TETN #30910
Visually Impaired Students with Vestibular Issues
Presented by
Kate Hurst, Statewide Staff Development Coordinator, TSBVI Outreach
with
Jim Durkel, Audiologist/Speech-Language Pathologist and APH, VI Registry, & Deafblind Census Coordinator, TSBVI Outreach
and
David Brown, Education Consultant,
California Deaf-Blind Services
A note to our participants:
There are a number of websites and articles you may wish to review prior to the TETN broadcast.
Facilitators my wish to bookmark some of the websites, especially the Vestibular Disorders Association link and the Tutis Vilis websites for participants to explore.
Please feel free to interrupt our presenters to ask questions or make comments. We know that many of you have first-hand experiences that will enrich our discussion. Also, if you have questions in advance of our presentation (after you review the materials in this handout), please feel free to email them to prior to 10 AM on the morning of the broadcast. We will do our best to address these during the broadcast.
How do we achieve balance?
Three separate components make up “Equilibrium Triad”
Input from the eyes (vision)
Input form the muscles and joints (proprioception)
Input from the vestibular organs (balance)
A Good Place to Start
Pediatric Resource - Vestibular Disorders Association
(
Causes Pediatric Vestibular Disorders
Head/neck trauma
Chronic ear infections
Maternal drug/alcohol abuse
CMV
Immune-deficiency disorders
Meningitis
Metabolic disorders (e.g., diabetes)
Ototoxic drugs
Neurological disorders (CP, Hydrocephelus)
Genetic syndromes (e.g., Wallenberg, Usher, CHARGE)
Posterior brain tumor
Family history of hearing loss/vestibular issues
Cochlear implants
Lack of use - movement issues, fear, ill health
So how does the vestibular system work?
Vestibular organs
Located in the bony chambers of the skull in the inner ear
3 semi-circular canals positioned in different planes for rotational movements
Otoliths (Utricle and Saccule) for linear accelerations
Semicircular Canals
Bulge at base of canals - ampulla
Ampulla contain sensory receptors for each canal
Canals filled with endolymphatic fluid and surrounded by perilymphatic fluid
Detect heads rotation
Demonstration on The Physiology of the Senses Transformations for Perception and Action, Tutis Vilis, University of Western Ontario, Canada
Otolith Organs
Utricle
Saccule
Demonstration on SenseWeb
Vision and Balance
Vestibular Occular Reflex
Normal head rotation: eyes move in opposite direction of head to stabilize retinal image (VOR)
Conflicting sensory information from visual and vestibular senses is a problem
The cerebellum repairs “slippage”
Demonstration
What Part Does Proprioception Play?
Sensation experienced by muscle and joint receptors
Requires a normal range of muscle tone to work properly
Feeds information to the brain that allows for awareness of where body parts are in space, movement, speed and direction of movement
A Redundancy for Balance
Brain and Spine Foundation Online
When one of the three parts of the Equilibrium Triade do not work or work well, the other two can compensate.
From Jean Ayers
Sensory Integration and the Child
“The vestibular system is the unifying system. It forms the basic relationship of a person to gravity and the physical world. All other types of sensation are processed in reference to this basic vestibular information.”
“The activity in the vestibular system provides a “framework” for the other aspects of our experience. Vestibular input seems to “prime” the entire nervous system.”
From Carol Stock Kranowitz
The Out-of-Sync Child
“When the vestibular system does not function in a consistent and accurate way, the interpretation of other sensations will be inconsistent and inaccurate, and the nervous system will have trouble ‘getting started.’”
“Gravitational insecurity is manifested by abnormal distress and anxiety in reaction to falling or the possibility of falling. It is a primal fear.”
“Indeed, our need to know where we are in relation to the earth is more compelling than our need for food, for tactile comfort, or even for a mother-child bond.”
References on Vestibular Issues
David Brown, California Deaf-Blind Services
“The Vestibular Sense”, DbI Review, June, 2007
“Educational and Behavioral Implications of Missing Balance Sense in CHARGE Sydrome”, reSources, Spring 2003.
Effects of vestibular problems
Organization of ALL sensory information
Postural security/muscle tone
Use of residual vision
Perception/processing sound
Remembering auditory sequencing
Memory development
Speech/Language development
Behavioral challenges
Bilateral coordination
Breathing, feeding, digestion, nutrition
Sociability
What do we do?
ASSESS
Vestibular Dysfunction Checklist in Out-of-Sync Child
Sensory Learning Kit
Vestibular assessment by Audiologist
OT/PT Evaluation
Sensory Integration Evaluation
TEAM
With OT knowledgeable about SI to develop menu of interventions
To plan flexible schedule related to fatigue and need for breaks
To select / train staff to respect individual differences in behavior, performance, pacing
With family to gain insight to home challenges, child preferences and for support
MODIFY
Seating to address postural concerns
Positioning for visual and auditory tasks
Materials and learning environment (isolate lines of text, reduce distractions)
Activities to incorporate SI approaches
Pacing
Schedule (general / day-to-day)
Staffing patterns
RESPECT
Student challenges in learning
Family struggle to address challenges / knowledge of the child
Staff challenges to adapt programming and the expertise each has to offer
To Learn More . . .
Brown, David, 2007. “The Vestibular Sense”, pp. 17-22. Dbl Review, January-June 2007, Deaf-Blind International.
Brown, David, 2003. “Educational and Behavioral Implications of Missing Balance Sense in CHARGE Syndrome”, pp. 1-4. re:Sources, Spring, 2003. California Deaf-Blind Services, San Francisco, CA.
Brown, David, 2008. “The Sensory Integration Perspective and What It Offers Us in the Field of Deafblindness”, pp. 22-26. DbI Review, July-December, 2008. Deaf-Blind International.
Brown, David, 2008. “The Forgotten Sense - Proprioception”, pp. 20-24. DbI Review, July-December, 2006. Deaf-Blind International.
Kranowitz, Carol Stock, 1998. The Out-of-Sync Child. The Berkley Publishing Group, 375 Hudson Street, New York, NY 10014.
Kranowitz, Carol Stock, 2003. The Out-of-Sync Child Has Fun. The Berkley Publishing Group, 375 Hudson Street, New York, NY 10014.
Vestibular Disorders Association
Brain and Spine Foundation - Dizziness and balance problems
Tutis Vilis - SenseWeb
Texas School for the Blind & Visually Impaired
1100 West 45th Street
Austin, Texas 78756
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TSBVI TETN#30910 – Visually Impaired Students with Vestibular Issues
Moss, Durkel, & Brown