It is very important that we strive for independence for children with visual impairment. Family and friends tend to feel sorry for them and do everything for them. This not only deprives them of becoming independent human beings but also has a negative influence on their self-image.
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.
Orientation and mobility
Children with visual impairment have serious delays in mobility. Often, they skip crawling and only start walking independently when they are three years old. They then have a shuffling gait with a very wide base as they cannot see the continuation of the floor and is scared to lift their feet. They are also scared of bumping into things and hurting themselves. They often have low motor tone because their proximal muscle groups are not being developed as they should because of lack of exercise.
These babies should therefore be encouraged to move as much as possible.
They need to be prepared for formal mobility and orientation training. The following are some ideas that can be used:
- Start with activities that will help them to lose their fear of movement such as using kick bikes, swings, see saws, being pushed around in cardboard boxes, allowed them to push things around.
- While doing the above verbalise what you are doing by giving it a name such as you are going backwards, forwards, up, down, over, under, left, right, etc.
- Always leave furniture in the same spot so that children have a sense of orientation without fear of bumping into things. Do not leave things lying on the floor.
- Do not leave doors half open. They must either be closed or totally open to prevent children from walking into them.
- Play ‘Hide and seek’ with the children. Move a few steps away and call them with three second intervals. Stay in the same spot until they find you. Then make a big fuss about how clever they are. Then move away and repeat.
- Do not hold the children’s hands when walking but let them hold onto your fingers.
- Explain to them where you are walking, on grass, paving, inside, outside, in the sun or the shade of trees, etc.
- Try to let them walk with bare feet as much as possible to enhance the tactile sensation of the surfaces on which they are walking. It will also help to orientate them, e.g., grass is outside, and carpets are inside.
- Let them push a wheel or toy in front of them. This will prevent them from bumping into objects or walls and will also warn them that there are steps ahead.
- Let them sit at a staircase and familiarise themselves with the height of the steps.
- Initially let the children crawl up the steps forwards and down the steps backwards.
- Tell them how many steps there are and then count them with them as they ascend or descend.
- Name each item of the food as it is eaten.
- With time the child will be able to recognise the food by its smell.
- Do not mix food. Each item of food should be tasted separately.
- Introduce new food by first allowing the child to smell and touch it.
- Be patient and remember that all children make a mess when they start eating by themselves.
Eating with hands
- Initially babies should be allowed to eat with their hands.
- Start by placing something, like a biscuit, in their hands and guide their hands to their mouths.
- Once they can do this, let them hold the dish with one hand, so that they can know where the dish is, and eat with the other hand.
- Cut the food, such as an apple, or a banana, a slice of bread or a Vienna sausage, etc. into small bite size pieces and encourage eating by themselves.
- See to it that a handful is not grabbed and stuffed into the mouth to prevent gagging.
- Start with small amounts.
Eating with a spoon
- Before introducing a spoon let the baby become familiar with a spoon by playing with it and verbalise about what the spoon looks like and for what it is used. Do this while the child is sitting in the usual feeding place so to associate the spoon with eating.
- Start by using a plate or dish with high edges.
- Use a non-slip area to put the plate or dish on.
- The child must still be encouraged to hold the dish or plate with one hand to know where it is.
- Start with food that will not fall off the spoon, like yoghurt or mashed potatoes.
- See to it that the spoon is held correctly.
- Sit behind the child and guide them through the action, verbalising all the time:
- Hold the spoon
- Move it to the plate
- Put food on the spoon
- Bring it to the mouth
- As the child masters the process withdraw support gradually.
- Praise and encourage the child throughout.
Eating with a fork
- In the beginning the child will use the dominant hand to eat with a fork.
- Start with a small fork, allow the child to feel the shape of the fork and guide them in the use of the fork.
- Sit behind the child and guide them through the process of sticking the fork into something and then bringing it up to the mouth. Again, use food that can be cut up in bite size.
See to it that the whole of the fork is not put into the mouth to start with.
In the beginning the other hand can be used to help to get the food onto the prongs of the fork.
Also see to it that that no item too big, such as a meat ball or a whole potato, is pushed into the mouth in one bite. Once this skill is mastered the child can start eating with both a knife and a fork.
Now the knife goes into the dominant hand and the fork in the non-dominant hand.
Start using a knife
- Introduce the child to a knife. Let them feel the knife and become familiar with the shape and the function of a knife.
- Guide the child to use a knife by cutting clay, dough, bananas and bread.
- Spread butter on bread using hand as a guide. Spread the butter from one side, next to the fingers, to the other side of the bread.
Eating with a knife and fork
- The child should sit upright, but slightly bent forward over the plate.
- Show the child how to hold the knife and the fork, guiding with your own hands.
- Teach the child how to find the cutting edge of the knife by listening to the sound of the serrated edge against the edge of the plate.
- Feel for the food with the fork.
- The knife must be used to scrape the food onto the fork.
- Sit behind the child and help with eating. With your hands move the child’s hands through the actions down to the food and back again until the actions become known and independent.
Drinking out of a cup or mug
- Allow the child to feel the empty cup.
- Put some water in the cup and allow the child to feel the level of the water.
- Place the cup on the table and allow the child to look for the cup by feeling carefully for it on the surface of the table.
- Put your hands over those of the child and lift the cup gently until the liquid touches their lips.
- Do this a few times and then let the child do it independently.
Dressing and undressing
To assist children with visual impairment with independence in dressing and undressing, the choice of their clothes is important. The clothes should be loose fitting and fasteners should be of a kind that are easily manageable. Before you embark on this process, allow the child to become familiar with actions like the opening and closing of buttons, zippers, Velcro fasteners and the tying of shoelaces.
It is also necessary to do this at an age-appropriate time.
In this article there are many practical tips for teaching a child with a visual impairment, and even those with additional issues, to dress independently.