Infants and children with blindness or visual impairment face many challenges that affect their overall development. Linda Gerra, EdD, Director of Children’s Vision Programs at Lighthouse Guild, is an expert on working with children with blindness or visual impairment and the effect of visual impairment on early motor development.
“Children with visual impairments learn differently than children with sight. Vision normally plays a dominant role in organizing environmental information. Therefore the occupational therapist can help by organizing the environment, using consistent communication and utilizing specialized materials in order to address their unique sensory needs and facilitate learning,” says Dr. Gerra. Guided and consistently sequenced instruction is recommended as the best teaching approach.
According to Dr. Gerra, children with blindness or visual impairment mature at a slower pace in all areas of development, compared with children with sight. Children with sight receive their information incidentally and encounter visual information constantly. Dr. Gerra identifies several factors that might affect a child’s vision, such as a medical condition, environmental factors, medications and even previous experiences with vision loss. These factors can affect a child’s vision as they develop, over and above their vision diagnosis or acuity. It is important for therapists to acknowledge these factors in their work with young children.
Children with visual impairment cannot readily interpret what’s around them or what is given to them because they cannot gather visual information from their environment. Dr. Gerra advises occupational therapists to teach the children about objects using simple and clear descriptions, comparisons with other familiar objects, and explanations about their actions. Therapists must also teach them how to use their tactile sense to explore and identify objects.
“You can’t assume that when you give them a toy they will necessarily know what it is or what to do with it. Their concept of people and things may be affected, fragmented or incorrect,” says Dr. Gerra.
Parental attachment plays a significant role in a child’s early development, especially for those with blindness or visual impairment. Dr. Gerra refers to psychoanalyst John Bowlby’s Attachment Theory, explaining that a parent’s responses, handling, nurturing and attitude can help infants and young children feel secure and emotionally strong so that they are comfortable exploring their surroundings.
It is often difficult for parents to give consistent feedback because babies with blindness or visual impairment do not respond with typical movements, facial expressions or provide eye contact as most children with sight do. A child with a visual impairment who is unusually fussy or anxious, unable to focus or play independently, unresponsive to a parent’s attempts to soothe, or fearful or being away from a parent may be exhibiting an insecure attachment with their parent or guardian.
“Infants with visual impairments may not be familiar with their environment, and this inability to visually monitor it may cause them to have less interest in moving,” explains Dr. Gerra. For instance, babies with visual impairment are often unmotivated to lift up their heads and necks to observe what’s around them because it is uncomfortable and there is nothing stimulating for them to perceive. This can cause their heads, necks and back to become underdeveloped unless they are coaxed to look up.
Dr. Gerra suggests using a favorite toy, which makes a sound, to encourage these babies to push and prop themselves up on their hands and forearms to reach for the toy. “They achieve their learning milestones later and often follow a different sequence than children with sight due to their visual impairment or blindness. They don’t receive the information from their environment the same way as children with sight. That’s the main thing,” says Dr. Gerra. “They need to be taught in a systematic and consistent manner.