VISUAL IMPAIRMENT AND LEGAL IMPAIRMENT

Severe visual impairment or legal blindness is defined as visual acuity in both eyes of less than 20/200 or
a visual field of less than 20 percent despite the best correction with glasses. A partially sighted
individual has visual acuity of 20/70 to 20/200 with correction. Blindness can be an isolated disability or
associated with another multiple handicapping condition such as cerebral palsy or mental retardation.

(a) Incidence of blindness in children is 0.4/1000; with 46 percent of this group born blind and 38
percent losing their sight prior to age one (American Humane Association, 1991).

(l) Approximately 25 percent are totally blind.
(2) Approximately 25 percent have some light perception.
(3) Approximately 50 percent have enough vision to read enlarged type.

(b) Causes of blindness in children are numerous:
(1) Prenatal viral infection and eye malformations are the most common congenital causes.
(2) Trauma, infection, tumors, and retinopathy or prematurity are also causal factors.

(c) Developmental differences are seen in blind children even when blindness is an isolated finding
and intelligence is normal.

(1) Infants display abnormalities in eye movement - random, jerky movements, neither
focusing on nor following objects. Baby does not blink or cry to a threatening gesture. Pupils do not
constrict when light is shone in the eyes.

(2) Muscle tone is floppy and gross motor skills are delayed. Most blind children do not
crawl. Sitting may not occur until after eighth month. Walking may not occur until two years to two
and one-half years.

(3) Speech and language development is delayed, but usually normal by school age.

(4) Unusual behaviors may be seen e.g. rocking, eye gouging, light gazing and head banging.
Behaviors can be controlled with behavior modification techniques. Behaviors decrease by age four
in normal intelligence children, but often persist in deaf- blind and mentally retarded-blind children.

(d) Outcome may be very positive depending on intellectual functioning and absence of other
disabilities. Technical or vocational training is generally available in the public school secondary
curriculum. Students with at least average intelligence should be encouraged to pursue college and a
professional career.

(e) Early treatment involves extra stimulation through the infant's primary means of exploring, e.g.
touch and sound. Parents need to do lots of explaining and describing,not become overly discouraged
by slow motor development, avoid overprotection and provide lots of touching and physical
affection.

(t) By school age the child may need to learn to read braille or use large-type materials. Supplemental
aids such as a volunteer reader, talking computer adaptations, opticons, and computerized operation
of appliances may also be beneficial.
(g) Mobility training needs will vary with the type and degree of visual impairments. Walking aids
such as seeing eye dog, cane, or sonar-guided obstacle device may be used to promote independence.














































HEARING IMPAIRMENT

Hearing impairment occurs when some part of the hearing apparatus malfunction with resulting
hearing loss and possible impairment or loss of the ability to speak.

(a) There are three types of hearing loss:
(l) Conductive - resulting from damage to external or middle ear.
(2) Sensorineural - results from malfunctioning of the cochlea or auditory nerve.
(3) Mixed - resulting from both sensorineural and conductive problems:

(b) Hearing loss is also categorized by severity.

(l) Mild hearing impairment means a child can hear sounds that are 15 to 45 decibels.
(2) Moderate hearing loss means a child can hear sounds if they are at least 45 to 70
decibels.
(3) Severe hearing loss means that sounds must register at least 70 to 90 decibels to be
heard.
(4) Profound hearing loss means that sounds must be at least 90 decibels to be heard.

(c) Hearing losses may be bilateral, involving both ears, or unilateral, present in one ear. Less than 20
percent of hearing losses are unilateral.

(d) Causes ofhearing loss in children include middle ear infections, other infections, cleft palace,
Down's syndrome, genetic or chromosomal abnormalities, and noise pollution. In approximately half
the cases, cause can not be determined.

(e) Communicative functioning varies as a factor of the degree of hearing loss.

(1) Mild hearing impairment: speech and conversational skills are normal, difficulty hearing
distant sounds.
(2) Moderate hearing loss: ability to speak clearly is affected. (articulation), ability to hear
conversation is significantly limited.
(3) Severe hearing loss: child cannot participate in spoken conversation, but may catch an
occasional word. Hearing aids are most often useful with this group.
(4) Profound hearing loss: child may react to very loud sounds, but hearing ability not useful
for communication. Hearing aid may help. Usually not able to speak/articulate normally.

(f) Long-term outcome is determined by factors which include severity of loss, and presence or
absence of other disabilities.

(l) Children with conductive losses often grow-up to attend college, have professional
careers, communicate verbally, and understand speech with help of a hearing aid.
(2) Children with moderate-to-severe sensorineural losses rarely speak unless the loss occurs
after child has already attained speech, e.g.after age three. Communication and language-based
reasoning are negatively affected. Deaf children may do well in mathematics and science, but even
children with above average intelligence, reading skills rarely exceed sixth grade level by high school
graduation.

(g) Treatment approaches are designed to improve hearing and speech language skills to the
maximum extent possible for each child.
(l) Hearing aids amplify sound to increase the range of sound a child can hear from 10 to 80
decibels. Ear level aids are more commonly used than more bulky body level aids.
(2) Preferential seating in the front row of the classroom facilitates lip reading from the
teacher.
(3) Oral and manual communication techniques are available and decision as to which to
emphasize is mostly made on the basis of the child's potential to develop understandable speech.
Decision is often controversial.











































CEREBRAL PALSY

Cerebral palsy refers to various disorders ofmovement and posture that are due to damage/
abnormality ofthe immature brain. This condition occurs before the child's brain has fully matured
(about 16 years) and it is not progressive. This disability does not have a cure.

(a) Cerebral palsy may be classified into three groups.

(l) Pyramidal or spastic cerebral palsy involves increased muscle tone which gives
way abruptly. Abrupt changes in muscle tone interfere with initiating normal movement. In spastic
diplegia the legs are more affected than the arms. In paraplegia, only the legs are affected. In spastic
hemiplegia, one side ofthe body is more affected than the other. In spastic quadriplegia, all four limbs
are spastic and the torso is involved. Seizure and visual or auditory problems are usually seen.

(2) Extrapyramidal cerebral palsy is most commonly choreoathetoid type and
involves problems controlling movement and maintaining posture because ofabrupt involuntary
movement ofthe arms and legs. Muscle tone is sometimes rigid and sometimes floppy. Facial
muscles are affected, leading to problems with feeding and speech. Fluctuating muscle tone leads to
instability and difficulty with sitting and walking.

(3) Mixed-type cerebral palsy involves elements of the two forms described above.
This type often involves extensive brain damage and is thus usually associated with other
developmental disabilities such as mental retardation.

(b) There are many causes of cerebral palsy. In 60 percent of cases, there is an identifiable
cause, but in 40 percent of children no cause is identified. Known causes include the following:
complications during labor, delivery and the neonatal period, chromosomal abnormalities, exposure
to radiation or harmful drugs during the first trimester of pregnancy, meningitis, head trauma, and
lead intoxication.

(c) Newborns in the following high fisk groups are more likely than other infants to have
cerebral palsy: premature babies, twins, small for gestational age babies.

(d) Developmental and behavioral differences are often seen early.

(l) Infants with cerebral palsy may experience excessive sleep, irritability, poor suck, weak
cry, poor alertness to environment, floppy resting position or arched, extended position in bed.

(2) During the first year, intellectual development may be normal, but motor development is
not.
(3) Primitive reflexes persist and interfere with normal movement and posture, e.g. walking,
sitting, etc.

(e) Many children with cerebral palsy also have other disabilities.

(1) Mental retardation is seen in approximately 60 percent of individuals with cerebral palsy;
most commonly with spastic quadriplegia, extrapyramidal and mixed-type.

(2) Normal intelligence is found in most children with hemiplegia and
some with spastic diplegia.

(3) Visual problems are commonly seen: retinopathy of prematurity, inability to see out of
one part of visual field, visual-perceptual interferences to academic learning, strabismus, or squint.
Incidence is approximately 40 percent.

(4) Hearing, speech, and language occur in approximately 20 percent of these children:
hearing loss, articulation problems, language disorders, and difficulty with tongue and vocal cord
movement.

(5) Seizure disorders develop in approximately 30 percent of affected children.

(6) Emotional and behavioral disorders are common. Hyperactivity and self-injurious
behaviors as well as psychosocial adjustment problems for the child and family may develop.
Adolescents with normal intelligence have a particularly difficult time.