tetn # 30910 visually impaired students with vestibular issues presented by kate hurst and jim...
TRANSCRIPT
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TETN # 30910
Visually Impaired Students with Vestibular
Issues
Presented by Kate Hurst and Jim Durkel
TSBVI [email protected]@tsbvi.edu With Special Guest
David BrownCalifornia Deaf-Blind Services
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Workshops and ConferencesWorkshops and Conferences
June 5-7 Appropriate Communication
Assessment for Babies with Deafblindness
HAS BEEN CANCELED
June 25-26 ECI Conference @ Embassy
Suites in San Marcos
June 26-27 5th Annual Statewide Texas
Parent to Parent Conference@ Omni Austin
Hotel at Southpark in Austin
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Roll CallRoll Call
How many How many participating?participating?
Remote sites?Remote sites? Taping or Taping or
streaming?streaming?
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Visually Impaired Students with Vestibular Issues
Presented by
Kate Hurst, Statewide Staff Development Coordinator, TSBVI Outreach with
Jim Durkel, Audiologist/Speech-Language Pathologist and APH, VI Registry, & Deafblind Census Coordinator, TSBVI Outreach and
David Brown, Education Consultant, California Deaf-Blind Services
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Our Special Guest . . .
David Brown Formerly of SENSE,
UK Currently with
California Deaf-Blind Services
World-traveler Funny guy
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How do we achieve balance?
Three separate components make up “Equilibrium Triad”
Input from the eyes (vision) Input form the muscles and joints
(proprioception) Input from the vestibular organs (balance)
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A Good Place to Start
Pediatric Resource - Vestibular Disorders
Association
(
http://www.vestibular.org/vestibular-disorders/specific-disorders/pediatric-vest.-disorders.php)
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Causes Pediatric Vestibular Disorders
Head/neck trauma Chronic ear infections Maternal drug/alcohol abuse CMV Immune-deficiency disorders Meningitis Migraine Metabolic disorders (e.g., diabetes) Ototoxic drugs
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Causes Pediatric Vestibular Disorders
Neurological disorders (CP, Hydrocephelus)
Genetic syndromes (e.g., Wallenberg, Usher,
CHARGE)
Posterior brain tumor
Family history of hearing loss/vestibular issues
Cochlear implants
Lack of use - movement issues, fear, ill health
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Some data . . .
VI Registry - 84 or 14%
CP - .3% CHARGE - 7.7% CMV - 2.7% Hydrocephaly - 1% Meningitis - .5% Shaken Baby - .5% Usher 1 - 1.7%
Deafblind Census - 147 or 19.9%
CHARGE - 9.7% CMV - 4.8% Hydrocephaly - 1.9% Usher 1 - 1.2%
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So how does the vestibular system work?
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Vestibular organs Located in the bony
chambers of the skull in the inner ear
3 semi-circular canals positioned in different planes for rotational movements
Otoliths (Utricle and Saccule) for linear accelerations
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Semicircular Canals Bulge at base of canals -
ampulla Ampulla contain sensory
receptors for each canal Canals filled with endolymphatic
fluid and surrounded by perilymphatic fluid
Detect heads rotation Demonstration on
The Physiology of the Senses Transformations for Perception and Action, Tutis Vilis, University of Western Ontario, Canada
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Otolith Organs Utricle Saccule Demonstration on
SenseWeb
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Vision and Balance
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Vestibular Occular Reflex
Normal head rotation: eyes move in opposite direction of head to stabilize retinal image (VOR)
Conflicting sensory information from visual and vestibular senses is a problem
The cerebellum repairs “slippage” Demonstration
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What Part Does Proprioception Play?
Sensation experienced by muscle and joint receptors
Requires a normal range of muscle tone to work properly
Feeds information to the brain that allows for awareness of where body parts are in space, movement, speed and direction of movement
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A Redundancy for Balance
Brain and Spine Foundation Online
When one of the three parts of the Equilibrium Triade do not work or work well, the other two can compensate.
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Moving Platform Posturography
QuickTime™ and a decompressor
are needed to see this picture.
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From Jean Ayers Sensory Integration and the Child
“The vestibular system is the unifying system. It forms the basic relationship of a person to gravity and the physical world. All other types of sensation are processed in reference to this basic vestibular information.”
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From Jane AyersSensory Integration and the Child
“The activity in the vestibular system provides a “framework” for the other aspects of our experience. Vestibular input seems to “prime” the entire nervous system.”
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From Jane AyersSensory Integration and the Child
“When the vestibular system does not function in a consistent and accurate way, the interpretation of other sensations will be inconsistent and inaccurate, and the nervous system will have trouble ‘getting started.’”
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From Carol Stock KranowitzThe Out-of-Sync Child
“Gravitational insecurity is manifested by abnormal distress and anxiety in reaction to falling or the possibility of falling. It is a primal fear.”
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From Carol Stock KranowitzThe Out-of-Sync Child
“Indeed, our need to know where we are in relation to the earth is more compelling than our need for food, for tactile comfort, or even for a mother-child bond.”
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References on Vestibular Issues
David Brown, California Deaf-Blind Services
o “The Vestibular Sense”, DbI Review, June, 2007
o “Educational and Behavioral Implications of Missing
Balance Sense in CHARGE Sydrome”, reSources,
Spring 2003.
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Effects of vestibular problems
Organization of ALL sensory information
Postural security/muscle tone
Use of residual vision Perception/processing
sound Remembering auditory
sequencing
Memory development Speech/Language
development Behavioral challenges Bilateral coordination Breathing, feeding,
digestion, nutrition Sociability
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What do we do?
ASSESS
Vestibular Dysfunction Checklist in Out-of-Sync Child
Sensory Learning Kit Vestibular assessment by
Audiologist OT/PT Evaluation Sensory Integration Evaluation
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Various testing deviceshttp://www.tchain.com/otoneurology/testing/engrot.html
QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
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What do we do?
TEAM
With OT knowledgeable about SI to develop menu of interventions
To plan flexible schedule related to fatigue and need for breaks
To select / train staff to respect individual differences in behavior, performance, pacing
With family to gain insight to home challenges, child preferences and for support
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What do we do?
MODIFY
Seating to address postural concerns Positioning for visual and auditory tasks Materials and learning environment
(isolate lines of text, reduce distractions) Activities to incorporate SI approaches Pacing Schedule (general / day-to-day) Staffing patterns
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What do we do?
RESPECT
Student challenges in learning Family struggle to address
challenges / knowledge of the child Staff challenges to adapt
programming and the expertise each has to offer
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To Learn More . . .
Brown, David, 2007. “The Vestibular Sense”, pp. 17-22. Dbl Review, January-June 2007, Deaf-Blind International.
Brown, David, 2003. “Educational and Behavioral Implications of Missing Balance Sense in CHARGE Syndrome”, pp. 1-4. re:Sources, Spring, 2003. California Deaf-Blind Services, San Francisco, CA. http://www.sfsu.edu/~cadbs/Spring03.pdf
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To Learn More . . . Brown, David, 2008. “The Sensory
Integration Perspective and What It Offers Us in the Field of Deafblindness”, pp. 22-26. DbI Review, July-December, 2008. Deaf-Blind International.
Brown, David, 2008. “The Forgotten Sense - Proprioception”, pp. 20-24. DbI Review, July-December, 2006. Deaf-Blind International.
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To Learn More . . .
Kranowitz, Carol Stock, 1998. The Out-of-Sync Child. The Berkley Publishing Group, 375 Hudson Street, New York, NY 10014.
Kranowitz, Carol Stock, 2003. The Out-of-Sync Child Has Fun. The Berkley Publishing Group, 375 Hudson Street, New York, NY 10014.
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To Learn More . . .
Vestibular Disorders Association www.vestibular.org
Brain and Spine Foundation - Dizziness and balance problems http://www.brainandspine.org.uk/information/publications/brain_and_spine_booklets/dizziness_and_balance_problems/how_does_the.html
Tutis Vilis - SenseWeb http://www.physpharm.fmd.uwo.ca/undergrad/sensesweb/L10Balance/L10Balance.swf