ASSESSMENT OF LOW VISION FOR EDUCATIONAL PURPOSES AND EARLY INTERVENTION

Foreword

Assessment of Low Vision in children has two main purposes: 1. to give basic information on functional vision for selection of teaching techniques or 2. to help in planning of early intervention.

Assessment of Functional Vision is usually needed for decision whether the infant or child is eligible for early intervention, special services or special education. In most countries these services are limited to children who are at least moderately visually impaired. In some countries the child needs to be severely visually impaired or 'legally blind'.

Since there is no internationally accepted classification of visual impairment in infants and children, many countries use classifications originally developed for workman's compensation. Users of these classifications do not seem to realise that vision cannot be assessed in young children as it is assessed in adult people and that the role of vision in the life of an infant and child is different from the role of vision in an adult person who loses vision.

Classification of visual impairment and disability has interested me ever since the first low vision clinic was opened in Helsinki in 1976 and I have written review articles on vision impairment in general since 1985 and on visual impairment in children during the last few years. The text on classification included here was a paper presended at the ICEVI European Conference in Cracow, July 9-13, 2000.

I will appreciate comments and suggestions on the question of eligibility. As I said after my keynote speech at the VISION99 in New York, the present strict adherence to 'legal blindness' when deciding on services leads to a situation where there are many 'illegally' blind children waiting for services that they need and deserve.

Functional Assessment is divided in three parts: Part I covers usual measurement techniques of visual functions. The text was written in Addis Ababa for the participants of the course in low vision as a summary of my lectures. It is written for special educators and teachers who have a visually impaired child in their classroom and therapists who take care of visually impaired children. After reading this basic information and after having seen the slides in the introductory lecture, it will be possible to assess functional vision of visually impaired children who do not have other handicaps complicating the use of vision.

Part II covers vision impairment in children with other impairments in hearing, motor functions or intellectual development. There is also a chapter on brain damage related vision impairment affecting higher visual functions.

Part III covers vision impairment in infants and in children who after a disease or accident fall back on early developmental levels. This part of the contents will grow in near future more than the other parts because the area is under rapid development.

Part III also contains discussion on "The Untestable Child". Even if testing techniques have developed and we have specific tests for each age group, some children are and will be difficult to test. However, we should be able to make the decisions on early intervention and special education even in these cases.

Early intervention is often understood to mean (re)habilitation during the first year. Although a great majority of visual impairments occur before, during or soon after birth, there are also later disorders, infections, tumours, traumas, near drowning, inherited diseases etc. that cause an impairment in a child who may have seen normally or nearly normally during the first year. In that case, early intervention means supportive therapies and education started at the time of preliminary diagnosis, during treatment and continued after confirmation of the diagnosis. As during the first year, early intervention should be a part of diagnostic work and care at all ages of childhood.

When I started in vision rehabilitation in mid-70s, the concept 'early intervention' meant starting supportive measures at the age of three (3) years, before that age it consisted of parental counseling. There are still several countries where the children in age group 0-3 years are not given special education, a few countries where special education starts when the child comes to school at 5-7 years of age. In developing countries not all visually impaired children are given special education.

To reiterate, early intervention means all the therapies and special education needed to help a child to enhance use of vision and to develop compensatory techniques in areas where visual information needs to be supported.

CONTENTS

PART I
Assessment of low vision in otherwise healthy children

PART II
Assessment of low vision in children with other handicaps

PART III
Assessment of vision during the first year and in children who remain at an early developmental level

9. Introduction

10. Causes of visual impairment/disability

11. Effect of visual impairment on the parents of the visually impaired infants

12. Typical features and assessment of vision development in visually impaired infants

0-3 months

4-6 months

Lighboxes in assessment and training/stimulation
Binocularity, strabismus, visual orientation in space
'Blindisms', stereotype behaviours
Compensatory modalities

7-12 months

Cognitive vision impairment

13. Children who become visually impaired and severely multihandicapped before school age

14. The Untestable Child