairment) advises on the purchase of speciaist equipment, such as crockery and cutery, moving and handing equipment, furniture and adapted toys promotes sef-hep skis and independence, for exampe the OT may suggest postura tips and other strategies to improve motor contro, such as when eating, drinking, dressing or paying may speciaise in modifying unhepfu behaviours and addressing sensory integration dysfunction (see Sensory issues and visua impairment section). The impact of visua impairment Many peope consider vision to be the most important sense. It has often been stated that we acquire 80 per cent of information through our eyes. Most successfu bind aduts woud disagree! However, vision does aow us to take in a ot of information very quicky A picture paints a thousand words. Vision can aso be considered to be the confirming sense. We may sense something, such as an insect on our skin, the sound of footsteps, or the sme of cooking and then ook to confirm what it is. A severe or compete visua oss wi amost inevitaby cause deay or difficuties in meeting deveopmenta miestones. These incude communication and anguage, socia interaction, independent iving skis, pay and earning. Many chidren are unabe to achieve the same eve of competence within a simiar time frame as their sighted peers. When a chid has additiona compex needs, access to earning is severey compromised. Some chidren may never progress beyond the very eariest stages of deveopment. In this case, independence may mean co-operating with dressing by straightening an arm in a seeve; communication by turning away from an unwanted spoonfu of food; or earning by gaining some understanding of the immediate environment and how to reate to it. Best of both Visua impairment Visua and impairment occupationa and physiotherapy 3

4 Chidren with compex needs do not have the same access to incidenta earning as their sighted, abe peers. They need hep to achieve the basic ife skis that most of us take for granted. For exampe, in order to eat and drink independenty some chidren wi require a high eve of support from a muti-discipinary team. The skis of eating and drinking rey on having good hand-eye co-ordination, motor contro and abiity to chew and swaow, but this is not a. Motivation to eat is not just driven by hunger, but by the sensory experience food gives us. We associate the ook, texture and sme of food with its favour. We earn to ook forward to foods that taste, sme and fee nice. Chidren whose eary feeding experiences have been unpeasant due to physica or sensory issues are more ikey to have ongoing probems with food and independent eating. Sensory issues and visua impairment Chidren with severe or compete sight oss are at increased risk of having an imbaance of sensory responses, known as sensory integration dysfunction (SID). In our experience, this condition seems to occur more frequenty with certain causes of visua impairment, incuding optic nerve hypopasia, cerebra visua impairment (CVI), and CHARGE Syndrome. Having additiona sensory, physica or earning disabiities increases the risk of SID even more. What does sensory integration mean? Sensory integration is a term used to describe the way we process and moduate information from our senses. Normay we are aware of the we-known five senses sight, hearing, touch, sme and taste as we go about our daiy ives. Sometimes we experience an unpeasant sensory shock that may temporariy overwhem us, such as a particuary unpeasant sme, the sound of fingernais scraping on a backboard, an irresistibe itch or the pain of a wasp sting. Mosty our senses remain in baance and work we together. We may hear a sound and ook to see what it is. We often choose a piece of fruit, such as a mango or pineappe, by ooking at its condition then smeing to confirm its ripeness. We are not normay aware of any particuar sense overriding, or being out of sync with the others. This is known as moduation; which is the abiity to respond just right to a sensory experience, ie to neither over nor under react. The hidden senses Less obvious are the senses that hep us understand and manage our bodies in reation to our environment. These are the vestibuar senses (baance and equiibrium) and proprioception (the feedback from musces and joints). These senses are at work a the time, informing us of where we are in space. We may ony be aware of them when our norma environment changes, such as being upside down on a roer-coaster ride, or the different effects of pressure and gravity we experience when standing in deep water. 4 Best of both Visua impairment and occupationa therapy

5 What is sensory integration dysfunction, and why are severey visuay impaired chidren at greater risk? Living without a major sense ike vision can throw the other senses out of baance. Many chidren with a severe visua impairment adapt we and earn to use other senses more effectivey. Sensory integration dysfunction is when the senses are out of baance, to the extent that they adversey impact on everyday ife. For some chidren this may mean that one sense wi knock out another. It is not uncommon to see a chid with CVI switch off visuay as soon as they hear a sound. Another chid might notice an object, but ook away whie reaching or exporing with their hands. In a more compex form SID is characterised by unusuay high or ow eves of arousa in response to sensory input. It can affect one or more senses. Exampes may incude hypersensitivity (being over-sensitive) to certain movements, sounds or textures (incuding tactie defensiveness and seectiveness ). Other chidren may be hypo-sensitive (under-reactive senses). These chidren wi often seek more intense sensory input. They might sef-injure, spin round in circes, stare at the sun or create a noise that no one ese can toerate. Some chidren may show a mixed pattern of over and under reaction in a the sensory systems. Sometimes extreme actions are a way of coping with unwanted sensations that are beyond the chid s contro. Sef-inficted pain or making a oud noise are actions that a chid can contro and have the desired effect of bocking out everything ese. Functiona actions However, from the perception of a QTVI, not a the unusua behaviours of chidren with a severe visua impairment may be due to SID. Some actions are functiona. Side to side movements can faciitate sound or echo ocation. Cicking, stamping, shouting and capping aso provide important feedback when traveing through different environments. Some chidren with CVI move constanty because they can ony see objects in motion (the same effect is achieved when the observer moves in reation to stationary objects). It is important that this is understood by a supporting aduts, so that chidren are not discouraged from using strategies that hep them. Best of both Visua impairment and occupationa therapy 5

6 Co-operative probem soving A recent discussion between the OT and QTVI supporting a group of chidren with severe visua impairment in a Specia Schoo heped to carify the reasons for some unusua behaviours. Understanding these issues from both the VI and the OT perspective proved reay hepfu when working out some strategies to hep the chidren concerned. These are described beow. Katie Katie, aged six, rocks constanty when she is sitting. She aso rocks from one foot to the other when standing and waking. The OT expained this from her perspective: Sighted peope get a the vestibuar stimuation they need during rhythmic and confident forward movement, eg brisk waking. A bind chid wi often seek vestibuar stimuation, but cannot wak with the same confidence and rhythm. Rocking from one foot to the other, or rocking whie seated gives the same vestibuar effect but with a stabe base from which to move. Rocking is aso comforting, as new parents, pacing the bedroom foor with a crying baby, at 3.00am wi verify! Aduts in distress wi often rock too. Sometimes rocking may be a way to aeviate boredom after a, a bind chid can t sit and watch the word go by. Equay, they can t observe that other peope don t rock! What can we do about it? The OT pointed out that if we can identify how a chid benefits from a particuar action, ie what do they get out of it?, then we may be abe to repace it with an aternative that gives the same benefit, but is more sociay acceptabe. Katie s teacher has estabished a daiy dance session at the start of the schoo day. Katie now gets the stimuation she seeks, but in an acceptabe way. Since starting the dance sessions, her rocking has decreased, both in frequency and intensity. Here are some other exampes: Pau Pau has CHARGE syndrome. He used to spend paytime spinning round on one foot, wearing out the soes of his shoes within no time! The schoo staff heped and encouraged Pau to use the pay apparatus. Now he enjoys swinging, cimbing and jumping every day. He has competey stopped spinning and is much happier at paytime. 6 Best of both Visua impairment and occupationa therapy

7 Aarti Aarti has profound earning difficuties. She is very difficut to motivate and ony the strongest stimui wi evoke a response from her. Aarti has some sef-stimuatory behaviours incuding breath-hoding and hyperventiating. These behaviours are aeviated when she is provided with stimuating tactie objects, such as a scrubbing brush, cracky pastic and a vibrating bumbe ba. Aarti benefits from a weeky movement session with her OT in the soft pay room. She has aso started a brushing programme (see beow). Mary Mary, aged two, coud not contro the continuous athetoid or sow writhing movements of her body, head and imbs. It was impossibe for her to focus on a visua stimuus. The QTVI made a joint visit with Mary s OT who wrapped Mary tighty in a banket unti she was sti and reaxed. She then sowy reeased one arm, keeping the rest of Mary s body immobiised. Mary remained reaxed and was then abe to focus on the ight and reach towards it. Deep pressure can have a beneficia effect for chidren with motor dysfunction, ike Mary. It is aso known to have a caming effect, and can hep some to aeviate distress caused by sensitivity to other stimui. The OT wi sometimes suggest the use of a weighted banket which has proved effective in many cases. For some chidren a deep pressure brushing programme can hep. Using a specia brush and appying deep pressure through the arms, egs and back, the sensory reactions experienced by individua chidren can be moduated from over or under reacting to sensory input. Brushing can be used to moduate a the senses, incuding vestibuar and proprioception. Brushing can hep to reduce over reaction to tactie input for a bind chid who is reuctant to touch and expore. It can wake up the imbs so that a chid is abe to move them more purposefuy. It can enhance the sense of touch and enabe a chid to access tactie information. Brushing can aso have a caming effect on chidren whose sensory hypersensitivity is causing them distress. This shoud be done as part of a structured programme, which the OT and QTVI wi advise on. These are just a few exampes to show that the QTVI and OT can work together for the greater benefit of the chidren with whom they work. Best of both Visua impairment and occupationa therapy 7

8 Concusion The aims of the QTVI and OT, and aspects of their support are often simiar. However, when they discuss chidren with whom they both work, from the different perspectives of VI and OT, it soon becomes evident that their background knowedge is very different. The combined knowedge and experience of these two professionas working together heps both parties achieve a greater understanding of the chid s deveopment, disabiities and needs. Together they can promote a earning programme that has more impact and ensures the best of both for the chidren they support. Insight magazine Inspirationa and practica information on the education, heath and webeing of chidren and young peope with visua impairment, incuding those with compex needs. Parents now receive Insight free when they become RNIB Members. Insight is aso now avaiabe free to VIEW members! For detais, ca and quote Insight offer. RNIB March 2011 Registered charity number