Dori Senatori

History:

 

Baby Y was born premature at 32 weeks in the summer of 2013 with Herpes Simplex Virus, infantile seizures and damage to ½ of the left side of her brain due to a cyst causing global delays. Baby Y was hospitalized for 6 weeks after birth with a Staph infection, and now takes medications for seizures which have the side effect of blurriness and double-vision.

 

Based on the FVE baby Y has a diagnosis of Cortical Visual Impairment and Nystagmus. Baby Y is at the low end of the CVI range (Building Visual Behavior from level 2-3).

 

Observation location/participants:

 

The observation took place in the living room area of the baby’s home. Present for the ECI session included the baby’s mother, father, O&M specialist and the TVI.

 

Format of the lesson being conducted by the TVI and the O&M:

 

 (The co-visit was used to allow for positioning of baby, other strategies, and any assistive technology needed to be set-up throughout the lesson.)

 

Swinging in a fabric swing:

 

The fabric was white and the baby began crying when she noticed the white fabric against the black rug, and she appeared to recognize what about to happen since this activity was had been done in previous lessons. Baby Y liked the swinging and signaled this by crying. The swing appeared to provide tactual input and also a possible indication of her ability to notice the contrast of colors used and anticipate starting the activity.

 

The swinging was done with verbal phrases as the TVI & O&M swung the baby side to side and back and forth. The goal of the lesson was to alert the baby of the positional change of lying on her back to sitting and being up in the air, with careful attention to attempt to direct the baby’s visual regard to her lower visual field (since her preferred choice is to look in her upper visual field and go into extension of her body). The TVI reported that the need to regard her lower visual field will enable her to have increased social interaction with her family and environment.

 

Throughout the lesson the TVI & O&M paused to allow the baby to signal with her visual regard to continue the swinging motions and asked her if she wanted more, once the baby made an indication with a smile or visual regard to continue the motion the TVI & O&M would continue swinging.

 

Lighted red bell ball rolling activity:

 

After the swinging activity the TVI & O&M lowered the baby to the floor and she began to cry. The mom mentioned the baby was crying because she really loved the swing activity and did not like it to end. The TVI positioned the baby in sitting as she sat behind her providing maximum assistance to maintain Baby Y in the seated and upright position. Initially the O&M provided a choice of two balls to Baby Y, the red bell ball and the blue bumpy ball. Verbal cues with the flashlight were used on each ball while they asked Baby Y to make a choice between the two. The TVI mentioned that they were trying to begin to teach her that there are more than 2 choices, and that they wanted to give an increased wait time while they wait for a visual regard to either ball choice. The O&M reported that Baby Y gave visual regard to the red ball and then they began the activity. The rolling back and forth activity consisted of the O&M shining the flashlight in to the red bell ball as she rolled it back and forth to Baby Y and the TVI would also begin to help Baby Y catch the ball and roll it back. During the session Baby Y was given increased time to reach out to the ball with two attempts to touch the ball on her own noted. The ball rolling activity worked on sitting balance in flexion, head control and visual regard in the lower visual field, encouraging purposeful movement, and midline play.

 

Initiating The Little Room set-up and configuration:

 

The TVI & O&M began to teach Baby Y’s parents about The Little Room and Active Learning. The professionals brought supplies into the home to demonstrate what The Little Room is and if they would like the idea of having a defined play space in their home. Baby Y was then positioned on a wedge in a mock-up little room made of PVC pipe to determine if it would be appropriately sized for her and how she would respond to it. The TVI began hanging a couple of items with light shining through them on one side, and then shiny beads on the other side. Baby Y immediately gravitated towards looking at the yellow slinky with the light shining through it. The parents reported that they would like this in their home for their daughter, so the TVI and O&M will begin to make one that is appropriate and specific to Baby Y’s needs.

 

Parent interaction with their child and the TVI & O&M:

 

The parents (mostly the mom) were very interactive during the lesson, and both the mom and dad sat on the couch in the living room providing constant feedback and answers to questions the TVI & O&M were asking them. The TVI & O&M began swinging the baby in the direction of the parents to attempt to have the baby make visual regard with the parents, and the parents were al able to provide verbal praise. Once it was sure that the baby was enjoying the activity the TVI asked the mom to stand up and they begin swinging the baby towards her so the baby’s foot would touch her each time, giving the baby an orientation of where she was in space by giving her input to her foot.  The baby’s pleasure was notable in that she was smiling during the whole time she was being swung, especially when her parents spoke to her. The TVI & O&M were providing instruction to the parents as they went through the lesson, and the mom was providing consistent feedback as the husband sat mostly silent. The TVI & O&M were providing suggestions during the lesson as to how they could do some of the activities on their own.

 

Collaborative methods used by service provider:

 

The co-visit provided for an excellent lesson for the ECI student, as it allowed one professional to position the baby and the other professional could position the equipment and/or obtain a toy or other device needed during the lesson. The two professionals worked together well as they communicated individually with the baby so as not to overwhelm her with too many verbal cues. Throughout the treatment session both professionals collaborated on the next idea to try, or if the current activity should continue. Both of the professionals took turns being in front of the baby during swinging and provided the baby with verbal cues and waited for a visual regard to continue the swinging lesson.

 

Strategies Used

 

Language Literacy:

 

The TVI & O&M facilitated language learning carefully and slowly throughout the session labeling each activity while attempting not to overwhelm Baby Y by providing too much talking. The swinging activity included a song about Baby Y ‘swinging back and forth, and then side to side ‘and she appeared to enjoy the movement with the song. Language was also used to teach about the ball rolling to the right side, left side, and to the middle, as the TVI & O&M said ‘it’s on your right side, roll it back to me.’

 

Thinking Skills:

 

The TVI & O&M have provided a predictable situation for Baby Y with the use of the white fabric for the swing and the lighted red bell ball. The professionals report they have kept these activities consistent to provide stability for Baby Y and so that she will understand the sequence and pattern of activity that occurs every time they come for a lesson. Baby Y begins to cry and signal that she wants swinging to occur first when she sees the white fabric. Baby Y is then given a choice of two balls during each lesson, and increased wait time is provided to encourage her to be the one to choose.

 

Self-control:

 

Baby Y expressed interest and dislike for an activity in the same way during the observation. Baby Y does not yet have the language as of yet and crying is her only way of signaling a want or need. Baby Y immediately began to cry in the beginning of the session when mom placed her on the floor next to the TVI. It was uncertain if she was crying about touching the floor or the fact that she saw the white sheet contrasted on the black rug. Baby Y began to stop crying when the TVI told her that she was going to swing in the white sheet, as she placed the baby supine in the center of the sheet and begun to swing her. The TVI mentioned the week before that Baby Y was unable to tolerate the swing and continued to cry, signaling that she wanted out of the swing and to stop the activity.

 

Self-confidence:

 

The TVI & O&M provided verbal praise to reward Baby Y for attempting to reach out towards the ball each time it would roll to her. When the ball would come to her they would say “Where is it?  I need you to look at the ball and touch it so I know you want to keep playing!” Baby Y would then visually regard the ball and with some assist reach out and touch the ball to roll it back to the O&M. The praise associated with the activity of looking, reaching, and rolling the ball back will start to build her confidence that she can participate and control her environment. In future lessons, The Little Room will also provide her with confidence as she starts to understand that she can manipulate objects and play independently as she chooses.