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Visual Impairment and Multiple Disability: communication, learning and assessment. Jonathan Bolt Specialist Teacher (MDVI) Cambridgeshire Visual Impairment Service November 16 th 2010. Outline for the day. 11.00 – 12.30: Communication and Learning 2.00 – 3.00: Assessment 3.00 – 3.30: Q & A.

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visual impairment and multiple disability communication learning and assessment
Visual Impairment and Multiple Disability: communication, learning and assessment

Jonathan BoltSpecialist Teacher (MDVI)Cambridgeshire Visual Impairment ServiceNovember 16th 2010

outline for the day
Outline for the day

11.00 – 12.30: Communication and Learning

2.00 – 3.00: Assessment

3.00 – 3.30: Q & A

my presentation in a nutshell
My presentation in a nutshell

Understanding the individual communication and learning styles of children who have multiple disabilities and visual impairment is essential for all subsequent, successful teaching.

questions and perhaps some answers
Questions and perhaps some answers

What would you like to ask regarding MDVI?

my role as a specialist v i teacher
My Role as a Specialist V.I. Teacher
  • Specialist role in multiple disability and visual impairment (MDVI)
  • Mainly working in special schools
  • PMLD/MDVI - 10% of special school population
  • Over 50% of the learners seen by the VI MDVI specialist teacher
  • Work as part of Multidisciplinary teams: Special and Language Therapists, Occupational Therapists, Physiotherapists, teachers, school management, community paediatricians, school nurses, social service teams, Connexions, SENSE etc
a mystery object
A mystery object


What do I want?

(Clue: it’s not about you, it’s about me)

bridging the gap between worlds humans live in their heads
Bridging the gap between worlds: humans live in their heads

A parent and child are walking along a

suburban street under cherry blossom trees on a

sunny day, but they are talking about elevenses

when they got home

  • Human beings do not live in the ‘here and now’ all the time
  • MDVI learners often do and can present teachers with a conceptual problem
barriers to communication theory of mind
Barriers to Communication: Theory of Mind
  • Multiple attitudes to objects and events
  • Not everyone makes the same associations
  • Need to know that another person can hold a different ‘attitude’ to an established, familiar object or event before you can be receptive to an entirely new object or event being introduced
mdvi a deficit description
MDVI – a Deficit Description
  • Visual: sometimes ocular, frequently cortical
  • Hearing: often assumed OK, but often unknown (can we make assumptions about processing?)
  • Communication: pre-symbolic, can be pre-intentional
  • Profound global delay: developmentally often pre-12 months
  • Physical: Cerebral Palsy, non-ambulant, very restricted gross and fine motor movement, joint dislocations, scoliosis
  • Medical: respiratory problems, epilepsy, management of medications and tube feeding, frequent infections
learners mdvi
Learners: MDVI

Typically need to;

  • share attention
  • develop skills typically acquired in the early years
  • develop a sense of self through play and exploration
  • develop a sense of self-agency and independence
initial learning goals for mdvi students
Initial Learning goals for MDVI students
  • Development of initial attachment and security
  • Development of near and distances senses in relation to the world
  • Development of the ability to structure his or her world
  • Development of natural communication systems
aim mdvi and communication
Aim: MDVI and Communication
  • To have developed effective communication skills by the end of Key Stage 2 (Primary)

If not:

  • To have developed effective communication skills by the end of Key Stage 4 (Transition from school)
what is successful communication
What is successful communication?
  • Exploring the world by ourselves and in the company of others, telling them what we find, listening to their discoveries
  • Making sense of a symbolic world
  • Having the means to communicate
communication partners
Communication partners
  • Establishing a sense of trust and security
  • “I like you, I like what you do”
  • Building shared attention
  • People first, objects second
  • Communication first, topics second
skills needed by a communication partner
Skills needed by a communication partner
  • Follow not lead
  • Recognise intentionality
  • Respond immediately
  • Offer access to activities the student needs or wants to do
the use of resonance
The use of ‘resonance’
  • Uses the student’s developing reflex response to external stimuli
  • Move from self stimulatory behaviours to behaviours that include other people and objects
  • Can be 1:1
  • Can be as part of a group
co active movement
Co-active Movement
  • Adult follows and then joins in the movement of the child in order to encourage later turn-taking
  • Basis for structuring routines through a chain of movements or actions
  • When established a component is left out – how will the student respond to this change?
  • Supports the development of shared attention
giving structure to experience
Giving structure to experience
  • Routines – supporting anticipating
  • Time and place
  • Cues and Objects of Reference
  • ‘Distancing’ – moving from the concrete towards the conceptual
objects of reference
Objects of Reference

Objects of Reference are objects that have special meanings assigned to them. They stand for something – in much the same way words do – whether spoken, signed or written

Adam Ockelford, ‘Objects of Reference’ (1993)

skills needed by the student to use objects of reference
Skills needed by the student to use Objects of Reference
  • The ability to discriminate objects by touch
  • An appreciation that an object can mean something
  • The capacity to remember the particular meaning an objects represents

NB: Objects of Reference can be multisensory

assessment also in a nutshell
Assessment – also in a nutshell

Assessments for learners who have multiple disabilities or multisensory impairments often consist of separate sections on each area of function/disability, identifying recommendations for visual access, hearing access, communication etc.

There can be a multi-disciplinary aspect to the compiling of the report.

The question then is how does this inform planning for teaching and learning?

assessment of learning style
Assessment of learning style
  • Prompt modality preference
  • Novelty or familiarity
  • Person or object orientation
  • Internal or external motivation
  • In context or out of context
  • Confidence or lack or perseverance
  • tempo of learning
  • small steps or whole task
some assessment tools and guides
Some Assessment tools and guides
  • A knowledge of typical development – Mary Sheridan
  • The Oregon Assessment
  • The Developmental Journal for Visually Impaired Children
  • Vision for Doing
  • Routes for Learning (Welsh Assembly)
assessment of individual learning needs approaches
Assessment of Individual Learning Needs: approaches
  • Observation
  • 1:1 working
  • Interviewing parents, carers, classroom staff etc
carrying out assessment
Carrying out Assessment
  • Repeated visits, possibly on-going
  • Videoing sessions gives you a ‘second pair of eyes’
  • People familiar to learner may get better results
  • Use familiar places, activities, and resources
  • Co-opt school staff
  • Always assess with school staff present
communication and assessment
Communication and Assessment
  • Communication provides an orientation for assessment and curriculum planning as a whole
  • Proximity
  • Exploration
  • Shared attention (key for curriculum access)
  • Labelling
  • Referent stage
sensory assessment
Sensory Assessment
  • Specialised or typical sensory environment?
  • How to support sensory access in typical environments?
  • Establishing consistent sensory access across different activities and settings
  • How do 1:1 and group settings support (or hinder) sensory access?
  • How does time (or the lack of it) support sensory access
  • Sensory access in transitions and on routes (mobility)
communication sensory assessment and mdvi issues for settings
Communication Sensory Assessment and MDVI: Issues for settings

Barriers to communication

  • Eye contact
  • Lack of shared attention
  • The world of objects
  • Low motivation from others and the environment
  • Typical first gestures not developing
assessing routines
Assessing Routines
  • Consistency of the routine
  • Regularity of the routine
  • Frequency of the routine
  • Interruptions in the routine
  • Staffing of the routine
  • Opportunities for learner to participate in the routine
assessing time and place
Assessing Time and Place
  • Enough time – extra time has to be given to transitions, hoisting, personal care etc
  • Distractions
  • Number of activities timetabled for the day
  • Duration – too much time and the coherence of the activity can break down
assessing cues
Assessing Cues
  • Accessible to the learner
  • Meaningful to the learner
  • Consistently offered to the learner
  • Time to respond
  • Time to process
  • Establishing Objects of Reference
assessing distancing
Assessing ‘Distancing’

The concrete to the conceptual: Many MDVI learners

do not do well with abstract concepts, e.g. topic on

the solar system

  • Concrete experiences?
  • First hand experiences?
  • Meaningful experiences?
settings and activities
Settings and activities
  • The resonance board
  • The sensory room
  • The hydrotherapy pool
  • Cooking
  • Music making
  • Play and exploration
  • Switch access – control, cause and effect
  • Anticipation and decision making