CREATING MIILESTONE SKILLS FOR A VISUALLY IMPAIRED INFANT

The following suggestions may help VI teacher/Low Vision Resource Person in getting started for intervention.Some of the major milestone skills have been addressed here. Do consult with the VI teacher/Resource person for expanded suggestions. Include parents experience and knowledge to contribute.   How to achieve head control: Provide several short periods daily of supervised prone position. While the infant is on his/her stomach, gently lift the child's head with one hand under the chin and the other behind the head; stroke the back of the neck, and talk in soothing tones to the infant; withdraw manual support gradually, as the infant is able to lift his/her head independently. Continue brief periods of prone position, to allow practice of head lifting. As head control increases, provide trunk support with a rolled towel under the child's chest; begin positioning child's forearms under his/her upper torso, providing support and preparation for independent lifting of head, neck, and chest.   How to achieve "reach": Securely suspend objects with interesting and varied sounds and/or textures within arm's reach of infant, so that accidental "swipes" will make contact with them. Guide the infant's hands toward the objects if necessary, to let him/her know they are there. To help encourage hand use: Encourage mid-line hand use by placing the child's hands on the bottle; play "patty cake"; play with baby's hands at midline. When facing baby, place his/her hands on caregiver's face and talk to him/her. Put sticky-tape on the child's fingers; he/she will try to get it off. (This is a supervised activity only; never leave a child with anything that can be put into the mouth and swallowed.) Place tactually interesting objects in the child's hands for exploration and manipulation. If the child has any useful vision, objects should be high contrast (black and white) for the first few months; colors are not as interesting until about 3-5 mos. and then red, yellow, orange are the most appealing.    To encourage rolling over: From stomach to back: (about 3-4 mos.) When child is on hi0wr stomach, tuck his/her bent arm under his/her chest and assist with roll-over; praise and practice daily. From back to stomach: (about 5-6 mos.) When child is on his/her back, extend one of his/her arms up, next to his/her head; gently roll baby's head over this arm (towards the floor) while lifting the same-side leg, with the knee bent and crossing over the other leg; gently press knee to floor and hip should follow; roll baby over to stomach; praise; practice daily. Note: Check with the Physical Therapist before doing these exercises if the child has orthopedic impairments.   Encourage independent sitting: From about 3 mos., prop infant with pillows in the comer of a chair, couch, infant seat, or crib - for only a few minutes at a time; infant should not be totally vertical until head control is achieved and back muscles are mature; a backwards leaning is preferable at first. Around 6 mos. (if torso and head control are present), place child in a sitting position between adults legs (child's back to adult's stomach); gently place child's hands, palms down, in front of him/her, to provide independent support; praise, and practice daily; as balance improves, place toys in front of the baby, between his/her legs, and encourage him/her to play with the toys; provide cushions or pillows for support until baby can sit without them (may take several months).   To encourage standing: Around 10- 11 mos., put baby in a standing position next to a couch or heavy overstuffed chair; put toys on the chair or couch, within reach; encourage the child to play with the toys while standing (leaning on the couch or chair); limit time to only a few minutes at first, extending time as the child is able; child may need assistance in sitting down; practice daily.   To encourage walking: Around 11- 12 mos. , place child in standing position, next to a couch or low table; place toys just out of reach, to the left or right of the child; encourage him/her to "side-step" to attain the toys; practice daily. Place child in a standing position, with back against the wall; offer a hand or finger to the child, for support; keep physical assistance minimal, and remove gradually as the child gains in confidence. A small chair, cardboard box, or walker (to push) might be used as practice supports; some toddler push toys (e.g., shopping cart, lawnmower, wagon) can also be used as "bumpers" for toddlers who are blind or have low vision.   Building language: TALK (constantly) to the visually impaired infant and toddler; describe what you're doing (and what he/she is doing) and how (whether the child understands or not; intonation and syntax may be imitated later); repeat sounds the baby initiates. A radio or TV is not the same as the caregiver's direct situational conversation. Do not use a radio or TV to provide meaningful sounds for the VI child. Name things and actions (e.g., "This is a spoon."). If the child is blind, put objects into his/her hands as you name them Let the child explore the objects before taking them away. Give the child time to absorb what is being said; it may take many repetitions for meaning to be attached to labels. As expressive language begins to emerge ("talking" begins), make extra effort to associate labels and objects; let the child manipulate as many things as possible, and encourage him/her to name them. Meaningful language requires direct experience for visually impaired children; it is critical because it will be the basis of formal reasoning later. Remember that it is difficult to learn while someone is talking. A VI child may stop an activity to listen; allow quiet time' occasionally, when thinking & problem solving can take place.   Encouraging social interaction: For infants and toddlers who are blind, or who have low vision, it is important to provide extra tactual and - auditory contact (nuzzling, cuddling, conversation); hands-on social contact must be substituted for eye contact and facial expressions. Social behaviors that are normally observed visually and imitated (e.g., waving bye-bye, shaking head "yes" or "no," shaking hands) must be physically demonstrated to the visually impaired child.   Building cognitive ability: Build meaningful language, both receptive and expressive. Language will be the medium of learning later - the means to manipulate ideas, and to "think" - so be sure every word the child learns has meaning to him/her. Make extra effort to answer questions, not so much with words as with demonstrations ("Let me show you.") Many visually impaired children do not know how to ask questions, because the situation or conditions they would ask about are based on visual observation. The caregiver must try to anticipate what the child may not understand, and "show him/her." If you can't bring the world to the child, take the child to the world. Insofar as possible, provide participatory experiences. The visually impaired child should not just hear about the world; he/she must interact with it. Pay special attention to cause-effect situations; demonstrate, or provide hands-on involvement. Every time there is a "What happens when " situation, remember that the visually impaired child does not see "what happens when" and must learn the result first-hand. Talk about sequences. As you prepare dinner, describe what you are doing (e.g., "First we have to get the pan out, then we put water in it; now we can put the potatoes in the pan."). There are many sequential events daily (e.g., getting ready for bed, taking a bath, getting dressed); watch for them, and talk about them. Sequence will be important later, as events are organized in a story, a chapter, or an outline. Don't be too quick to solve a problem for your child; sometimes, give the child time to figure out a solution for him/herself. (Waiting for the child to devise solutions to problems can be frustrating for the caregiver, but it is essential if independence is to be encouraged.) Something as simple as how to get around an obstacle in his/her path can provide a problem solving experience for a child. He/she will have many occasions to use this skill later, and the earlier it is learned and practiced, the better it will be when needed. Enjoy your child. Play games with him/her. Beginning with very simple hiding games (even "peek - a - boo"), progressing to guessing games ("What Am I" and then giving clues), and on to memory games ("What did we do when...?") . Encourage the child's brain to work, and the earlier the better!

MAJOR CAUSES OF VISUAL IMPAIRMENT IN INFANTS AND TODDLERS

There are many possible defects or diseases of the visual system , but, fortunately, many of them appear after the first few years of life. There are still many defects, diseases, infections, disorders and malformations that can affect the visual system in infants and toddlers. Only a few of the many visual disorders found in young children is described below:   Cataracts: defined as a clouding of the lens of the eye; can be congenital, caused by trauma, or associated with disease; when caused by maternal rubella, cataracts are not removed early, and acuity never develops well; if not caused by rubella, cataracts are surgically removed soon after birth (usually within the first two months), to allow the retina to be stimulated by light within the first 6-8 weeks of life; good acuity is possible if cataracts are removed early enough.    Glaucoma- (infantile): (also known as "buphthalmos") intraocular pressure build-up caused by an imbalance between the rate of production of the aqueous fluid and the rate of normal drainage; must be treated medically (often surgically).  Cortical Visual Impairment (CVI): apparent lack of or reduction in vision when eyes appear to be normal; cause of the visual reduction is in the visual cortex of the brain; there is no nystagmus; special intervention techniques are indicated (contact VI teacher). Infections: many types, with a variety of symptoms; most common involve the conjunctiva (thin layer of tissue lining the eyelids and connected to top layer of sclera); require medical treatment (usually medication); other systemic infections (toxoplasmosis, herpes, cytomegalovirus) can also involve the visual system. Malformations: many types; most common are clefts in the iris, dislocated lens, and syndrome-related abnormalities; may have prenatal causes Ocular-muscle problems: most common is strabismus (one or both eyes out of alignment); can be outward, inward, upward, or downward, depending on which muscle(s) are affected; must be evaluated medically, for possible surgical treatment; if noticed after 6 months of age, child should be seen by an eye specialist; treatment can be before the child is a year old; every year of delay past age two lessens the chances for good prognosis in acuity; can cause loss of or diminished acuity in one eye (amblyopia) if not treated. Nystagmus is another ocular-muscle anomaly; manifested by involuntary eye movements, usually noted as "jerky" or "jumpy" eye movement; occasionally occurs alone but most often accompanies other eye conditions; there is no cure; acuity may be reduced, but visual function may improve with age. Ocular trauma: occurs when the eyeball is hit, lacerated, or punctured; always requires medical evaluation and treatment. Optic nerve defects: Optic atrophy occurs when, for a number of possible reasons, the optic nerve does not function properly; may result in inconsistent visual functioning; often causes reduced acuity; there are usually no outward indicators - the eyes appear normal ; glasses will not improve acuity; must be medically diagnosed; the phrase pale optic disk(s) suggests the possibility of optic atrophy. Optic nerve hypoplasia (ONH) differs from optic atrophy; in ONH, the optic nerve has regressed in development (usually during the prenatal period, and usually caused by a prenatal insult to the neurological system); must be medically diagnose; may have accompanying brain malformation and/or endocrine problems; there is no treatment, and glasses will not help. Septo-optic dysplasia seem to be an extreme form of ONH. Refractive errors: (nearsightedness, farsightedness, astigmatism) These are the only defects glasses will help, but, since the infant eye is still developing (and clear acuity is still poor), they are usually not identified as problems in the early months. If present to a marked degree after about 12 months, they may require a prescription for glasses but most toddlers will not need corrective lenses. If acuity seems to be reduced (not within normal ranges) after about age 2, medical evaluation is recommended. In the case of premature infants, an eye specialist should monitor vision periodically from birth. Retinoblastoma: a tumor behind the eye which, if left untreated, can be both blinding and life-threatening; medical treatment (chemotherapy and/or enucleation) is essential, usually before age 2. Retinopathy of Prematurity (ROP) : (formerly called retrolental fibroplasia, or RLF) a condition found primarily (but not exclusively) among premature infants; despite the suspected role of oxygen in this disease, prematurity seems to be the major factor; identified medically; cryotherapy appears to halt the progression of the disease; visual function can range from near normal acuity to total blindness, depending on the stage of the disease; about a fourth of children with ROP have severe visual impairment; many of these children are also myopic (nearsighted). NORMAL DEVELOPMENT Normal Development Age Body Control Hand Use Language Social Behavior I month Primitive reflexes Fists 2 months Lifts chin when on stomach Smiles Socially 3 months Lifts chest when on stomach Hands open; begins to reach by "swiping" Coos: cries 4 months "Swimming" movements when on stomach Midline play Laughs 5 months Rolls stomach to back 6 months Full head control when in prone position; in sitting position, props self with hands in front; rolls back to stomach Plays with feet; transfers object hand to hand; palmar grasp. Babbling Looks for lost toy stretches arm to be picked up; responds to mirror image 7 months Bounces when standing; Sits alone. Can bring food or Toy to mouth. Imitates sounds. Responds to name. 8 months Raking grasp. Says "Ma-ma." Understands "no." 9 months Crawling Index finger can poke & probe. 10 months Stands with help. Claps; voluntary release. Can play "Pat-a-cake" and wave bye-bye. 11months "Cruises." Pincer grasp. 12 months First steps. Throws object. Two-three words. 15 months Can build a tower with blocks; makes marks with a crayon. Follows one-step commands 18 months Runs "stiffly;" jumps. Scribbles; turns pages Has 10-20 real words; Can identify (point to) body parts Can follow two-step commands-, parallel play 24 months Walks up and Down steps. Imitates lines. Has about a 300 word Plays with peers. Vocabulary. 36 months Can run; can peddle a tricycle. Tums pages, one at A time; can use Scissors to snip." Can use about 1000 words, but understands About twice that many Understands "taking turns."

MONITORING VISUAL DEVELOPMENT "FROM BIRTH TO THREE YEARS OF AGE"

In the early months of life, the visual system is still maturing; it is not fully developed at birth (and is even less developed in the premature infant). From birth to maturity, the eye increases to three times its size at birth, and most of this growth is complete by age 3; one third of the eye's growth in diameter is in the first year of life. Some knowledge of normal visual development is necessary if abnormalities are to be noted. The following information gives indicators of normal visual development in young children from birth to three years. In a premature infant: (depending on the extent of prematurity) The eyelids may not have fully separated; the iris may not constrict or dilate; the aqueous drainage system may not be fully functional; the choroid may lack pigment; retinal blood vessel's may be immature; optic nerve fibers may not be myelinized; there may still be a Pupillary membrane and/or a hyaloid system. Functional implications: lack of ability to control light entering the eye; visual system is not ready to function. . At birth: The irises of Caucasian infants may have a gray or bluish appearance; natural color develops as pigment forms. The eyes' pupils are not able to dilate fully yet. The curvature of the lens is nearly spherical. The retina (especially the macula) is not fully developed. The infant is moderately farsighted and has some degree of astigmatism. Functional implications: The newborn has poor fixation ability, a very limited ability to discriminate color, limited visual fields, and an estimated visual acuity of somewhere between 20/200 and 20/400. By 1 month: The infant can follow a slowly moving black and white target intermittently to midline; he/she will blink at a light flash, may also intermittently follow faces (usually with the eyes and head both moving together). Acuity is still poor (in the 20/200 to 20/400 range), and ocular movements may often be uncoordinated. There is a preference for black and white designs, especially checkerboards and designs with angles. By 2 months: Brief fixation occurs sporadically, although ocular movements may still be uncoordinated; there may be attention to objects up to 6' away. The infant may follow vertical movements better than horizontal , and is beginning to be aware of colors (primarily red and yellow). There is probably still a preference for black and white designs. By 3 months: Ocular movements are coordinated most of the time; attraction is to both black and white and colored (yellow and red) targets. The infant is capable of glancing at smaller targets (as small as 1"), and is interested in faces; visual attention and visual searching begins. The infant begins to associate visual stimuli and an event (e.g., the bottle and feeding). By 4 months: "Hand regard" occurs at about 15 weeks; there is marked interest in the infant's own hands. He/she is beginning to shift gaze, and reacts (usually smiles) to familiar faces. He/she is able to follow a visual target the size of a finger puppet past midline, and can track horizontally, vertically, and in a circle. Visual acuity may be in the 20/200 to 20/300 range. By 5 months: The infant is able to look at (visually examine) an object in his/her own hands; ocular movement although still uncoordinated at times, is smoother. The infant is visually aware of the environment ("explores" visually), and can shift gaze from near to far easily; he/she can "study" objects visually at near point, and can converge the eyes to do so; can fixate at 3'. Eye-hand coordination (reach) is usually achieved by now. By 6 months: Acuity is 20/200 or better, but eye movements are coordinated and smooth; vision can be used efficiently at both near point and distance. The child recognizes and differentiates faces at 6', and can reach for and grasp a visual target. Hand movements are monitored visually; has visually directed reach." May be interested in watching falling objects, and usually fixates on where the object disappears. Between 6 and 9 months: Acuity improves rapidly (to near normal); "explores" visually (examines objects in hands visually, and watches what is going on around him/her). Can transfer objects from hand to hand, and may be interested in geometric patterns. Between 9 months and a year: The child can visually spot a small (2-3mm) object nearby; watches faces and tries to imitate expressions; searches for hidden objects after observing the "hiding;" visually alert to new people, objects, surroundings; can differentiate between known and unfamiliar people; vision motivates and monitors movement towards a desired object. By 1 year: Both near and distant acuities are good (in the 20/50 range); there may be some mild farsightedness, but there is ability to focus, accommodate (shift between far and near vision tasks), and the child has depth perception; he/she can discriminate between simple geometric forms (circle, triangle, square), scribbles with a crayon, and is visually interested in pictures. Vision lures the child into the environment. Can track across a 180 degree arc. By 2 years: Myelinization of the optic nerve is completed. There is vertical (upright) orientation; all optical skills are smooth and well coordinated. Acuity is 20/20 to 20/30 (normal). The child can imitate movements, can match same objects by single properties (color, shape), arid can point to specific pictures in a book. By 3 years: Retinal tissue is mature. The child can complete a simple formboard correctly (based on visual memory), can do simple puzzles, can draw a crude circle, and can put 1" pegs into holes.

Farsighted engineer invents bionic eye to help the blind

For UCLA bioengineering professor Wentai Liu, more than two decades of visionary research burst into the headlines last month when the FDA approved what it called “the first bionic eye for the blind.”

The Argus II Retinal Prosthesis System — developed by a team of physicians and engineers from around the country — aids adults who have lost their eyesight due to retinitis pigmentosa (RP), age-related macular degeneration or other eye diseases that destroy the retina’s light-sensitive photoreceptors.

At the heart of the device is a tiny yet powerful computer chip developed by Liu that, when implanted in the retina, effectively sidesteps the damaged photoreceptors to “trick” the eye into seeing. The Argus II operates with a miniature video camera mounted on a pair of eyeglasses that sends information about images it detects to a microprocessor worn on the user’s waistband. The microprocessor wirelessly transmits electronic signals to the computer chip, a fingernail-size grid made up of 60 circuits. These chips stimulate the retina’s nerve cells with electronic impulses which head up the optic nerve to the brain’s visual cortex. There, the brain assembles them into a composite image.

Recipients of the retinal implant can read oversized letters of the alphabet, discern objects and movement, and even see the outlines and some details of faces. And while the picture is far from perfect — the healthy human eye sees at a much higher resolution — it’s a breakthrough for people like the first patient, a man in his 70s who was blinded at age 20 by RP, to receive the implant in clinical trials. “It was the first time he’d seen light in a half-century,” said Liu, adding that “it feels good as the engineer” to have helped make this possible.

Liu joined the Artificial Retina Project in 1988 as a professor of computer and electrical engineering at North Carolina State University. The multidisciplinary research project was funded by the U.S. Department of Energy’s Office of Science because it envisioned a potential pandemic of eyesight loss in America’s aging population. Leading the project was Duke University ophthalmologist and neurosurgeon Dr. Mark Humayun, now on faculty at USC. He tapped Liu to engineer the artificial retina.

“I thought it was a great idea,” Liu said. “But I asked, ‘What can I do?’ because I didn’t know much about biology.” Humayun handed him a six-inch-thick medical manual on the retina. “The learning curve was very steep,” Liu recalled with a laugh.

However, Liu’s fellow engineers questioned his sanity. “I was working on integrated chip design and had just gotten tenure when I signed on to this project. They said, ‘You’re crazy!’ But I’m glad I made that choice, getting into this new field.”

Free Eye Camp "10 March 2013" - POS PUNJAB

Highlights of the free eye camp held on 10 march 2013 by Pakistan Optometric Society. A Total number of 273 patients screened and dispensed medicines. 127 refractions performed, Free of cost spectacles were provided. A number of 39 cataracts booked and refereed for IOL Implantations. 

Optometrists: Aamer Niazi, Lubna Iram, Miss Sadia.

Camp Review in pictures :-