Independence Training of the Visually Impaired Child

1. Orientation and mobility 1

2. Eating 2

a) General principles 2

b) Eating with hands 2

c) Eating with a spoon 3

d) Eating with a fork 3

e) Start using a knife 3

f) Eating with a knife and fork 3

3. Drinking out of a cup or mug 4

4. Dressing and undressing 4

a) Practical skills needed 4

Press on fasteners 4

Buttons and buttonholes 4

Zippers 4

b) Prerequisite skills needed 4

c) General principle 4

d) Undressing 5

Shoes: 5

Socks: 5

Trousers: 5

T- Shirt: 5

Shirt or jacket that opens in front: 5

Shoes: 5

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.

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

A child with visual impairment has 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 re. Kick bikes, swings, see saws, pushing them around in cardboard boxes, allowing them to push things around.
  • While doing the above verbalise what you are doing by giving it a name, backwards, forwards, up, down, over, under, left, right, etc.
  • Always leave furniture in the same spot so that the child can orientate himself 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 the child from walking into them.
  • Play ‘Hide and seek’ with the child. Move a few steps away and call them with 3 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 child’s hand when walking but let them hold on to 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 him, 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 the child sit at a staircase and familiarise themselves with the height of the steps.
  • Initially let the child 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.


General principles

  • The child should be told what he is eating. Name the food as it is given to him.
  • With time he will be able to recognise the food by its smell.
  • Do not mix food. Let him taste each kind of food separately.
  • Introduce knew 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 the baby should be allowed to eat with his hands.
  • Start by placing something, like a biscuit, in his hand and guide his hand to his mouth.
  • Once he can do this let him hold the dish with his one hand, so that he 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 the baby to eat by himself.
  • See to it that he does not grab a handful and stuff it into his mouth
  • Never leave the child alone while eating in case he gags.
  • Start with small amounts

Eating with a spoon

  • Before introducing a spoon let the baby become familiar with a spoon. Let him play with it and verbalise about what the spoon looks like and for what it is used. Do this while the child is sitting in his usual place where he is fed so that he can 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.
  • Child must still be encouraged to hold the dish or plate with one hand so that he knows where it is.
  • Start with food that will not fall off the spoon, like yoghurt or mashed potatoes.
  • See to it that the child holds the spoon correctly.
  • Sit behind the child and motor him 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
    • Repeat
  • As the child masters the process withdraw support gradually.
  • Praise and encourage the child throughout.

Eating with a fork

In the beginning the child uses his dominant hand to eat with a fork.

  • Start with a small fork, allow the child to feel the shape of the fork and guide his hands to use the fork.
  • Sit behind the child and motor him through the process of sticking the fork into something and then bringing it to his mouth. Again use food that can be cut up in bite sizes.
  • See to it that he does not put the whole of the fork into his mouth to start with.
  • In the beginning he can use his other hand to help to get the food onto the prongs of the fork.
  • Also see to it that he does not eat food off the fork, like a frikkadel or a whole potato

Once this skill was mastered the child can start eating with a knife and 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 him/her 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

  • Sit upright, but slightly bent forward over the plate.
  • Show the child how to hold the knife and the fork, guiding him/her 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 him to eat. Motor the child through the actions and backward chain as he starts getting it until he can do so independently.

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 for it on the surface of the table.
  • Put your hands over that of the child and lift the cup gently until the liquid touches his 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 is 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.

Practical skills needed

Press on fasteners

  • Initially practice with click blocks like Lego or Duplo block. Let the child feel both sides of press on fastener, e.g. on a duvet cover and match the two.
  • Begin with bigger and move to smaller fasteners.

Buttons and buttonholes

  • Practice – cut a hole in the lid of a shoe box. Push button through from one side and use the other hand to take it at the bottom.
  • Do the same with material and a button.
  • Start with a big button and gradually go smaller.


  • Start with a smaller item like a purse.
  • Children love the sound of the zipper and can unzip their lunch boxes.
  • Teach them to feel that both sides of the zipper are free of obstruction before they pull it up or down.
  • Attach a piece of string of thin metal through the eye of the zip to make it easier to grip.

Prerequisite skills needed

  • Motor and cognitive ability needed.
  • Must know body parts.
  • Must be able to distinguish left and right.
  • Must know the names of the clothing.
  • Must understand spatial concepts such as top, underneath, back, through, inside, outside.

General principle

  • Support initially. Child places his hand on yours and lead him/her through all the steps, while you are sitting behind him.
  • Show how to identify inside and outside of clothes.
  • Put a mark in the back of the clothes, always in the same spot so that the child can know how to turn the clothes to have the right side in front.
  • Always follow the same procedure for dressing and undressing.
  • Clothes must always be stored in the same place.
  • Describe every action as you proceed: e.g. Place your foot in the opening of the shoe.
  • Start with a T-shirt without buttons. Start with pants without zips and buttons.
  • Reward the child after successful session.
  • Initial support by helping later by encouragement.
  • Start with dressing and undressing in summer when it is warm.


Shoes: this is usually the first piece of clothing a child can remove

  • Support by sitting behind the child and motoring him/her through the step. Place one hand on the heel and the other on the toe of the shoe.
  • Let him do the next shoe independently.


  • Initially remove nearly the whole sock and allow the child to complete the action.
  • Start with a big sock and later use a more tight-fitting sock. Socks must be placed in the shoe.


  • Allow the child to feel the trousers. Speak about the trousers. Say this part is for the legs and where your feet go in and come out. Count how many legs there are and how many legs you have got.
  • Strat by using a tracksuit pants with no buttons of zips but with an elastic waistband and which is loose fitting.
  • Pull the pants down to the ankles, allow the child to sit and then help the child to remove it completely. He must not have shoes on while doing this.

T- Shirt:

  • To start help to remove one arm from a sleeve and then help the child to remove the other arm and then pull it over the head.

Shirt or jacket that opens in front:

  • Help the child to get the first arm out. By pulling the garment at the cuff with the opposite hand until the arm in the sleeve can bend and the hand be brought forward.
  • Now use opposite hand to pull garment of the shoulder.
  • Shake the body that the garment falls loose and then pull the garment off the other arm with the opposite arm.


  • Start with shoes with no fasteners. Encourage parents to buy shoes with Velcro fasteners.
  • Let the child become familiar with the shape of the shoe and his foot. Let him understand that the toe of the shoe is where his toes are going to be.
  • Mark the one shoe that the child can know which is right and which is left.
  • Let the child sit on the floor. See to it that the shoe is properly opened so that the foot can go in with ease.
  • Guide the child to put in his foot and feel with his fingers that the foot is properly in. He can even stand up and stamp his foot to allow the foot to slip in properly.