When a young child is not able to use his hands or arms for reaching and holding objects he misses opportunities to mouth objects. Mouthing toys is an important activity for a young child to learn how to use lips, tongue, and jaw as well to relieve teething discomfort. Mouthing toys helps a child prepare for eating more foods safely and making the sounds required for speech. Many children that have had a hard time growing and thriving are found to have problems moving his or her mouth (oral motor).

There are a few mounting systems on the market currently to help a person with limited use of their arms and hands to push a switch with their cheek. These devices can also be helpful in holding a toy for a child to mouth. In these photos a two-year-old uses the Slim Armstrong Mounting System for two different activities. On the left he enjoys exploring a toy with his mouth and in the picture on the right he pushes a switch with his cheek to turn on and off a bunny (a battery operated toy).

Here’s a picture of the Ablenet Slim Armstrong device:

More information on these mounting systems can be found at the following websites:

http://www.ablenetinc.com/cart/Browse.asp?txtSearchString=switches&sbSubmitBtn=SEARCH

http://www.infogrip.com/product_view.asp?RecordNumber=275&sbcolor=%23FFCC00&option=mounting&subcategory=61&CatTxt=Switch&optiontxt=Mounting

http://www.gstsdesigns.com/Mounting-PowerOptions/Mounting.htm

Caution: An Occupational therapist and/or Speech and Language therapist with training in feeding/oral motor issues should be consulted in matters of oral motor concerns.

Securing switches (and Mouth-able Toys) as a printable PDF document

Information compiled by Andrea Story 9-06

Play boards and Position boards

as described & adapted by Andrea Story

A play board stabilizes objects so that a child who can not rely on vision and/or has problems moving can grasp and release an object or toy and it won’t roll away. The toys can be tied to the board with elastic so that the child can explore it but it will stay in approximately the same place. The toys can also be attached with Velcro.

For an older student, books can be velcro’ed on the play board for those that do better with a vertical presentation or for those that need both hands to explore. Paper can be attached to the board to make an easel.

Here a child is able to use the play board on his wheelchair tray. A switch can be attached to the board to operate the taperecorder that is placed inside the play board.

Here is a play board consisting of magnets and a special tray to promote container play. A sheet of thin metal is attached to the board with Velcro.Handles, blocks and toys are adapted with magnets. The black line of duct tape divides the board into sections (above and below).

To make a play board you will need three sides. Slots in each corner are cut to attach them together. Four inch strips of strapping Velcro works very well with these slots to attach the boards to one another. The Velcro is sturdy and the boards can be quickly taken apart or put together. Rounding the corners off each board makes the corners smoother and less likely to catch the child’s fingers.

Decide what dimensions are best for the child. A smaller base brings the playboard to a nearly vertical surface. This one is good for a narrow base (such as a tray) but needs to be stabilized with C clamps or Velcro on the tray.

A wider base brings the surface lower which is sometimes preferable for mounting switches. It also may be easier for some children to reach on a lower plane. It all depends on the child’s needs.

Another idea is to cut holes in the pegboard (as pictured) so that the child can explore inside. A bag or box can be attached inside so that surprises can be hidden. The picture to the left shows a flat playboard or position board.The basket is basted down to the pegboard and the toys are tied with elastic. This can be helpful when a child’s throwing behavoir is a concern.

References:

Application of Achieved Spatial Relations (Chapter 7) Space and Self, by Lilli Nielsen
Making Toys Accessible for Children with Cerebral Palsy, by Carol Schaeffler, Spring 1988, Teaching Exceptional Children

If you would like more information on using the Gateway digital camera as a photoscreener click on this link:http://www.abcd-vision.org/vision-screening/adbc.htm

Once there, scroll down the page and click on Gateway DV-S20 Set-up Instructions to get a PDF version of the directions.

If you would like more information on HOTV vision acuity screening and a down-loadable version click this link: http://www.abcd-vision.org/vision-screening/HomeAcuityTest.html

Click here or on the image to download a PDF of our brochure.

Referral to VISIT Services is usually:

• By parents, infant learning program teachers, community therapists,
  physicians, and public health nurses.
• Via phone, fax, or mail.
• Only after parent permission for the referral has been given to the referring agency.

Part C vision impairment eligibility in Alaska is based on established and high-risk conditions.

I. The following diagnoses indicate Significant/Progressive Vision Impairment Part C eligibility:

• Cerebral Vision Impairment: 377.7
• Optic Nerve Glioma: 191.9
• Optic Nerve Hypoplasia: 743.57
• Bilateral Retinoblastoma: 190.6
• Retinopathy of Prematurity (Stage IV or V): 362.21
• Bilateral Peter’s Anomaly: 743.44
• Retinal Dystrophy/Leber’s Congenital Amerousis: 362.7
• A designation of Legal Blindness as determined by an ophthalmologist

II. The following diagnoses frequently qualify as Significant/Progressive Vision Impairment:

• Albinism: 270.2
• Bilateral Congenital Cataracts: 743.3
• Delayed Visual Maturation: 377.71
• Glaucoma: 365.00
• Homonymous Field Defect: 368.45
• Microphthalmia: 743.1
• Nystagmus, Congenital: 379.51
• Optic Atrophy: 377.1
• Retinal Detachment: 361.0
• Visual Field Defect: 368.4

However, even within one diagnosis there can be a wide range of visual functioning between individuals. Therefore, final Part C eligibility is determined by:

• An assessment of functional vision/developmental visual skills completed by a vision impairment educational specialist,
• Consideration of other medical/developmental concerns, and
• Findings of an ophthalmological exam.

III. Clinical Opinion

There can also be a qualification of Significant/Progressive Vision Impairment by clinical opinion when there is a high risk for a vision impairment diagnosis due to medical history (prematurity, birth injury, IVH, diagnosed syndrome, etc.) and visual skills less than expected for developmental age as assessed by a vision impairment educational specialist.

The main eligibility requirement is that the child qualifies as Part C. Part C vision impairment eligibility in Alaska is based on established and high-risk conditions.

I. THE FOLLOWING DIAGNOSES INDICATE SIGNIFICANT/PROGRESSIVE VISION IMPAIRMENT PART C ELIGIBILITY:

• Cerebral Vision Impairment: 377.7
• Optic Nerve Glioma: 191.9
• Optic Nerve Hypoplasia: 743.57
• Bilateral Retinoblastoma: 190.6
• Retinopathy of Prematurity (Stage IV or V): 362.21
• Bilateral Peters Anomaly: 743.44
• Retinal Dystrophy/Lebers Congenital Amerousis: 362.7
• A designation of Legal Blindness as determined by an ophthalmologist

II. THE FOLLOWING DIAGNOSES FREQUENTLY QUALIFY AS SIGNIFICANT/PROGRESSIVE VISION IMPAIRMENT:

• Albinism: 270.2
• Bilateral Congenital Cataracts: 743.3
• Delayed Visual Maturation: 377.71
• Glaucoma: 365.00
• Homonymous Field Defect: 368.45
• Microphthalmia: 743.1
• Nystagmus, Congenital: 379.51
• Optic Atrophy: 377.1
• Retinal Detachment: 361.0
• Visual Field Defect: 368.4

However, even within one diagnosis there can be a wide range of visual functioning between individuals. Therefore, final Part C eligibility is determined by:

• An assessment of functional vision/developmental visual skills completed by a vision impairment educational specialist,
• Consideration of other medical/developmental concerns, and
• Findings of an ophthalmological exam.

III. CLINICAL OPINION

There can also be a qualification of Significant/Progressive Vision Impairment by clinical opinion when there is a high risk for a vision impairment diagnosis due to medical history (prematurity, birth injury, IVH, diagnosed syndrome, etc.) and visual skills less than expected for developmental age as assessed by a vision impairment educational specialist.

Services Provided

• Early intervention consultant services to families of infants and toddlers who experience, or are at risk of experiencing, a vision impairment. This includes functional vision, developmental, orientation and mobility assessments; adaptive materials; and collaboration with a child’s related service providers.
• Inservices and workshops to community organizations upon request on functional vision screenings; the impact of a sight loss on a child’s
  development; and strategies for working with children who experience a vision impairment.
• Information and referral services for families that need to connect with a pediatric ophthalmologist for an eye exam.
• Services throughout the state of Alaska without cost to families, infant learning programs, or related service providers.

VISIT Services Are Important Because

• 80% of typical developmental skills are learned visually.
• Children with vision impairments are at high risk for experiencing
  developmental delays. An educator with specialization in vision impairment
  and early childhood education can facilitate skills development, and
  help reduce the risk of unnecessary delays.
• There is a wide range of sight loss, and each family should have materials
  and information to meet the individual needs of their child.

VISIT Providers

Andrea Story, Program Coordinator

Debby Oakes , VI Infant Learning Education Specialist

Children are considered automatically eligible for CEEHI services when they meet Part C requirements for eligibility. What is “Part C“? In a broad sense, it’s the name for infant learning. Alaska has spelled out who qualifies for Part C infant hearing services as follows: (revised as of September 2003):

Hearing Loss as a qualifying Part C condition requires:

• 40 dB or greater in two or more frequencies, bilaterally [both ears], pure tone hearing loss as diagnosed by an audiologist (you can see this on the child’s audiogram), or
• Chronic Otitis Media (six or more months in duration) diagnosed by a medical provider, with fluctuating hearing loss diagnosed by an audiologist

Use of Clinical Opinion to qualify children with Hearing Loss for Part C services requires:

• Less than 40 dB bilateral hearing loss (diagnosed by an audiologist with additional risk factors which could lead to a 50% or greater delay in one or more areas of development or
• Unilateral hearing loss greater than 30 dB (diagnosed by an audiologist) with additional risk factors which could lead to a 50% or greater delay in one or more areas of development

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