Physical and Sensory Development

The Absence of Sight

The primary stimulus for a baby to move, vision, is absent when a baby is visually impaired, with the result that these babies tend to be passive. Visual impairment, therefore, has a negative impact on gross motor development as the early stages of learning and movement is visually dominated.

Moving Around

Babies start moving because they see things. They then try to get to it, to touch it and learn about it. Babies with visual impairment cannot see objects around them and will therefore not try to go towards it.

Not being able to see thus has an impact on the baby’s movement and also on his/her learning. In the early stages of a baby’s development the ability to see is very important.

Moving around also helps with the development of balance and coordination. The baby may even have problems with the correct positioning of their body when trying to do things as they cannot see how other people do things. This may be the reason that the visually impaired child finds it difficult to learn more complex movements and will start walking and running later than the child that can see.

I1=year child walking behind small chair for balance

Gross Motor Development

Vision is the driving force behind early gross motor development.

Age	Sighted baby	Visually impaired baby
0-3 mths	At this age babies do not have enough control of their limbs for purposeful movement. They can see, turn and lift their heads to explore the world around them and can follow the movements of others around them. As babies gets older they start swiping at objects that they can see. This helps with the development of the arm and shoulder muscles. The sighted baby makes sounds and interacts with caregivers that encourage them to pick the baby up and play with them.	The baby with visual impairment does not have the stimulus to look around and this leads to a delay in the development of head control. The baby with visual impairment cannot see the toys hanging in the pram or cot. They may, by accident, connect with something but the action will not be repeated as the visual input that will help them to make sense of this movement, is not there. The development of strength and control of the arms and shoulders therefore does not happen. The baby with visual impairment often is a very passive baby and only demands interaction when hungry or uncomfortable. This delays opportunities for motor experiences even further as the caregiver does not pick them up or plays with them.
3-8 mths	At this age babies with vision explore their body, play with their toes and with toys and gain more control over his anti-gravity muscles. This lays down the building blocks for control of posture and co-ordination.	Babies with visual impairment now becomes more passive. They do not receive meaningful feedback from the environment and the baby does not reach out into the unknown world. The building blocks for the development of gross motor activities are therefore further delayed.
8-13 mths	At this age, a baby starts to move around. They manage to sit by themselves and pull themselves up against furniture. They start to crawl or shift along, and by the end of the first year the baby starts to walk.	The child with visual impairment now loses out even more. They only start sitting by the end of their first year. VI babies often skip crawling. Some of them now barely manage to stand up against furniture.
13-24 mths	Walking soon becomes the primary means of moving around. In the second year of life babies start to run, jump and climb. This involves balancing and the building up of muscle strength. Babies can also use their hands to carry things, push and pull objects and handle objects.	Babies with visual impairment tend to shuffle their feet along the floor. They do not lift and step forward in the usual way of walking. They are scared to lift their feet from the floor. This is probably because they do not see where they are going.

For the child who can see, the ability to move around opens up the world. As they go along they learn about the world around them. This has a dramatic impact on overall development. They develop new skills on all levels of development, fine motor, perceptual, psychological, intellectual and sensory ability .

For the visual impairment baby these opportunities are limited. Goal directed movements are absent and the development of the strength and control of the upper limbs are negatively affected. These children tend to develop low muscle tone, because of lack of movement.

Object permanence, the fact that things exist even if you do not see or touch them, have not yet been established.

Sensory Development – The sense of touch and the other senses, hearing, tasting and smelling

Sensory Integration

Your senses tell you about the world around you. Humans have five senses, the eye for seeing, the ear for hearing, the nose for smelling, the tongue for tasting and the skin for feeling. Of these the eyes are the most important in early life.

In life one hears or smells something, but it is only when you look that you really know what it is and how you must react to it. For example you can smell smoke, hear the crackling of the fire and feel the heat. You now know it is fire, all your senses worked together, but it is only when you look that you can decide what you must do (adaptive responds). Should you put it out, or is it safe?

Touch

Touch is a very important sense for the visually impaired child. They need to discover the world through their hands. Unfortunately, they often become intolerant to touch. People tend to put things in their hands without explaining or they force them to touch something. This scares the child and he will pull back his hands or throw the object away. This is a natural response to protect him/herself. This is called tactile defensiveness.

Balance

There are other systems in the body which are necessary for a person to be able to balance and make coordinated movements such as walking. These abilities only develop with movement. The visual impairment child does not move around enough, therefore these abilities do not develop appropriately.

Body Awareness and Posture

A person is able to say where his body parts are, e.g. my left hand is behind my back. This happens because your brain gets messages from your joints and muscles. This ability is called proprioception. The development of proprioception also depends on movement.

The information you get from the movement of your body, arms and legs, helps with your posture, muscle tone and balance.

Babies with visual impairment does not have the stimulus to move around. They do not know what the world around them looks like and are careful to move as they may come up against something that can be dangerous. Caregivers tend to leave them where they are as it is safe, which further limits visually impaired babies and deprive them of experiences offered by movement. Body schema, the knowledge of your body parts and where they are, develops through proprioception and this is gained from active movement.

Motor Planning

Motor Planning is the ability a person has to plan and perform a movement. Children learn through copying others. They see how others do things and then try it themselves. Without vision this is impossible. In order to teach children with visual impairment they need to be taken through a new movement pattern, like eating or even riding a bike, to learn it.

These articles are all indicated in the Home Program, but for quick reference here they are listed:

1. This article describes how you can play with your baby during the different development stages , preparing them for later sports and recreation.
2. This article gives many more ideas to teach your child to play with toys.
3. This is another article about playing including treasure basket & sensory box.
4. More Activities for little ones.

1. This booklet shows inexpensive ideas for creating educational toys and activities for children with a visual impairment.

Adult laughing with blind children playing with the tail of a zebra skin

Independence training of the visually impaired child

It is very important that we strive for independence for the child with visual impairment. Family and friends tend to feel sorry for the child with visual impairment and do everything for him. This not only deprives him of becoming an independent human being but also has a negative influence on his self-image.

Young boy helping with the laundry, closing the washing machine door

We should spend as much time as possible on the development of independence especially in activities of daily living (ADL). These include mobility and orientation, eating, dressing and hygiene.

Refer back to the Home Program and the articles below for further guidance.

Helper behind child holding dominant hand with spoon, child’s other hand on bowl, which stands on non-slip mat

on bowl, which stands on non-slip mat

Read more in this Activities of Daily Living guideline.

Here are also ideas for teaching VI children about location

Here are some tips for toilet training your VI toddler.

• This article has many tips about dressing, also children with multiple disabilities.