European best practices to support children with high potential and to access training for gifted children with disabilities.

– GIFTED (FOR) YOU –

2014-1-RO01-KA201-002957

This guidebook aims to share some knowledge and advice to parents of visually-impaired children and also to teachers, giving them practical means to meet the needs of their students.

Coordinators:

• Conf. Univ. Dr. Anca Rozorea

Authors:

• Liana Maria Mitran Duţu - Ministry of Education and Scientific Research, Romania
• Romeo Adrian Cozma - School Inspectorate of Bucharest
• Georgeta Nămolovan - Special Middle School for Vision-Impaired, Bucharest
• Florica Stoica - “St. Mary” Special Middle School for Hearing-Impaired, Bucharest
• Ioana Rîmniceanu - “St. Mary” Special Middle School for Hearing-Impaired, Bucharest
• Ileana Ţîrlui - “St. Mary” Special Middle School for Hearing-Impaired, Bucharest

CONTENTS

Preface

Dear parents and teachers, the purpose of this guidebook is to provide more knowledge and advice about the way how we should behave when coming into contact with a visually-impaired child - amblyiopic or blind.

Firstly, sight provides a child with experiences through which he is aware of being distinct from the rest of the people – he sees his mother coming and going, he learns that she is a separate being.

Starting from the large role which sight plays in shaping the „self”concept:

• A visually-impaired person explores the world of objects only by touch; it takes him more time to discover his own body parts - he usually makes this discovery when he manages to explore them using his mouth;
• His mother's presence is known at first only through his touch, and later by associating her presence with the sounds she produces - this association occurs later, the same as with the visual association of a normal child;
• His body image is formed by tactile exploration and later through verbal communication and verbal feedback;
• His limited number of social relationships is due to overprotective parents who try to keep him away from any potential negative feedback and because of his school experiences, when teachers either make special concessions or are not realistic in formulating their expectations. All these may be obstacles for him in building up a realistic self-concept. Sometimes, it is not only success that contributes to his development, but also his failure, which is essential for his general and vocational adjustment.

We believe that this guide is imperative for parents who have found out that they have visually-impaired children, as well as for teachers who are just beginning to work with them.

CHAPTER 1 – DEFINITION. ETIOLOGY

Throughout the development of medical, psychological or educational sciences, as well as of special education for students with disabilities, the research of vision impairment included both assiduous efforts to clarify concepts and to operate with appropriate scientific terminology.

Vision impairment is included, as is natural, into the sensory deficiencies caused by the impairment of the sense organs, being studied mainly by the Pedagogy of Blind Children.

In modern studies, the term defect/ deficiency is used to denote both the organic modifications that lead to a functional impairment (various lesions of the visual analyzer) and functional impairment itself (the extent and aspects of the decrease of vision).

Unlike the deficiency, a disability represents the total consequences of the respective deficiency, in terms of the child’s adaptation to the life around him and the structure of his individuality.

The same distinction operates with other authors: "Disability means the impairment of an individual’s normal relations with the environment, especially with the social environment, based on an existing deficiency”.

Etymologically, the term amblyopia comes from the Greek words "amblys" (weak, dull) and "ops" (sight), denoting, therefore, poor eyesight, partial vision, decreased vision, weak vision.

Having several meanings, the term "amblyopia" is pretty vague and often wrongly used. In a larger sense, amblyopia denotes all the cases of diminished visual capacity, irrespective of etiology and gravity, or the decrease in vision which is still there even after the appropriate correction was made.

In a more restricted sense, amblyopia is defined as "diminishing vision with or without organic lesion, whose importance is not proportional to the decrease in vision.” This definition differentiates blindness, which, broadly defined, means the absence of vision.

According to a definition in educational terms, amblyopic people are those persons who, due to deficient vision, cannot attend the courses of a regular school without putting their sight or educational development in jeopardy; on the other hand, blind people are those who lack eyesight or whose vision is so diminished that they need educational methods which do not involve its use.

From this educational perspective, the first category includes children with “diminished’, “limited” or “partial vision”, all of which can participate in special conditions, in an "education integrated in regular classes."

In general, a common etiology is employed for amblyopia and blindness, based on a criterion widely used especially in ophthalmology, both for classification and for etiologic taxonomy, namely the anatomic localisation of the various eye conditions or the pathology of the segments of the visual analyzer and its annexes.

• Diseases of the eyeball annexes (eyelids, lacrimal apparatus, orbit conditions, conjunctivitis).
• Eye refraction disorders (ametropias: shortsightedness (myopia), farsightedness (hyperopia), astigmatism.
• Disorders of the anterior chamber (sclera, cornea, uvea)
• Disorders of the crystalline lens
• Disorders of the vitreous body
• Disorders of the posterior chamber (retina and optic nerve)
• Disorders of the intracranial optic canals
• Glaucoma
• Eye injuries (at work and other activities – with children, sportsmen)
• Eye traumas (mass displacement of the eyeball, eyeball contusions, lesions, retinal detachment, produced by physical and chemical agents, injuries, eyeball ablation, drug-related diseases).
• Alterations of the visual field (choroidal and retinal disorders, glaucoma, hemianopsia).
• Binocular vision disorders (strabismus, motor-ocular paralysis).
• Adjustment disorders to dark and light.
• Alterations of the chromatic sense.

There is not always a direct relationship between the gravity of the visual analyzer disorder and the degree of the visual decrease; as was already shown, in functional amblyopia eye injuries do not occur. However, diseases or alterations of the visual analyzer components are responsible for the vision impairment, acting either directly or by means of physiological or psychological factors.

• Congenital malformations;
• Perinatal or post-natal causes or factors acting at different periods of the human existence. Congenital malformations are "morphological, morpho-physiological or metabolic abnormalities, manifested at all levels of organization (organic, tissular, cellular, sub-cellular) at birth or postnatal life. They are determined by the prenatal action of a causal factor (genetic or environmental factors) or by their correlated action".

CHAPTER 2 - DESCRIPTION OF OPHTHALMIC DISORDERS COMMONLY FOUND IN THE SCHOOL ENVIRONMENT

Myopia (shortsightedness) is an ametropic (or refractive disorder) in which, due to structural and functional modifications, the light rays are focused in front of the retina; the modifications are either in length or elongation of the anterior-posterior diameter or of the crystalline lens.

There are two forms of myopia:

• Benign, less serious and with, a slow evolution up to age 20-21 but directly favored by school activities that primarily require use of vision, especially in inadequate lighting conditions, with efforts of eye accommodation and convergence for near vision, which can lead to the lengthening the anterior-posterior diameter of the eye. Refractive error correction is needed using divergent concave lenses (marked "-") to increase sight efficiency.
• Malignant (progressive), with a high degree of hereditary refractive error (10-40 diopters) and with less favorable evolution and prognosis because, in most cases, it is accompanied with funduscopic lesions and macular pressure disorders (“macula lutea” the Latin term means “yellow spot”), with tapeto-retinal degenerescence, coroidosis or retina detachments, leading to blindness. Optical correction is partially effective, with an increased utilization of contact lenses.

Farsightedness (Hyperopia) is an ametropia which occurs when the longitudinal axis of the eyeball is too short because of the insufficient development of the eyeballs or when the refractive power of refractive environments is too weak or the corneal curvature is too small. Light rays are focused beyond the retina, which affects the near vision, at close range. The absence of accurate refraction is compensated by continued accommodative tension of the cilia muscle of the crystalline lens which may lead to their hypertrophy. The image of the objects is clearer, while closer objects are perceived as diffused/pale, blurred and unclear. Farsightedness is characteristic to young ages (low gravity, latent farsightedness, decreasing with age because compensation occurs through accommodation of the crystalline lens). In cases of accentuated farsightedness (high), which is accompanied in most cases by strabismus or congenital amblyopia (organic causes may exist, of the type of intraocular lesions), optical correction is required (with glasses having convex – convergent lenses - labeled “+ "), as well as specific visual training.

Astigmatism is also an ametropia (or refractive disorder) due to the imperfect curvature of the crystalline lens or cornea and the different refractive power in their various areas, which can be, in most cases, myopic astigmatism or hyperopic astigmatism. The rays are focused onto the retina at several points at different distances from the fovea, forming a distorted and unclear image.

Astigmatism can be:

• Congenital, associated with innate amblyopia;
• Acquired, after other diseases in remission with sequelae.

Suitable measures are optical correction (glasses having cylindrical or contact lenses) and specific visual training.

Anizometropia is an ametropia determined by the different refractive capacity of the two eyes, one being normal (emmetropic) and the other ametropic in various degrees, or both eyes ametropic, with different refractive defects.

In all cases an efficient optical correction is necessary, performed early to avoid secondary consequences - primarily those which alter visual acuity and binocular vision.

Among the congenital disorders of the cornea, the most common are:

• Transparency alterations;
• Sclerocornea or Peters’ anomaly or The adherent bilateral congenital corneal leucoma.

Among the acquired disorders, the most common are different type keratitis, with various degrees of decreased vision.

• Keratitis occurs typically in the second decade of age, with increasing distortion of the visual field and of the far sight, in some cases being associated with pigmentosa retinopathy, aniridia, the Down syndrome or the Marfan syndrome. The treatment is effective with rigid contact lenses in the early stages and keratoplasty (cornea transplant), which reduces the progressive degeneration of the cornea, reducing the risk of blindness.
• Leucoma (corneal opacification scar), which can also appear in stafilom form, is common. Treatment also involves, besides specific operations (keratoplasty or iridectomy) a systematic exercise to harness new visual possibilities.

Among iris disorders, most common are congenital aniridia and coloboms.

• Aniridia (absence of the membrane of the iris or its underdevelopment, is an inherited disorder that leads to visual acuity decreasing up to 1/10 - 2/10, to photophobia, to concomitant constriction of the visual field and to secondary complications such as: nystagmus, cataract, crystalline lens dislocation or opacification, underdeveloped retina, glaucoma, strabismus. In forms with less serious complications, efficient measures can be: solar protection, dim lighting and optical aid with dark lenses.
• Congenital coloboms are disorders in which various parts of the eye may be subject to deformation, their severity depending on the moment when they occur. They are manifested by diminished visual acuity, photophobia, and loss of the upper visual field. They associate with nystagmus, microphthalmia, polydactyly or mental retardation, and cataract as a secondary complication. Contact lenses are effective and prophylactic measures, as well (sun protection, optical aid).
• Choroiditis (infectious, nodular, serous, and disseminated) is a disorder of the choroid identified by infrastructural changes, but also by symptoms such as: the sensation of "flying flies", decreased visual acuity, pathological scotoma the visual field, hemeralopy, metamorphopsy (deformation of objects – macropsia - when objects appear larger or micropsia - when objects appear smaller). These are disorders that can lead to serious conditions such as: optical atrophy, cataract and retinal detachments.
• Cataract is either a congenital or acquired disorder, with a very high frequency, caused by the partial or complete opacification of the crystalline lens.
  • Congenital cataract is caused by diseases such as rubella or drug poisoning during pregnancy;
  • Acquired, traumatic cataract is caused by physical agents;
  • Secondary cataract occurs after extra capsular extraction of the crystalline lens;
  • Juvenile, pre-senile and senile cataracts have unknown etiology.
• Afakia (absence of the crystalline lens) may be post-surgical and, more rarely congenital or traumatic, being corrected with spherical lenses or combined with cylindrical lenses, contact lenses or crystalline plasty.

Among the congenital disorders of the retina, accompanied in many cases by choroid disorders (its vascular-nutritive membrane), the most common are:

• Toxoplasmotic chorioretinitis, in which the affected zones are the macula (macular nodules) or the periphery (dispersed lesions), having in its etiology a fungus transmitted by spores hosted in animal fur. The macular type is manifested by diminished visual acuity, centered scotoma of the visual field, poor color vision; in the peripheral type, scotoma occur in the corresponding lesion area. It is accompanied by mild headache, convulsions and has a serious prognosis. Prevention is necessary to avoid the risk of contamination and optical aid for visual problems.
• Retrolental fibroplasia caused by modifications in the blood vessels and vitreous body, has in its etiology the administration of high levels of oxygen to premature infants. It is manifested by diminished visual acuity, grave myopia, scarring, retinal detachment, with consequent loss of the visual field and possible blindness. Secondary complications are glaucoma and uveitis; optic aid and controlled lighting are recommended.
• Diabetic retinopathy is an inherited disease, which is manifested by: diplopia, failure to accommodate, and fluctuating vision, loss of color vision and of visual field, defects of refraction, decreased visual acuity, bleeding of retinal blood vessels, and retinal detachment. Secondary complications consist of glaucoma and cataract, and associated disorders can be of the respiratory, cardiovascular or skin type.
• "Tay-Sachs" familial amaurotic idiocy is transmitted by recessive autosomes and it is caused by the "lipid storage" in the retinal ganglia cells and brain cells.
• Retinal colobom consists of tears in the retina.
• Albinism (total or partial absence of the pigment in the retina, iris, hair, skin) is an inherited disease that leads to underdevelopment of the macula, causing photophobia, decreased visual acuity of various degrees (20/200 - 20/70), nystagmus, variable visual field, astigmatism. In general, it does not evolve; it can be corrected with tinted or dark lenses, with absorption eyewear (contact lenses) and it requires dim lighting.
• Acromatopsy is a hereditary disease caused by malformations of the cones, which produce total color blindness. It is manifested by the reduction of the visual acuity up to 20/200, extreme photophobia and nystagmus, while the visual field is normal. There is no evolution, photophobia and nystagmus decreasing with age.
• Retinal pigmentary degeneration (retinitis pigmentosa) is a hereditary pigmentosa degenerative disease, which is manifested by hemeralopia, concentric narrowing of the visual field to a tubular view, making orientation in space almost impossible, as well as differentiation due to macular degeneration; it also causes irreversible decrease of the visual acuity and chromatic sensitivity (decreased visual acuity in tapeto-retinal degenerescence evolves to optic atrophy and blindness), night blindness.
• Acquired retinopathies: vascular, inflammatory, degenerative, tumoral, retinal detachment, are caused by diabetes or hypertensive disease.
• Retinal detachment is the detachment and atrophy of a part of retina from its supporting structure, from very different causes (diabetes, degenerative myopia, etc.). The symptoms consist of intermittent rays occurring, intraocular pain, loss of visual field, micropsy (visual disturbance where objects are seen smaller than the real ones), and damage of the chromatic sensitivity and of visual acuity if the macula is affected.
• Atrophy of the optic nerve and neuritis cause diminished visual acuity and concentric narrowing of the visual field.
• 
  Glaucoma is a hereditary disorder that consists of intraocular imbalance (increased intraocular pressure due to flattening of the eyeball). It is primary or secondary, with complications of primary eye diseases of the retina and the optic nerve. It is characterized by alterations of the visual field (narrowing), disorders of the sense of light and of color sensitivity, excessive lacrimation, photophobia, opacification and cloudiness of the crystalline lens, buphtalmie (eye enlargement), papillary alterations and hypertonic eye, which, in most cases, are irreversible and lead to blindness because glaucoma is an evolutive disease, with total blindness occurring in its final stage.

  Although initially the clinical signs are not noticeable, when the disease progresses, there are diffuse pains and vertigo, an enlarging of the blind spot and floaters, which gradually intensify until becoming the sure symptoms of the disease. Infantile glaucoma (early or late congenital glaucoma) is a genetic disease (buphtalmie or hidrophtalmie – enlargement of the eye), common, with severe prognosis, especially if its treatment is administered late. Eyeglasses and surgery are recommended, as well as special measures to prevent serious complications.

• Marfan syndrome is an inherited disease that affects various parts of the eye, manifested by the decoupling of the crystalline lens, decreasing visual acuity, severe myopia, dislocation of the pupil in many parts, retinal detachment with simultaneous field loss, differently colored eyes, strabismus, nystagmus, modified sclera. Skeletal and limb disorders (flattened fingers), considered as abnormalities, are present, as well as underdevelopment of muscles and cardiovascular problems.
• Strabismus is a disorder of ocular motility and binocular vision, through lack of normal balance in the coordination of the two eyeballs, determined by the deviation of the visual axis of the two eyes, which prevents the fusion of the images and achieving stereoscopy.

Strabismus can be: paralytic or concurrent (latent - heterophoria or manifest - heterotropia), convergent or divergent. Strabismus, especially the convergent one, causes functional amblyopia, either with central fixation or with eccentric fixation: the distance from the central fovea determines the degree of the decrease in eye vision.

• Nystagmus consists of involuntary oscillation of the eyeballs, usually accompanied by a number of diseases such as corneal leucoma, congenital cataract, macular lesions. This disease causes difficulty in macular fixation with consequences in reading and writing: missing the lines, letters and words, the spelling signs, reading without continuity. Visual training will optimize the capturing of visual information and the exploratory strategies.
• Microphthalmia – an insufficient development in size of the eyeballs – affects binocular vision and, implicitly, the perception of objects in relief, the correct position of objects in depth, the appreciation of distances, the interpretation of graphical images.

CHAPTER 3 - FUNCTIONAL INDICES AND EFFECTIVE VISION. FUNCTIONAL INDICES OF VISION EXAMINATION

• Visual acuity (VA) is the main indicator and represents "the power of the eyesight", which refers to the size of the objects and the distance from which the eye can recognize them accurately.

  Visual acuity is considered physiological when it measures 5/5 (1) in each eye.

  The following are measured:

  • Kinetic Acuity (with moving objects), as a dynamic testing for functional ophtalmological exploration and for the evolution of certain neurological or neuro-surgical diseases with ophthalmic implications;
  • Professional Acuity which represents the minimum VA required to pursue a profession in a particular workplace, without eye fatigue (when it is normal); VA bilateral up to 3/4 (0.75) is compatible with most professions; VA examination is done using tables (eye chart) including letters, numbers or various signs (rings, hooks, drawings of objects).
  • 

    Near Vision and Distance Vision are determined using special eye charts, including typographic signs, geometric shapes, and drawings of objects, calibrated to this purpose.

    To determine the VA we use eye charts standardized according to age, including letters, numbers, different signs (rings, hooks, forks), sketches and artistically drawn objects - at the distance of 6m.

    For children we use tests with images (M.Ardouin) as well as special eye charts, including typographic signs, geometric shapes, drawings of objects to determine the VA at the distance for reading (the near vision).

• The Field of Vision (FOV) or peripheral vision is the space that the eye can perceive when it stares at an object.

  The following are determined:

  • The Monocular vision field – the space that the eye covers when it stares at a fixed spot;
  • The Binocular vision field - all the spots in the space covered by both eyes wide open.

  The visual field is measured by using the optic perimeter and a device (field meter) used for determining the space that the eye can perceive when it stares at an object.

• Light sensitivity (the light sense) is the ability to distinguish light intensities. It is determined by means of an adaptometer or photometer and it is the elementary form of the visual function, the ability of the eye to sense the light and to adjust to changes in illumination.

  The following are determined:

  • The absolute light sensitivity (the property of the retina to perceive a minimum of visible light);
  • The differential light sensitivity (the property of the retina to perceive a difference in light between two adjoining zones).

  Hemeralopia is the inability of the eye to adjust to the dark (with retinopathy pigmentosa and a deficiency in vitamin A).

  Light adaptation is measured with the nictometer and dark adaptation, with the adaptometer.

• Contrast sensitivity is the ability to distinguish the difference in light intensity between concomitant stimuli (distinguishing the object from the background).

  Light and contrast sensitivity is determined empirically by identifying the perception of light / dark by turning on electrical bulbs of decreasing light intensity, to the lowest of a flashlight (the sense of light).

• Chromatic sensitivity (the sense of color) is the eye's ability to distinguish colors, to obtain colorful vision, mainly in the colors red, green and blue. It is explored with color tables, by means of the chromatoscopic method (ie with colored light signals) and with the anomaloscope. The deficiencies of the color light sense are called dyschromatopsies (partial or total), which are difficulties of various degrees in recognizing colors or the absence of color perception. Most of them are congenital and definitive. They are:

  Acestea sunt:

  • Deuteranomaly, deuteranopy – the dyschromatopsy for the green color;
  • Protanomaly, color blindness – the dyschromatopsy for red;
  • Tritanopy – the discromatopsy for blue (less common).

  Chromatic sensitivity is determined by a physician with laboratory equipment (calorimeters or anomaloscopes). It can also be determined by testing the matching and classification of the colorful samples (differently colored pieces of wool, chips, etc) or with pseudoizochromatic tables ("confusing tables”) to spot identical tonal brightness.

• Actual Visual Effectiveness – is not the mere sum total of the functional indices, but the result of their activation in relation to various intellectual factors, motivational skills, etc.

  Visual effectiveness is different from visual acuity, as it depends on all the parameters of vision and reflex-conditioned interaction of the analyzers, achieved by cortical analysis and synthesis.

CHAPTER 4 - TYPE OF VISUAL DEFICIENCY / DEGREE OF VISUAL IMPAIRMENT

The VA between 1 and 2/3 = 5 / 7.5 = 0.67 is considered within physiological limits; the VA below this level is considered low. Amblyopia is the decrease of the VA below 0.5.

According to values of the VA, some authors (F. Zamfirescu – Margescu , F. Marin) have established the following classifications:

• Mild amblyopia - VA from 0.5 to 0.3;
• Medium amblyopia – VA from 0.2 to 0.1;
• Severe amblyopia (accentuated) with VA below 0.1 and, respectively:
• Absolute blindness - absence of light perception;
• Relative blindness – with perception of hand movements and of light.

Blind persons are considered the persons with a VA below 0.08, in both eyes or in the best eye.

CHAPTER 5 - FEATURES OF PERCEPTION AND REPRESENTATION IN YOUNG, VISUALLY-IMPAIRED SCHOOLCHILDREN

5.1. Visual perception

In the context of human psychology, perception is "a complex sensory psychological process with an objectual content, which reflects, in a direct and unitary way, the total attributes and structure of objects and phenomena, in the form of images or primary precepts”.

Perception is "a complex psychological behavior by which an individual organizes his sensations and takes notice of the real – a relation between the object, with its own characteristics (objective intensity factors, instantaneity, contrast, characteristic of stimuli) and the subject, with his personality as a whole, developed within the limits of personal and social experiences - subjective factors, such as exploratory activity (E. N. Sokolov), mechanisms of relaxation and retrieving information (Attenave, J. Bruner) perceptual patterns or psychological structuralism, motives and attitudes (P. Fraisse), as well as all the whole cognitive apparatus (P. P. Neveanu ).

Perception plays an important role in the school activities of a young, visually impaired schoolchild, through its signaling, informational and regulatory function of the behavioral activity.

The development of visual perception organization goes through different stages in point of quality, which J. Piaget details as follows:

1. The sensory-motor period:
   • Stage I: 0- 4 months
   • Stage II: 4/5 - 10/12 months
   • Third stage: 12 months - 2 years
2. The period of representative operating intelligence (perceptual activity)
   • Stage I: 2-4 years
   • Stage II: 4-7 years
   • Third stage: 7-8 years and over

According to Piaget’s stages, the main features / acquisitions structured by visual acuity are:

1. Features of the sensory-motor period:
   • Stage I: 0- 4 months
     • Lack of coordination between tactile, visual, auditory sensations
     • No perception constant of shape and size is formed (the constant of shape occurs at 2-3 weeks);
     • In the first weeks after birth begins the coordinated spatial localization because the baby turns his gaze to the source of the sound (M. Wertheimer);
     • Visual sensations are distorted when changing the distance, position and the object itself;
     • In the newborn, there is only the reflex of retention and tracking a stimulus through eye movements, not by ocular-motor mechanisms (V. Preda );
     • The process of individualized visual perception of the image (the human face) begins now, generating a response to its smile;
     • The beginnings of visual perception are connected with the special sensitivity to stimuli in motion (N. F. Dixon, 1973);
     • Several elementary spatial relationships are formed, reflecting features of topological geometry that are perceived: the attempt to approximate the elements in the same space (perceptual field); the separation of the closest elements in relation to environment; the relationship of order in spatial succession; the relationship of continuity that is modified according to the evolution the closeness – remoteness relation (separation);
     • In a newborn there is discrimination between face and background (W. Kessen, P. Salapatek, M. M. Haith) and almost certainty at 15 days of age;
     • The perception of shapes, patterns, objects is present since the first weeks of life (R. L. Frantz);
     • At 2 weeks of age there are perceptive discrimination by color, shape and preferences for an object;
     • In the first 5 days sudden and irregular movements of exploration are dominant on the horizontal level, as well as the exploration of the contents, therefore we can speak of a perceptual organization of the suckling baby (P. Slapatek );
     • These relationships are not static – they evolve with the child’s development;
     • There is not a clear distinction between "motor" and "perceptive" and therefore the movement of the objects and of his own body is often confusing;
     • In the first months of life the regulating mechanisms of the perceptive apparatus are functional; the system of local exploration and targeting operations is taking shape, through which the closure of the perceptive field is achieved in accordance with the extent and space-time configuration of the stimulus object (M. Golu ).
   • Stage II: 4-5 to 10-12 months
     • In his perception of the object, the child is not capable of taking it out of the general context where it is, but keeps perceiving it in its context;
     • The beginning of the coordination between vision and grip, due to the maturation of the nervous system and the progress of practical intelligence;
     • Depending on sensory-motor activities (movements of eyeballs, tactile exploration), the child builds up the main perspectives of the shapes and acquires the constant of shape and size (at 6 months of age); he almost elaborates the simultaneity of the existing relationships depending on the activity he is doing (realization of the permanent object – at 9 months of age) and keeps improving it to age 12 months).
     • The perceptive constants are missing ("the stable, integrative, perceptive models of the object") in the first 9 months of life, but the child can distinguish the object that he has perceived in the past by color, size, shape, due to his orientation reaction; -The somatic-object and instrumental motions are outrun by the development of remote-reception functions that influence the schemes of perceptual organization. (V. Zaporozhets, 1966);
   • Stage III: 12 months - 2 years
     • The child’s field of action is amplified with the appearance of walking;
     • The visual-perceptive organization through direct and current perceptions reaches a form comparable to the one found in adults;
     • Space exploration is diversified with the walking, thus contributing to the development of object relationships, which leads to the emergence of the mental image (an early representation) about the essence of objects as seen in the same homogeneous environment;
     • Practical operations with material objects are developing by imitating the adults.
2. The period of representative operating intelligence (perceptual activity)
   • Stage I: 2-4 years
     • Representation, as the evocation of objects in their absence, replaces the sensory-motor activity and its perception in the presence of the object, introducing the relationship between signifier and signified;
     • The development of the representative pre-operating intelligence and later on, of the concrete operating intelligence, influences the higher mechanisms of one’s own perceptive organization (visual stimulation is therefore absolutely necessary);
     • The child does not explore systematically; he experiences accidental touches when exploring an object (rudimentary and imperfect exploration);
     • The onset of the "representative space", at first limited to the topological relationships, then extended to the projective and metric space.
   • Stage II: 4-7 years
     • The perceptive-exploratory activity has three specific aspects:
       • Global exploration;
       • An incomplete analysis of the particular features of the object;
       • A complete analysis, but lack of a synthesis of the forms perceived.
     • Perceptive schemes are elaborated and improved with age;
     • Development of internal operational schemes with a generalizing character, through the internalization of the external actions;
     • Exploration of configurations and syncretism.
   • Third stage: 7-8 years and over
     • It coincides with the stage of concrete operations;
     • Exploration is systematic, starting from a fixed reference point;
     • Perceptual activity can evolve depending on the intellectual progress;
     • “Representative space "is completed at 9-10 years of age;
     • Perceptive activities are systematized and become automatic.

5.2. Representation

With visually-impaired students, especially preschool and young schoolchildren, the difficulties in the perceptive activity and the deficiencies in some of the visual images obtained, extend also to their visual representations, with distinctive features such as:

• The stock of representations is rather poor, as both cognitive and practical experience is poor;
• Some representations are inaccurate, incomplete, distorted in terms of shape, size, color, spatial relations, details, especially because of a limited visual exploration and exploratory strategies less focused on elements with maximum informational value (on significant details, on a hierarchy of features that are essential for the respective image);
• The relationship between representation, intuitive support and notion is functionally weak; the notion is often correct, but without intuitive coverage and semantic understanding;
• Representations are not very effective in the cognitive and practical activity, devoid of mobility, sometimes distorted as to the relationship between the object’s component parts or between the objects themselves;
• There are preferences for using auditory or tactile-kinesthetic representations, even in children with residual sight, which gradually leads to losing of visual dominance.

CHAPTER 6 - METHODOLOGICAL PRINCIPLES

Visual-perceptual education (VPE) – a specific activity in the special education of the visually impaired – contributes to the compensation of poor vision both at organic level, by the maximal recovery of the residual sight, and at functional level, the impaired visual function is supplemented by the more intense use of the valid analyzers in new relationships, as well as by the higher cognitive processes.

1. VPE is an integral part of the formative process of compensation-rehabilitation of the special education for visually impaired students, with special classes included in the curriculum, covered by specialist psychologists, special education experts and teachers, or other teachers specialized in this type of activity.
2. VPE activities unfold individually and/or in mini-groups organized according to various criteria (specificity, nature, extent and dynamics of the visual deficiency, functional indices of vision, visual effectiveness, recommendations and restrictions of the ophthalmologist, level of intellectual and social maturation, age, associated deficiencies, etc).
3. VPE is performed in specially equipped rooms provided with apparatus and specific tools, as well as with more simple tests and techniques, in a shorter time - 20-30 minutes, at the students’ own pace;
4. The distribution of different types of exercises is based on the ophtalmological diagnosis and targeted on achieving the corrective-compensatory and recovery-based formative objectives established in accordance with the defectological diagnosis;
5. The activity of visual education is integrated into the context of the students’ cognitive and practical activity;
6. Any activity requires gradual visual effort, with reasonable increase of visual complexity, duration and difficulty of the exercises;
7. Visual training must have a systematic and continuous character, any acquisition or progress being reinforced with new exercises that will enhance vision effectiveness;
8. Each activity must be assessed in terms of meeting the proposed objectives, of compliance with the methodological requirements so that, through the feedback, we could redesign future activities either to correct the acquisitions or to provide a new beneficial effect and progress at the level of vision function;
9. Visual exercises can be divided according to age groups and Piaget’s perceptual structuring;
10. Any exercise of visual education is carried out in stages, namely:
    • Acquiring a notion (individually or collectively)
    • Checking understanding of the notion;
    • Checking of gained knowledge
    • Returning to a complex reality.

CHAPTER 7 - CONCEPTUAL DELIMITATIONS – ACCESS TECHNOLOGIES

The term „Access Technology” (AT) refers to hardware and software applications by means of which visually-impaired persons can use information technology or the computer, with everything related to it, including the Internet and its communications services.

Any equipment in the field of electronics can be included in the AT category if it meets several conditions:

• facilitates independent access to information for people with visual impairment;
• allows the formation of new skills for an easier social and professional integration;
• allows performing tasks in a relatively independent way and at a pace similar to that of a person without disabilities;
• offers support in educational activities and social interactions.

The new access technologies allow a disabled person to perform a work task (eg at home: using the email, searching materials on the Internet; at school: reading books and course books, writing various materials, etc; at his workplace, etc.) in a period of time and at a relatively identical level to a valid person.

In the field of special education, access technologies have enabled a new direction and approach to the issue of persons with disabilities, both in terms of corrective-compensatory intervention and the development of their new skills.

Access Technologies are classified into hardware and software access technologies.

Thus, the main hardware access technologies used in the work with visually impaired students are:

• 

  The Braille display is one of the most representative computer peripherals designed for the blind. The purpose of the Braille display is to render in Braille characters both descriptive and textual information that the user needs in order to be able to interact with the applications.

• THE BRAILLE ALPHABET

  
• The electronic office magnifier, is an electronic device designed for people with poor vision (amblyopia) to enlarge and read written documents. This device comprises a display (an LCD screen) and a camera. The camera captures the image of a document (book) and displays it on the screen in the desired size. The device allows displaying either in natural or fake colors, to help increase the contrast, especially for reading purposes.
• The scanner with vocal rendering is an independent device for the scanning, recognition (OCR) and vocal rendering of a text. This device incorporates several technologies, including: a Pentium processor, text scanning and recognition software, text-reading software, synthetized voice software.
• The apparatus for tactile charts - produces tactile images or charts. It works with special paper which has incorporated alcohol microcapsules which expand upon heating. The making of a tactile image on paper begins with the drawing of the desired contour, using a special ink pen which must contain fine carbon particles, as the selective heating of the paper is done by infrared thermal radiation.
• The Daisy readers or players are devices that allow listening to the books created in the Daisy standard. They are similar in some ways to an MP3 / CD player.

  However, unlike the latter, they are the only ones that allow selective listening to the information created in the Daisy format. They are specifically designed for people with visual impairment.

  To be read, the Daisy books or other types of text or audio files, must be loaded through a computer into the internal memory of the device or copied onto a CD.

The most widely used access technologies in individual work on the computer are the software access technologies.

The main software technologies are:

• The screen reader is a software application that converts the text on the screen into voice.

  The program is able to read all the text displayed on the screen including menus, dialogue boxes, controls and buttons which can be controlled with the keyboard. The screen reader is a tool designed for blind people to use the Internet (e-mail, Web browsing), to work with text processing applications, and perform other tasks using the computer. For media based on Microsoft Windows, the most popular screen readers are JAWS and Window-Eyes.

• Programs to convert texts into audio files (Text-to-Speech) are software applications which allow conversion of files containing text into audio files. The difference between such an application and a screen reader application type is that the rendering of the text in voice is saved in an audio file type that can be read any time with any device which allows listening to music.
• The electronic magnifier (screen magnifier) for the computer screen, is an application designed for people with visual impairments (poor sighted), which allows the enlarged viewingof the computer screen. One of the most popular applications of the electronic magnifier type is the ZoomText which can magnify the screen up to 36 times and also allows you to choose which part of the screen should be enlarged.
• 

  The RoboBraille is an e-mail and web-based service which can automatically convert documents into a variety of alternative formats for persons with visual impairment and reading difficulties. RoboBraille is available 24/7 as a solution for self-service, it is free for all users, whether registered or unregistered, who do not use this service for commercial purposes. The objective is to support and promote the autonomy of people with special needs throughout the educational system and the labor market. As an additional benefit, RoboBraille provides privacy protection for those who need materials in alternative formats.

CHAPTER 8 - TIPS FOR PARENTS AND TEACHERS

WATCH THE CHILD’S BEHAVIOR !!!!

• He keeps the objects close to his face (eyes).
• He often rubs his eyes. He has red eyes, swollen eyelids, recurrent eyesores (sties).
• He has ocular secretions (watery eyes).
• He always turns his head to one side, using his peripheral sight.
• He may have crossed eyes.
• He bows his head down towards the table.
• His eyelids are unusually large.
• He frowns.
• He avoids lights.
• He often blinks.
• He experiences difficulties in reading and writing .
• He has a good long-term memory.
• He avoids clay, sand, plasticine, etc.
• He stumbles against objects and falls.
• He is easily distracted by the sounds that frighten him.
• He avoids getting involved in activities.
• He does not observe personal space.
• He tackles new activities with apprehension.
• He cannot find his way about the classroom.
• He does not use materials efficiently.
• He prefers just one place in the classroom, and that would be at the table.
• He keeps his head bent when he speaks.
• He manifests mannerisms (flaps his arms against his body, stares at a source of light, swings his body).
• He can be scared easily.
• He falls over frequently

TO REMEMBER!!!!!

1. Set the place from where the student can see best.
2. Encourage the child to use his sight.
3. Use visible inscriptions.
4. Set the lighting, reducing its reflexes.
5. Reduce the noise in the room and the external visual stimuli.
6. Use teaching materials and equipment.
7. Notice the first signs of fatigue: yawning, rubbing eyes, blinking, etc.
8. Read aloud the tasks and instructions.
9. Encourage the child while performing his routine activities - that would increase his autonomy.
10. Warn the child before touching or moving him.
11. Magnify the images.
12. Use appropriate timbre and intensity of voice.
13. Offer paper sheets with pronounced/bold lines for the children to use at writing.
14. Walk in front of the child or at level with him - never behind him.
15. Use bookmarks.
16. Encourage the child to explore the environment as actively as he can (especially by touch).
17. Notice and avoid the loud sounds or other stimuli that may scare the child.
18. Give him the opportunity to handle objects.
19. Use bright, fluorescent colors (red, yellow, pink, orange).
20. Provide the child with an abacus at Math classes.
21. Use audio devices in the teaching-learning-assessment process.
22. Convert texts and tasks into the Braille format.
23. Use verbal praise and touch for stimulation, encouragement.
24. Encourage the child who wears glasses with phrases like: “Did you know that people who wear glasses are considered very smart?"

GLOSSARY

BIBLIOGRAPHY:

[1]. Rozorea Anca, Deficienta de vedere - o perspectivă psihosocială și psihoterapeutică, Ed. ProHumanitate, 1998.

[2]. Rozorea Anca, Deficienţele senzoriale din perspectiva psihopedagogiei speciale, vol I și II, Ed. Ponta Constanţa, 2003

[3]. Ilie Stanică, Mariana Popa, Doru-Vlad Popovici, Anca Rozorea, Ionel Muşat, Psihopedagogie specială Deficienţe senzoriale, Editura Pro Humanitate, 1997;

[4]. Ştefan, M., Educarea elevilor cu vedere slabă, Ambliopi, E.D.P., Bucureşti, 1981;

[5]. Roth, W., Tiflologia. Psihologia deficienţlor vizual, Cluj, Univ. Babeş-Bolyai, 1973, p.3;

[6]. De Laet, H., Cum interpretăm un examen ocular, Ed. Medicala, Bucureşti, 1965, pag. 111;

[7]. Bangerter, A., Traitement de l ambliopie, Charleroi, Heraly, 1953, pag. 17;

[8]. Chapman, E.K., Stone, J.M., The visually handicapped child in your classroom, Casell, London, 1989;

[10]. Cernea, P., Anomalii oculare congenitale, Ed. Medicala, Bucuresti, 1988, pag. 12;

[11]. Popescu-Nveanu, P., Dicţionar de psihologie, Bucureşti, Ed. Albatros,1978, pag 523;

[12]. Sillamy, N., Dicţionar de psihologie, Ed. Univers Enciclopedic, Bucureşti, 1996, pag. 228;

[13]. Golu, M., Op. cit., 1972;

[14]. Maria-Elena Osiceanu, Mihaela Sterian, Rolul tehnologiilor de acces în stimularea abilităţilor cognitive de învăţare la persoanele cu deficienţă de vedere, Conferinţa Naţională de Tehnologii Inclusive, secţiunea: „Accesul la educaţie pentru persoanele cu deficienţe de vedere”, Academia de Studii Economice, Bucureşti, 17-18 aprilie, 2008.

[15]. Popa Ion, Nămolovan Georgeta, Tehnologii de acces, Casa Corpului Didactic a Municipiului București, Școala Gimnazială „Uruguay”, Conferința Națională Globalizarea și noile tehnologii, Ediția a III-a, 11 iunie 2014, Editura Atelier Didactic, București, 2014, pag. 162-167, ISSN – 2360 – 4700, ISSN – L – 2360 – 4638;

[16]. http://en.wikipedia.org/wiki/Assistive_Technology_Acts , 2013.

ALFABETUL BRAILLE