Manual on the Management of Children with Visual Impairment

i

CARE OF CHILDREN WITH SPECIAL NEEDS

Manual on theManagement

ofChildren with Visual Impairment

By

Family Health Development Division Ministry of Health, Malaysia

September 2003

MOH / K / ASA / 35.03 (G.U.)

ii

Family Health Development Division, Ministry of Health, 2003

iii

PREFACE

iv

CONTENT

Introduction

Visual Developmental Milestones

Basic Eye Examination

Stimulation Activities

Specific Stimulation Activities

Material Needed For Eye Assessment And Stimulation

References

Acknowledgement & Contributors

1. INTRODUCTION

1.1 Definition Of Visual Impairment

1.2 Action To Be Taken By Public Health Nurse

3

1. INTRODUCTION

4

1.1. Definition of Visual Impairment

Visual Impairment

Low Vision

Blindness

ORooo

5

1.2. Action To Be Taken By Public Health Nurse

oooooo

2. VISUAL DEVELOPMENTAL MILESTONES

2.1 Warning Sign of Visual Impairment

9

2. VISUAL DEVELOPMENTAL MILESTONES

Note : Give children up to 8 weeks allowance to achieve target milestone

Age (Months) Normal Behaviour

10

2.1. Warning Signs Of Visual Impairment

2.1.1. Appearance

2.1.2. Behavior

2.1.3. Complaint

3. BASIC EYE EXAMINATION

3.1 History 3.2 General Examination 3.3 Eye Examination

3.4 Technique on Eye Assesssment

3.5 Indication for Referral to Ophtalmologist

3.6 Visual Assessment Record

13

3. BASIC EYE EXAMINATION

3.1. History

oo

o

3.2. General Examination

3.3. Eye Examination

GeneralObservation Normal Abnormal

14

Examination using

torchlight

Normal Abnormal

15

3.4. Technique On Eye Assessment By Age Group

AGE : NEWBORN TO 1 MONTH

FIXATION TO LIGHT

FACE REGARD

Technique Observation Illustrations

16

FIXATION TO HIGH CONTRAST OBJECT

REFER IF

AGE : 2 - 3 MONTHS

For other age group from 2 – 3 months onwards



17

FACE REGARD

FIXATION AND TRACKING

REFER IF

Observation Illustrations Technique

18

AGE : 4-6 MONTHS

FACE REGARD


EYE AND HAND COORDINATION Hands regard

REFER IF

Observation Illustrations Technique

19

AGE: 7-9 MONTHS


GROSS EYE AND HAND COORDINATION

FINE EYE AND HAND COORDINATION

REFER IF


20

AGE: 10-12 MONTHS


FINE EYE AND HAND COORDINATION

HUNDREDS AND THPUDSANDS TEST

Note:

REFER IF


21

AGE: 1-2 YEARS


MATCHING OBJECTS For Distance:

For Near:

.

Note:

correct size


22

IMITATE MOVEMENT

REFER IF

MATCHING OBJECTS (DISTANCE) Do not change the size of the pictures

Technique Illustrations Observation

23

AGE: 3-5 YEARS


FINE MOTOR AND VISUAL PERCEPTUAL SKILL

SHERIDEN GARDINER TEST

Visual Acuity Measurement

Illustration ObservationTechnique

24


Note:

SNELLEN E CHART TEST

Note

REFER IF

25

3.5. INDICATIONS FOR REFERRAL TO AN OPHTHALMOLOGIST

Recommended Age Method Indications for Referral to an Ophthalmologist

72

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egA

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tcejbognikcarT/

ecaFdrageR

sdnaHdrageR

& eyE ssorG dnaH

noitanidrooC

& eyE eniF dnaH

noitanidrooc

pu gnikciP & sderdnuH‘

‘ sdnasuohT

& rotom eniF lausiv

lliks noitpecrep

V lausi ytiuqA

nadirehS(/renidraG nellenS

)trahC

ytivitcA

62

4. STIMULATION ACTIVITIES

4.1 Introduction to Stimulation Activities

4.2 Check List for Stimulation Activities

29

STIMULATION ACTIVITIES

4.1 Introduction

i. Ensure safety of the home environment

ii. Use and Maximise The Other Senses in the Management of Child with Visual Impairment.

A child with visual impairment must be taught to use his other senses of touch, hearing, smell and taste to learn about the world around him. Some of the ways he can be taught to do this are as follows:-

ii.

30

Touch:

Hearing:

Smell:

Taste:

This is safe as long as the object is clean and

big enough so it cannot be swallowed.

31

4.2. Checklist For Stimulation Activities

Ages No. Activities Assessment Stimulation Pages

Remarks

Yes

Areas of stimulation

Full PartialNo

32


Remarks

Yes


Full PartialNo

33


Remarks

Yes


Full PartialNo

34


Remarks

Yes


Full PartialNo

35


Remarks

Yes


Full PartialNo

36


Remarks

Yes


Full PartialNo

37


Remarks

Yes


Full PartialNo

38


Remarks

Yes


Full PartialNo

5. SPECIFIC STIMULATION ACTIVITIES


41

AGE 0 < 3 MONTHS

A. MOBILIZATION AND ORIENTATION


42

AGE 0 < 3 MONTHS


* Start the activities when baby is more then 2 ½ months old

RIGHT TO THE LEFT

LEFT HAND TO THE RIGHT


43

AGE 0 < 3 MONTHS


1) PRONE POSITION*

2) CARRIED OVER THE SHOULDER

*These activities can be done when baby is more than 2 months. *Get advice from health staffs


44

AGE 0 < 3 MONTHS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING DEVELOPMENT


45

AGE 0 < 3 MONTHS



46

AGE 3 < 6 MONTHS


UP…

DOWN


47

AGE 3 < 6 MONTHS


* Get advice from health staffs.

RIGHT HAND TO THE LEFT

RIGHT TO THE LEFT


48

AGE 3 < 6 MONTHS



49

AGE 3 < 6 MONTHS



50

AGE 3 < 6 MONTHS



51

AGE 3 < 6 MONTHS



52

AGE 3 < 6 MONTHS



53

AGE 6 < 9 MONTHS A. MOBILISATION AND ORIENTATION


54



55



56

AGE 6 < 9 MONTHS



57

AGE 6 < 9 MONTHS



58

AGE 6 < 9 MONTHS



59

AGE 6 < 9 MONTHS



60

AGE 6 < 9 MONTHS



61

AGE 6 < 9 MONTHS


* Introduce one person at a time so that he can recognize the voice with the person.


62

AGE 6 < 9 MONTHS



63

AGE 6 < 9 MONTHS



64

AGE 6 < 9 MONTHS



65

AGE 6 < 9 MONTHS



66

AGE 9 < 12 MONTHS

A. MOBILISATION AND ORIENTATION


67

AGE 9 < 12 MONTHS



68

AGE 9 < 12 MONTHS



69

AGE 9 < 12 MONTHS



70

AGE 9 < 12 MONTHS



71

AGE 9 < 12 MONTHS



72

AGE 9 < 12 MONTHS



73

AGE 9 < 12 MONTHS



74

AGE 9 < 12 MONTHS


SIT DOWN

DO IT! DO IT!

75


AGE 1 < 2 YEARS


* Make sure there is no obstacles blocking.

RIGHT LEFT RIGHT LEFT

PUSH FORWARD FORWARD,FORWARD

76


AGE 1 < 2 YEARS


Caution:

* Don’t do this activity on slippery surface

* While walking encourage child to hold one hand up in front of forehead to avoid knocking into objects at eye level

* Explain surroundings toavoid accident

77


AGE 1 < 2 YEARS


JUMP UP AND DOWN….. JUMP UP AND DOWN…..

78


AGE 1 < 2 YEARS


“KICK THE BALL WITH YOUR RIGHT FOOT…..”

“KICK THE BALL WITH YOUR RIGHT FOOT…..”

79


AGE 1 < 2 YEARS


80


AGE 1 < 2 YEARS


STEP DOWN.. STEP DOWN,,

81


AGE 1 < 2 YEARS


82


AGE 1 < 2 YEARS


83


AGE 1 < 2 YEARS


84


AGE 1 < 2 YEARS


85


AGE 1 < 2 YEARS


86


AGE 1 < 2 YEARS


87


AGE 1 < 2 YEARS


88


AGE 1 < 2 YEARS


89


AGE 1 < 2 YEARS


* Introduce one word at the time.

headhead

90


AGE 1 < 2 YEARS



91

AGE 2 < 3 YEARS A. MOBILISATION AND ORIENTATION


92



93



94


*This activity must be strictly supervised by an adult at all time.


95

AGE 2 - 3 YEARS



96

AGE 2 - 3 YEARS


1)

2)

3)

Refer to Rehabilitation equipment:- Buku ADL - Mari-Mari mengenal Bentuk


97

AGE 2 - 3 YEARS



98

AGE 2 - 3 YEARS


Brushing teeth


99

AGE 2 - 3 YEARS


Hand washing and wiping face


100

AGE 2 - 3 YEARS



101

AGE 2 - 3 YEARS



102

AGE 2 - 3 YEARS


EAT RICE


103

AGE 2 - 3 YEARS



104

AGE 2 - 3 YEARS


*Rememberencourage him to use all his other senses.


105



106



107



108



109



110

AGE 3 < 4 YEARS



111

AGE 3 < 4 YEARS



112

AGE 3 < 4 YEARS



113

AGE 3 < 4 YEARS



114

AGE 3 < 4 YEARS



115

AGE 3 < 4 YEARS



116

AGE 3 < 4 YEARS



117

AGE 3 < 4 YEARS


* Do not shift the basket


118

AGE 3 < 4 YEARS



119

AGE 3 < 4 YEARS


* Play and sing the alphabets in rhythm


120



121

AGE 4 < 5 YEARS


Thisactivity is for low vision children)

Refer Rehabilitation Equipment : - The colour book


122

AGE 4 < 5 YEARS


For buttons:

Repeat the same procedure for press studs, hooks and eyes.

Refer Rehabilitation Equipment : - ‘Buku A.D.L.’


123

AGE 4 < 5 YEARS



124

AGE 4 < 5 YEARS


brushing his teeth.

Bathing.

Dressing and grooming


125

AGE 4 < 5 YEARS


Examples:

NOT

Examples:


126

AGE 4 < 5 YEARS


Examples:

Introduce one taste at a time*Give different types of food of the same taste


127

AGE 4 < 5 YEARS


*This can be done anywhere and at anytime


128



129



130


Walking stick is available at Malaysian Association For The Blind* Adjust the length of walking according to child’s height


131

AGE 5 < 6 YEARS



132

AGE 5 < 6 YEARS



133

AGE 5 < 6 YEARS


Refer Rehabilitation Equipment : - Buku A.D.L. for tying shoelace and velcro


134

AGE 5 < 6 YEARS



135

AGE 5 < 6 YEARS



136

AGE 5 < 6 YEARS



137

AGE 5 < 6 YEARS


*You can mark the clock with ‘raised’ beads

3 beads to mark 12

2 beads to mark 3,6,9

1 bead to mark 1,2,4,5,7,8,10,11

Refer Rehabilitation Equipment - Clock


138

AGE 5 < 6 YEARS


* Expose the child to the environment e.g heat of the sun during day


139

AGE 5 < 6 YEARS


Refer to Rehabilitationequipment – Tactile Book


140

AGE 5 < 6 YEARS


RehabilitationEquipment “Mari Mengira”

Refer to Special Education

6. MATERIALS NEEDED FOR EYE ASSESSMENT AND STIMULATION

143

6. MATERIALS NEEDED FOR EYE ASSESSMENT AND STIMULATION

INSTRUMENTS REQUIRED FOR EYE EXAMINATION

SUGGESTED TOYS FOR REHABILITATION PROGRAM

Characteristic of toys

Example of ToysJustification

144

Characteristic of toys

Justification Example of Toys

7. REFERENCES & CONTRIBUTORS

147

REFERENCES

Best,

Albert & Jacobiec

Constable & Lim

Fichtner

Freeman

Huber, M.J.E. & Reacher, M.H.

Illingworth, R.

Rajalawski

Sonken, P. & Stiff, B

Thylerors, B.

Werner, D.

Anderson, D.R

8. ACKNOWLEDGEMENT/ CONTRIBUTORS

151

List of Contributors

Opthalmologist, Hospital Ipoh, Perak

Opthalmologist, Hospital Selayang

Opthalmologist, Hospital Kuala Terengganu

Consultant Paediatrician, Hospital Kuala Lumpur

Family Health Medical Officer, State Health Department, Perak

Opthalmologist, Hospital Kuala Lumpur

Family Medicine Specialist, Klinik Kesihatan Telok Datuk

Optometrist, Hospital Kuala Lumpur

Optometrist, Hospital Selayang

Optometrist, NGO

Occupational Therapist, U.S.M. Kelantan

Occupational Therapist, Hospital Ipoh

Grafik Artist Hospital Seremban

Grafik Artist, Hospital Alor Star,

Public Health Matron, State Health Department Ipoh

Public Health Matron, Family Health Development Division, Ministry Of Health

Public Health Nurse, Health Clinic Gopeng

Public Health Nurse, M.C.H.C Batu Gajah

Public Health Nurse, Health Clinis Chemor

Public Health Nurse, Health Clinic Ulu Dedap

Public Health Nurse, M.C.H.C Batu Gajah



152

Special Education Teacher Early Intervention Program, Malaysian Association for the Blind, Kuala Lumpur

St. Nicholas School, Penang

St. Nicholas School, Penang.

Editors

Principal Assistant Director, Family Health Development Division, Ministry of Health

Public Health Sister, Family Health Development Division, Ministry of Health

Senior Medical Assistant, Family Health Development Division, Ministry of Health

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Manual on the Management of Children with Visual Impairment

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