Minimally Responsive Child These students need to be assessed over time and in different environments, and w/ caregiver or other who knows child well! Children who may have complex medical complications requiring ventilation, tube feedings & highly technical wheel chair design and/or postural supports due to severe physical limitations, asymmetries, contractures, and quality of postural tone. Regulatory systems are often significantly impaired, second-are to brain injury, trauma, seizure disorder, and/or medication to manage medical needs & to support life functions. These students manifest behavior states that range from constant agitation to deep, profound sleep states. For these children, programming often focuses on massage & visual & auditory stimulation/bombardment rather than on integrating the CNS so the visual system can become organized and ready for taking in and using information.

Posture-Vision Relationship Apparent Light Perception Strategies: Posture-Vision Relationship – Items may be elicited by therapists during sessions, interviews with caregivers & others, or elicit the postures yourself through play and social interaction. Apparent Light Perception – GIVE BLACK LIGHT WARNING!! Ensure that student is in state of readiness to respond, and in a posture that offers sufficient stability for movement of head and eyes. This part of the assessment may need to take place over time and in different environments and contexts.

Posture-Vision Relationship Rationale Interrelationship between postural system and visual system is so powerful that deficit in one significantly influences the other. Vision may be present but cannot be expressed until postural and motor system is prepared So, what this is saying, is………………

We Must Prepare the Visual System for Function!!

Assessment Sequence Organize postural alignment and symmetry Facilitate quiet alert state Influence movement and postural components that support visual function

We Won’t Impact Vision Until We Get Postural System in Place Every Time We Make a Postural Adjustment We Must Allow For a Visual Adjustment As we’ve stated before, the interrelationship between the postural system and the visual system is so powerful that a deficit in one significantly influences the other. Vision may be available but cannot be expressed until postural and motor system is prepared for expression of visual potential. Another thing to remember when looking at posture: the less the student has to work against gravity, the easier it is to organize the visual system. Remember, we want to: Organize the student’s posture to provide proximal stability for eye mobility Align the head and neck, when appropriate, to prepare the visual system for function Facilitate optimal arousal and attending behaviors to enhance visual functioning

Intervention with the Child is Your Assessment Intervention consists of positioning and aligning. And, intervention strategies should include activities that are designed to address: Organization of visual system Integration of vision within a movement activity Immediate application of the visual skill within a functional Materials used should share attributes likely to elicit visual awareness and attention in neurologically impaired systems: Faces (especially familiar ones), reflective surfaces, fluorescent materials, illuminated toys, etc

Minimally Responsive Child Posture & Movement Components of Visual Function Postural tone Head/neck Components Shoulder Girdle Components Upper Extremity Components Trunk Components Movement Skills Indicate with a check-mark if each is WNL or deficit, based on child’s chronological age.

Apparent Light Perception Rationale If light perception is apparent, it may represent minimal level of visual functioning Any amount of light may be made more efficient for functional application Student may be made aware of visual capacity and attend to motion, color, and distant lighting sources to better orient to and discriminate his surroundings and, subsequently, increase his independence

Minimally Responsive Child Apparent Light Perception Eliciting Context /Nature & Quality of Visual Response Facilitated Contact Imposed Light Motion Against Light Form Against Light Detail Against Light What we’re trying to do is find out if child has LP; to elicit what’s there and then expand it! LP is important – using to orient, etc. We will look at and report on: Source of light Quality of light Contrasting light Distance Field For each of the above eliciting contexts, there is a hierarchy of responses: Does not respond Alerts Orients Localizes Reaches Activates Shifts Moves toward Pursues Searches * Scans * Discriminates * * these are cognitively driven

Good Lookin’ Video http://www.aph.org/webcast/ISAVE.html - Video #2