TOPIC 3: VISUAL IMPAIRMENT

Introduction
It is not always easy to recognize that a child might be visually impaired. Although even very
young children can show some physical signs of having trouble with vision, many times
problems with a child's eyesight are not detected until after he goes to school. The American
Optometric Association points out that because 80 percent of a child's learning relies on his
vision acuity, early detection and treatment are needed.
Objectives
By the end of this topic you should be able to:
 Define visual impairment.
 Explain classification of visual impairments
 Describe causes of visual impairment.
 Explain teaching strategies for children with visual impairment
Learning activities

Learning Activity 3.1: Reading

Read the provided topic notes on visual impairment. You have also been provided some links
Learning Activity 3.2: Journal
In 500 words summarize the causes of visual impairment. Post your contribution in the provided
journal.
Post your article in the journal provided
Learning Activity 3.3: Discussion
Children with visual impairment will have more difficulties in learning than those without. Participate in a
discussion on strategies of teaching children with visual impairment.
Post your discussion in the provided discussion forum
Assessment
The journal in activity 3.2 and Participation in the discussion in activity 3.3 will be graded
Topic Resources
URL Links
https://www.researchgate.net/publication/
341000567_Teaching_Students_With_Visual_Impairment

VISUAL IMPAIRMENT
Visual impairment" means impairment in vision that, even with correction, adversely affects a
child's educational performance. The term shall include both partial sight and blindness
Classification of Visual Impairment
With reference to Hong Kong Review of Rehabilitation Programme Plan (1994/95-1998/99) the
definitions of visual impairment are as follows:
1. Total Blindness Persons with no visual function, i.e. no light perception.
2. Low Vision

 The mild low vision group - people with visual acuity from 6/18 to better than 6/60
 The moderate low vision group - people with visual acuity from 6/60 to better than 6/120
 The severe low vision group - people with visual acuity of 6/120 or worse or people with
constricted visual field in which the widest field diameter subtends an angular sub tensed
of 20 degrees or less, irrespective of the visual acuity.
Characteristics of children with visually impaired
Children with visually impairments may exhibits the following characteristics
Physical Signs-
Crossed eyes,
Eyes that turn out,
Eyes that flutter from side to side or up and down, or
Eyes that do not seem to focus are physical signs that a child has vision problems.
 Clumsiness: Poor vision might be the cause when a child is constantly running into things
or falling down.
 Behavior- Some children who have vision problems appear to have a short attention span.
 Poor Eye-Hand Coordination: e.g difficulty throwing or catching a ball, tying shoes or
copying schoolwork from the blackboard. Poor handwriting is often another sign of poor
eye-hand coordination.
 Poor Academic Performance

Causes of visual impairments in children

There are also numerous other eye conditions that can cause visual impairment. Among them
are:
Retinopathy of prematurity: Retinopathy of prematurity is an eye disorder affecting
premature infants.
Optic Nerve hypoplasia: refers to the underdevelopment of the optic nerve during pregnancy.
Albinism: refers to a group of inherited conditions. People with albinism have absent or reduced
pigment in their eyes, skin or hair.
Optic nerve Atrophy: a permanent visual impairment caused by damage to the optic nerve.
Cataracts: defined as a clouding of the lens of the eye; can be congenital, caused by trauma, or
associated with disease;
Cortical Visual Impairment (CVI): apparent lack of or reduction in vision when eyes appear to
be normal; cause of the visual reduction is in the visual cortex of the brain; there is no
nystagmus; special intervention techniques are indicated (contact VI teacher).
Glaucoma- intraocular pressure build-up caused by an imbalance between the rate of production
of the aqueous fluid and the rate of normal drainage;
Infections: many types, with a variety of symptoms; most common involve the conjunctiva (thin
layer of tissue lining the eyelids and connected to top layer of sclera); Malformations: many
types; most common are clefts in the iris, dislocated lens, and syndrome-related abnormalities;
may have prenatal causes
Ocular-muscle problems: most common is strabismus (one or both eyes out of alignment); can
be outward, inward, upward, or downward, depending on which muscle(s)
Nystagmus is another ocular-muscle anomaly; manifested by involuntary eye movements,
usually noted as "jerky" or "jumpy" eye movement;
Ocular trauma: occurs when the eyeball is hit, lacerated, or punctured; always requires medical
evaluation and treatment.
Refractive errors: (nearsightedness, farsightedness, astigmatism), an eye specialist should
monitor vision periodically from birth.
Retinoblastoma- a tumor behind the eye which, if left untreated, can be both blinding and life-
threatening.

Curriculum Areas and Objectives of the Education of Visually Impaired Children

The curriculum for visually impaired children aims at developing academic and functional skills
in these children. The curriculum areas therefore include academic and cultural subjects,
technical and practical skills, functional and self-care skills, etc.
The objectives of the education of visually impaired children are:
To develop the physical, mental and social potentials of these children to the full. To develop
independence, self-reliance and competence in these children.
To develop life adjustment and self-care skills in these children so that they can become well-
adjusted and independent individuals in society

Learning Difficulties of Visually Impaired Children

As visual impairment imposes limitations on the children in such aspects as
a. mobility,
b. the range and variety of experiences and
c. the ability to cope in different situations,

 Difficulties in Perception and Concept Formation

 Delay in Physical and Motor Developments
 Problems in Social and Emotional Development
 Difficulties in Visual Functioning
Visually impaired children have to face more learning difficulties than ordinary children. They
may be unable to read the blackboard, projected materials, print and diagrams of small sizes. As
each child's problem is unique, strategies to cope with problems are highly individual. With their
limited experience, they normally have little or no learning skills. As there is little or no imitative
learning through vision, their learning will also be slow and their attention span short. They may
require more time to complete a task. With limited mobility, they may encounter difficulties
when participating in classroom activities, games and outdoor activities. Low self-esteem and
poor social skills may also lead to emotional and behaviour problems. Visually impaired children
with other additional disabilities may have even greater learning difficulties than those without.

General Principles in Teaching Visually Impaired Children

The most important principle is to monitor the children's progress regularly. Systematic planning
in teaching should be emphasized. The approach should consist in understanding the learning
needs of the children;
 Planning long term and short term teaching objectives; assessing the children's baselines;
 Providing a favourable learning environment and adequate resources.
 Adopting appropriate teaching approaches; carrying out evaluation and
Keeping record of progress.
Teaching Approaches
There are a number of teaching approaches that the teacher can adopt, for example, teaching
through activities,
 role play,
 unit teaching,
 discovery method,
 programmed instruction,
 behaviour modification, etc. The following suggestions may serve as reference for
teaching visually impaired children:
 Emphasis on Concrete Experience

Basic Teaching Approaches

Visually impaired children cannot learn by imitation through visual experience alone. They need
to do it through their other senses also, such as sense of hearing and sense of touch. Appropriate
teaching aids should therefore be used to allow them to touch and learn from concrete
experience. What they have learnt will thus be clearer and more accurate.
Use of Verbal Instructions
Instructions and explanations given by the teacher should be clear and concise. The teacher
should read out clearly everything written on the blackboard. When speaking to the children, he
should first address them by their names to ensure attention. To make sure that the children
understand what is taught, he should ask them questions when necessary.
Management of Printed Materials and Diagrams
According to the visual condition of individual children, the teacher should choose appropriate
teaching materials to meet their individual learning needs. Printed materials and diagrams may
have to be adapted by using contrasting colours, tactile marks, enlarged size, increased boldness,
adequate spacing, etc. In producing tactile diagrams for these children, the teacher should note
the following:
 choose diagrams of appropriate sizes to suit the fingertips of totally blind or severe low
vision children
 simplify cluttered or superimposed diagrams without compromising accuracy emphasize
the most important areas, lines and points in tactile diagrams;
 Avoid cluttering too much information and coding on one page, or this will confuse the
children.
Classroom Organization and Management
Attention should be given to classroom organization and management so as to provide optimum
learning. The classroom should be big enough to allow the children safe mobility. The children
should be provided with large desktops for their bulky textbooks and equipment so that they can
have a comfortable work area. Since natural light is the best source of illumination, low vision
children will benefit from sitting by the window or the Wyteboard
Although better illumination often improves the perception of low vision children, direct sunlight
should be avoided. Venetian blinds can be installed to address the problem. In gloomy days or
other adverse illumination situations, intensive lights with background lighting of diffused
fluorescent lights can be installed in the classroom especially for low vision children who use
ink-print books. As far as possible, the surface of furniture or walls should best be in matt finish
to avoid unnecessary glare. In order to facilitate the use of intensive lighting, audio and visual
equipment, adequate electric power points should be installed safely in appropriate places.
The classroom should be equipped with adequate notice-boards for display of learning materials,
timetables, schedules, educational posters, children's work, etc. both in print and in braille.
Materials and equipment kept in a particular classroom or special room should be clearly labelled
in large print or in braille to give the children easy access. Should the teacher find it necessary to
move the furniture in the classroom, all children should be informed beforehand.

Safety Precautions in Conducting Outdoor Activities, Sports and Games

The teacher should take special safety precautions when conducting outdoor activities, sports and
games. The activities should be conducted in spacious ground. Places with fixtures, objects or
wall-blocks that can be of danger to the children should be avoided. Anything lying disused on
the floor should be cleared so that the children will not fall over them. Children with history of
 dislocated lens,
 detached retina and
 high myopia should not be allowed to carry heavy loads or take part in vigorous
activities. Children with
 Albinism should not be asked to stand for too long uncovered under strong sunlight. They
can wear tinted glasses to reduce the discomfort caused by the glaring sun. Children who
require spectacles should wear plastic glasses.

Specific Teaching Strategies for Totally Blind and Severe Low Vision Children
Medium of Literacy- As visually impaired children are not able to use print as a means of
communication, Braille has to be used instead. Before the children are ready for Braille reading,
training in the development of

 tactile sensitivity of the hand is important.

 Training in long and short term memory to retain the impression of configuration of
symbols is helpful to the development of reading readiness.
Braille should be taught as early as the children are ready to learn them.

Developing Skills in Other Modalities

Tactile Skills -Direct contact by means of touch is the only way in which totally blind and severe
low vision children can learn about form and texture.
Auditory Skills - The teacher may offer programmes that encourage the children to pay attention
to auditory materials and provide tape-recorded materials instead of, or in addition to, printed or
Braille texts. The teacher can devise listening activities to reinforce what has been learnt.
Specific Teaching Strategies for Mild and Moderate Low Vision Children
Training in Visual Efficiency-
Favourable Visual Environment-
Way to Help Reading- The children should be encouraged to read with book-stands so that they
do not have to bend over the table for too long. Reading with page markers and reading windows
will be helpful to the children, who find it difficult to focus on a word or a line of print. Lamps
with variable light intensity and position can provide the children with suitable lighting for
reading.
Way to help Writing- Writing may be a great problem to many mild and moderate low vision
children. Black felt pens or soft dark pencils can be used with bold-line paper for writing. The
children can also be taught to type or use a computer for writing. Long sessions of desk work
should also be avoided to prevent the children from visual fatigue.
Way to Save Vision- The children should be asked to use close vision and intermediate vision at
alternate intervals so that they can relax visually. Since these children are unable to see
demonstrations and writing from the distance, they should be encouraged to make proper use of
optical or technical aids in order to see clearly.
Use of Special Aids and Equipment
For the education of visually impaired children, it is necessary to use a variety of teaching aids
and equipment to help them to learn. What aids and equipment to use will depend on the
children's visual functioning and educational levels. Owing to rapid development in technology,
the list of adaptive aids and equipment shown below is not exhaustive. However, they can be
categorized into visual, tactile, auditory and computer aids and equipment.
Visual Aids and Equipment
Closed circuit television: used to enlarge images on a television screen with variable sizes,
contrasts and illumination.
Lighting: using lamps to provide the amount and angle of light required for maximum reading
efficiency.
Textbooks and instructional material: learning materials to be presented in large print.
Book-stand or raised desk-top: to bring printed materials closer to the children's eyes for better
lighting and easy reading.
Optical aids: spectacles, contact lens, telescopes and magnifiers, which are important low vision
aids and should best be prescribed by qualified professionals

Tactile Aids and Equipment

Braille books: books transcribed into Braille.
Optacon: an electronic reading device which transforms ink-print characters in books with an
electronic lens into vibrating shapes that can be read tactilely with a single finger
Paperless Braille writer : a Braille writing and reading device which can store Braille written
information on audio cassette tapes, floppy disks or computer chips and can be retrieved later .
Slates and stylus: writing slates made either in a plastic or metal frame with openings through
which Braille dots are punched with a pointed stylus.
Thermoform duplicators: duplicating machines for mass-producing plastic Braille pages and
raised pictures for Braille users.

Auditory Aids and Equipment

Print access reading systems for totally blind and severe low vision children: the Kurzweil
Reading Machine, OSCAR or Arkenstone Reading Systems using computer scanning technology
to convert print into synthetic speech output.
 Audio tapes and recorders: useful for taking notes, recording homework, listening to
assignments, etc.
Talking calculators, clocks, electronic dictionaries, etc.: aids available with synthetic speech
output.
Computer Applications -Microcomputers, operated with appropriate special software and
computer adaptive devices, make it possible for visually impaired children to have equal access
to electronic data like their sighted peers. Besides learning the computer as a subject in special
schools, visually ipaired children can use the computer to assist them in learning other academic
subjects and as an aid to communication with sighted children.