Once you’ve worked with a DB student who has difficulty with communication, it becomes clear that any goals you establish must be the child’s goals, not the therapist’s. Classic therapeutic goals sometimes conflict with child-centered goals.
Here is an example:
The DB student wants to:
- Have relationships
- Be comfortable in all the daily contexts: home, bus, school, community
- Know who can help her, and how to access that person
- Have things to do that are fun and interesting
- Go places, be included
Therapist often wants to
- Improve motor function
- Expand fine motor skills
- Increase muscle tone, strength and endurance
- Work toward objective, measurable "results"
This curriculum attempts to make the case that the primary goal for DB students who have problems with communication is to bring them into some kind of literacy so that they can form and sustain meaningful personal, social and work relationships.
As you read through the “Defining Literacy” portion of the “Goals” section, think about how you as a therapist might accomplish what you know to be priorities (the clinical issues you need to address) within the larger context of developing and reinforcing communication and literacy.
As therapists, we have two specific reasons to be interested in notions of Literacy when working with DB students:
- Like all of the other students we serve in public schools, literacy is a primary objective that will equip students for a life in the community. It may not be identified as a “PT” goal, or show up in an OT IEP, but literacy must be a primary focus for children who lack communication skills.
- The activities that therapists often employ in school-based settings provide Excellent opportunities for teaching literacy. That obstacle course you set up in order to address motor planning is packed with language-learning potential. If we plan it well, that meal time skill-building session twice a week could end up also helping the DB student learn the names of objects and foods (through sign, Braille, gesture, print, speech – whatever is available!)
When we think of literacy for typically developing sighted students, we most often think in terms of reading and writing, and doing both at a level that allows communication.
Literacy allows us to:
- share messages and information with each other
- keep a record of interactions and
- create a form of relatively free expression.
We understand print forms, such as books, magazines and electronic messaging as viable forms of literacy. American culture also values photographs, film, and many kinds of graphic design as powerful forms of communication. Print forms are the most tangible, we can hold them in our hands, but they are accessed visually. Photography, film and graphics are even less “substantial” experientially, accessed solely through vision and hearing. Spoken language, too, is accessed through hearing and vision.
Many students with deafblindness will not be able to hear spoken language or develop speech of their own. Many will lack the tactile or cognitive skills needed for learning Braille, the most standardized alternative to print available for readers with visual impairment. For those deafblind learners, literacy requires physical access to information. Most communication in-the-moment (i.e. communication that substitutes for interactive speech) will take the form of coactive signing (signing into the hands of the person you are “speaking” to, and “reading” their sign in your own hands when you are the “listener.”)
Additionally, DB students miss out on much of the INCIDENTAL LEARNING that their peers experience. “Incidental learning” refers to the acquisition of knowledge through informal, “natural” processes of assimilating information. When a toddler climbs up on a rocking horse to play, she will learn more than just how to get up on the horse. She will notice that she can see different things than she can when she’s crawling (and later generalize that to a notion that “the higher I get, the more I can see”), she will develop a sense of how far off the floor the seat is (even if her feet don’t touch the floor),etc. The DB student does not necessarily learn the incidentals of an activity, which often diminishes the motivation for the activity, and the child’s proficiency.
For such students, ”literacy” often involves : Pictures, Objects, Gestures, Sign or other forms of dynamic communication.
Instead of focusing solely on reading and writing, literacy for these students is about being able to follow directions, use a recipe, make a list, remind yourself about an upcoming event, understand a schedule, make a request.
As Therapists, we can help the DB student develop functional literacy skills by incorporating some of the following strategies:
1. Pick “topics” tailor to the likes and dislikes of the child and also target the strongest abilities of the child
If your student likes things that spin, make a book that offers tactile experiences of spinning things – pictures of buses with wheels that spin attached to the page. This helps spark an interest in the idea of representation and “book,” by pairing visual and tactile senses. It replicates formal aspects of “book,” - something we recognize as literacy – and also provides a way for the DB student to share an experience or interest with a peer.
2. Wait – extend your usual response time to give the child time to process your request or question
3. Make a “book” for your therapy sessions.
Use a Book box: A collection of objects used in a routine, kept in a specifically designed spot, in a box that the child will recognize it as a representation of the activity
Use a Book Baggie: Make a “book” out of objects the student uses in a routine. Put one object into each ziplock bag, and staple the edges of the bags together so that they can be manipulated as though they were “pages” in a book This provides a way to “talk” about what the student is doing, or going to do. Have a conversation about toothbrushing, or making a smoothie, by reviewing all of the objects you use for those activities.
4. For young students, find out what book the class is reading
during circle time or reading time. Gather actual objects that are mentioned during the reading of the book and put them in a zippered bag. This gives the DB student a chance to practice locating and identifying objects that are named (signed to him, etc.) and an opportunity to share. Also, teaches the concept of “things go in places,” which is something the DB student needs to learn as early as possible in order to organize and understand their world. Great portability, too.
These four videos are also available from Teaching Research Publications one a single DVD that can be played on a computer or home DVD player. Cost: $5.00 per DVD (includes shipping).
To order by mail, phone, or email:
Teaching Research Publications
Attn: Lisa Wilson
345 N. Monmouth Ave.
Monmouth, OR 97361
When you approach the task of formulating an IEP for a DB student, it may not be clear how to proceed. Much has already been written about formulating IEPs for these students.
Here are some sites that offer information you may find useful:
- IEP Quality Indicators for Students with Deafblindness - The IEP information is divided into Etiology, Access to Information, Social Issues, Communication, Calendar System, Behavior, O & M, Related and Supplemental Services and Transition Planning. A quick look into these instructional categories will give you an idea how to prioritize target skills.
- Joseph's Coat: People Teaming in Transdisciplinary Ways
A team, or “integrated” IEP is a document containing goals and objectives developed collaboratively by all team members. Based on family priorities, the group establishes an integrated set of goals (four to six) and two to three objectives per goal (eight to twelve objectives total for the IEP). If an objective relates to a particular related service, that related service provider is identified as responsible for insuring that instruction addressing the objective is implemented and that documentation is collected.
Teaming allows specialists, teachers, and families to work together to teach skills in natural contexts where there is more opportunity for frequent practice.