[ Music ] ^M00:00:06 >> [Background Music] Texas School for the Blind & Visually Impaired Outreach Programs Present, Active Learning Study Group, October 7th, 2014 presented by Kate Hurst, Statewide Staff Development Coordinator and Matt Schultz, Deafblind Education Consultant for the Outreach Programs. >> Good afternoon. I'm so glad to have so many of you joining us again for our second in our Active Learning Study Group series. Today, it's Matt and I joining you again, and we're going to get into our content right away. As I hope you all know this week our assignment was to read Chapter III and this is -- was to me a really interesting chapter kind of sets the basis for all of Lilli's work and -- though it wasn't terribly new information. It was just really nice to kind of go back through and get clear my mind about typical child development and then think about some of the things that may or may not be happening for students with disabilities, and then what we can do to help them. So, I hope that many of you were able to get the book and do the reading. Since I know some of you were not able to get the book, what Matt and I have decided to do is in your handouts which, I hope all of you received; we tried to give you very detailed notes from -- covering everything in that chapter. So, hopefully, if you keep the notes, it will give you enough information to be able to sort of stay up with what we're talking about and fell free to contribute. So, let me know how that works for you. I'm hoping that we'll make a difference for some of you who have not been able to get the book yet. OK. So, Matt, you want to take it away with the first part? >> Sure do. >> OK. >> Good afternoon everybody. So like Kate said, we're going to run through the information that Lilli writes about in Chapter III, entitled "Movements: A Pre-requisite for Learning". If you have questions or comments, please feel free, you know, use the chat, interrupt us, that's fine. We want to cover the material but also take time to talk about it as well. So right away, in the beginning of Chapter 3, Lilli writes that the ability to move is a pre-requisite for all learning. And she described the initial movements that the fetus undertakes inside the womb. Does anyone remember what those two types of movements were? I'm going to give you the answer. [ laughter ] The first two movements that a fetus experiences are reflexes and REM, rapid eye movement, these are unintentional movement that help form the development of the central nervous system. It's the foundation of the foundation, if you will. And these unintentional movements occur and form the basis for all future intentional movements that happen afterwards. It's ground zero. So, non-disabled infants have no trouble learning to move intentionally. They come pre-programmed for movement and thus pre-programmed for learning. We know this isn't the case for our kids. Students with visual impairments and multiple impairments, they have some serious issues with movement and gaining information from their environment. So, why are we going to talk about typical childhood development for a while today? Well, Lilli explains that by learning how typical kids learn through intentional movement, it may be possible to give our VIMI students' optimal opportunities for intentional movements, thus achieving pre-requisites for learning skills that can enhance the quality of life. So right away she kind of gives us a pillar of active learning there. A big piece of the puzzle. So active movement begins right from birth, actually even before birth -- to an extent that to me was completely new information. So, the movement and experiences that the fetus undertakes starts three to four months after conception, movements of the arms, movements of the legs, movements of the mouth, the hands or the fetus learns to put their hands on their mouth to suck, to open and close their hands and spread their fingers. They bend and stretch their bodies. As they do this, their body is coming into tactile contact with the uterus; immediately giving those movements feedback. As the baby grows, the uterus -- the space that they're in becomes smaller and more of their bodies come into contact with the uterus, more opportunity for feedback. So right away, the fetus learns that certain movements lead to certain results and the baby -- the fetus -- excuse me -- learns to tighten its muscles and thus also untightening its muscles and they begin to collect information about their immediate environment. For new born infants, they start to combine these movements with tactile experiences, OK? At five to six months of experience of actively moving when they're born. They come out of the womb with five to six months of experience actively moving. When they're born, their arms and legs no longer come into contact with the uterus but they come into contact with the bottom of their crib, or their sleeper or with the clothes that are on their arms, or the socks that are on their feet. They start to get that new experiences with new tactile objects and experiences. Even empty air, suddenly they move and there's nothing there. They experience that as a new experience after they're out of the uterus. >> And Matt I just have to throw in here one of the things that Lilli talked about every time I heard her lecture; and I hadn't really paid attention to it until she did, but ever since then it's something I always do the minute I check a baby in the crib. She said that the babies will get to a corner or against the side of a crib or bolster because there is that need to feel that contact that they've felt in the uterus. And that's where a lot of the early denning comes from, is they want to get themselves as much as they can back into the environment that they were in in the uterus. So I challenge all of you as you're checking out babies in the world. If they're asleep in the crib or somewhere, see if they're not working their way into the corner. They're amazing how they do that. >> That it amazing, and it gets back to the point that they're pre-programmed for this; for these experiences, for collecting this information, that's why swaddling is so confronting for a lot of babies. It gives them that tight supportive feeling like they had in the uterus. So at five to eight months, the baby starts to grab its feet, playing with it and bringing their feet closer to the mouth, turning and bending. We look at this and we think it's adorable, because it is. But it's incredibly -- it's a scientific activity that they're participating in. They're collecting information and going through these movements that are the foundation for things like them learning to sit up, them learning to eventually stand. Later on in life, when they learn to take off their socks and shoes and put them on. All of that learning starts at this point when they're brining their feet towards their face and touching them with their hands. These type of movements are really exciting, right, we think they're adorable so we get in front of the babies face and we said, "Oh my gosh that so cute look at you move your leg, yes you moved your leg," and give then a ton of feedback with our voices and our faces. We'll talk some more about that here in a minute. So, infants without disabilities go through these procedures, or these processes and get a lot feedback. They're also able to get a lot of feedback just by themselves. Kicking, sucking their hands, stretching and bending as well as babbling as long it's daylight and there's a light in the room, they are in an environment that they are stimulated in. Their bodies and their brains are processing information at every waking moment. >> And Matt, you know, the thing that occurred to me as I was reading that is, you know, our kids that have the vision and or sometimes no hearing, they really do the same things and we called it self-stim. And that is it. You know, there is a need from all humans to be engaged. And so, if they don't have the sensory information that their eyes would bring in or their ears would bring in and maybe their bodies are enable to move s freely or as well. Then they do what they can and -- >> They find ways. >> They find ways, they find way, and it's really important not to try to squash those self-stims but help expand them. >> Yeah. And understand -- >> Yeah. >> -- what it is, those little brains and those little bodies are doing what they're supposed to do -- >> Exactly. >> -- in collecting information. >> Exactly. >> So, just a few weeks, the infant discovers that he can see moving things in front of him. And these lead to their first multisensory experience. Their kinetic system and their visual experience working together, discovering that, "Oh, I have one hand. Oh, I had two hands together". This is kind of a -- It can be a wonder discovery for the baby that has a really lasting imprint on their brain as their brain develops and these two systems; the kinesthetic system and the visual system work together to process information and help the baby learn. These experiences are repeated again and again and as memory is formed and established, and these sensory systems learn to work together. It's sensory integration, and it happens, again, in just a few weeks old for these babies that have -- are born without disabilities. Their ability to see is of really great importance in providing motivation for them to explore the world that they're in; tactually as well as visually exploring. That's how their bodies collect information. They're doing it at just a few weeks and the vision is a big part of it. So, now we're going to see a video of a couple incredibly cute babies learning to move. >> OK. This... that you're going to see here as the child starts at three months it goes all the way to 10 months during his clip -- video clips. And there is no sound. ^M00:11:28 [ Silence ] ^M00:13:44 >> The scenes there at the end with the giraffe toy and the ring toy I think were just really clear examples of how important vision is to providing these kids with motivation to move. It seemed to be that the factor that give that baby the desires to make that big turn and come across. So we know that's going to present some issues for our kids that can't just look around the room and see things that they're motivated to reach out to. >> Right. >> We'll talk more about that as we go, but that's a hurdle that we have climb with our kids. >> Yeah, you know, the thing that I loved about this video even though it kind of focused on aspect of, you know, like learning to roll or whatever. I think it really illustrates a lot of what, you know, Lilli talks about in the first chapter and that, you know, discovering hands, learning that, you know, how to move fingers and stuff like that, you know, and two hands together and then, you know, using feet. You know, baby uses it all just not just one part of it. And then that attempt that builds the strength to be able to get the body to go over and then like you said that visual thing that really motivates that child to make the extra effort. I really liked that sequence for them. I thought it was a good illustrator of -- And this was a typical baby and it took them seven months to learn this. >> Yeah. >> You know, seven months. >> Well it's like, after I watch videos like this and read just Lilli's Chapter III. I can't look at kids now without looking at them. >> That's right. >> As little scientists. >> Exactly. >> You know and knowing that every intentional movement is connected to -- >> Exactly. >> -- greater movements that are going to after. >> Exactly. >> And they're just -- They spend all their time practicing. >> They do, they work all they long. They really do. >> Very early on, the infant starts to have their first experiences with sound. And these experiences occur without their influence. They just -- the baby kicks their crib or moves their legs out and hits the crib and suddenly they start to realize, "Oh my gosh I move my leg. I hit that surface. It make a sound." So they get their kinesthetic their visual and their auditory systems working together to collect information. That system gets more work as the baby learns to vocalize. They learn that they can use vocalizations to draw attention about their surrounding. To say, "Hey mom I want to eat, or I want to be cuddled, or I want to play". That's a very powerful tool that they use to learn to get things that what -- to get the things that they need and want. The adult that get summoned to them can be seen, they can be heard they can be touched. Again this kinesthetic, this tactile, this visual and this auditory systems and experiences working together allowing that child's sensory integration system to work; so that the brain begins to make sense. All these are layers that start to be created before we ever ask this baby to learn a formal language, right? >> Yeah. >> All of this is practice and foundation that gets worked on for years before they get into school. ^M00:17:09 These sensory experiences like we talked about may get a lot of attention, right? We love playing with babies. We love seeing these movements. And we clap and we coo and we say nice job. These become really powerful sensory experiences. And these movements, when there are -- proper feedback is provided, kind of build into new ones. These modalities continue to develop and become enhanced over time. At three to four months, baby hits their hands towards the mother's chest. I think we've all seen babies at that age that like to reach out and hit, and hit tables in front of them, or maybe the surface in front of them that they eat. Again this isn't first signs of bad behavior. >> No. [ laughter ] >> This is exploratory behavior and that is required for their sensory system to integrate. At 12 to 14 months, babies began to use objects to use various hitting games. Again, maybe not the most pleasant stage for new moms and new dads to have the babies hitting everything all day long. But I think if we think about it, as what it is. It's -- they're little scientist collection information that might help us with that. Kicking movements also really increase at this point. And again it's them collecting information but also their bodies are starting to develop the muscles that they're going to need to do more involved movements later in life. >> And they're also kind of refining that neural network too, you know, because there's a lot of neural pruning that's going on during that time as well, you know, reinforcing certain neural pathways and letting others go away. >> Yeah. Those pathways form magically and slowly and that's -- hence the need for all that repetition that these kids kind of are born into a world that's made for that repetition. >> Exactly. >> Unlike our kids. So, new experiences enhance the opportunity to satisfy the innate need for activity and establishing memory concerning a combination of sensory experiences. I like that term the "innate need for activity." We all have it. That's -- We're born with it every living being has that innate need for activity so that they establish memory and have sensory experiences. This forms the basis for the ability to experience the surrounding world and therefore how to use it, how to experiment in it, how to explore it, how comprehend it. The foundation, again, of all learning, movement. ^M00:19:58 Infants use several movements to get emotional reactions, right, or to express emotions. They express their appreciation, their joy, their happiness, they express their needs or wants with movements, and dissatisfaction as well with movements. They also use movement to begin the sucking and smacking lips and clutching of adult fingers or hair. Waving their hands, reaching kicking, all of these movement are use to communicate what they want at a very early stage of development. These movements are incorporated in all the games that we like playing with babies, you know. From the very get-go of playing peek-a-boo and the baby imitates our movements and again little scientist putting all these things in their toolbox so they learn new skills as they grow. >> Yeah, I love it with one of my favorite things as babies when they get really excited. That very early age and start just kicking and their whole body is just, you know, fall up and down like they could get million sit-ups all at one time. And there's just -- it so -- They're so enthusiastic at that point. There's just so much energy and joy in that movement I think. >> Yeah. And it's just amazing how all that is connected to their growth and development of their body. >> Yeah. >> That they're going to need those muscles to do more involved movements. >> Yeah, exactly. >> Getting back to that point that we keep coming to is that these kids are -- all kids are really pre-programmed to collect this information and develop. >> And then we are -- Because we love them and adorable can't help but coo over them that begins to establish the first interactions which is the basis for all communication. >> Yeah. >> And again that's what our kids oftentimes the sound on. >> So to sum up this first part of Chapter 3 movements related to typical childhood development. These early movements become a part of a tactile, a visual, an auditory, and an olfactory experience in infants without disabilities. The first movements occur and then responses to movements, movements -- response. And I think we should add the word intentional in here. Intentional movements are really, really the crucial element in this development. All of these things work together... that or provide really the foundation for all future learning. >> So now let's look at the child with visual impairments and multiple disabilities. And I think that the two points that Lilli makes in this chapter really is that because the child has no vision and or hearing, they -- most children are born with the ability to at least move some, but they're not motivated. And we've got lots of research that supports this. We knows this to be true that vision and hearing are the key senses to really motivate a child to move and to do things. So, they're not motivated and, in many cases, they've have problems with muscles; either for -- because there's spasticity or high tone or low tone. And one of the things that Lilli points out, and we know this to be true, we can do a lot of good things to keep those muscles and sinews and joints supple in working, but it's not the same as if the child was moving that joint or muscle on their own. It makes a difference in how those networks are formed. She distinguishes between two types of children that have multiple impairments. One is the premature infant. And, here she's talking about a child who has vision loss, may have some other things or may not, but because of the medical interventions that are going on, if a child is very premature. Especially babies that are born and under a pound. I mean, we know, there is so much equipment on them, and there are so many things going on to just keep them alive that they really don't -- aren't allowed a lot of movements. And one of the things she proposed is, you know, should we look at the design of NICUs and see how we can improve the environment, so that they are able to have more movement on their own. And this is one thing that Matt and I were talking about and we'd like to get some feedback from you. So here's your first poll and please take some time in putting your answer, should a NICU have more ways to give premature infants -- especially those who are vision and hearing impaired more feedback? And, if you think that's so, what are some of your ideas, or I haven't been in a NICU in a very long time -- some of you may -- and what are you aware of that they're doing that might provide more feedback to a premature infant in a NICU setting. OK, says perhaps recording of the mother's voice in response to movement or cries, a good idea and we've got some of the little devices that we could easily do that, I like that, that's a good idea. >> Yeah. >> Well, I was thinking, you know, I know that they do a lot of swaddling and things like that. But, I was thinking maybe some bit of time where they're placed on maybe a different type of surface like the bedding was rotated wasn't always exactly the same bedding and I know that might be a little hard. But, you know, that might -- just the different texture might be of interest to the child, might give them a little bit more feedback. Here's another answer that we're seeing. See, one thing I hear repeatedly from respected physicians is to balance the level of stimulant -- stimulation, these babies cannot take a lot of stimulation. And that's a great point. It is really tricky and I know especially some of these kiddos are so fragile that you really, really have to be careful. Let's see, possibly some -- see, I lost myself. Possible some simple multisensory toys that they do not over stimulate or interfere medically. Yeah, I think more surfaces for hands and feet to touch. I like the recording of voices and maybe some movement therapy. I'm curious, you know, I know that there's a lot of new things that they're doing in NICUs. I'm curious about the amount of movement that they allow them to do. I think once the infant is stable then look at changing the incubator method to allow for more movement and touch, and I think that's right. And I think, you know, once you can get the babies off of some of those monitors and the tubes and all of that. And I suspect they do a lot more of that than they used to. >> Well, I got curious after we read this and Kate and I talked about it -- and just did a quick little online research, and discovered that Lilli's point is well taken or has been well taken. And NICUs across the countries have began to build individualized rooms for babies. So -- >> Cool. >> -- someone mentioned how, you know, for some babies, there's -- they're ready for different levels of stimulation, right, different experiences. So these individualized rooms allow for the lighting to be adjusted based on where they are, right? The -- it allows for the mothers to be there more often [inaudible] and by having it more private, so the mother is able to feel more comfortable giving that feedback that we know is really important to those early movements, so... >> Yeah. And I would think, you know, being able to like maybe use some soft clothing that was on the mom, you know, it would carry her scent but also, you know -- >> Yeah. >> Like we do with puppies, you know. But I do think that that, you know, the olfactory sense could be really viable one to use at that point. >> Yeah. >> Now, the other type of individual that Lilli talks about is a full term child who is born with visual impairments and multiple disabilities. And this could be even be a child who acquires their vision in additional disabilities like kids that have had meningitis or something like that. And she said, you know, they can move but whatever movements they have, often times, become -- they become habituated to them. And so they kind of, you know, explore new movements on their own. And, the lack of response or their continuation of just the same movements, they just get bored with it, they don't carry it further and it results in a lot of passivity. And I think we've all seen that with children who have multiple disabilities is, you know, very few of them are really problem children [ laughing ] in classrooms. Because unless somebody has really been actively engaging them or unless they're in pain, they're pretty passive for the most part, you know. >> Well, I think that highlights that fact of -- we know how important that relation between movement and feedback are. >> Absolutely. >> So, if movement continues to occur without the feedback -- >> Yeah. >> -- the movement fades away. >> It just fades away. And you get just these... really, I think that of a lot of respects fostered the self-stim too because that's all they know to do. It's the only thing that really gives them feedback, you know. And so, they're just going to do what gives them feedback and it becomes kind of obsessive. >> Yeah, at which -- that explains why it's so difficult sometimes when those self-stim patterns gets so ingrained -- >> Yes. >> -- and then, as teachers, we come in and we want to introduce something else -- >> That's right. >> -- we don't want them to put their mouth on that table during lunch, and that can become very upsetting for the kid. >> That has become [ inaudible ] part of their personality. >> Yeah. >> You know, and you can't just rip that out. It's a real struggle. So the sooner we can get kids into situations where they're getting more feedback, the better we're going to be. ^M00:30:35Now, Lilli gets in to discussing kinematic. And this was something that was kind of new to me when she first brought it up, though it made perfect sense. And what she talks about is that initially all of the movements that infants make are unintentional; their reflex movements. And we've heard a lot about this, we know this to be true. And what she talked about is that the -- because that reflex is repeated again and again, they began to become aware of that movement and they get sensory feedback from that movement, so they'll begin to make that movement intentionally. And, the other thing she talks about is the intentional movement of one limb often times causes the other limb or another part of the body to move unintentionally. I have to say for myself, what I think about, as a kid and even now still sometimes as an adult. When I start cutting or doing something with my hands, a lot of times, the old tongue comes out and, you know -- [inaudible]. You know, and it's a reflex action but it just happens. It just -- in the other -- they start moving. And we see this with babies all the time, that they start to move one part of their body, and like maybe their arms or their hands, and those feet get involved in that movement as well. And, this is what she calls with whether it's intentional movement that brings about unintentional movement that's a kinematic movement. So that is an important little phrase to be aware of -- to understand -- and let me back up just a little bit. The other thing that she talks about in kinematic movement is that... if we go put -- if we're doing say for example we've got a kiddo in a little room. If we will put an object near the hand that doesn't move while a child in engaged in -- the same object near the hand when a child is engaged with an object with the other hand -- that a lot of times, they'll get movement out of the hand that doesn't move intentionally; and that starts them engaging with that object, with the hand that doesn't move intentionally. And what I gathered from my reading is that it was important to have similar objects in both places so that they could do some comparing of it, and then it made more sense for them. And she also talked about that it was really important that we are aware though of what... unintentional movements that hand might make. So, for example, if the movement is a scratching kind of movement ,and that's all they seem to be doing unintentionally, then we probably need something there that it's a scratching -- has a scratching quality to it. And that kind of confuse me a little bit. The only thing I can think of is, say for example, you know, if they're doing something with the good hand where there is, say we've got bundle of straws or something like that they're feeling with or plying with. Maybe what we want to put over by the other hand, that's not moving so much, is something that has similar quality to it but that they actually could scratch on. That's the whole movement the hand was making. So, you know, that's something that I have thought about before but I think we have to pay attention to that when we're doing our observations with our kiddos. ^M00:34:21She says that kinematic -- she describes that as movements resulting from certain forces and automatism; action performed without conscious control. So it's two words, put together. Kinematic is -- she says, is the relationship between movement and automatism and describes particular constant movement that often appear as the outcome of natural reaction to experiments with and the results of intentional movements. So there again, we're talking about that, one hand moves that causes the other to move and things begin to happen. OK. Moving right along. Then, she goes into learning to move by means of tactile and auditory experiences. She says that infants with visual impairments or other disabilities need environments or environmental interventions that will make movement meaningful to them. And so, we're going to have to focus on things that are non visual. She says that these kids may not have the opportunity to combine movements with these new sensory experiments. And she said, for example, that a lot of times, she'll see children with additional disabilities -- when they hear something, they stop all movement just so they can listen. So it's sometimes very hard for them to do that sensory integration that we're talking about where they can bring all their senses together. But she says that they need opportunities to combine movements with tactile and auditory experiences. A couple of things she pointed out during -- in this discussion was that visually impaired infants do not seem to be interested in touching smooth surfaces. I kind of knew that, you know, bowl -- boring plastic, smooth surfaces don't do much for them. And she says, they also do not like really rough surfaces. So some of the suggestions she made is that for the infants, we need to be providing things with acute points, holes the size of the single finger, raised surfaces and materials of contrasting temperatures. And so I think that that, you know, both in terms of bigger objects and if we've got a kiddo that we're doing scratching boards with -- and they're very, very young, we need to be mindful of that. She also says that we need to experiment with those environment because if we're not getting movement from child, then that environment needs to be modified. But she said, if we do modify the environment and we're still not getting anywhere, we really need to look at the child's positioning, because she says a lot of times -- and we know this is true, repositioning those bodies is really important. And I think this where your physical therapist can come in and be very helpful with you and thinking about in this environment, what's the best position to put this kiddo in, so that they're able to use their bodies as well as possible, you know. And they're not fighting gravity and working so hard. And I threw in this note, when we're doing things and including auditory information in these environments for kiddos, one of the things that's really important is; one, if you know the child has some type of hearing loss or you suspect some type of hearing loss, you really need to pay attention to what type of sounds the child responds to best. If you got any kind of audiogram and, you know, for example, they have a high frequency loss, then you want to get objects and things that are going to make lower frequency sounds and the reverse if they got a low frequency loss, you want a higher frequency sounds. And I saw this in action when I went out and did some interactions with a little boy who had a high frequency loss. He definitely didn't respond to high frequency sound. It was the only -- I'm sorry, backwards. He had a low frequency loss. He didn't respond to those low frequency sounds, he only responded to the high frequency sounds, but he really loved them and was highly motivated by it. So that's just another note. Again, if you got a kiddo with a suspected hearing loss, get with your speech language therapist or your teacher of the deaf and hard of hearing and try to think about how to do some sort of functional hearing assessment and get an idea of what they're going to respond to. And sometimes, it's just collecting a wide range of toys that make different types of pitches, and just seeing which one they go for. But also talking to parents and seeing if their favorite sounds -- that child has that they respond to. OK. Learning to move by means of visual experience. Well, this one, most teachers for visual impairment are real into this. If there's any vision at all, we want to use the types of visual information that's going to motivate the child and enhance their use of vision. So movement, color, lighting, all those things are really important. You know, we've got ideas about -- especially children with cortical visual impairment -- some of the things that are more motivating to them, we want to be using those things. And of course, if the child has no vision then they're not going to be motivated by visual stuff, so we really got to focus on other qualities of the object. Learning to move by means of olfactory experiences. She talks about in this chapter that the earliest level of development is orally centered. And by that, she meant that, you know, babies do things with their mouth. They're constantly licking, sucking, tasting, you know, even if they're not able to grasp with their hands but if they're very young, they're going to do this -- our kids will probably have to do this longer especially if they don't have the hand use. And I know that for a lot of people, it's very discouraging that kids continue to mouth objects, lots of people talk about this, but it's really important and especially if a child is visually impaired and they don't have good hand use, because this is one way they're going to get the information that they need. And she talks about -- that we can add smell into this, because smell and taste are close together; that smell can be a real important thing to include in an environment to encourage movement. But one of the things that I've heard from others and that, you know, Lilli has mentioned too, is that we really have to one, consider preferences, because smells can be really outputting. And what one kid may like, another won't. And we need to be sure to determine that the smell that we're putting in... into those environment... are not going to cause problems, because of allergies or seizures. Because that can often trigger -- some kids can have... seizures triggered very easily by smell. So we need to be aware of that. ^M00:41:45 OK. Learning to move hands and fingers, she says one of the things that's really important for us as educators working with these children is to observe where their hands habitually are positioned. If the hands and arms are for example, motionless at the side of head their -- and we're seeing a lot of kids like that where they're just sort of laying out their hands kind of this way. She said, get things, get objects hung near those hands -- whether it's in a little room or however you do it -- that touch to hands. Just barely touch the hands. She said, they need to have things that they can fiddle with their fingers. So, things that are stringy; beads, things like that are real interesting. She said, when they are able to move their arms a little bit, they like to push things and so we need to make things, the objects that we have move graspable, by putting loops or strings things like that they can get. And... then she talked about if a child can't rotate their hand, that they need objects at a certain shape. And I have to say, I didn't quite understand this, but she gives the example of a triangle with the little dinging piece of metal that's attached to it as something that would be an example of that. She goes on to talk about the importance of scratching boards, how they help improve muscle strength of the fingers. And, you know, we're always talking about pre-braille skills and pre-this skills, you know. This is where these kids are, and so we need to recognize how important it is to get those -- that muscle strength that the fingers -- going -- giving them the ability to move separate fingers at a time. All of this works towards that. She talks about the importance of their being able to bend and stretch fingers as a pre-requisite for learning to grasp. And so using those scratching boards are really important for that. And then, if you remember in one of her -- well I think the book that we talked about last year, in the scratching boards, there's a progression. First there's just the flat board that has a different materials and things that are just scratchable. And then, she moves to the board where it has a very short elastic, but there're more objects on there where they actually can grasp that. And she says, you know, we have to think about the profile link, so that the child can get their hands around, that they can a lot of times grasp with just a kind of 'palmar grasp' -- to include on that. But they have just a little bit more stretch in that string for them to be able to grasp and let go. She also talked about -- that as a kid gets better in a little room and able to grasp things, if we want to give the muscles a bit more of a workout, we use a little stronger elastic. I thought that was good. I never thought about doing that, but makes sense. She talked about using a 'buncher' and for those of you who aren't as familiar, it's just a little elastic thing that attaches to an object so you could attach the object to the child's hand. And she said, you know, putting vibrating tools like a toothbrush or something like that on a buncher on their hand while they're on a resonance board, so that if I just lay it down, they're going to get some feedback from it. And then, she says, once they begin to kind of respond to that, putting different toys near by, so that as they touch different toys, they'll get a certain -- a different kind of feedback from the various toys that they touch with that buncher -- so like a metal plate and a wooden bowl and things like that will give different kinds of feedback. And of course, she says, you know, one of the things that kids often do is they'll get their fingers all tied up in that elastic and most of us, that have been doing this for very long, have learned, putting that plastic tubing, like from an aquarium -- feeding the elastic through that stops kids from getting their hands caught up in that, and actually cutting off the circulation. So that makes a big difference. And then, she says, in interactions with adults who are trying to build that finger use, is give them our fingers to play with. And I've seen parents do this with other kids all the time. I just never thought about doing it with our kids with disabilities. But letting them grasp fingers, that that's an important thing or having objects, holding objects above them that they can grasp and let go and fiddle with; that that was really important. Then in learning to move legs and feet, she says there's a couple of different reasons why legs and feet might not develop very well for children with multiple disabilities. First of all, she says, oftentimes it's just a general weakness; and we know that through the health reasons or whatever. Or the fact that they've been in hospital so long that they just haven't been able to move very much. Of course, spasticity can be a problem. And then, she said -- and I thought this was kind of interesting -- she said that often times, we don't pay a lot f attention to the use of legs and feet with these children. And I got to thinking about it, and unless they're making attempts to walk and move, I don't know how much attention I typically pay to a child who's not mobile -- to their legs and feet; and that just really sort of got my attention. >> Yeah. I think we do think about the hands more and what's going on -- >> Yeah. >> -- you know, up here. >> Yeah. And so, she really encouraged that, you know, encourage that we get them using those legs and feet. Because, she said, what she's seeing is that as the child gets older, a lot of times they act as if their legs don't even belong to them. And I've seen kids who -- looking back, I kind of think that's where they were. You know, they just had no real awareness of their legs and feet on purpose. >> We know all these movements are connected, right? >> They're very connected. >> So if we're struggling with movements with the hands, maybe we pay attention to the feet some more, that the hand movements will come after that. >> Well, I think they definitely improve, no matter what. And then, she talks about, you know, of course, that oftentimes foot and leg -- feet and legs are very cold due to the lack of circulation and so that's a problem for the child. And then, she talked about that as their hands and fingers develop that, often times we will see -- watch the kinematic movements, the unintentional reflexive movements of the legs, as feet and hands get moving. And I'm seeing this with kids in the little room. They'll be laying there. They don't use their legs or feet and they'll be doing something with their hand and all of a sudden, their leg will move, or their foot will move, and it'll cause something to happen and then they'll repeat it. So I think that's just a real important thing to remember. Some of her suggestions for moving legs and feet, to work on that, is while they're in supine, have then kick against an Essef board that's attached to a wall. Or while sitting -- in a sitting position, put an Essef board under their feet, and put things on it that'll make noise then they jiggle it. Or put them in a net swing and have the Essef Board attached to the wall so that as they're swung into it, they could impact that Essef board and start to push themselves off of it. She also talks about -- and I think some of you have seen this in some of her videos, having an Essef board near one of those wall ladders that have objects hang on it so the child could clime upon it and then use that ladder to pull themselves up. And you're really going to work on balance when you get on that Essef boards when the kid does, if you've ever seen them. And then, of course the HOPSA Dress with things under their feet that give auditory and tactile feedback. And she says, to improve fine motor movements of the feet -- that we need to include things that could be fiddled with toes. So I wanted to show you guys a little video example of one kiddo who is in a HOPSA Dress and he is doing some pretty neat things with his feet and legs. ^M00:50:07 [ Silence ] ^M00:50:13 [ Noises ] ^M00:50:34 [ student vocalizing ] ^M00:50:48 [ Silence ] ^M00:51:17 And I want to mention that this little boy has problems with that right foot, he almost never uses it. And so, doing stuff with that right foot and bringing it down flat is a pretty major achievement for him. And here on this Essef Board, both of his feet are very, very flat but in a minute, you're going to see him go up and you'll see how little he uses his right leg and foot typically. ^M00:51:46 [ Noise ] ^M00:52:17 One of the things when I met with Barbara Miles was that she was really concerned that there wasn't enough focus on communication and language during active learning. How do you think that using some of Lilli's approaches relate to the development of communication and language in these children, when we're focusing on getting those body's moving? >> Hello? >> Yes? ^M00:52:40 I was just gonna say that I have a student right now who has hypertonia, I believe it's called, and she doesn't routinely use her muscles very well, she's very weak. She often squats down, but she just learned to walk last year and she's seven. And, some of things I noticed with getting her to communicate -- we have to use a lot of things with her body -- and tactile -- get her muscles to move, her body moving -- using her eye gaze to tell us what she wants, and things like that. My comment is that this is very helpful, because I noticed in some of the topics that we're talking about I can definitely use with her; getting her to give us more feedback during our lessons. ^M00:53:23 Yeah. That's a great comment because, you know, before a child can talk or communicate in other ways, even if you're just playing games with their bodies, that turn taking, back and forth -- to me, that is a real foundation for communication, that back and forth. Plus, I think they're building concepts while they're in this play, while they're learning to move those muscles and interacting with their environment. And I think that it just launches, you know, when we think about a typical child developing language, a lot of times, we start out with some of those give and take games that are around body stuff, again clapping and things like that. I know when I was working as a teacher, I had a PT telling me that if I wanted my kids to learn to communicate and get going and really communicate -- this is when I was working with deaf, multiply impaired kids -- he said, focus on gross motor stuff. And, you know, I started making gross motor a part of ever activity we did, and the kids that I had for two years I got nowhere with all of a sudden begin to produce that language. So there's such tying in. It really is. Good comment. Thanks. ^M00:54:33 >> I have a comment on that. You know, Lilli always talked about that after you do an active learning experience, or after the child participated in an active learning experience, there was a time where you communicate with them. You know, giving them time -- talking to them about what they did. And I found that's very... good for my kids. You know, by giving them all those opportunities to move and do that -- like you said, the turn taking activities there. They become more able to do turn taking activities, or activities where you try to move them, and then stop, and see if they'll let you know they want to do more. All those things seem to do better, if you have the opportunity to move themselves. I think really -- I would disagree with people who say it doesn't help communication. ^M00:55:24 >> I am so with you and you're right. You are very right. I know that we're going to have to get off in this time has gone so quickly. But everything that is in the book, we've included in your notes, in brief, so you can look over those. We'll be doing Chapter IV next time. We thank you in joining us and we're going to signoff for now. Bye. >> Thanks you all. ^M00:55:47 [ Music ]