Adaptations for Learning to Use Touch Effectively
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Strategies for Young Children who are Deaf-Blind: A Teachers
By Patty Salcedo, M.A.
After my daughter graduated from the Infant-Family Program of the
Foundation for the Junior Blind in Los Angeles in 1986, I began working
there as an early interventionist. That program serves children (birth
to 36 months) with visual impairments and multiple disabilities. Many
of the children are considered deaf-blind.
In 1989, I began teaching at the Blind Childrens Learning Center
in Orange County. Children who are deaf-blind comprise a small yet
consistent portion of the student population in the preschool. The
Center participated in Dr. Deborah Chens model demonstration
network for infants who were deaf blind and their families.
In 1995, I began working in the Sacramento County Office of Educations
Infant Development Program, which uses the transdisciplinary team
model. We identified several children who were deaf blind, most with
additional disabilities. The teachers credentialed in the area of
visual or hearing impairments lead the team for infants who are deaf-blind.
Other disciplines include occupational therapy, physical therapy,
and speech therapy. As the babies began to move, an orientation and
mobility instructors provide consultation.
Role of Teacher in Visual Impairments
As a teacher credentialed in visual impairments, my primary role is
to identify the childs visual abilities and the impact of visual
impairment on development. With children who are deaf-blind, my primary
role also includes working closely with the teacher of the deaf and
hard of hearing to develop an integrated intervention program for
the child and family based on learning through touch. An integrated
program requires a true transdisciplinary approach as we share salient
ideas from each of our fields, and seek information from the field
of deaf-blindness. My role also includes articulating areas of need
in other areas, and bringing in the appropriate team members. Needless
to say, my role is to schedule many meetings!
As part of the team in both infant and preschool programs, I develop
tactile strategies and adaptations to meet the needs of children.
With infants, our goals include building a strong child-caregiver
relationship, developing a communication system, and helping the child
find methods for exploring the environment in a meaningful way. We
began by establishing touch routines with family members. Caregivers
would communicate their presence through a touch and then learn to
read infant cues for interaction. We work to build the babys
anticipation for being picked up and held. Caregivers develop individualized
touch and gestures to identify themselves, (e.g. Daddys beard
The infants environment is structured so that the baby can easily
encounter objects in close proximity. Objects are selected based on
a variety of tactile characteristics. We use toys made of wood, plastic,
and different textures of fabric. We incorporate household objects
of metal (measuring spoons), foam (curlers), and nylon (hair brushes).
build concepts by using many tactile variations of the same object
such as a ball, a spoon, or a cup. In this way, the child learned
the characteristics of the object that describe its function as well
as those characteristics that may differ. For example, a cup may be
large, small, heavy, or light. It may be made of plastic, glass, metal,
or ceramic. Yet, all cups fall within certain size and shape parameters
and all can hold liquids. The child discovers what is different and
what is consistent through exploring many examples of an object.
The child with vision recognizes how a model of an object (e.g., a
plastic fruit) resembles the real object. Children who are deaf-blind
do not have this information. They identify objects based on shape,
size, texture, weight, temperature, and smell.
When possible, real objects should be used to teach concepts. Real
objects provide the necessary information with which the child who
is deaf-blind can identify and discriminate objects, and thus build
concepts of the nature and function of objects.
As toddlers begin to travel, it is important to store toys in the
same place, not to move furniture "landmarks" and to allow
many opportunities for repetition and practice. We incorporate touch
into daily routines and built learning activities into these routines.
In preschool, classroom space is divided so that the children can
travel throughout it using touch. Large open spaces do not provide
sufficient information as to location or expected activity. Students
use tactile landmarks to navigate the classroom, such as cubby storage,
the piano, and the tables. Using a relevant item to label an area
helps the children associate where they were with what occurs there,
e.g., a printed sign identifies the block area with a wooden block
attached to it. The dress-up area is a favorite for many of the children
who are deaf-blind. They enjoy the hats, ties, hair salon games (curlers
and brushes), and jewelry. All of these objects are used on the body,
and seem to feel good to the children. As with infants, an environment
should be rich in tactile experiences yet organized, because every
experience needs to have meaning to the child who is deaf-blind.
Preschoolers are assigned seats at circle, snack, and lunchtime. The
child who is deaf-blind will get to know the child on either side
over a period of time. Adults can facilitate interactions by prompting
the other children to share objects, pass materials, and identify
themselves verbally and by cue. The other children are taught how
to read the communication of the children who are deaf-blind by looking
at their gestures, facial expressions, and movements. They are also
taught to "wait a little bit longer" to give the child time
to respond. This is not easy , but very rewarding for all of the children.
Circle time provides another opportunity for interaction. Real objects
associated with the learning themes are provided, such as articles
of clothing, household objects, outdoor objects, and toys. An experience
box can be used to re-tell the story of activities that the class
had enjoyed together. Themes are selected with the use of objects
and peer interactions in mind. Rhythm and movement activities are
popular, and are often conducted with partners. Traditional circle
time activities, such as identifying the weather, allows the child
who is deaf-blind to go outside and experience it directlyespecially
fun when it is raining. A calendar box represents the days of the
week because class activities vary by day. Circle time activities
are kept short, and not every child is expected to engage in each
Some of the children enjoy music. We use instruments that are highly
resonant and provide strong feedback. Favorites include drums (the
larger the better), a dulcimer, and the piano. The dulcimer is held
across the lap, providing more input to the childs body when
strummed. The piano is placed perpendicular to the wall, allowing
the child to feel vibration through the back of the instrument. The
children enjoy different rhythms, produced by clapping, foot stamping,
or with rhythm sticks. Some children enjoy music and fine motor activities
on a platform, such as Lilli Nielsens resonance board as this
increases feedback to the child.
Object books are developed for both toddlers and preschoolers. An
experience can be recalled through the use of associated objects.
A party or picnic might include a paper hat and napkin, balloon, or
plastic utensil. The experience book (or box) is used in conjunction
with the childs communication system.
Many of the children are potential braille readers. The children are
exposed to braille incidentally, rather than engaging in formal Braille
instruction. Braille appears around the room as print does for the
sighted preschool child, only within the reach of small hands. Many
of the children find braille labels interesting to touch. The playhouse
contains a braille menu, the classroom areas are labeled with braille
signs, the library corner contains print/braille books, the writing
area offers a Perkins braillewriter, and each childs cubby features
his or her name in print and braille. The children are prepared for
formal braille training by engaging in wrist and hand strengthening
activities such as wringing sponges, washing and pinning up doll clothes,
cutting paper, opening containers, and pinching play dough. The children
need to learn to discriminate and understand patterns, so they engage
in play and naming activities focusing on concepts such as rough,
smooth, beginning, ending, top, bottom, same, and different.
Orientation and mobility (O&M) training becomes more important
in preschool. The children spend much time trailing in the classroom,
identifying features and mapping their environment. O&M instructors
work directly with students and consult with families and staff. Classroom
areas are demarcated by the position of storage units. Tabletop activities
are adapted to establish boundaries of personal space using trays
or placemats, and materials are in close proximity and in easily identifiable
Children who are deaf-blind require much exposure and repetition with
activities. We introduce objects using the technique of offering (touching
childs hand and waiting for an attempt to grasp), or by hand-over-hand
joint movements. This is followed by an opportunity for the child
to engage in the activity independently. The hand-under-hand technique
allows the child more independence while providing guidance, or "navigation"
around a person or object. A child with motor difficulties, such as
cerebral palsy, might require more stability. A seating position should
be developed, which allows the most independent hand use. Materials
may be adapted to be heavier, larger, or with enhanced handles, to
promote more successful grasp.
Working as a team to develop learning activities strategies is challenging.
Touch cues need to have meaning for the child. This meaning has to
be developed and takes time for the child to learn. With limited hearing
or vision, a child does not learn meaning incidentally. Agreeing on
the most meaningful, efficient, and easy to use strategies is often
an obstacle for a team. A large team brings many backgrounds and opinions
to the table. Once consensus is reached, everyone needs to teach others
involved with the child to use the strategies consistently. Families
need to be able to voice whether they can realistically incorporate
strategies (or risk a label of "not following through."
Consistency is vital to making a learning activity successful. Everyone
needs to know, and commit to using, the same touch strategies. Everyone
needs to greet the child in the same way, use the same routines, and
the same names and labels, cues and signs. "Everyone" includes
all educational staff as well as the childs caregivers and classmates.
Opinions differ as to when sign language should be introduced, or
how meaningful a touch cue is to the child. Questions arise as to
the timing, position, and repetition of touch cues. Working with young
children involves facilitating language development. As teachers and
interventionists, we need to know the small steps in typical language
development and then make adaptations for the child who is deaf-blind.
This is not always easy. The children require clear, concrete messages,
much opportunity for repetition, meaningful and satisfying activities,
and ample time to learn. With sufficient support, children who are
deaf-blind can learn about the people, objects, and places in their
environment through their sense of touch.
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