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Routines and Early Learning

Understanding the Impact of Deaf-Blindness

Clyne, M., Parker, A., Blaha, R., Borg, J., Hartman, V., Martin, B. (2015)

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Stepping Back

For interveners, it is important to understand why routines are critical from an early development perspective.
This involves us looking at the role that the brain and sensory systems play early in life.
It is also important to revisit the impact of deaf-blindness to recognize why routines are important.

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This Impact is Long-Lasting

For older students, this presentation may provide additional perspectives on:

Continued “missing pieces” of concepts.
Positive effects of routines, especially in stressful situations.
The critical role family members play on each student’s educational team.

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Routines, Infants, and Young Children

All infants and young children benefit from having predictable and supportive routines.
Those with disabilities rely even more upon routines for access to information and learning.
For infants and children who are deaf-blind, routines help children compensate for missing environmental information and support “meaning making.” Routines also support self-regulation and interactions with people.

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Early Brain Development

“On average, researchers found the newborn brain grows one percent each day immediately following birth, but slows down to .4% per day by three months of age.”

Source: UC San Diego Health System, 2014

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The Importance of Early Identification and Referral

In earlier modules, you learned about the national deaf-blind child count which is critical for identifying children who are deaf-blind.
Identification is important so that families and service providers can begin to use strategies to support a child’s learning as early as possible. Using routines is one of those important strategies!

Listen as Barbara Purvis, an expert in early intervention with children with disabilities, shares the need for finding and serving infants and toddlers.

Transcript

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Let’s Review the Senses!

Body Part	Function	System
Eyes	See	Visual
Ears	Hear	Auditory
Taste buds	Taste	Gustatory
Nose	Smell	Olfactory
Hair/Skin	Touch	Tactual
Semicircular canals/inner ear	Movement	Vestibular
Muscles/joints	Gravity	Proprioceptive/kinesthetic

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The Brain and the Senses

The central nervous system consists of the brain and the spinal cord.

The brain communicates by receiving sensory information from the environment via the eyes, ears, nose, mouth, position in space, and nerve endings throughout the body. This information is then sent to other parts of the body via the spinal cord and the peripheral nervous system.
The brain also must integrate information and interpret or make meaning of the information received.

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The Brain: Organizer of Sensory Information

Remember that the brains of infants and young children are still developing.
The sensory information that a child is receiving is helping her learn about the world and building her understanding of the patterns and meaningful events in her daily life.

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Our Brains Influence Our Development and Our Experiences.

Don’t stress! You don’t need to memorize this diagram. It is meant to give you an overall idea of the regions of the brain and the location of the visual and auditory processing areas.

Source: Flatword Education, Inc., 2014

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Neuroplasticity and Sensory Systems

Neuroplasticity simply means “the brain’s ability to reorganize itself by forming new neural connections throughout life.” Source: MedicineNet.com, 2012
Some specific neuroimaging research with adults with one sensory impairment (deafness or blindness only) has shown that parts of the brain that were thought to be related to processing visual or hearing information can be “recruited” or “reorganized” to support another sensory system.

Sources: Emmorey, 2002; Hannan, 2006

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Neuroplasticity and Sensory Systems (cont.)

For example, in one neuroimaging study researchers found that when they compared brain activations in blind and sighted participants, that the blind participants had increased brain activation in the visual regions of the brain during all tactile tasks (including braille reading), while the sighted subjects showed a reduced activation of the visual areas of the brain during tactile tasks. Source: Sadato et. al., 1996
This and other studies indicate that our brains, including the sensory regions are adaptive.
Our experiences and routines are influenced by our brains and our brains change and adapt based on those experiences.

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Sensory Systems

All of the information we receive comes from our sensory systems.
Let’s look at this short clip. As you watch, make mental notes about the sensory stimuli in this environment.

Transcript and Audio Description

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What is Sensory Integration?

Sensory integration is the process by which:

the central nervous system coordinates input from sensory receptors throughout the body,
associates this input with stored memories of prior experiences, and
produces adaptive responses to life situations.

Consider what the little boy in the stroller and his brother may be experiencing.

Ask yourself what the experience might mean if the child in the stroller were deaf-blind.

Transcript and Audio Description

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Sensory Input and Children Who Are Deaf-Blind

Children who are deaf-blind experience greatly reduced access to both visual and auditory information.
Many infants and young children who are deaf-blind have neurological (brain) insults or injuries. For these children, incoming information can be even more difficult to process and organize.

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Sensory Input and Children Who Are Deaf-Blind (cont.)

Many young children who are deaf-blind have medical conditions that require repeated surgeries and therapy.
A child’s health, neurology, medications, motor impairments, and cognitive impairments can have a big impact on how much sensory information she can access and process.

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Sensory Input and Children Who Are Deaf-Blind (cont.)

For children who are deaf-blind with additional disabilities or health complications, routines are vital for establishing predictability and reducing stress.

Source: Nelson, van Dijk, Oster, & McDonnell, 2009

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Children with Additional Motor Impairments

Often, when young children experience a brain related injury or insult, they have atypical motor development. This can range from mild to severe.
Differences in patterns of movement can restrict the type of information and experiences that a child has in his environment.

In this video, the child is positioned so that his trunk (center part of his body) is well-supported. This makes it easier for him to play with the toys on the tray of his wheelchair.

Transcript and Audio Description

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Children with Additional Motor Impairments (cont.)

Some routines will be developed with the support of a physical therapist (PT) or an occupational therapist (OT) so that the student can be positioned properly to practice specific movement patterns.

Routines may also incorporate the use of special equipment that is prescribed to support the child’s positioning and posture.

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Children with Additional Motor Impairments (cont.)

The proper physical support within daily routines can provide the child’s body with more sensory and environmental information.

Images courtesy of the Cleveland Clinic.

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Children with Additional Motor Impairments (cont.)

Supportive routines may also help reduce a child’s stress level.
Many children with cerebral palsy, which is a group of brain related disorders that cause impairments in voluntary movements, have a sensitive startle reflex.
Using supportive routines in early childhood for children who are deaf-blind with motor disabilities is important for reducing stress and supporting learning.

Shafer, 1998

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Get Familiar with Some Key Terms

Interveners, teacher and families often work closely with PTs that serve young children who are deaf-blind with motor impairments. It is important to understand a few key terms that you may encounter when supporting students.�

Hypotonia (“floppiness”) = lower than normal muscle tone.��Hypertonia (“stiffness”)= increased muscle tone.��Athetosis- disorganized movements caused by changes in muscle tone.��Ataxia- Underdevelopment of balance against gravity and lack of precision in movement.

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Routines: A Support for Developing Sensory Efficiency

Sensory efficiency = “Learning how to integrate all remaining senses to counter the impact of any missing or impaired sense.”
It is an important skill that teachers of the visually impaired, orientation and mobility specialists, and teachers of the deaf-blind work on with students.
The use of routines can help a student attend to visual and auditory information in an organized way.

Source: American Foundation for the Blind, no date

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Sensory Integration

Many researchers and practitioners in the field of deaf-blindness have emphasized how important it is for all team members (families, interveners, teachers, etc.) to understand as much as possible about a child’s vision, hearing, motor skills, and overall health in order to provide the student with access and support.

Kim Lauger, the mother of a son with CHARGE syndrome and a nurse, describes the need to provide her son with organized information so that he can be more organized in his responses.

Transcript

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Routines as Access to Information

For all students who are deaf-blind, routines can serve as a pattern that helps them attend more effectively to relevant sensory information in the environment.
Materials and elements of activities can be organized to reduce visual clutter and background noise.
This can help children use the senses that they do have to process information.

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Self-regulation, Stress, and Routines

Dr. van Dijk and other researchers in the field of deaf-blindness have described the connections that are formed between environmental stimuli and experiences that an infant may have as a foundation for learning.

Source: Nelson, van Dijk, Oster, McDonnell, 2009

By recognizing a young child’s behavioral cues and using this information to build repeated positive experiences with young children, family members are helping them anticipate events and reduce stress.

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Self-regulation, Stress, and Routines (cont.)

Other experts have also developed supportive curricula to guide families and early educators in the use of information from early behavioral cues to build supportive and enjoyable routines.

Source: Klein, Chen, Haney, 2000.

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For students with

Deaf-Blindness . . .

Routines are a tool for adding structure and predictability to the day – and they are a part of a larger picture of communication.

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Research on language development in typical individuals suggests that all children use routines to develop communication and language skills (tickle games, peek-a-boo, pat-a-cake).

Source: Hagood, 1997

Routines as a Framework for Communication

Notice Jen using a typical game in a play routine with her son. Routines not only support communication skills, they provide a rich context for language development.

Transcript and Audio Description

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