TETN # 30910
Visually Impaired Students
with Vestibular Issues
Presented by
Kate Hurst and Jim Durkel
TSBVI Outreach
KateHurst@tsbvi.edu
JimDurkel@tsbvi.edu
With Special Guest
David Brown
California Deaf-Blind Services
Workshops and Conferences
 June 5-7 Appropriate Communication
Assessment for Babies with Deafblindness
HAS BEEN CANCELED
 June 25-26 ECI Conference @ Embassy
Suites in San Marcos
 June 26-27 5th Annual Statewide Texas Parent
to Parent Conference @ Omni Austin Hotel at
Southpark in Austin
Roll Call
 How many
participating?
 Remote sites?
 Taping or
streaming?
Visually Impaired Students with
Vestibular Issues
Presented by
Kate Hurst, Statewide Staff Development Coordinator,
TSBVI Outreach with
Jim Durkel, Audiologist/Speech-Language Pathologist
and APH, VI Registry, & Deafblind Census Coordinator,
TSBVI Outreach and
David Brown, Education Consultant, California DeafBlind Services
Our Special Guest . . .
 David Brown
 Formerly of SENSE,
UK
 Currently with
California Deaf-Blind
Services
 World-traveler
 Funny guy
How do we achieve balance?
Three separate components make up
“Equilibrium Triad”
 Input from the eyes (vision)
 Input form the muscles and joints
(proprioception)
 Input from the vestibular organs (balance)
A Good Place to Start
 Pediatric Resource - Vestibular Disorders
Association
(http://www.vestibular.org/vestibular-
disorders/specific-disorders/pediatric-vest.disorders.php)
Causes Pediatric Vestibular Disorders
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Head/neck trauma
Chronic ear infections
Maternal drug/alcohol abuse
CMV
Immune-deficiency disorders
Meningitis
Migraine
Metabolic disorders (e.g., diabetes)
Ototoxic drugs
Causes Pediatric Vestibular Disorders
 Neurological disorders (CP, Hydrocephelus)
 Genetic syndromes (e.g., Wallenberg, Usher,
CHARGE)
 Posterior brain tumor
 Family history of hearing loss/vestibular issues
 Cochlear implants
 Lack of use - movement issues, fear, ill health
Some data . . .
VI Registry - 84 or 14%
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CP - .3%
CHARGE - 7.7%
CMV - 2.7%
Hydrocephaly - 1%
Meningitis - .5%
Shaken Baby - .5%
Usher 1 - 1.7%
Deafblind Census - 147
or 19.9%
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CHARGE - 9.7%
CMV - 4.8%
Hydrocephaly - 1.9%
Usher 1 - 1.2%
So how does the vestibular system work?
Vestibular organs
 Located in the bony
chambers of the skull
in the inner ear
 3 semi-circular canals
positioned in different
planes for rotational
movements
 Otoliths (Utricle and
Saccule) for linear
accelerations
Semicircular Canals
 Bulge at base of canals ampulla
 Ampulla contain sensory
receptors for each canal
 Canals filled with endolymphatic
fluid and surrounded by
perilymphatic fluid
 Detect heads rotation
 Demonstration on The Physiology
of the Senses Transformations for
Perception and Action, Tutis Vilis,
University of Western Ontario,
Canada
Otolith Organs
 Utricle
 Saccule
 Demonstration on
SenseWeb
Vision
and Balance
Vestibular Occular Reflex
 Normal head rotation: eyes move in
opposite direction of head to stabilize
retinal image (VOR)
 Conflicting sensory information from visual
and vestibular senses is a problem
 The cerebellum repairs “slippage”
 Demonstration
What Part
Does Proprioception Play?
 Sensation experienced by muscle and joint
receptors
 Requires a normal range of muscle tone to
work properly
 Feeds information to the brain that allows
for awareness of where body parts are in
space, movement, speed and direction of
movement
A Redundancy for Balance
Brain and Spine Foundation Online
When one of the three parts of the
Equilibrium Triade do not work or
work well, the other two can
compensate.
QuickTime™ and a
decompressor
are needed to see this picture.
Moving
Platform
Posturography
From Jean Ayers
Sensory Integration and the Child
“The vestibular system is the unifying
system. It forms the basic relationship
of a person to gravity and the physical
world. All other types of sensation are
processed in reference to this basic
vestibular information.”
From Jane Ayers
Sensory Integration and the Child
“The activity in the vestibular system
provides a “framework” for the other
aspects of our experience. Vestibular
input seems to “prime” the entire
nervous system.”
From Jane Ayers
Sensory Integration and the Child
“When the vestibular system does not
function in a consistent and accurate
way, the interpretation of other
sensations will be inconsistent and
inaccurate, and the nervous system
will have trouble ‘getting started.’”
From Carol Stock Kranowitz
The Out-of-Sync Child
“Gravitational insecurity is manifested
by abnormal distress and anxiety in
reaction to falling or the possibility of
falling. It is a primal fear.”
From Carol Stock Kranowitz
The Out-of-Sync Child
“Indeed, our need to know where we
are in relation to the earth is more
compelling than our need for food, for
tactile comfort, or even for a motherchild bond.”
References on Vestibular Issues
David Brown, California Deaf-Blind Services
o “The Vestibular Sense”, DbI Review, June, 2007
o “Educational and Behavioral Implications of Missing
Balance Sense in CHARGE Sydrome”, reSources,
Spring 2003.
Effects of vestibular problems
 Organization of ALL
sensory information
 Postural security/muscle
tone
 Use of residual vision
 Perception/processing
sound
 Remembering auditory
sequencing
 Memory development
 Speech/Language
development
 Behavioral challenges
 Bilateral coordination
 Breathing, feeding,
digestion, nutrition
 Sociability
What do we do?
A
S
S
E
S
S
 Vestibular Dysfunction Checklist in
Out-of-Sync Child
 Sensory Learning Kit
 Vestibular assessment by
Audiologist
 OT/PT Evaluation
 Sensory Integration Evaluation
Various testing devices
http://www.tchain.com/otoneurology/testing/engrot.html
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
What do we do?
T
E
A
M
 With OT knowledgeable about SI to
develop menu of interventions
 To plan flexible schedule related to
fatigue and need for breaks
 To select / train staff to respect
individual differences in behavior,
performance, pacing
 With family to gain insight to home
challenges, child preferences and for
support
What do we do?
M
O
D
I
F
Y
 Seating to address postural concerns
 Positioning for visual and auditory tasks
 Materials and learning environment
(isolate lines of text, reduce distractions)
 Activities to incorporate SI approaches
 Pacing
 Schedule (general / day-to-day)
 Staffing patterns
What do we do?
R
E
S
P
E
C
T
 Student challenges in learning
 Family struggle to address
challenges / knowledge of the child
 Staff challenges to adapt
programming and the expertise each
has to offer
To Learn More . . .
 Brown, David, 2007. “The Vestibular Sense”,
pp. 17-22. Dbl Review, January-June 2007,
Deaf-Blind International.
 Brown, David, 2003. “Educational and
Behavioral Implications of Missing Balance
Sense in CHARGE Syndrome”, pp. 1-4.
re:Sources, Spring, 2003. California DeafBlind Services, San Francisco, CA.
http://www.sfsu.edu/~cadbs/Spring03.pdf
To Learn More . . .
 Brown, David, 2008. “The Sensory
Integration Perspective and What It Offers
Us in the Field of Deafblindness”, pp. 2226. DbI Review, July-December, 2008.
Deaf-Blind International.
 Brown, David, 2008. “The Forgotten Sense
- Proprioception”, pp. 20-24. DbI Review,
July-December, 2006. Deaf-Blind
International.
To Learn More . . .
 Kranowitz, Carol Stock, 1998. The Out-ofSync Child. The Berkley Publishing Group,
375 Hudson Street, New York, NY 10014.
 Kranowitz, Carol Stock, 2003. The Out-ofSync Child Has Fun. The Berkley
Publishing Group, 375 Hudson Street, New
York, NY 10014.
To Learn More . . .
 Vestibular Disorders Association
www.vestibular.org
 Brain and Spine Foundation - Dizziness and
balance problems
http://www.brainandspine.org.uk/information/publicatio
ns/brain_and_spine_booklets/dizziness_and_balance
_problems/how_does_the.html
 Tutis Vilis - SenseWeb
http://www.physpharm.fmd.uwo.ca/undergrad/sen
sesweb/L10Balance/L10Balance.swf