Description of graphical content is included between Description Start and Description End. Transcript Start Chapter 1. Scalp massager Narrator: Jack has Microcephaly, Hypotonic Cerebral Palsy, Dysgenesis of the Corpus Callosum, and CVI, Cortical Visual Impairment. At the time of this video, Jack was able to roll over independently. He was working on sitting with support. He is not able to independently get into a prone on elbows position. His vision report states that he has visual responses in the midline to inferior regions, with visual loss throughout the superior range. He responds well to red light. In the video we see Jack learning to sit with assistance. You will see him sitting with very little assistance at certain points in the video, and at other times, when he is stressed, he leans back into the adult and needs assistance for balance. Once relaxed, again, his balance improves. At this stage Jack was touching objects briefly and letting go. He is working on learning to grasp items and hold onto them. He is beginning to use two hands at midline, and bring an item to his mouth. The goal of this activity was to encourage him to use a familiar way of playing, namely pushing, to lead to more grasping and exploring the features of an object. Jack likes vibration and pushing items to create a tapping or other sound. In this video, we see Jack, who is almost three years old at this time. He is sitting on a resonance board with Cindy, who is a familiar staff person, and she is presenting a number of different materials to him. Usually there would be a mirror in front of them, so that she could observe Jack's reactions. On this day, the mirror was not being used, because of the filming. Note that there is a wide variety of objects all around them, so that Cindy can easily reach for other materials, as needed. Jack's feet are bare and his pant legs are rolled up, so that he can explore with his feet, as well as his hands and face. He is sitting with his bare feet in a metal bowl with strings of beads. As the video begins, Cindy is holding a vibrating scalp massager at chest-level, near Jack's right arm. Note that she does not say anything to him, nor does she give him any instructions. She is not touching him with the vibrating object, but, rather, is holding it there and allowing him to discover it himself. Be sure to note how long Cindy waits for a response from Jack. It is important to allow Jack plenty of time to explore materials in the way in which he is most comfortable. [children's music playing] Cindy: Hey, would you turn off the music, please? I sure will. Cindy: Thank you. A number of times Jack looks towards it, but then looks away. Cindy continues to hold it quietly and steadily. [music stops] [vibrating metal sounds] After several minutes without a visible response from Jack, Cindy turns off the scalp massager. [vibrating stops] Jack immediately vocalizes and smiles, at which point Cindy turns it back on. [vibrating metal sounds] Jack reaches out and touches the massager with the fingers of his right hand. He holds onto it for several seconds, and then lets go. He vocalizes, again, and moves his feet in the metal bowl. Cindy imitates his communication sounds. [telephone ringing] [background voices] Intercom: Jody, you have a call o n line one. Jody. Line one. Narrator: This activity is an excellent example of Offering, which is the first of the Five Phases of Educational Treatment outlined by Dr. Lilli Nielsen. During this phase, no demands are placed on the learner and the learner decides whether or not to interact with an object. [Jack vocalizing] [background voices] Chapter 2. Vibrating brush, clatter, rattles Cindy turns off the massager and puts it away. Note that, again, she does not speak, but rather, just quietly reaches for the next item. Cindy presents a vibrating brush. [electric motor whirring] Jack reaches for the brush with the index finger of his right hand. As before, he removes his hand, and then reaches back to touch the brush a number of times. [electric motor whirring] Cindy places the vibrating brush on Jack's left foot. He immediately starts to whimper and fuss. [Jack whimpering] Cindy says to Jack, 'Do you feel that tickling your feet?' Cindy: Do you feel that tickling your feet? Is it tickling your feet? Narrator: She asks him if she should turn it off, and then does so, while saying 'Off.' Cindy: Should we turn it off? Should we turn it off? Off! [Jack whimpering and crying] Narrator: Cindy doesn't dramatically respond to Jack's negative reaction to the vibrating brush, but simply acknowledges that he would like to move onto something else. She repositions Jack and reaches for a different object. Cindy repositions Jack and reassures him that, "It's alright", but she doesn't end the session just because Jack has been unhappy. He quickly adapts and Cindy holds a clatter suspended near his right hand. Again, because this is the Offering stage, she simply presents the object to him without comment or requesting that he do anything. [background noises] [Jack vocalizing] Jack smiles and vocalizes. [Jack vocalizing] Cindy introduces a seed pod rattle on Jack's left side. He vocalizes and brushes the rattle with his left arm. He touches the clatter with his right hand. Items are held at the level where he is likely to touch them with random movements, which then encourages further exploration. Again, note that Cindy doesn't touch Jack with the items, but rather, these objects are simply offered to him. [background voices] [clatter noises] [rattle noises] Jack vocalizes and makes smacking sounds. Cindy imitates him. [smacking sounds] Jack brushes the clatter again and Cindy places it in his lap. He explores it with both hands at midline, while continuing to vocalize. They continue with vocal play, while Jack explores the clatter in his lap. [Jack vocalizing] He makes sounds with his breath, and Cindy imitates these, as well. Time passes. Jack brushes the seedpod rattle with a random movement with his right hand, and then continues to explore it after he has discovered it. He reaches across midline to play with the rattle. He explores the seedpods with his fingers. [rattling sounds] [background noises] Cindy: [imitates sigh] Narrator: After a brief break, Jack uses both hands together to explore the seedpod rattle. Cindy places the rattle in his lap, so he can explore it independently. [rattling sounds] Jack grasps the handle of the rattle and pulls it towards himself. He again uses both hands together at midline to explore the rattle. Jack interacts with the seedpod rattle, pushing it away and pulling it towards himself. [rattling sounds] Note that Cindy observes Jack carefully, watching for any reaction to the objects. She allows plenty of wait time before removing anything or introducing anything new. Jack vocalizes and smiles and laughs when Cindy imitates him. Cindy introduces a different type of seedpod rattle, without removing the others. [rattling sounds] Jack explores the seedpods with his right hand, while vocalizing with Cindy. There is some background noise as someone enters the room and speaks in the background. [knock on door] [background voices] Chapter 3. Bells, balls, etc. Time passes. Cindy introduces bells and Jack smiles broadly. [small bells ringing] Again Jack vocalizes and smiles, while Cindy imitates him. Jack bumps into the bells with his left hand and then looks down at them. Cindy puts down the bells in Jack's lap, along with the other objects. She then reaches for another seedpod rattle, which she holds in back of his head. Jack tips his head backwards to make the seedpod rattle. He laughs and vocalizes while doing this. [Jack vocalizing] [rattling sounds] [rattling sounds] Jack vocalizes and Cindy responds, "That's a good story," while he continues to vocalize. She puts down the seedpod that she had been holding behind his head. Cindy presents the paddle drum together with a bundle of pipe cleaners. Cindy: That's a good story. Narrator: She scrapes the surface of the drum with the pipe cleaners and then stops. Jack reaches out and touches the drum. He touches the drum with both hands at midline. [scratching sounds] Cindy scratches the surface of the drum and Jack responds with happy vocalizations. [scratching sounds] [Jack vocalizing] [scratching sounds] [Jack vocalizing] [Jack vocalizes, Cindy imitates] Cindy: Here comes the ping the ping pong balls. Narrator: Cindy flips over the drum and places ping pong balls inside. [Jack vocalizing] Jack reaches forward and moves the ping pong balls with both hands. He continues to vocalize, as Cindy imitates him. [Jack vocalizing] He continues to move the ping pong balls with both hands and then picks one up with his right hand. He brings it to his mouth with both hands and briefly taps it against his teeth. Jack moves the ping pong balls some more and picks up another one. Again he brings it to his mouth. Cindy adds more balls to the paddle drum. The balls are different weights, but are comparable objects. Some are heavy golf balls, some are ping pong balls, and some are hollow wiffle balls, which invite comparison as Jack explores them. Cindy: [whispering] [Jack vocalizing] Narrator: Jack continues to vocalize and bring the balls to his mouth. He picks up a golf ball and Cindy says, "It's bumpy." Cindy: Yeah it's bumpy. [metal clanging in background] [Jack vocalizes] [metal clanging in background] Cindy: Thanks. [Jack vocalizing] Narrator: Jack alternates between placing his hands in his mouth, vocalizing, and exploring the balls with his hands. [Jack vocalizing] Cindy: [imitates sigh] [Jack vocalizes] [Jack vocalizes] Cindy transfers the balls from the paddle drum to a metal bowl. Note that she changes just one element at a time, as she makes the transition from one activity to the next. Jack reaches into the metal bowl and picks up another ball to bring to his mouth. After playing with the balls in the metal bowl, Jack explores the items that are in his lap, including the clatter. [background voices] Cindy places some balls and the bundle of pipe cleaners back in the metal bowl. Jack laughs and vocalizes. Cindy continues to offer the bowl of balls and pipe cleaners, but without making any demands of Jack. She imitates his vocalizations. [student vocalizes off camera] [Jack vocalizes, Cindy imitates] [loud student in background] [Jack vocalizes, Cindy imitates] [loud student in background] Cindy puts down the metal bowl and picks up two strands of metal beads. She holds them suspended in front of Jack, slightly to his left side. Notice how Jack is beginning to search the environment around him, [loud student in background] [Jack vocalizes, Cindy imitates] [student vocalizes off camera] Cindy puts down the strands of metal beads and presents a wire ring. She places it in Jack's lap. Cindy: [imitates sigh] [Jack vocalizes, Cindy imitates] Cindy introduces a small, vibrating Z-Vibe at upper chest level on Jack's left side. He touches it with both hands, and grasps it briefly with his right hand. [Jack vocalizes, Cindy imitates] [student crying in background] [Jack vocalizes, Cindy imitates] [student crying in background] Jack discovers the wire ring and puts it around his right arm. Cindy recognizes that Jack has been engaged in an Active Learning activity for a long time. Now, Jack probably needs to engage in a completely different type of activity. She concludes by reviewing the things they played with, which helps to reinforce the language related to the experience he has just had. Cindy: Are you all done? Are you all done? Okay, we were playing with lots of stuff. We made noise with ping pong balls... and bells and... these rattles. That was a good day! We had a good time, yeah? [Jack vocalizes] Yeah, there were lots of things to play with. Is it ready for your lunch, soon? Are you getting hungry? Yeah, it's going to be lunchtime, soon. You did good talking today. [Jack vocalizing] Yeah. Did you have a good time? Yeah, I did, too. Okay, see you later.