The ECC: Webinar #5 This video is posted online with the following chapter markers: Chapter 1. Introduction - Intro of Millie Smith, education professional and author of the Sensory Learning Kit. Chapter 2. Learning Media Assessment - Detailed steps in completing LMA for student in the Sensorimotor Stage. Chapter 3. Closing Comments - Closing Comments The ECC: Webinar #5 Transcript [ Music ] Chapter 1. Introduction [ Start slide: ] [ End slide: ] [ Start slide: ] Ann: I really don't know that we need that much introduction for Millie Smith, but she has graciously agreed to present our fifth webinar on the ECC. And today she will be focusing on Sensory Efficiency. A few things in relation to that: Her handout is the first thing in your handouts. There's a little table of contents that's starting on page one. [ End slide: ] [ Start Screen Share: ] Learning media assessment, the sensory motor stage, and I also want to refer you to the fact that in the ECC Essentials book, which I would hold up -- but I think that my camera might have just disappeared -- Millie wrote chapter five. So, I want you to refer you to that to make sure that you realize what an excellent resource that is. After Millie's handout on LMAs for Students at the Sensory Motor Stage is the resource document that we've been trying to add to each of the webinars. And it is a chart that includes assessment tools on the left‑hand side, and then on the right‑hand side, a list of teaching materials and resources for whatever the particular area of the ECC is for the day. That starts on page thirteen in your handouts today, and just want to refer to that, hopefully, at the end of this, I would say that I'm looking forward to it, I'm not sure that I really am, but Debra Sewell and I are planning to compile all this information in what we hope is a more usable format, but anyway, for now you have some information. And the very first teaching material that you see up there on page thirteen, under the column for teaching materials and resources, is chapter five of the ECC Essentials book. And it is by Millie Smith. And so, Millie, we don't want to take any more time away from all of the great stuff that you have to tell us. Chapter 2. Learning Media Assessment Millie: The Expanded Core Curriculum Sensory Efficiency section is one that a lot of people have been requesting assistance with. The feedback I got from the editors of the new ECC book is that there was a whole lot more professional competency in regard to the other eight areas. That makes a whole lot of sense, because the sensory efficiency area is the newest one. Most of you remember that it used to be visual efficiency and then in -- oh, I don't remember exactly what year was it? About -- I think it was about 2009 ‑‑ >>Ann: In your book you say ‑‑ [ Laughter ] Millie: Oh, it's in there? Ann: It is. You said 2009, Millie. [ Laughter ] Millie: You all can either blame or thank the National Agenda at AER for changing that area to sensory efficiency rather than visual efficiency; and that was pretty obvious; a recognition of the fact that efficiency, in all of the sensory systems is vitally important and [ Inaudible ] So, with that let me tell you what I'm going to do. I'm going to use as the tool for addressing sensory efficiency needs, something that I created called the Learning Media Assessment: Sensorimotor Stage... shell. I'm doing this with the assumption that most of you are TVIs, I hope that's correct. And let me tell you why I'm addressing the Sensorimotor Stage in particular for sensory efficiency. The reason is this, that sensory efficiency skills develop to maximum -- sensory skills develop to maximum efficiency in infancy and early childhood and [indiscernible] children. The research that we have indicates that that -- that stage of development is the window in which maximum efficiency can be achieved most easily. That's not to say that sensory efficiency isn't an issue to be addressed for all different types of students with visual impairments across all age ranges. Of course it is, but here's the difference: For infants, toddlers and students with severe disabilities [Interference on the phone line] sensorimotor stage, sensory efficiency is the primary issue in their learning, and sensory efficiency issues for other kinds of students tend to be addressed in other areas of the ECC. And in particular, in compensatory skills and in Orientation and Mobility. So the sensory efficiency area is -- specific attention to it is targeted for those individuals who are still developing those sensory skills that are typically developed to full maturity in the sensorimotor stage of development. So you are still going to do all of your pre‑braille stuff. You are still going to do all of your environmental landmarks with auditory and visual skills and Orientation & Mobility lessons, all of that is also sensory efficiency. Okay.... What we want to do now then is take a look at the shell and let me explain to you, first of all, the format. The first part of the shell is some paragraphs numbered one through seven. And the idea is that those would be the seven paragraphs included in a Learning Media Assessment for an individual at the sensorimotor stage of development. And as I said, that would be your infants, your toddlers and your students with severe disabilities. The reason this is addressed in the Learning Media Assessment is that that is the vehicle for addressing sensory efficiency needs, and so let me go through the seven paragraphs with you, and then the second part of the tool is a set of an appendices. Okay. So, if you use the Learning Media Assessment as your vehicle addressing sensory efficiency needs for your sensorimotor stage learners, the suggestion in the shell is the that first thing you address is your assessment procedure. Now, the wording in the paragraph under assessment procedure is just an example of what you might use, of course you just adapt this and modify it to -- to say what you want it to say. What I said was at the sensorimotor stage of cognitive development the efficient use of viable sensory systems is critical because the primary activity of learning is sensory exploration. Knowledge of people, objects, actions and places acquired through sensorimotor exploration is the foundation that supports all learning throughout life; including literacy, by the way. And then this will be your assessment procedure statement. Parent interview, records review, observation of regularly occurring activities, and direct assessment were used to determine strengths and needs related to the efficient use of each sensory system. Then there's a list of different tools [ Inaudible ], which we'll talk about when we finish these other paragraphs. So for your typical Learning Media Assessment for a student at the sensorimotor level, or a child of the sensorimotor level, I should say, in case it's an infant or a toddler; the tools are going to be some combination of grant interview, record review, observation, regularly occurring activities, and direct assessment. So paragraph number two in your assessment is going to address sensory systems, assessed, and -- and you're going to have two statements, one for primary systems and one for secondary systems. So for primary systems, you will want to say something like this, remember it's going to be a vehicle not only for directing the needs of your students, but also for communicating information for your other IEP team members and parents. So that's why some of these statements are included at the beginning. For primary systems, touch is always a primary system at the sensorimotor stage, and can never be excluded from assessment even when severe motor impairments limit hand use. For this assessment the tactile sense was assessed using the following modes. And then you're going to indicate one or some combination of three possibilities. The three possible modes are oral, manual and podal, and I know that podal is probably a new word for most of you, it just means feet -- think podiatrist. So you are going to assess the tactile system for your student, for all of your students, with one or some combination of those three modes. And then there's a statement then about functional vision. Functional vision becomes primary when combined with touch, but vision alone can't be a primary sensory system at the sensorimotor stage, because visual perceptual skills, such as constancy, do not develop without combined looking and touching. Now that's -- that's new, that's new for most TVIs. And it's a really big change in the way we've approached visual efficiency and sensory efficiency. Most of us have been, you know, we've gone through the drill that 80 to 90 percent of what we learn is visual and if there's any functional vision, you know, you want to work as hard as you can to make it primary. Well, all of that... is true. We do want to work hard to make vision primary, but, here's the big caveat, but vision cannot be primary at the sensorimotor stage by itself, ever. So we're going to make vision as efficient as possible, vision has to be combined with touch at the sensorimotor stage. The perceptual skills that we're talking about are identification, figure ground, closure, constancy, visual motor and the perception of three dimensions. None of those things develop, they cannot develop, without vision being combined with touch. So don't overgeneralize. Vision can be primary by itself, after the sensorimotor stage of development. So if a learner has gone through a stage where they have developed by combining vision and touch, a high degree of efficiency and good visual perceptual skills, then at that point vision can be -- can be primary by itself, but not before that. So, then your statement about whether or not vision can be primary with touch is the last sentence in that primary systems paragraph; the Functional Vision Assessment indicates that vision can or cannot, you indicate which one, be used in combination with touch as a primary sensory system. And if -- if there's any functional vision, then the answer would be can. So the next thing you're going to address is secondary systems. All secondary systems, and actually if you have the ability to write on a handout, that really should be changed to the following secondary systems were assessed, and then you just list the ones that were assessed, because you may not, in fact, assess all of them. So a better introductory system there for secondary systems would be: The following secondary systems were assessed, and then you list then and the possibilities are: auditory, olfactory, gustatory, vestibular and proprioceptive. And there needs to be some special statement about the auditory system and what I'm suggesting is that you say something like this: The auditory system has special significance at the sensorimotor stage, because of its role in language development, but it cannot be primary at the sensorimotor stage, because language skills are not yet developed to the levels necessary for the use of language as a primary source of information, and because environmental sounds provide no information about their sources, unless they are touched and seen as heard. So what I'm saying is auditory is extremely important. Putting it in the secondary systems category doesn't mean it isn't important. It doesn't mean it's not a primary source of information unless it's combined with vision and touch. And then the final thing to indicate there, in the secondary systems, is no abnormal responses to sounds and voices were observed during this assessment or abnormal responses to sounds and voices were observed during the assessment, and additional evaluation of the auditory system is needed. And then two other important statements. You may not need either one of these, but if you do exclude any secondary systems, you need a statement there that says why you excluded them, and so it says: if needed the following systems were excluded from assessment because conditions documented in current information; and then you indicate what those conditions were for each of the systems excluded. It's really important because you don't -- you need -- you need a specific, usually medical reason, for excluding assessment of a particular system. And then also important, if needed, the following systems were included with specific cautions. So for instance, that gustatory system was assessed, but citrus was excluded because of citrus allergy, something like that. And we need to scroll down. So, the third paragraph, Sensory System Response Prevalence, and let me start off by saying that prevalence is not the same thing as primary. So for instance you could do an observation where the most prevalent responses were to movement; which would be vestibular or proprioception, but those can't be primary learning sensory systems. So prevalent does not mean primary. So, what you would want to say is: sensory system responses to media, people, objects and actions; in three regularly occurring activities; and that's what I'm suggesting that you base your statements here on three regularly occurring activities were observed in order to determine sensory system response prevalence. The following summary, I will show it to you in a minute, indicates that instruction and accommodations must be provided to increase the prevalence of positive tactile responses. And usually tactile is the area where instruction and accommodations need to be provided. That's usually, for most of our students, the weakest area. And next part -- well, it can be due to a lot of different things, but it has a lot to do with -- with manual avoidance and motor impairments. So that's one possibility. Or -- and or you might say the following summary indicates that instruction and accommodations must be provided to increase the prevalence of positive coordinated tactile and visual responses. And another possibility and or the following summary indicates that instruction and accommodations must be provided to increase the prevalence of positive coordinated, and you would choose one of these: tactile/auditory or tactile/visual/auditory responses. The prevalent auditory responses do not support learning about people, objects, actions and places unless they are paired with touching and looking, when functional vision is available. So if you are right there, tactile/auditory, that means that functional vision isn't available, otherwise you would write tactile/visual/auditory. So that would be the statement about what your primary -- what the primary need of your student is. Do they need instruction and accommodations to increase tactile, instruction and accommodations to increase tactile and vision, instruction and accommodations to indicate tactile and auditory or tactile, visual and auditory. So then paragraph number 4, Present Levels of Sensory Performance. Now, that's a made‑up term. And -- and I think it's highly appropriate, and I highly encourage the use of it for sensorimotor stage learners. It's not a term you would use for any learner that you serve who's not at sensorimotor stage. And you are not just going to address present levels of sensory performance for your sensorimotor stage learners, you are going to address present level -- you are going to do PLAAFP program for functional academic skills also. But -- remember sensory learning is the foundation of all learning. You aren't going to develop functional and academic skills if you don't have good sensory efficient skills. So a present level of sensory performance is crucial at the sensorimotor stage. So this is what you're going to put. Something like this: Sensory system responses to media, people, objects, actions, in three regularly occurring activities were observed in order to determine (same three activities, you're not doing three more) were observed in order to determine sensory response levels. Present levels of sensory performance are summarized below. We will look at that later. Appendix D. Instruction should be provided to increase the percentage of responses at the one of three different levels. The quiet alert attention level, or the active alert exploration level, or the partial participation function level. Those are your three levels of sensory performance. And if you are familiar with the Sensory Learning Kit, you know what those terms refer to. If you're not, just let me give you a little -- just three -- an example of each. So one of the learning media items that you are assessing might be bells. So if the learner quiets and listens to the bells, and usually you determine the presence of active listening by quieting or -- sometimes by the cessation of self-stimulatory behaviors, or if the learner looks at the bells as they are rung by another, that's attention or quiet alert level. Exploration level would be if the learner uses the hand, foot, mouth, to interact with the bells for the intentional purpose of gathering information about them. And usually it's a -- it's a variety of different kinds of information that you are looking for and it's kind of random. They are intentionally looking for information, but they're not intentionally looking for a specific kind of information. So they just interact with the bells in different ways to see what happens as a result; and as a result they get information about texture, temperature, density, size and shape, weight -- and tactile and visual sensory channels combined hopefully. So that's exploration or active alert. And then an example of -- of partial participation or function level, would be that the learner copies a sound pattern modeled by another. Okay, so those are your three function levels, and those would be -- you would summarize -- you would indicate which is the predominant level for your student and whatever their present level is, then you would want to say, they need to strengthen their skills at that level or they need to begin instruction on the next level up. Paragraph five, highly effective learning media. That's what we've called in the past the Appetite List. So the statement there is: direct assessment was used to -- direct assessment was used to assess the effectiveness of learning media items for each viable sensory system. The following learning media items with attractive sensory attributes should be used as topics for instructional activities. And paragraph six is your accommodations paragraph, the following accommodations must be used during instruction. And then paragraph seven is your referral paragraph. Abnormal responses to sensory media were observed in the following systems. So, Kate, if you would tell me how you would like to proceed at this point. We could have questions about the seven paragraphs, or we could go through the tools which might, in fact, answer a lot of the questions that are on people's minds, but what do you think would be best at this point? Kate: Continue. So Millie, I'm saying, let's continue. Millie: All right. All right. And I'll try to do this as quickly as we can so we have time for questions and comments at the end. So Appendix A, these are -- this goes with paragraph one, and these are the tools for your assessment procedure. So for parent interview and records review, there are two tools. The Sensory Learning Kit and -- and -- in particular, the tool in the Sensory Learning Kit that would be for parent interview and records review would be the tool called the Sensory Learning Summary. Those of you that are familiar with the Sensory Learning Kit and the Sensory Learning Summary know that it has a column over on the right side of the page that says source of information, and it's something that I didn't make adequately clear, and I will do a better job in the revision of the sensory learning kit guide book, but that's supposed to indicate that that can come from FIE Report, but it's also meant to make it clear that that tool can be used as a parent interview form. So the Sensory Learning Summary is one possibility for parent interview, records review. Another tool, that I like a lot is the Individual Sensory Learning Profile interview, from Tanni Anthony; and that's a shorter parent interview if you don't want to go into quite as much detail. So those are available to you. For observation of regularly occurring activities, there's the tool called the Environmental Inventory and the Chen and Downing book Tactile Strategies; and just a note on that, change the last column to sensory rather than tactile, Chen and Downing created it as an ecological inventory for tactile performance, and if you want to use it across sensory systems, just change that -- that -- that word tactile to sensory. Another possibility for observations is the Sensory Learning Kit Revised, and so you don't have it yet, but you'll have a sample of it when we get down to the appendix for the observation -- for the activity observations. And it would be pretty easy to recreate on your own, if you like it. And then for direct assessment, there's the Sensory Learning Kit, and of course that's the Sensory Learning -- I'm sorry the Sensory Response Record, and Every Move Counts is another direct assessment. The only thing that you need to keep in mind, if you use direct -- if you use Every Move Counts, it doesn't assess nearly as many items, so you're going to be restricted in terms of the possi -- the number of possibilities for your appetite list. All right, so those are tools. The -- the second paragraph is your statement about which sensory systems you assessed, and if you assessed all of them, then you won't need either of the examples in Appendix B. If you excluded some, then there's an example there of system excluded, and for, just as an example, it says gustatory and the condition that requires exclusion was poor swallow, no stimulation of saliva production or smell by taste, and the source of that information was parent interview. And then, if you are assessing some systems but with cautions, then that's the next -- that's what the next grid indicates. An example there, you are assessing the tactile system, but you are going to have to avoid light touch, soft textures or aversive; and again there the source is parent interview. So exclusions and cautions. For paragraph number three, what you are doing here is talking about sensory system prevalence, and you're going to observe three activities to determine that. This -- the observation tool will come up in just a minute. But this is an example of how you might summarize that information from your three observations. So, in appendix C you'll see that -- let's see, all sensory systems were assessed. The appetite totals: there were two positive responses for tactile, two positive responses for visual, four for auditory, zero for olfactory, zero for gustatory, four for proprioceptive and one for vestibular. And aversion totals, you can take a look at those. The statement that is significant up there, says that prevalent is not the same thing as primary; tactile/visual combined -- tactile, vision combined with tactile, and auditory combined with tactile and visual will be targeted. The prevalence of positive proprioceptive responses is significant, though. It's significant because it indicates that this sensory system can play a significant role in the management of arousal states related to creating and maintaining alertness. So prevalence is always significant, but prevalence isn't enough to indicate primary. Cyral: Hi, Millie. It's Cyral. I just joined in, but I'm not sure that I understand that statement: Prevalence and the relationship between something being prevalent, as in frequent, versus primary. Millie: Okay. The primary systems for learning at the sensorimotor stage, you know, this is based on all kinds of neurological and cognitive psychological research. It's just primarily neurological. It has to be vision. It has to be touch or vision and touch. So that's always going to be the case with any learner. If there's no functional vision, it's going to be touch alone. If there is functional vision, it's going to be vision combined with touch. So those are your primary systems, that's never going to change. Those, however, many, many times, with a high degree of frequency, those primary systems won't be the learners prevalent systems. Because they are difficult to use. If you have a vision loss and if you have motor impairment, or if you have tactile -- if you have manual avoidance because your hands have been overmanipulated, then vision and touch are not -- those are not going to be the prevalent systems. That's why -- that's the nature of our jobs in a nutshell. It's to make those primary systems also prevalent. So if -- if your observation shows that your prevalent systems are something like auditory and proprioceptive, as indicated in this one, what that's telling you is that those systems are very, very significant in terms of using them for highly motivating topics, for instructional activities, but that the focus of your work is going to be, while you use those prevalent -- you use those systems to where the student, the learner, really likes using those systems, you use them for motivation, and you use them for arousal state management, but you use them as a means of providing activities whereby you provide instruction that makes the primary systems more prevalent. Did that help at all? Cyral: Yeah. Actually, I think I know what you are saying, but I'm having to kind of go through all of those words in my head. Millie: You're going to use -- you're going to use -- you're going to use prevalent secondary systems as motivating topics for instruction, and then in that instruction, you are going to try to make primary systems more prevalent. Cyral: Perfect, thanks. Kate: You are going to try to kick in that vision‑touch system using those auditory and proprioceptive. Ann: This is Ann. Millie: That's -- that's it. Hi Ann... Ann: I get the information and the chart except for the percentages at the bottom. 10, 10, 20. Like how did that percentage come -- Where'd that come from? Millie: It just means that 10 percent of the total responses -- of the total responses observed, 10 percent were positive tactile, 10 percent were positive visual and 20 percent were positive auditory... Ann: So the percentages are just the positive ones? Okay. Millie: Just positive. Right. Yes, positive responses... Ann: The two out of twenty. Okay. Millie: And only positive responses are -- significant in terms of either topics for instruction or trying to increase prevalence. So all that shows you is that those are really low, and the prevalence of tactile and visual is not nearly high enough. And you would use that, if you're going to write an IEP goal, that's your baseline data. So an IEP goal might be something like: learner will increase positive tactile responses to learning media in instructional -- in three instructional routines to 50 percent. So those totals there can be your present level -- your baseline, your present level for your IEP objective. So Appendix D is your present level -- present level of sensory performance, and again, that means one of four possibilities, extended state; and extended state is less than alert. So we're looking at fussy, drowsy, agitated, sleep -- there for extended state, and then quiet alert, active alert, partial participation. And that -- the numbers and the percentages that you see there are the totals from the observation. So, this is an example of present level sensory performance data summary for response levels that might be included in your fourth paragraph. It indicates that this student's present level of performance is extended state, and that instruction should be provided to increase responses at the quiet alert level. Quiet alert is the same thing as attention. So -- the next thing is the observation guide I was telling you about, this will be in the revised Sensory Learning Kit Guidebook, but -- it can be easily recreated by you for any activity that you choose to occur. So this example is Pals PE, the place at the gym, the staff is Linda, that's the teaching assistant, the time is 10:45 to 11:35, and then the date and the observer is the teacher, Ray. And what you do is list the media, just during the observation as the student is -- is either presented with media or interacts with media, you just list what that is. And the first thing that this learner, Mary -- the first media is she came into contact with was peers and staff. And you just give sort of a brief description of what that consisted of: it was random rubs and pats and vocal greetings. You indicate what position she was in: in her wheelchair. What was the primary sensory system involved: it was multi‑sensory, lots of vision, lots of auditory, lots of tactile. You indicate what her response level was: it was extended state and then you describe the response: it was fussy. Head turned away, tongue sucking. And a little information about the environment there which might also have been a contributing factor: that it was noisy, lots of random, complex input. So I'm not going to go through all of the items in the observation guide, but that gives you an example of where you are getting the information that's in the grid above which indicates the levels of responses. So that's for your present level of sensory functioning. Appendix E. This is your summary -- well, this is basically your appetite list, if that's what you are used to thinking of in regards to this, but it's in a little bit different format. It's not just a list of learning media items that got positive responses. It's broken down a little more specifically. So what you have here is -- in your -- in your Learning Media Summary, it's divided into primary sensory systems and secondary sensory systems, and then each is divided into plus threes, plus twos, and plus ones. Those of you who have used the Sensory Response Record know that that's one of the things that you evaluate when you do it; the strength of the student's response, either a strong response - which would be a three, a moderate response - which would be a two, or a mild response - which would be a one. And you see here that for Mary, her primary -- her primary systems and the tactile sensory system, she had 2 plus threes to the massager and the vibrating pillow. So vibration is a big deal for her. And she had 1 plus three, I'm sorry, 1 plus two, which was the paint roller, and it was used to apply deep pressure. And -- and just -- just to call your attention to the red coloration there, if you look at the -- the -- the key -- I mean, the note down at the bottom, it just means that that item was plus two, but only with accommodation. So for visual, she liked face play with accommodation, mirror with accommodation, and pen light with accommodation. For auditory, she liked piano music with accommodation and drum. For proprioceptive, she liked wrist and ankle weights, ball pit and blanket wrap; all of those were strong plus threes, which means they can be used as topics for instructional activities and for arousal state management. She liked the swing. And the next one is your accommodation summary. So you list the system and then the accommodation that goes with it. For multisensory, the accommodation is reduce environmental complexity, avoid random simultaneous input from two or more sources. For auditory, use high volume, low frequency auditory medium. Avoid complexity in music. She couldn't tolerate, for instance, instrument -- instrumentation and voice simultaneously, had to be one are or the other. For voice presentation, has to be within three feet of her left ear. For tactile accommodations, use lingering, slow paced, firm touch; avoid unexpected light; fast paced, intermittent touch and soft textures; use hand-under-hand guidance and tactile modeling; wait 15 seconds for initiation of motor responses to input; present objects explored manually to face for oral confirmation. Olfactory, avoid strong smells. Gustatory assessment postponed pending medical evaluation and parental approval; and then on -- by the way, for the vision in this -- this is a really, really important part of your sensory efficiency assessment intervention. People often ask me in sensory vision -- in sensory efficiency, where does CVI come in. This it where is comes in. All of your CVI stuff will go in under accommodations in the vision, for the visual sensory systems. So if you look at those accommodations for vision, you'll see they're all "provide high contrast." They're all -- most -- well, some CVI stuff is there. The other big thing in vision accommodations is positioning. Use prone positions and hanging arrays to present visual media in upper hemisphere, where hand regard is best, avoid lap and tray level presentations when sitting. This is a huge, big deal. We've got a lot of these kids that are in slightly reclined seating arrangements where their eyes are sort of tilted upward a little bit. They can never -- and when their learning media is down on their trays, they can never see their learning media, and even more significantly, they can't see what their hands are doing with it. So make sure that you address positioning for vision. Oh, the accommodation guide. Listen, I just stuck that in there, that's from the SLK revision guide book. But I don't want people to have to wait for that because Tristan tells me that they are way backed up on projects, and it may be a while before that revised guidebook gets out. So I decided, whether they liked it or not, to go ahead and put this in here, because I really would like for it to be available for people to take a look at. And that's just some -- it's a menu. It's just a bunch of different possibilities for different accommodations when you're preparing your students for the presentation of learning media, when you are presenting learning media and -- and pacing. And we are down to the last two that are pretty quick and easy. This is your -- your statement about additional assessment, if you notice anything abnormal. So for auditory, no responses to speech beyond three feet were observed. And no environmental sounds at low volume or high frequencies. And then for tactile, fussy, agitated when touched during grooming, feeding and social greetings. So that's -- more assessment is needed for those two sensory systems. What you would be looking at for tactile, is the possibility of tactile defensiveness. And so an occupational therapist would evaluate for that, and for auditory you would be looking for some hearing loss. So an audiological would be called for. And I think that's it. So we don't have very much time for questions, but... Listen, I really appreciate the words of encouragement, Chrissy and Dawn, thank you. And I also know that -- and I really want to acknowledge that this is a new way of looking at the sensory systems for most TVIs, and I very much appreciate the fact that this has not been part of your training or your pre‑service preparation. This -- what I just went through is -- is a departure from the VI tradition, and -- and it's a stretch for most of us. I'm hoping that these issues that I've raised will be a part of VI training, both in pre‑service programs and in the kind of training that Kate and the service centers are providing. But the reality is that, for most of us right now, this is a big change and it's a lot of new stuff. It's a new perspective. [ End Screen Share: ] [ Start slide: ] So it'll take some time to get used to this. At the same time, I do want you to appreciate that this is all the research based best practice that we need to be moving to. Chapter 3. Closing Comments Ann: Millie, I want to thank you because it is -- because this is a different way of looking at what we do and so many TVIs, you know, we've struggled with this, and the best ways to address the population of kids in the sensorimotor stage, and we knew what we were doing wasn't working. We knew it wasn't right, I think, and so this is so helpful. We can't thank you enough. And I also know that we will probably be needing lots and lots of more support to go through this. We can't wait for the SLK revision, it sounds like we might be waiting a little longer, but helping us -- also helping TVIs know that you're not crazy, and it's not that you've "done anything wrong," it's just that we learn more and more all the time. In fact, every time Millie talks to us we learn something knew. Thank you, Millie. Kate: Millie, we thank you so much. We will stick around for a few minutes, we're going to let our captioner go. If you have any questions or comments for Millie, we'll hang on for a few minutes more, but otherwise, we will see you next time. Thanks for joining us. [ End slide: ] [ Music ]