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Welcome to TSBVI Outreach. TETN # 30910 Visually Impaired Students with Vestibular Issues Presented by Kate Hurst and Jim Durkel TSBVI Outreach [email protected] [email protected] With Special Guest David Brown California Deaf-Blind Services. Workshops and Conferences. - PowerPoint PPT Presentation
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TETN # 30910 Visually Impaired Students with Vestibular Issues
Presented by Kate Hurst and Jim Durkel
TSBVI [email protected]@tsbvi.edu With Special Guest
David BrownCalifornia Deaf-Blind Services
Workshops and ConferencesWorkshops and Conferences June 5-7 Appropriate Communication
Assessment for Babies with Deafblindness HAS BEEN CANCELED
June 25-26 ECI Conference @ Embassy Suites in San Marcos
June 26-27 5th Annual Statewide Texas Parent to Parent Conference@ Omni Austin Hotel at Southpark in Austin
Roll CallRoll Call
How many How many participating?participating?
Remote sites?Remote sites? Taping or Taping or
streaming?streaming?
Visually Impaired Students with Vestibular Issues
Presented byKate Hurst, Statewide Staff Development Coordinator, TSBVI Outreach with Jim Durkel, Audiologist/Speech-Language Pathologist and APH, VI Registry, & Deafblind Census Coordinator, TSBVI Outreach andDavid Brown, Education Consultant, California Deaf-Blind Services
Our Special Guest . . .
David Brown Formerly of SENSE,
UK Currently with
California Deaf-Blind Services
World-traveler Funny guy
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
(
http://www.vestibular.org/vestibular-disorders/specific-disorders/pediatric-vest.-disorders.php)
Causes Pediatric Vestibular Disorders
Head/neck trauma Chronic ear infections Maternal drug/alcohol abuse CMV Immune-deficiency disorders Meningitis Migraine Metabolic disorders (e.g., diabetes) Ototoxic drugs
Causes Pediatric Vestibular Disorders
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
Some data . . .
VI Registry - 84 or 14%
CP - .3% CHARGE - 7.7% CMV - 2.7% Hydrocephaly - 1% Meningitis - .5% Shaken Baby - .5% Usher 1 - 1.7%
Deafblind Census - 147 or 19.9%
CHARGE - 9.7% CMV - 4.8% Hydrocephaly - 1.9% Usher 1 - 1.2%
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.
Moving Platform Posturography
QuickTime™ and a decompressor
are needed to see this picture.
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.”
From Jane AyersSensory Integration and the Child
“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 Jane AyersSensory Integration and the 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.’”
From Carol Stock KranowitzThe Out-of-Sync Child
“Gravitational insecurity is manifested by abnormal distress and anxiety in reaction to falling or the possibility of falling. It is a primal fear.”
From Carol Stock KranowitzThe Out-of-Sync Child
“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 IssuesDavid Brown, California Deaf-Blind Services
o “The Vestibular Sense”, DbI Review, June, 2007
o “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
Various testing deviceshttp://www.tchain.com/otoneurology/testing/engrot.html
QuickTime™ and a decompressor
are needed to see this picture.QuickTime™ and a
decompressorare needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
What do we do?
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
What do we do?
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
What do we do?
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. http://www.sfsu.edu/~cadbs/Spring03.pdf
To Learn More . . . 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.
To Learn More . . . 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.
To Learn More . . . Vestibular Disorders Association www.vestibular.org Brain and Spine Foundation - Dizziness and balance
problems http://www.brainandspine.org.uk/information/publications/brain_and_spine_booklets/dizziness_and_balance_problems/how_does_the.html
Tutis Vilis - SenseWeb http://www.physpharm.fmd.uwo.ca/undergrad/sensesweb/L10Balance/L10Balance.swf