ERIC EJ1137409: Effective Collaboration between Physical Therapists and Teachers of Students with Visual Impairments Who Are Working with Students with Multiple Disabilities and Visual Impairments PDF
Preview ERIC EJ1137409: Effective Collaboration between Physical Therapists and Teachers of Students with Visual Impairments Who Are Working with Students with Multiple Disabilities and Visual Impairments
Effective Collaboration Between Physical Therapists and Teachers of Students with Visual Impairments Who Are Working with Students with Multiple Disabilities and Visual Impairments EricaM.Stearns F or almost 20 years I have worked as a physicaltherapistassistantinvarioussettings, includinglong-termcare,acutecarehospitals, short-term rehabilitation, and the school sys- tem. For the last three years, I have also worked as a teacher of students with visual impairments. Initially, it seemed as if those professional worlds would be quite separate, but each day in my practice as an educator I amrealizinghowwellbothrolescomplement each other. POSITIONINGANDPHYSICALFUNCTIONING Part of a physical therapist’s job is to deter- mine which seating systems, braces, or other pieces of equipment help promote optimal functioning to allow individuals to perform well in their daily lives, adjustments that can help the students to access the curriculum in the best way possible. Proper positioning from a physical therapy standpoint can help maintain good skin integrity, prevent muscle tightness, provide support, and help reduce abnormal muscle tone. Teachers of students with visual impair- ments realize, from a different perspective, how crucial positioning and physical func- tioningcanbetothesestudents.Forexample, it is common for a student who has multiple disabilities and is dependent for mobility to undergoseveralpositioningchangesthrough- out the school day. These changes may in- cludetimespentondifferentsurfacessuchas a mat table or in various pieces of equipment like standers or supportive classroom chairs. Teachers of visually impaired students take this into consideration when making 166 JournalofVisualImpairment&Blindness,March-April2017 ©2017AFB,AllRightsReserved recommendationsaboutwheretopresentma- somecases,bracesmaybenecessaryandcan terials and position assistive technology as help improve a student’s overall level of sta- these changes take place throughout the day. bility and support and can, therefore, allow We must also understand how a student’s thestudenttochannelmoreenergyintovisual physical strengths and deficits contribute to activities. Examples of when braces can be that student’s ability to utilize their vision usefulwouldbewhenastudentappearstobe in different situations. Reviewing a student’s experiencing problems during ambulation or physical therapy evaluation can provide im- to have overall balance issues. Sometimes a portant information about physical strengths, student may be experiencing muscle weak- deficits, and limitations. Through direct con- nessthatmaycauseatoetocatchonthefloor sultation,aphysicaltherapistorphysicalther- or weak trunk muscles that may make it dif- apistassistantandthevisionprofessionalcan ficultforhimorhertomaintainsittinginone establish what a student’s unique vision and place for too long. A physical therapist can physical needs are and the challenges each help determine the right tools to correct this studentfaces.Together,thetwoprofessionals weakness and help stabilize the body. cancomeupwithstrategiestomakesurethat Some students require the use of a wheel- the student’s overall needs are being met in chairthatcanbetiltedforwardandbackward order for that student to function optimally in order to allow them to change positions. from a physical and a visual standpoint This can help to unweight (or shift weight throughout the day. from)certainpartsofthebodyandassistwith Havingabasicunderstandingofeachother’s head control. Vision professionals can work rolesisimportant,andtheobjectiveofeach with therapists and other staff members in specific activity needs to be understood. understanding that as positions change, the There are times when students may be student’s center of vision will change as well working on increasing overall head and andmaterialswillhavetobeadjustedaccord- neck strength as part of a physical therapy ingly. A desktop computer screen may have objective, requiring them to have less sup- initially been set up in a classroom for a portinordertopracticeliftingtheirmuscles student who is seated in a neutral position in against gravity. A student with poor trunk his or her wheelchair. That same screen may and head control may find it challenging to suddenly become inaccessible when the stu- visually fixate and attend to materials while dent is tilted backward. they are working so hard to stabilize their bodies. During these moments, vision goals COMBININGKNOWLEDGEABOUTPHYSICAL maybesecondarytophysicaltherapygoals. LIMITATIONSWITHVISUALABILITIES When vision is the focus, having the proper There are two specific examples from my support is imperative in order to have the own practice in which consultation with the stability and energy to function well visu- physicaltherapisthasbeenbeneficialinhelp- ally. ing me to gain information to help students withmultiple disabilities and visual impair- WORKINGTOGETHERTODETERMINE ments. I was recently asked to perform a THEBESTINTERVENTIONS functionalvisionassessmentonastudentwho Collaboration between the physical therapist had suffered a traumatic brain injury at a and teacher of visually impaired students can young age, leaving her unable to move her help determine the best intervention methods legs and restricting movements in her entire for the student, especially during the most upperbody.Thisstudentspentthemajorityof visually challenging activities of the day. In her academic classes in her wheelchair. 167 ©2017AFB,AllRightsReserved JournalofVisualImpairment&Blindness,March-April2017 Although she could occasionally move her vision only. Other times, she was able to head and neck to a neutral position, she fre- move into full left neck rotation. Overall, quentlykeptherheadrotatedtotheleft,rest- this student would predominately look to ing it in her headrest. Consultation with the her right when viewing, but I did not want physical therapist helped me to understand to automatically assume that this was her how much strength and range of motion the preferred visual field without further inves- student had in her head and neck. It also tigation. It was important to rule out the helped me to understand which positions possibility that she might be able to see as weretheeasiestforhertomaintain.Iwasable well or better in other visual fields, but that to provide the physical therapist with infor- shehaddifficultyaccessingthosefieldsdue mation about the student’s vision that ex- to a physical disability. plainedwhythestudentcouldnotseewellon From my physical therapy experience, I her right side and why that should be consid- knew that some positions help the body to ered when providing instruction. relax more than others. For instance, placing WhenIfirstobservedherinseveralclasses, a student in a position that takes away the I realized that most of her technology was student’s burden of having to fight gravity, positioned too low for her to see and was suchasasupineposition,oftenallowshimor ofteninthecenter.Whenstaffhadherengage her to move more easily. For this reason, I in activities using the monitor, she would worked with the physical therapist to help often cry. We first had to assess her to make assess the student in multiple positions in- sureshewasabletoseeimagesonthescreen cludingsupine,prone,inawheelchair,andin atall.Aftermakingthedeterminationthatshe astander.Wefoundthatthereweredefinitely wasabletoviewtwo-dimensionalobjectsand positions in which the student was able to pictures on a screen, we made some slight relax better than others and, as a result, the adjustments to the monitor height and posi- amountoftimeshewasabletovisuallyattend tioned the technology to her left. After the to materials and objects increased. We also adjustments were made, the teacher reported discovered that in certain positions, the stu- that the crying had ceased. dent was able to track objects into specific Sometimes students may have disorders visual fields with greater ease than in others. that make it difficult to control their body Thiseasewasobservedwhenthestudentwas movements, which may affect their ability to prone and was able to stabilize her head use their vision while in certain positions. I nicely by placing her chin on a pillow. Al- received a referral for a student who was though she was able to lift her head against diagnosed with cortical visual impairment gravity, tracking objects into her superior and who also had a movement disorder that field was not as successful in this position as would cause spontaneous involuntary move- it was in supported sitting or standing. Par- ments and moments of both increased and ticular positions or even sudden loud noises decreased stiffness in different parts of the may trigger reflexive patterns for some stu- body.Thechallengewastotrytofigureoutif dents that make it difficult to hold specific certain obstacles to accessing the curriculum posturesormovevoluntarilyinpreciseways. were the result of visual issues, physical is- It may not be that the student does not have sues, or a combination of the two. For exam- the visual ability to track objects or attend in ple,whentestingvisualfields,thestudentdid certain fields; it may be the result of a phys- not always move her head past midline ical inability to do so. towards the left, but would sometimes shift I explained to the physical therapist that her eyes and appear to use her peripheral some of the hallmarks of cortical visual 168 JournalofVisualImpairment&Blindness,March-April2017 ©2017AFB,AllRightsReserved impairment, especially in its earliest phases, In-servicetrainingsessionsareagreatway are decreased ability to visually attend to ob- to educate others about the roles we play as jects,decreasedvisualfields,andtheinability part of an education team and how we can to use vision functionally in complex and assist one another to help our students. Pro- overly stimulating environments. The staff fessional workshops and continuing educa- did a wonderful job with setting up a quiet, tion classes can provide insight into various low-contrast learning environment, but the topics specific to physical therapy and vision constantmovementthestudenthadtoendure thatmanyotherdisciplinesmaybenefitfrom. seemed to be creating a complex and highly Ongoing communication between disciplines stimulatingenvironment.Thesebodilymove- isimportanteitherthroughface-to-facemeet- ments were most likely exhausting for the ings, phone conversations, or e-mail mes- student and quite possibly made it very chal- sages. Getting a physical therapist’s input on lenging for her to visually attend to materials positioning during an assessment has helped and objects. me determine how the student appears to use The physical therapist revealed that by theirvisionbest.Physicaltherapistsareaware learning more about cortical visual impair- that vision leads movement, and they will mentshewasabletomodifyaportionofthis often ask questions about ways to use moti- student’s walking program and improve her vating visual stimuli to initiate gross motor ability to walk further distances. Initially, tasksforstudentswithimpairedvision.Ifind they were having the student ambulate with observingthesessionsofothertherapistsand an iPad attached to the walker, which proved teacherstobehelpful.Iinvitemembersofthe to be distracting. They made a change and different educational teams I am involved gave the student the iPad during rest times with to observe my vision sessions and ask only, when she was completely stopped. The questions. As an itinerant teacher of visually physical therapist reported that this improved impairedstudents,ithasbeenespeciallyhelp- thestudent’sabilitytowalkfurtherandseemed ful to establish a rapport with others, which to increase her overall level of focus. makes ongoing collaboration easier. The use ofanyofthestrategiesdescribedinthispaper DISCUSSION will help maintain effective collaboration be- Usually, most professionals working in a tween physical therapists and teachers of vi- school setting are specifically trained for a sually impaired students in order to help stu- particular job. There can be a disconnection dentswhohavemultipledisabilitiesandvision among disciplines as each staff member fo- impairment. cuses on their specific specialties and objec- tives. I often look back on the times when I EricaM.Stearns,M.Ed.,teacherofstudentswith workedwithlowvisionstudentsasaphysical visualimpairmentsandphysicaltherapistassistant; mailingaddress:966PleasantStreet,Worcester,MA therapist assistant and how my focus was 01602;e-mail:[email protected]. strictly on how the student was able to func- tionphysicallytoaccesshisorhereducation. Experience in both fields has allowed me to see that these two disciplines truly need to work hand in hand to give our students the best opportunities for optimizing physical functioning and vision. There is much to be gained from the collaboration of these two disciplines. 169 ©2017AFB,AllRightsReserved JournalofVisualImpairment&Blindness,March-April2017
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