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Techniques for Infants and Toddlers with Visual Impairment

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By Alycyn Ferrell and Sharon A. Raver

Before examining the major issues involved in visual impairment in infancy, it is necessary to define terms used to describe aspects of this disability. For example, visual impairment is generally used to refer to an array of eye conditions that result in visual abilities that are less than normal. The Education of the Handicapped Act, uses visually handicapped to refer to children who have a “a visual impairment which, even with correction, adversely affects a child’s educational performance”. Both of these terms are broad and cover a range of visual functioning from total blindness to minor refraction problems When these terms are applied to infants, they become even more nebulous, particularly since methods for identification of visual impairments in young children have not been perfected.

To further complicate the situation, there are other terms currently used by the legal and educational communities. Legal blindness, for example, is used by federal and state governments for certain entitlement programs. It is based on specific clinical measurements of distance vision and requires that an individual have central visual acuity of 20/200 or less in the better eye with corrective lenses, or a visual field defect of 20 degrees or less in the better eye (Koestler, 1976). Central visual acuity of 20/200 means that the individual can see at 20 feet only as well as the individual with normal vision sees at 200 feet. Obviously, these measurements have little applicability to infants who are unable to read a Snellen chart.

Also, these terms provide little information about visual functioning. Visual functioning is frequently used to refer to a continuum of visual ability that ranges from normal or near-normal vision to total blindness (Barraga, 1977). Visual functioning (also described as functional vision) is how individuals use the vision they possess. That is, many individuals who are legally blind for distance are able to read regular size print at near point. Regardless of measure of visual acuity, visual functioning may vary depending on the environmental conditions and the tasks required. In regular daytime room lighting, for example, an infant with a visual impairment may use vision to guide play with stacking and nesting toys. On a bright sunny day at the beach, however, the same infant may have to rely on touch to play with the same toys, or may, more likely, refuse to play at all. The tasks have not changed, but the environment makes the child functionally blind due to the bright sunlight and the glare from the sand.

Children with visual impairments are further described in terms of the primary learning modality by which they learn. The blind infant learns primarily through sensory modalities other than vision (usually, but not exclusively, touch and hearing). (The genetically blind infant is a child who is blind from birth). The low vision infant is severely limited visually, but will be able to use vision to some extent in conjunction with other sense. The visually limited infant is a child who is primarily a visual learner but who is limited visually under specific everyday conditions such as bright sunlight (Barrage, 1983).

There are not only many degrees of visual impairment, but an extremely broad range of visual functioning as well. For intervention purposes, it is best to assume that any visual impairment, regardless of degree, has the potential to affect the child’s ability to obtain information about the environment and the people in it.

 

In 1989, Dr. Turben received funding that enabled the Cleveland Sight Center to initiate the first large-scale, family-centered Children's Services Program in Cleveland, Ohio. Dr. Turben worked for Lake County Early Intervention Collaborative Group in 1988-89 as the consultant who prepared the County Needs Assessment and assisted the collaborative in the preparation of the 1988-89 Lake County Early Intervention Collaborative Plan, which launched family collaboratives as a network of families with children who had disabilities.
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