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Physical and sensory

See tips and advice for supporting children with various physical and sensory impairments.

Fine and gross motor skills

What I might see

Fine Motor

  • difficulties with scissors and cutting activities
  • ineffective pencil grip
  • incorrect pressure when mark making
  • problems with dressing (buttons, zips) and cutlery
  • incorrect letter formation, and poor spacing and positioning of letters
  • poor spacing of words

Gross Motor

  • may appear clumsy
  • difficulty navigating spaces
  • reported difficulties riding a bike
  • poor catching and throwing
  • dislike of PE
  • doesn’t sit up straight- leans on other children or on furniture

Classroom Strategies

  • ensure furniture is the correct size for the pupil
  • offer a range of writing tools- pens and pencils of different sizes and shapes. Little hands need little pens not chunky whiteboard pens.
  • try a range of different pencil grips.
  • left handers will require specific support- left handed scissors, rulers, grips paper positioners
  • practice letter formation as large shapes that are then reduced in size.
  • provide non-slip surfaces or a sloping writing surface
  • support correct posture for working- correct furniture, feet flat on floor, table at correct height for chair
  • gross motor programmes for the whole class as part of “brain breaks”
  • pupil sat in an appropriate position to minimise movement around the classroom

Targeted interventions and further support

Implement a motor skills programme such as:

Hearing impairment

Here are some facts about being Deaf in the UK today

  • there are about 12 million people in the UK with a hearing loss
  • deafness is the third most common disability in the world, but you wouldn’t spot a Deaf person in a crowd easily
  • 9 in every 10 Deaf children are born to hearing parents, but only 1 in 10 of those parents will learn sign language to be able to communicate fully with their son or daughter
  • 48% of Deaf children failed to achieve Level 4 or above in English and Maths last year
  • 1 in 4 Deaf people face job discrimination
  • over 75% of Deaf children attend mainstream schools
  • 70% of cinemas don’t show subtitles as it is too “distracting” for other people watching films which means Deaf people often don’t enjoy films until they are released on Netflix or Amazon Prime and other channels

What I might see

  • each Deaf person’s hearing loss is very individual and what they can hear is based upon where on the spectrum of low to high pitch sounds their hearing loss falls. Deafness is judged on an average of scores across a range of frequencies into 4 categories of loss- mild, moderate, severe, profound

Mild

Mild hearing loss is between 20 and 40dB 

  • this makes situations with background noises harder to understand but pupils can usually hear everything that is said to them in a quiet room, but not if they are far away from the speaker.
  • a pupil would not be able to follow a whispered conversation or hear a ticking clock.
  • pupils may use hearing aids

Moderate

Moderate hearing loss is between 41 and 70dB-

  • without hearing aids, a pupil is unlikely to be able to hear most of what someone says to them within a quiet room even if they speak clearly. With hearing aids, they are likely to be able to follow a conversation within a quiet room
  • with hearing aids, the correct amplification will allow access to conversational speech in a quiet room
  • pupils will find it extremely difficult to follow a conversation in a large group, if there is background noise or they are far away from the speaker

Severe

Severe hearing loss is between 71 and 95dB-

  • this means pupils will have difficulties usually with speech and group conversations, and comprehension is impossible without amplification
  • with cochlear implants most pupils will be able to follow a conversation within a quiet room provided that the speaker is within two to three metres of them. However, a pupil with a severe hearing loss who wears hearing aids will struggle to hear speech even in a quiet room
  • a pupil is likely to benefit from assistive learning devices such as Radio Hearing Aids (RHAs) to be able to follow a conversation within a quiet room 
  • some pupils may also require additional communication support, for example, British Sign Language (BSL) support to understand speech in the presence of any background noise or within a group conversation
  • in the presence of background noise, the pupil will find it more difficult to understand speech even with communication support

Profound 

Profound hearing loss is over 95dB-

  • without a cochlear implant or hearing aids a pupil will not be able to hear speech or other sounds. They may be able to feel very loud sounds such as a lorry passing them in the street
  • without a cochlear implant or hearing aids the pupil is likely to use a sign-based language to communicate directly with another person
  • with cochlear implants or hearing aids the pupil may require additional communication support (for example through BSL) to access speech, especially within background noise or within a group In the presence of background noise, the pupil will find it extremely difficult to understand speech

It is important that specialist advice is sought as appropriate. The following are general supportive strategies that may need adapting according to the individual pupil's needs:

Supporting hearing and understanding speech

  • hearing aids do not fully compensate for a hearing loss – pupils do not always hear speech clearly, consequently they may mishear words and misunderstand the context of what has been said
  • speech discrimination requires more listening effort for pupils compared to their peers. When required to listen, be aware that they may experience listening fatigue and be less able to discriminate speech accurately
  • it takes more effort for child with a hearing loss to listen, compared to their peer group. Provide breaks and change activity types - time to rest and recuperate
  • build additional processing time into lessons, particularly if they contain new information or a 'question and answer' session
  • avoid overloading lessons with too much information or too much talk. Ensure resources (visual representations and iPad for searching) are available to support the understanding of unfamiliar language/keywords
  • allow enough time for the deaf pupil to look at the visual material before you start talking again - this gives them time to focus their attention back on the teacher or the teaching assistant
  • get to know what teaching methods or activities the deaf pupil finds most tiring and build in breaks or find alternative methods and adapt activities to include tasks that do not solely rely on lip-reading and listening

Seating in classroom

  • it is best for pupils to sit within good listening and visual range of the teacher (facing forward, towards the front of classrooms)
  • when sitting on the carpet, pupils need to sit in front of the person speaking, with a good view of their face (i.e. not too close) 
  • hearing aids or cochlear processors do not pick up sound well over distance - it is best for people talking to pupils to be near to them

Whilst speaking, adults and children should

  • check you have the pupil’s attention before speaking to them
  • talk to pupil facing them
  • avoid speaking whilst turning your back; stay still when talking
  • don’t stand with your back to a window (backlight obscures the view of face/mouth)
  • keep your mouth clear of obstructions. Covering your mouth with your hand or a book (for example) will make it difficult to lip-read
  • speak normally and clearly, at a normal volume, not too fast and not too slow
  • name peers before they answer a question and repeat their answers. Modify and model good language
  • use open-ended questions to check understanding, as this prevents the deaf pupil from nodding without really understanding
  • visual clues will help to clarify speech sounds that may be missed - use illustrations or real objects to demonstrate new vocabulary or concepts
  • it is difficult to hear electronic recordings through hearing aids so a live speaking voice should be used at all times

Improving the listening environment

  • ensure that Deaf students are seated so that they can see and hear you easily.
  • make sure they are paying attention before speaking.
  • keep background noise to a minimum.  (Noise from scraping chairs, heaters, squeaky board pens, computers, projectors, nearby classrooms).
  • improve classroom acoustics and make reasonable adjustments in order to absorb unwanted noise e.g. use of displays, soft furnishings, felt on bottom of pencil pots

If you have concerns, please contact the Sensory Impairment Team:
sensoryimpairment@worcestershire.gov.uk

Useful Links

The National Sensory Impairment Partnerships has a variety of factsheets and toolkits for educational professionals, as well as links to other useful information.

The National Deaf Children’s Society has a range of resources for professionals working with deaf students.

Training

All training from the SI team is bespoke to the needs of the child. Please contact: sensoryimpairment@worcestershire.gov.uk
 

Vision impairment

What is a Vision Impairment? 

A vision impairment is an eye condition which cannot be corrected by glasses. A squint, long or short sight or need for coloured overlays are unlikely to be considered a Vision Impairment (VI) in isolation to other conditions.

Ophthalmologists can choose to register a CYP as Sight Impaired (SI) or Severely Sight Impaired (SSI) but this is not necessarily an indication that one child has lower vision than another.

What I might see

Both distance and near vision can be affected by poor acuity, but not necessarily to the same degree. Some pupils may be able to see quite small print on a page but be unable to see at a distance, while for others the opposite may be true.

Additionally, the CYP may have a mild reduction in visual acuity but be functioning within a different visual category due to a further ophthalmic condition, e.g. an oculomotor disorder such as nystagmus, visual field reduction, cortical vision impairment, and/or additional learning difficulties.

Your Qualified Teacher of Children with Vision Impairment (QTVI) will tell you the near and distance vision levels of the CYP and level of loss. They will explain the relationship between N sizes and point sizes/fonts and any other assessment data clearly in their report.

Mild VI 

Near: the CYP may require print size N14-18 (this will require some enlargement of desktop resources)

Distance: the CYP can access from 6 metres what a fully sighted peer can see from 12-18 metres away

Moderate VI

Near: the CYP may require print size N18-24 (this will require enlargement of all desktop resources and some modification to content)

Distance: the CYP can access from 6 metres what a fully sighted peer can see from 19-36 metres away. They will require support to access content from a distance in class, such as teacher demonstrations, displays and the board.

Severe VI

Near: the CYP may require print size N24-36 (this will require enlargement and modification of all desktop resources)

Distance: the CYP can access from 6 metres what a fully sighted peer can see from 36 - 120 metres away. They will not access content from a distance in class, such as teacher demonstrations, displays and the board without substantial support.

Profound VI

Near: the CYP can access small quantities of N36 or larger so is likely to be a Braille user

Distance: the CYP can access from 6 metres what a fully sighted peer can see from 120 metres or more away. They will require substantial support to access the curriculum and remain safe, as well as to learn Braille and are likely to require a TA with specialist training and skills.

How might vision be affected

Central vision loss

This affects the area of the visual field that is used for detecting fine detail and most of our colour vision (the retina or macula).

Pupils may detect a dark or blurry spots in the centre of their vision and are likely to experience difficulty with reading, writing and close observation, tracking and scanning from the board, as well as reduced colour and contrast sensitivity.

Some CYP have central vision impairments which are degenerative and the loss can sometimes be experienced as a number of patches, meaning the impact is greater.

Peripheral vision loss

This is narrowing of the visual fields and CYP may see well when things are directly in front of them but experience gaps or spots in the sides of their vision.

It can create difficulties in moving around and locating objects, as well as poor vision in low light, but learners may be able to access small print effectively with detail using their central vision.

It can also present learners with difficulty locating their place on a page, scanning or finding details in diagrams. This condition can be progressive in some cases.

Loss of visual field (Hemianopia)

The CYP may experience total loss of vision in one half of their vision this will be experienced in both eyes and causes difficulties with movement round school as well as scanning and tracking of work on the board and on the page.

Low contrast sensitivity

Some visual conditions cause particular difficulties where an object does not stand out clearly from its background.

For these pupils the lighting and colour scheme of the school environment will be especially significant and there will need to be attention paid to steps and stairs to ensure they are accessible and safe.

The CYP may also find the clarity and contrast of print on the page more important than its size and will require visual “clutter” removed from resources.

Light Sensitivity

Many pupils with a vision impairment will find strong changes in light difficult to manage. They may find bright light painful (photophobia), while others may find it difficult to adjust visually when moving from a bright to a dimly lit area or activity.

Oculomotor (Eye movement) difficulties

Some visual difficulties arise from problems in controlling different muscle functions in the eye. Nystagmus, for example, involves a continuous involuntary movement of the eyes, usually from side to side, which creates significant focusing difficulties and causes a blurred image.

Some learners may have problems with convergence (the ability to train both eyes on the same object at the same time), others may find it hard to shift their focus from a near to a far object and some are unable to move their eyes to track, relying on head movements instead.

Colour Loss

This should not be confused with red/green colour deficiencies and in a CYP with a VI means reduction or absence of all colour, sometimes meaning the world is seen only in shades of grey.

The extent of a colour vision loss varies between individuals and may involve difficulty in distinguishing detail in pictures, maps and diagrams.

Activities which depend on colour coding may also present significant access problems to learners with a severe colour loss as will changes in surfaces around school unless clearly defined.

Cortical Vision Impairment (CVI)

A CVI can affect ability to recognize objects and faces, process motion, visual memory, orientation, visual spatial perception and simultaneous perception. There are 10 areas which may be affected:

  • colour preference (often red and yellow)
  • need for movement – it can be easier to track a moving target than a stationary one
  • need for light
  • visual latency (delayed response)
  • visual field preferences
  • difficulty with complexity
  • difficulty with distance viewing
  • difficulty with visual novelty
  • absence of visually guided reach 
  • atypical visual reflex responses

If you suspect a child has a VI

It is important that specialist advice is sought as appropriate from a Qualified Teacher of Children with Vision Impairment (QTVI).

What to look for

  • is the child experiencing headaches more than normal?
  • do they close their eyes to try to read the board or a book and appear to struggle? Do they rub or poke their eyes often? Are their eyes more red than normal?
  • do they wear glasses but still appear to struggle to see things?
  • are they missing tasks or information that has been written on the board (for example, homework)?
  • do they tire easily? Is there a limited period of time over which they can work efficiently?
  • how competent are they in moving around the classroom independently and safely? Do they bump into things and appear clumsy?
  • do they participate in social interactions with peers?

If you have concerns, please contact the Sensory Impairment Team:
sensoryimpairment@worcestershire.gov.uk

Inclusive Classroom Strategies

Planning

  • always think ahead with planning and resources to ensure access
  • ensure support staff have time to modify materials before the lesson
  • find alternatives that avoid relying on visual learning 

Resourcing

  • prepare worksheets in an appropriate font and print size. The QTVI will advise
  • reduce the visual “clutter”. Good contrast, high quality copies will give best access
  • when enlarging, do two sheets of A4 rather than A3 so it’s a more manageable size
  • ensure the child/young person always has their own copy so they can view at their preferred angle and distance

Teaching

  • use the CYP’s name to gain their attention
  • consider modifying activities for the whole class
  • allow the CYP extra time to complete tasks
  • apply any QTVI recommendations for tests and examinations at all times
  • verbalise key information and have real objects and artefacts whenever possible
  • seat the child in the position advised by their QTVI. This is not always at the front or in the middle
  • verbalise board content and homework tasks
  • please ensure the child or young person is seated with a friend when they are using any specialist equipment
  • be aware of background noise as this will affect ability to concentrate

In class

  • avoid moving furniture or resources around the room and walk through any necessary changes to classroom layout with the child or young person 
  • minimise clutter in class, keep cupboards closed and bags off the floor which could be potential trip hazards
  • consider whether they will be better off using the teacher’s laptop monitor or an iPad to view the whiteboard
  • bright light is not always good light. Use blinds to adjust light levels, cut glare and always face the source of light. The child should have the light behind them
  • use a black or blue pen on the whiteboard
  • consider allowing the CYP to answer every other question in a time limited task, therefore keeping the increasing complexity but allowing time

Resource Modification

  • plan ahead – modification takes time
  • make sure support staff know exactly what is required and by when
  • consider producing materials for all pupils in an accessible print size and typeface e.g. comic sans/ arial , to reduce the amount of modification needed
  • remove visual clutter, busy backgrounds and unnecessary detail from resources
  • prepare resources electronically so that they can be saved and modified easily to produce different versions, avoiding PDFs
  • provide electronic copies of resources for older pupils so they can put them into their preferred format themselves on their own computers
  • allow learners pupils to submit written work electronically wherever possible and add your own comments electronically so that they are also accessible to learners
  • please enlarge on A4 paper rather than A3

Useful Links

The National Sensory Impairment Partnerships has a variety of factsheets and toolkits for educational professionals, as well as links to other useful information:

Training

All training from the SI team is bespoke to the needs of the child. Please contact: sensoryimpairment@worcestershire.gov.uk
 

Accessible environments audits

The Habilitation Specialist from the Vision Impairment team will undertake an audit of the environment as necessary and advise according to need, but there are a number of measures you can take to improve accessibility for children with a vision impairment in your setting.

  • is there good lighting in all areas? 
  • are blinds fitted in rooms?
  • do all steps have a contrast colour edging?
  • do the seating arrangements ensure good sound to noise ratios for all pupils?
  • are there quiet rooms available to pupils who need this facility?
  • are pathways firm, even and level?
  • is there a change in paving to warn of steps/ ramps?
  • is there adequate locker/cloakroom provision to avoid pupils’ belongings becoming a hazard for the vision impaired pupil?
  • do you ensure that doors are either fully open or closed? 
  • are handrails in place on steps and stairs?
  • are handrails colour contrasted and smooth?
  • contrasting colour between décor and furniture
  • are floor coverings plain?
  • are surfaces matt?
  • are doorframes in a contrasting colour to the door and walls?
  • are door handles clearly visible and in contrast to the door?
  • are storage areas organised for easy access for vision impaired pupils?
  • are signs clear with good contrast between the writing and the background? 
  • are there non-visual guides to assist people to access the building? e.g. tactile signs
  • do your emergency and evacuation facilities have both a visual and auditory component? e.g. flashing fire alarm.
  • do you have arrangements to provide information in simple language, symbols, large print, in audio format or in Braille?
  • do you ensure that information is presented to staff, pupils and parents in a way that is user friendly for all people with sensory impairment.  
  • are trees and bushes regularly cut back and pathways kept clear of weeds and debris?
  • are corridors kept clear of unnecessary obstacles?  

Physical Disability Outreach team

The PD Outreach team supports children with a diagnosed physical disability and or medical condition which affects their physical functioning and access to a mainstream nursery curriculum. 

For further information please visit the Physical Disability Outreach team page.

Bladder and bowel issues

Bladder and bowel issues can occur in any child or young person and at any stage of development. They have a huge impact on the affected individual’s wider health and wellbeing. They are associated with embarrassment, stigma, social isolation, reduced self-confidence and self-esteem, poorer experiences of education, social isolation and feelings of difference. These combine to reduce quality of life for the child and their family.

The United Nations Convention on the Rights of a Child (UNCRC) sets out the civil, political, economic, social and cultural rights of all children and young people and was ratified by the UK in 1991. Some of the articles of the UNCRC relate directly to the management of bladder and bowel issues in educational settings including: Article 3, the best interests of the child should be the primary consideration; Article 6, the rights to healthy development; Article 12, the right to participate in decision making; Article 16, the right to privacy; Article 23, the right to special care, support and access to education for those with a disability; Article 24, the right to good quality healthcare; and Article 28, the right to education.

All providers must make reasonable adjustments (e.g. additional adults working with children and young people support to meet the needs of each child (Equality Act 2010, Chapter 2 Section 20;). Children and young people should not be excluded nor treated less favourably because of their bladder and bowel issues (Children and Families Act (2014)).

Worcestershire Children’s First have worked with partners (Health, Public Health and PD Outreach) to update guidance on supporting settings to ensure the rights and needs of children with bladder and bowel issues are understood and met.

If further support is required by any setting please contact the Physical Disabilities support teams at:

Resources and advice downloads

Download: Helping Children and Young People with Bladder and Bowel Difficulties(PDF)

Download: Completing a Personal Care Plan (PDF)

Download: Kitting out the Personal Care Facility (PDF)

Download: Health Care Plan (Word document)

Download: Record of Intimate Care (Word document)

Download: Paediatric Referral Form (Word document)

Download: Personal Care Plan (Word document)

Download: Bladder and Bowel Policy (PDF)

Sensory Environment Audits – Sensory Processing

These audit tools were designed to support settings in assessing the environment in relation to sensory processing needs. The audits were jointly designed by Paediatric Occupational Therapy and the Autism and Complex Communication Needs teams. They are intended for use by school staff in education settings. 

For further advice in using these audits, please contact your school’s linked teacher or autism@worcestershire.gov.uk

Download: