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As I is or is: respect to works for the collaborative in Concord Massachusetts as a teacher of students with visual impairments . She is also affiliated with the Minuteman early intervention program supporting infants and toddlers with visual impairments and their families. She is a teacher providing information and resources about cortical cerebral visual impairment and its effect on education and the Solomon and the website is the TBI teacher@WordPress.com.

Welcome, Ellen.

Hello, everybody. When we see speak about compensatory skills and learning, there are young children with -- multiple disabilities -- when we think about children with visual impairment, we think a lot about the vision. When I was in school we learned an awful lot about the anatomy

You. It is a shortage it should you have your volume is as fast as you can get it to go. Ellen is wearing a microphone on her lapel and she wants to make sure it is as loud as it can be. >> If you run the chat, standby. We will ask if you can hear her in a second.

Give the test --

Testing one Testing 123.

Thank you, thank you. She will associate your. We may need for you to protect the little boy. Thanks Elizabeth. Start again, Ellen.

Thank you for coming in today to the webinar. -- Compensatory Skills -- Essential considerations for learning. What we think about compensatory skills, some of the essential considerations -- I am especially the about the young child with visual impairment or the early skills with the -- the children with multiple disabilities. I've been a teacher for about 30 years. When I was in school, we learned an awful lot about vision. Vision loss, the anatomy of the eye and function of the eye and how to assess vision. How to read a doctor's report. But, we didn't have a lot of information about the other senses even though as a teacher of the visually impaired we wanted to capitalize on the other senses to build a more full idea about children's environments. There was much less discussion about the other senses --, child uses smell and taste which are completely ignored, really. And there was very little discussion about the development of a typical visual skill in children. So, I feel like we are catching up with all of the improved brain science that is out there right now. As we think about the census, we cannot think of them in isolation. We cannot think of the eyes is separate from the brain. When they are all one mechanism -- the eye and brain are connected in the ears of the brain are connected and the sense of touch in the brain are connected. It is a total package. We can't think about these senses outside of rain processing.

What is the job of the brain? The job is to gather information and this is where the census command. The brain does not the eye reaches out of

the brain and collects information. We want to make sure -- get the child to the eye doctor especially to make sure that that mechanism is working correctly. We want to make sure that the mechanisms are working correctly. That is the first step in the understanding of how things -- how information is gathered. Then we wanted to take a look at the functional skills. If the ears are working okay, how the child is using that hearing. How is the child -- we want to think about that.

When we think about the brain and interpreting information, this is an area that we may -- we make huge assumptions about because we cannot really see how the child is interpreting the information humming into the brain. The only way that we know that a child understands what is happening is by how they respond. So, the child has eye gaze toward something we are talking about or if the child makes eye contact or icy reaching or looking toward objects in the environment. The child might answer me with words or gestures or signs. They might move toward the item to let me know they understand what I said. We make huge assumptions about the children understand. Think about the children with multiple disabilities that are not able to show us what they understand as easily add we make assumptions about what their brains are interpreting.

This is an area we have to be very careful about. Here we have a skill model of the human body. The areas that are the largest are the areas that are the most sensitive areas of the human body. So you see very large eyes, very large ears. Large hands and lips and tongue. Large nose. These are the access point for learning and they are the senses -- the most sensitive -- certainly around the faced the most sensitive that are here. Again, these are the important access places for learning. This allows us to make brain connections and allows us to understand the environment.

Advocate is also very important what we think about children and children with sensory loss in place ourselves in their experience. Try to understand what their experience with being of the child with a visual impairment. I think about something as simple as pulling your nose. -- Blowing your nose. We have a typical child that sees you getting a tissue and sees you heading for their nose -- they understand the language perhaps you're going to wipe their nose. They have full information about what is going to happen. They may not like it, but they still have a full information about what's going to happen. I think about the child with a visual impairment or multiple disabilities who basically has their nose attacked and again if you look at the scale model of a human being, and a highly sensitive part of their body, you have a basically attacked the nose with no prior information to the child. Sometimes I wonder whether we haven't created some real sensitivity -- tactile sensitivities and children because of how we approach and how we lack the ability to put ourselves and our kids shoes for something as simple as wiping her nose. We might want to tell them what we're going to do. We might place the tissue in a less sensitive part of their body like other hand or on their elbow and explain what is going to do. We might do and under hand reaching up to their noses so we can wipe their noses to gather rather than having that come from nowhere. Again, a little more of a sensitivity toward

gift experiences with these sensory losses. >> What to do the center ring to us but we have the near senses -- touch, taste, smell. These materials have to be near in order to be experienced. Then we have the distance sensors. That is vision and hearing. By far, vision gives us the most information of the world about what is happening in the environment. If the child doesn't have the ability to connect with what they hear with understanding and essentially it is just noise to them. Hearing is the distant sense, but it is not connected to something. It is just noise in the environment. So, I think mission overrides all of that.

Why are we considering this at all? As a teacher of the visually impaired, it is my job to understand how those other senses are operating. It's my job to be able to assess how that child is using those skills. Take a look at the child's strengths -- what other sensory strings? Also take a look at the week areas -- what are their week areas of need? On the IEP -- not only will I have vision goals but I will need to have goals around the compensatory skills because those are things I will be working on.

I think about week skills that some children -- especially with multiple abilities might have -- because of their lack of access visually and some motor problems, they really lack the ability to gain information about their world in the same way as a typical learner. Something as simple as -- if I gave you a tissue or a birthday card or a paper towel, these are all made of paper. You could have your eyes closed and reach and touch and give me exactly what I asked for. Because of your multiple experiences with those materials over time. The sense of touch especially is based in experience. Willie getting materials into the hands of kids that are not just hard plastic toys but of audible textures and the discriminations.

We want to understand how the senses are developing in children because at birth all the senses are not operating at full capacity. We need to understand when certain skills come in and what skills can be enhanced in a better way. We want to be able to assess them functionally and to assess all of the skills functionally. Then, pick about strategy that we might use to support learning in both senses. Again, support learning with the sense that is the strongest and really support the other senses to build these skills because kids really need all of those in operation.

We are going to go onto vision. Vision rules the brain. It is in control of so much of what happens. It is a great connector of information. It gets the brain ready for certain kinds of experiences. Something like -- McVie have a red jellybean on the table, just by looking at it it prepares my mouth for something smooth, a certain size, if it is red, I will expect strawberry or cherry. It is getting my brain ready for those two tastes. It limits the size -- when I have my vision to support that. It drives children to move, rollover, put their head, crawl, walk, reach -- this is all driven by vision.

It fosters all of the reaching to explore and play and access the world which is so much as touch. It really determines the understanding of

what we are hearing. >> As we said, vision is the distant sense for understanding the world. It is also very connected to memory. You will really remember about 60% of what you see and only about 10% of what you hear. Again, the vision is really ruling all parts of your brain. Let's take a look at how the visual skills developing typical child.

Vision develops -- at birth the children are seeing black, white, gray. They are seeing between eight and 12 inches away. This is a perfect place for mom or dad space. At about one week they start to see some colors. Red, orange, yellow, green. Their vision is poor -- 20/400. Children are looking at the light.

At about for three months we see more eye contact. I want to make a comment about eye contact in general. As far as socialization and body. I contact between a mom and baby creates a bond that is very strong and many parents of children with visual impairment have a difficult time bonding or connecting with the child that is not looking back at them. It is a huge area to try and help parents understand other subtle cues that kids are using to let them know that they are attending to their mom. Or to dad.

I contact for us is a strong motivator to talk to children. I have to be very careful about this myself. I think all of us should be. I see many times people come into classrooms and they speak to the children looking at them. The children that are not making eye contact -- they are greeted less often and talk to two less often and make it talked to for a shorter length of time. Be careful when children are not making contact -- we have to be careful about our own responses.

Between two and three months old we are seeing Julie is getting sharper. Their eyes are beginning to work together. Children are following objects with guys that are now working together. They are shifting the gays to some of the elements in the environment. At about 4 to 6 months they are watching their own hands. I believe that the whole area of development where children are watching the hands is a precursor to reaching. -- This is my hand and this is what I can do with it before I can use the tool in order to access the world. Again, a lot of the kids with visual impairment and multiple disabilities miss that whole time of hand watching. If there is a way that we can highlight that for children and left them know this is a part of your body -- something that belongs to you. This is a tool you can use. I've done things like putting red scrunchies on the kids risked in order to highlight their hands if they have poor vision just to connect --, this movement causes me to see this thing that is my hand.

Depth perception is developing. The acuity is up to about 20/25. This is very close typical. You're having some region which begins as batting and gets more purposeful. You are getting a recognition of things at a distance. This will feels are building. This is typical development, but to concede that the brain and I are making the connections. The eyes are the same all the development -- it is the brain and eye connection causing this vision development to be happening.

As we move along between seven and 10 months, we have children reaching to smaller and smaller things. There is more interest in pictures. Again, the leap from being able to look at a three dimensional object its way to be dimensional object is a cognitive deep as well as visual.

They are recognizing things that are partially hidden. Coordinating vision and movement. They have better eye and hand movement and better eye and foot movement. They are often playing with their toes. Letting kids with visual impairment or multiple disabilities have their feet highlighted with some nice red socks or sound making things on their feet -- begin the connections between what I hear and what I see belongs to my body. This is very important. They are beginning to judge distances better. At about 12 months you seek recognition of pictures. More recognition of different kinds of pictures. Faces of people that they know in pictures. They are anticipating adult attention and they have near adult skills at about 12 tons of age.

-- 12 months of age.

When a child has a visual impairment, what sorts of things are impacted? Understanding of object is reduced. They are not -- they cannot access things -- only think they can touch. Understanding the variety of objects and amount of objects and the amount of objects that are the same as one another are much more reduce. Think of something as simple as it all. A child with a visual impairment may only understand that this one although they play with is called a ball. Where as a child because he understands the variety and multitude of kinds of balls that they have seen in pictures and have seen other people playing with. Their object understanding is reduced.

The relationship between objects also is reduced. Object permanence comes later as we know. Things seem to come into existence and go out of existence. This happens for a long time before there is an understanding. It is very connected to their vision.

Cause-and-effect is also involved when they have a limitation in vision. I think about a six-month-old baby in a supermarket line -- I was behind one the other day -- watching this the child what the multitude of sequences that were happening from money being taken out of the wallet to the materials being scanned smiling at the person behind the counter and having a smile returned -- all of that learning is not the visual warning that was happening. Does that visual learning. >> Spatial relationships and content development., Communication point of view -- facial expressions because of the lack of eye contact and the ability to make and see poor eye contact does not lack of facial expression and understanding or gestures and body language. Children with visual impairments confuse pronouns because pronouns are very visually days. He and She refers to to someone somewhere else.

Gross motor development is impacted. Fine motor development is impacted. Bonding, as he said -- because of lack of eye contact and just being passive because there is just not enough to engagement or perhaps

overprotective parents who get nervous that children are going to be heard. You get a bit of more passive in a situation.

When we have children with visual impairment, assessment is a huge these. We will get the child to an ophthalmologist or a Logan vision clinic. That is the first step. We want a teacher on the team to a function of vision assessment. If there is any kind of indication of the brain involvement we certainly want to look at critical as will impairment or if the eye doctor report doesn't match the optional vision you are seeing, you want to take a look at the cortical is an assessment by Christine [last name indiscernible]. Also, understand that cortical visual impairment -- the goal will be to seek improvement in visual skills where as with some of the ocular issues you are more working around the vision loss.

You want to be doing learning media assessment -- this tells us how a child is learning. The best way of accessing the information of their environment. Also the teacher of the visually impaired is going to be able to -- sorry -- forgot to move the slides.

Interpreting reports -- we want the diagnosis and early correction and glasses and surgery of possible if that's in the cards. Of course, early intervention.

We want improved lighting and reduced glare. After distance information. Higher contrast. Larger sizes. We'll objects and natural routines. Extra time to explore items because they're going to have to do that tactilely. Work is with cortical visual impairment highlighting colors -- use movement to draw attention and use familiar items. Best distance for seeing and best visual field. We want to think about the complexities -- backlighting, we want to control like to reduce the non-purposeful gazing everyone to increase the time that a child looks at something and recognizes it and reaches for it. That is the latency time.

Let's take a moment to answer questions raised back let's reflect on this for a moment.

The senses -- as well as sensory channels. We thought it would be -- there's a lot of information. If you are reflecting on vision, we can take questions for a minute or two. One question I have, homunculus Ellen -- you showed us the human model -- the beginning of the slides. In the field we talked about how the hypersensitive information that comes into vision -- sometimes as high as 80 or 90% we often say. Yet when you look at the model the hands and lips are so large that you pointed out -- yet the ice seen relatively small. Can you comment on that relationship? Or will this happen later in the --

The model itself -- into the scale model, the eyes are small because eyes are smaller than hands. It is more of a relationship -- they are being depicted larger as well.

Thanks.

I do not see any questions. But go ahead.

What we think about hearing, we know that the neural pathways for thing develop early in utero. Children have been looking for about 12 weeks before they are born. I remember myself when I was pregnant but I went to a lecture and there was thunderous applause I could feel my baby react to that sound. It was very clear.

This is something that is intact and used for birth. Hearing improves over time and does not have full skills until adolescent. When I say bull skills is the ear and brain connection that I'm talking about. The mechanism of the ear has been stable, but it is the processing and skill level with the hearing that is important. Frequency sensitivity -- high-frequency are are understood much better until the second year of life. Think about the babies or children that you work with -- some of the early skills test my children with multiple disabilities. I think about all of us as human beings -- whenever we interact with the child -- the frequency of our boys get higher -- even the largest football player will speak to a baby and a very high-pitched voice. We seem to understand that as human beings. This is what children need. We do many things without realizing it.

Frequency sensitivity is one area that we need to think about.

Found location is also a skill that develops over time. We know that children understand the horizontal sounds much earlier and are not very good at the vertical sound. Think about when we stand up of children. Specially children in wheelchairs. That is a vertical sound. Some of the above us. That's not fully developed until they are seven years old. It should be face to face with children and thinking about the best place for auditory information. >> We think about during skills like specials. These are essentially hard of hearing until about six months old. I gradually improves again through puberty. Again, it is not the mechanism of the ear, it is the processing piece. The brain processing piece. The temporal resolution built over time. Babies need more time between words and more time between information to have understanding. Again, think about the early skill learners. How quickly we might be talking to them and if we just slowed down our speech and thought about the temporal resolution of the information.

Discriminating sound from the background is also a skill built over time. It is very poor in a busy and young childhood. Discriminating and a loud classroom -- think about somebody trying to sort a background noise from important information. Again, think about the noise in the classroom.

The child that is cited as a something in the world and turns and visually connects the sound to the visual information. They begin to understand what is making the sound and how the sound is made and maybe how it turns on and off and they are getting much more full information. A child visually impaired would hear the sound but really lack the understanding of the sound direction or source. They don't really have a connection to any part of it other than random sound. >> Hearing and music -- I bring this up because all young children love

music. I think there is no child I have ever worked with no matter what level of impairment that I've ever seen doesn't love music. The brain really favors music because the brain favors patterns and music is pattern. Music skills are in both hemispheres. Even if you have a brain injury, chances are it is an available tool to use with children. Again, you see many children with special needs that love music and music is very beneficial for learning.

I was able to watch a couple of rehabilitation videos on Gabby Gifford -- she had a gunshot wound to her head and has a brain injury. They very much used is again your rehabilitation. There are nice videos out there that you can watch on some of her rehab and watch would speak against the use of music. This is important when we try to have children access information.

When we think about assessing hearing, we want to make sure that the gear mechanism is checked out by a physician. We want to get hearing tested. We also need to look at the functional information. The hearing skills within the classroom. What is the reaction to language and speech? Is there any alert to a familiar voice for instance? Do they have a favorite voice that they like or think a person that they know by voice? Do they have a favorite song or artist? Again, even with some of the children that don't seem to have a lot of auditory discrimination have favorite songs. I worked with the boy who cried every time happy birthday came on. You had to be careful with this birthday.

Another girl that I work with Billy likes Aretha Franklin. It can't be somebody else. It has to be Aretha Franklin. That is auditory description. The child has that ability, we can tap into it. That level of assessment -- parents are there read valuable when we start to think about function. Function of all the senses. They have a vast amount of information to give us especially around music and favorite songs at I try at least once a year to have a conversation with parents around music that they like or skills that they show around their senses. Think about how the child is assessing reactions to the environmental sounds. A door slamming, someone crying. Anything happening in the environment.

I wanted to think about what types of sound cause a reaction. Or is it, if I drop a light bulb the sound is very quick, short, and died. It is a vacuum cleaner on, it is an extended time. Which kind of sounds are paid attention to? Are their preferences? Certain things that children like? Are the better sound reactions inquired traverses a loud environments? Is the sound direction important? What I think about a child hearing skills -- again, how long does the sound need to last before the child pays attention to the sound or reacts to the sound?

Some of the strategies we want to think about with hearing -- when there is a noise in the environment we want to bring the sound to them as much as possible. Bring the thing taking the sound to the child or bring the child to the sound. We need to allow them to create the sound in order to understand how it turns on and turns off and have the power over the sound. Again, using music. Think about using music in your

teaching. Predictable books. Children like predictable books because the brain likes a pattern. Predictable books are books with a very rhythmic repeatable text. You think Brown bear Brown bear what do you see? That particular global book sounds very much more like music than it does a spoken word. All kids like predictable books. I find that kids with disabilities really like them as well.

The predictable books will be a great tool.

Again, because we know that children hear better in the horizontal area and we want to get down to their level and speak to them at eye level.

We know that resolution is not that great. We went to slow down our speech and have more space between words and directions. We want to label sounds in the environment. If the vacuum cleaner has turned off and I bring the child over to show the vacuum cleaner and allow them to turn it on and off and I label it, then over time I don't need to do that. I don't need to bring them to the sound because that information is a full idea. A concept that is understood. Again, labeling sounds very important. Being aware ourselves of sounds and the environment -- we filter the ones that are not important to us. Children may not be filtering the sound. So when a child is crying on the other side of the room, we might want to say to a child -- that Joe -- he's okay. He's with Susan. She is making sure that he is okay. He's going to be all right.

This is to knowledge where the sound is coming from and labeling it.

A quieter environment --

Addressed a child by name for delivering the message. Think of yourself sitting in a knotted criminal of the sun and somebody says Ellen, what the answer? By calling my name you have alerted my brain to the oncoming message. That is very important to do just that say their name first to alert them to the oncoming message.

Then, labeling voices -- identifying myself. We want to identify ourselves for children so that they begin to connect what they see with what they hear and what they're going to experience.

These are strategies that we would want to use when we think about the skill of hearing. >> Question test that

I was thinking of a couple of things. One common theme that I am hearing is that the level of presence -- by getting of information while it is occurring -- but whether it is what I am saying or hearing or as you go into what you are feeling just talking about the tissue -- this is one kind of paper and another. I knew a little boy who had learned the difference between musical instruments. He was delighted with being up to hear a song on the radio and say I hear a guitar. I hear a flu. I hearing from. In the same way that some kids learn dinosaur names and football teams. He attached the circle estimates. He could tell the difference between them just by hearing them.

Yes.

That is a wonderful thing to tap into for children. Certainly for hearing and also for leisure skills it is a great tool that is underused.

Going to make another point. I do not CNEs questions specific to hearing.

I want to tell a story that happened fairly recently. I thought about this in the context of hearing. I had a three-year-old boy who had a visual impairment and I went to his IEP meeting. The town had done an assessment of the child and the speech therapist and mom started to discuss their concerns about the child speaking nonsense language.

Didn't have that experience with the child so I asked for more information. Mom said well, he says things like mom, firetruck. There is no fire truck there. It is nonsense.

What happens when his twin brother said mom, firetruck? There is a fire truck and mom says oh, yes -- a big red truck moving fast with a beautiful truck. Look at the three men on the truck. It is a long prolonged social interaction between mom and his twin brother. Yet, the three-year-old with the visual impairment when he says mom firetruck, the answer is -- there is no truck.

He doesn't know that. He doesn't know that his brother is referencing a visual event. So, it's not nonsense language. He's trying to have the same interaction that his mother had with his brother. These sorts of things -- being tuned into the sense of hearing and vision and all of that, especially suspect this child was going to be labeled as a child using nonsense language when in fact it was an effort to socialize. That is a story that I wanted to share.

That's a good one.

Let's move on to smell. Smell is really, really and underused learning tool. And underused consideration for much of learning. That's unfortunate because it is a very well developed sense available immediately and useful immediately at birth. If you have an one hour old baby and you soak a pad in that child's mother's breast milk and a strangers breastmilk and put them on either side of the babies had, the baby will turn toward the mother's smell. That's how strong and powerful and useful that will is right from the get go.

It's also does but the sense of smell has no filters. It is hardwired right to the Padula -- and important part of your brain for emotions and memory. -- Any learning tied to the amygdala lasts longer and it is very powerful early and powerful for young children right away. >> We store about 10,000 different scent smells and are sent memory. Certain smells will evoke certain memories enough. I think about myself -- in the season we are in now -- the lilacs are coming out. When I took a walk and smelled lilacs it took me right back to being a little kid in Vermont where our back yard was ringed in lilacs. It took me

back to all the memories in the backyard. When I bring in my Christmas tree, and the smell of Evergreen, I initially get taken back to some of the Christmases in the past. All of us have those very, very strong sense memories which are powerful from childhood. Much less so now. Now my memories -- after I am about 15, the memories get much more connected to things that I see and hear. Some of the sent memories really fade. All of you can think about a smell that takes you right act to your early years. We are powerful -- this is a powerful tool for us. I wonder why we don't use it. I think perhaps we don't use it because it is not easy to assess. We are into assessment. I think it is a difficult thing to assess a child sense of smell. Perhaps that's why we don't use it that much. Again, it is a very powerful tool for us.

I don't think we can talk about smell without talking about taste. They are highly connected.

It is very important we think about them together.

Smell and taste -- your tongue only has four think that it can detect a -- suite, sour, bitter, and salty. Every other kind of what we call taste is really what you're smelling. It is information that you are getting.

I want to show you -- this is called a flavor wheel. Many food industries have these flavor wheels. If you look on the right-hand side, these are all -- when you think about a flavor wheel, these are all the smells that this coffee industry is interested in. If the will is there important. The words on the left-hand side are taste words. You can see how many more considerations the coffee industry has about the smell of coffee versus the taste of coffee.

The chocolate industry had to feel like this that looks much the same. Smell is important to the taste of chocolate.

That beer industry and the maple syrup industry haven't wheel. Any food manufacturer has a consideration about smell because they understand how much more information about what something taste like it delivered by the sense of smell, not your mouth at all.

So, taste is well developed at birth. Taste input causes your mouth to celebrate, your time to move, and some of the coordination because of the saliva -- son of the coronation of swallowing. When I think about this, I think about some of the children that are fed on G tubes and how -- because they are not tasting things -- tongue and lip movements are not practice. Swallowing is not coordinated. If you can, try and figure out with a physician if there is a way to deliver a taste to children. I think it is a very important thing. Certainly for any kind of speech and any kind of control of the mouth movement itself. I am a big believer in seeing if I can get [indiscernible] to children even if they are primarily fed by a G tubes.

Tastes are important for emotional development. Fats and sweets Connie down. Breastmilk and formula are sweet. All of these are sweet. They improve attention and they help with sleep.

A child has been tasting the amniotic fluid ultra development. Paper for the sweetness. Children will take up to 20 exposures -- typical children -- 20 exposures before the new tastes are accepted very well. Again, think about children -- once they don't like it, they never get to see it again. 20 exposures a long time. Keep at it with some of those whose. We want to broaden their sense of taste for different kinds of foods.

So, how do we assess what a child smells and when a child taste again, parents are a huge benefit. Do they have a favorite food? If they have a favorite food, I can figure out that their sense of smell and taste are working any better way than might be expected. Do they turn away from it billed loon? That would tell me that they are smelling a -- eight filled spoon.

To be sniffed an object when you handed them? Here's is something you can try at home. There is a wonderful jelly belly -- a distinct flavor to jellybean. If you put them on the table and close your eyes -- I don't want you to see the yellow one. It might be lemon. That would give your brain a clue to think about lemon. I don't you to have that clue. Close your eyes. You will also hold your nose and pick a jellybean and eat half of it. While your noses close. See if you can figure out what the taste of the jellybean is. You will be able to. Then put the second half of the jellybean in your mouth and take your finger off your nose and you will be flooded with the taste. You will see how much of what you taste is delivered to your nose. You will be amazed. You don't even think jellybean the smell that much. It is astonishing. Try that at home if you can. >> PR strategies for using taste and smell in your instructions. Again, you will identify and name smells. Often I think children are eating things that they have no idea what it is. They really have no idea. You want to label some of the smells. You want to allow time for children to smell. Really, just give the smell as close as possible so they of a chance to process with the smell is. In bed the smell into instructions -- one of the best ways to embed that into the instruction is to use real objects and experiences. If you are in cooking class in the project calls for lemon juice, don't use one of the squeezy plastic lemons. Give the kids a real lemon. It feels like a real lemon and it is the right size of a lemon provision. If smells like a real lemon and taste like a real lemon. It's the real thing. Experience with the real thing. Total knowledge about that through. Perhaps I can be extrapolated to other things.

Food avoidance is is another way to take a look at smell and taste as we said. Children with visual impairments are often picky eaters for two reasons -- one maybe the taste itself and another A.B. texture. I think it is the textures that people have a difficult -- children with visual impairment have a difficult time hitting over the change in texture.

Again, I think that is a lack of visual information. You don't see the applesauce -- all of a sudden there is something shocking. You and I can see the Buddha we understand it will have a certain texture long

before against warm out. I was just talking to him on the other day and she had taken the child to a feeding specialist recommended cheese doodles. We can look at a cheese doodle and understand what that's going to feel like an hour mouth. This boy this young man was having into full-time. My suggestion to her -- okay. Now but played with the sense of touch -- play with it on an activity tray rather than try to get into his mouth. Then, playing with him will get the smell of it and he will accidentally tasted with his hands in his mouth and he will get the feeling of what it feels like. That might be a good way to introduce new foods. Applied into the other senses before you get the feeling in the mouth. >> Let's stop for questions.

Yes, thought about smell and taste. Just as we were moving to this segment, one of the participants, Roxanne, was talking about the motivators and reinforcers of sound you mentioned. She ventures that she has a blind student that was the vacuum cleaner. So his mom has been able to use that as a reinforcer. It is something that motivates him. Another story about how you can tap into understanding what children will respond to.

Yes. I love to hear that. I am also a very big believer in getting information from parents. Even writing in the IEP what children like. We are all going to learn about what we like. In a much more motivated way then we are about something else. I often said that I could go to an MIT lecture and astrophysics test but I just don't get it. But if you take me to a conference about churning -- children are learning and the brain and I will soak it up and hold onto it. We like to learn about what we like.

Before we move on, let me say couple of things. For those still attending, it is after 5 on the East Coast. I what was knowledge that we started at the quarter hour. We still have about 15 or 20 min. more to go. If you need to drop off, we understand. Come back for the recording. As I mentioned at the top of the hour, these presentation slides will be available as a handout. We will stay on the air. Let me get the floor back to Ellen Thank you, maybe we have another one?

Asking for the video and written information. Those that register, you will get a follow-up tomorrow with a link to the recording.

Let's press on. >> Now we want to move on to the sense of touch and how that develops. The sense of touch is probably the poorest in development when the child is born. The child in utero is touching things. Pushing and pulling. The more full term a child is the tighter the environment is in a more pushing and pulling an action that a child will get on their hands and for their sense of touch. Think about the children that are born prematurely that are basically floating around when they are born. They miss the huge part of touch development, I believe, the pushing and pulling in a very tight space.

Baby it is important to provide them with smaller areas -- areas to pull and push up against after they are born.

Again, the sense of touch is not well developed at birth. It only develops because of experience. That discrimination only builds because you have touched the thing billions of times. If I have a paper towel in a tissue and a card, and I say give me the tissue -- you will give me the right thing because you that thousands of opportunities to touch these objects. Manipulating these objects. Discriminating the objects.

With visual impairment and especially for children with multiple disabilities -- they are moving to an environment independently -- they don't have access to and activity tray of paper towels or paper or metal objects or anything that isn't just plastic or bury. -- Three -- a stuffed animal. Try to provide kids with as many tactile experiences as possible. >> Up until about four months old, touch is passive. You are being touched. Then it moves out a little more into the world. You start to reach to play in the environment. You have the active touch -- your own touch. Again, this is delayed in children with visual impairment because they don't see that thing hanging. They don't see the objects manipulated. At about eight months they can really identify a familiar object without seeing it. I've seen children with visual impairments who can -- typical children as well -- they can scan their own they have this back they can pop the BG in amount. The tactile discrimination is really good at eight months old. >> What we think about touch we think about I abilities -- the skin sensation -- I am touching something or I am being touched.

Temperature. We don't think about temperature that much. But if you pick up something that is metal, it is colder than plastic. Colder than cloth. We don't think about that, but that is a part of the experience is like our tactile experience.

Pain -- reaction to pain. Proprioception -- many people will make that a separate sense -- the sense of movement and position in space. Some people consider that separate but I will put it underneath a sense of touch.

When I try to test but when I think about it child's sense of touch -- whether or not they moved to pain. Parents give us wonderful information about whether children are reacting to pain. How they react to pain. To date move the part of the body that I touch? If I tap the foot and say can I have this put, do I see a little movement from that put or is it just not happening? That gives me an idea whether that is being understood. Do they moved to a touch Q? If I said I'm going to pick you up now -- if I touch them there after a while, will they lean forward and respond to the touch? That will give me information about how they understood about being touched and what it meant.

Distinct likes and dislikes as far as materials. We can use what they like and we can try to build on some of the ones that they dislike.

Do they fully explore items in the mouth? Many times people will say -- that is a sensory seeking behavior. There is mounting that is sensory seeking but I think of it more as putting something in your mouth and biting down to get the sensory information. I think the kids with visual impairment [indiscernible]. They roll it in their mouth versus

biting down on it. I try to see which one I get from a particular child. Do they explore items with their hands?

How do they react to light pressure versus the pressure? Different types of temperatures, movement, how to the react to the sensitive parts -- the palms of their hands -- fingers, mouth stash that what is the reaction to those as sensitive parts of the body? We have children that come in that do not want anything near their hands at all. We will start with their feet and we will gradually building up from the which is a much less sensitive part of the body then testing the elbow is less sensitive than they have. Build these experiences. >> We get to the highly sensitive parts. We think about touch we want to have -- active learning. The overall philosophy -- little rooms and sensory vests and asked her pewter trays -- just have the basic philosophy that a child with multiple disabilities or a job with visual impairment never is without something to touch their environment. It is usually here in front of them. Very close. It is a philosophy on just having materials to interact with.

I think about an adult friend of mine who is visually impaired and we take a ride to Vermont. She brings a bag of buttons with her. The whole time we talk she is a stimulating your brain by comparing and contrasting the buttons that she has brought. She likes to keep her brain active. As a person with site, as I drove along I think about the car colors of the trees and all of the things stimulating my brain. Because my friend does not have site she uses her sense of touch to stimulate. So, when we think about touch we went to think about allowing mouthing -- some kids with multiple disabilities have never been allowed -- he cannot bring things to their mouth. Like to present things to them out. They really like to make the connection. I will try to allow mouthing.

And underhand expiration. I try to con underneath handset explore together so they always have the ability to pull off my hand. Then I reengage from the elbow to encourage: exploring to the child is able to explore on their own.

Increasing their explosion time with materials. Allow that.

I am going to pull your nosedown -- I'm going to pick you up. This is the hand I'm going to put the spoon in -- and alerting behavior to allow the children to say okay, this is where they're going to go next. This is where they're going to interact with me. This is the part of my body they're going to move.

Touch without Hans blitz. Hans Blix are a wonderful thing from and OT point of view. With for a child with a visual impairment -- covering up your palm and fingers and thumbs take away a lot of tactile information. We wanted to negotiate with the OT about how we can let the child explore materials with full and access and put the splints on when there is less concern about that.

We're going to stop for a minute and talk about touch. >> I couldn't get muted and unneeded. I appreciate what you said about the splints.

Thinking about the whole hand does not not just the sensation of things that help bartend hard and soft they are. If you're only touching with a couple of fingers or the side of your hand, you don't necessarily appreciate seeing the whole picture.

Yes.

If you take a stretchy headband and wrap it around your hand and your thumb, then go into your present try to find something -- for me it is very important to try to put myself in the kids shoes. It is so enlightening when you can put yourself in their shoes. Try them.

Anyone have any other thoughts about touch or movement X

We're going to bring it all together. Here comes.

When we think about sensory channels we talked about how to assess each individual sense. I think we want to find out a primary way that a child gains information. Which sense is the primary way that they gain information? The learning media assessment is a tool used by teachers of the visually impaired to identify what best access points are for kids. What kind of materials they're going to read. The kinds of distances they are going to access. It is a wonderful tool. I especially like within the tool the sensory channels assessment. Basically, what the assessment is is to provide yourself the opportunity over five visits to sit down and watch children. Watch children and see what they do with materials. You will write down the material that the child is interacting with or the media that the child is interacting with and what they do with it. The first thing they did.

If you had child something and the first thing you do it is putting amount their mouth -- that could be a touch since. It is their most important assets or taste and smell.

If the first thing the tiled does is put their eyes on it, then we know that vision is the most important channel for them. If they run their hands over, we know that touch is important. If they bring it up and put it to their nose, we know that perhaps smell is important to their understanding. The first way of interacting with the material.

If they banging on the table or she could hear their inner it is more likely that it is their auditory sense that is giving them the most information.

I want to find out the primary access method. The first sense that they use when they try to gain information. That is important. Then I want to know some of the secondary sense is that they are using to. They put it in their mouth and then bring into their eyes. I will say that putting it in the mouth might be their sense of touch but vision is the secondary way. Vision is the way that they support more understanding of what they know. So, I am getting very channels and secondary channels and I am also finding out what they don't use at all. All of this information is very important.

I about the cartoon -- it is called the blind man an elephant. It is basically six men with visual impairment standing about an elephant. One of the legs says oh, and elephant is like a tree. The one touching the nose said no, and elephant is like a snake.

The one touching the tusks says no, it is like a spear. It is limited experience. This can give one idea. We need a capital idea. That is really what using your senses effectively and building and the weak areas and supporting the strong areas and really getting kids full ideas about their learning materials which is very, very important.

I wanted to talk a bit about self body play. People call this self stimulatory behavior. I see self body play as a child's way of stimulating your brain. Children don't do something [indiscernible]. The brain likes patches. The brain likes predictability. The brain likes stimulation. That is what body play is all about. Taking a look at a child self body play tells a lot about the sensory channels. If I have a child yelling all the time, perhaps their best way to access the world is to the auditory piece. That's their play that they want to do.

And five a child who always wants to be something, maybe it is their auditory sense that is their primary. We want to take a look at self body play is a puzzle. Build on that self body play and move it away from the non-purposeful into a more purposeful use.

Bringing it all together -- using all the senses is very important but using them together is really the only way that we get those meaningful constructs -- the solid idea and understanding. I really encourage you when you are working with kids to think all about all of the other sensory channels that kids are learning to do some assessment and take a look at their best senses and weaker senses and work on all of them. Capitalize on all of it. As with these children. I want to thank you so much for coming in today. And for thinking about compensatory skills -- an essential consideration.

Thank you so much, Ellen. There are still quite a number of people on the line. If you have questions, enter them in the Q&A. It's a lot to think about. As we work through each of the senses to get an idea of what it is you can look for and learn from as you observed children and the students were working with. Ellen, I wonder if I could ask you a question about CTVI. Do you see these sensory skills -- other than vision -- developing or used differently from children that have ocular impairment?

No, I would say that it is used in a similar way. Lack of vision creates other ways of accessing the world. It depends on the severity. People will turn to their sense of touch. Okay.

The part of your brain is but they always say that children with visual impairment -- other parts of their brain -- this is partially true -- the brain connections get much stronger because the senses are being used for greater degree.

Thanks. That is interesting. Sometimes particularly in working with kids with CPI we might concentrate on that skill and we might lose sight of some of the ideas that you raised about CVI other senses to tap into or help them. I wanted a presentation last summer about some of those techniques that you can use. Sons that she mentioned today -- the redhead dancer from a hand to help the child will find their hand. Connect meeting with the color that they responded to.

Mary says you are awesome. We second that emotion.

Where can people see you next, Ellen ?

What do I wanted to plug X -- plug?

That is a department of education CVI class this summer on. Three of them. University of Massachusetts. You can check into those. I am an e-learning junkie.

All of them.

[laughter] There is an assistant technology once it is fabulous -- we are doing is like crazy. It is great.

That was I unsolicited testimony. Thank you for that. It was unsolicited. Let me also say a couple of other things about the month of June. Will not have a webinar in June. We will close out this year's program and start to plan for next year. We will take them about. Is a great opportunity for those of you have not been able to catch up on some of the webinars you've missed in 2013 or 2014 as we get ready for the next session which will be in July. We will address those tactile books presented by the teaching staff here at the Perkins program -- talking about using tactile books of the curriculum and particularly as literacy lessons. There are no questions. I will wrap up. I want to apologize for those that had to do with it but I wanted to acknowledge that there were some conflicting information about the start time. But the difference and think you for those that waited. Our thanks as always to my partner who is but -- Phuong CVI Please give the webinar again please

It is to the Massachusetts Department of education. Special development Institute. It will be July 26 and 27th -- Saturday and Sunday -- then the first week in August -- Saturday and Sunday. Online modules. [indiscernible] in [indiscernible] to the Department of Education. You can take it for the graduate credits. Thank you. Thanks again for asking about that, Roxanne. I was in my closing stash but this is probably [last name indiscernible]. Look for a follow-up e-mail tomorrow with a link to the recorded webinar and also we had other the presentation. The presentation slides that you saw today. Enjoy the rest of your year. Happy Memorial Day weekend. We will see you in July. Thank you.

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