A Child-Centered Approach: Common Themes in the Early Years
by Joe Cutter

Historically, orientation and mobility has been taught from adult to adult with particular emphasis on cane travel. This tradition can be referred to as a "top-down" approach, adults already having the concepts and learning the motor schemes to match their comprehension.

With a pediatric perspective, however, the approach will be "bottom-up." First, the child learns purposeful movement and out of the relied-upon motor schemes will come the concepts. During the first two years of life particularly (known as the sensorimotor stage of development), the child will come to know and master his/her environment with a lesser or greater degree of competency. The orientation and mobility specialist will be better equipped to assist the blind child if knowledge is gained about how children learn.

The following list of concepts respects the "bottom-up" approach. It's a peek at some of the ways blind children will come to know and move in their world.

1. Holistic Nature of Child. The child is more than the sum of his/her parts. The child perceives changes in the world and responds to those changes. The baby does not know, for example, that he/she is seeing or hearing or touching, but rather experiencing a change in the environment.

2. Development will be Head to Foot and Proximal to Distal. This is quite significant, as the blind child's hands and feet will be the last to develop control in the first year of life. Foot travel and integrity of hand use will be needed by the blind child for life and yet the blind child is quite vulnerable in how he/she develops control in them.

3. Play. Lorraine McCune states: "When play is defined to include all of a baby's freely chosen encounters with objects, a large proportion of the child's waking time is play time!" When blind children are restricted in the kind and amount of play they may be allowed to perform, when they are limited by others in their free, intentional movement, the context of their understanding of people, places, and things will also be limited along with their ability to reason, experiment, and create a more functional understanding of their world.

4. Reflexive. Accidental. Intentional. There is an integrative function to the brain, so that the child learns progressively. The blind child is vulnerable to not taking advantage of "accidental behavior" (example: hands coming into view), which has an impact on developing intentional thought. So, we must provide an appropriate menu of nonvisual experiences that promote accidental learning in the blind child.

5. Using Residual Vision. In the early years, residual vision may be ignored because it is less than "print vision." What may start out as light perception or projection in the infant may, by two or three years of age, become more useful. CAUTION: DO NOT PUSH VISION TO THE POINT OF INEFFICIENCY.

6. Active vs. Passive Use of Body. Blind children are quite vulnerable in this area. Often, intentional actions are interrupted by adults doing for the child. Over time there is a subtle and potentially devastating concept of the world "reaching to you" and you not "reaching to it." The role of the orientation and mobility instructor can be instrumental here, structuring the environment to facilitate the child's movement.

7. Parental Interaction-Close In to Moving Away. First through touch and sound, attachment occurs, but often during the second year, parents move to more verbal interaction with children. Blind children may need a prolonged period of touch interaction here, a period of infant-parent attunement.

8. Preview. Lacking sight, the blind baby does not get a visual preview of the world. How can we provide experiences that will give the blind baby a preview of his body and the world?

9. Synchrony. In the early years, blind children—the same as sighted children—use two senses at a time instinctively to experience the world. For example, when babies hear a voice, they turn, expecting to see a face. What of the blind baby who turns, but does not see a face? Would moving the arm to feel the face provide a meaningful function? One 13-month-old baby, when hearing a person's voice on the phone (and not being able to touch the person), smelled the phone. Was this an attempt to verify the sound? To synchronize?

10. Affordance. The structure and function of objects have a lot to do with a child's interest, amusement, and interaction with them. Giving thought to the child's play environment can facilitate purposeful thought and movement.

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