The Interface Between Habilitation & Rehabilitation Work

By Peter Lock & Lisa Petrie

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Aims

To explore the similarities and differences in skills and knowledge needed between Rehabilitation and Habilitation Specialist for delivering habilitation.

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Objectives

During this workshop through case studies, discussion and presentation the following areas will be explored:

• What Habilitation involves

• Additional skills and knowledge needed for Habilitation work

• The framework that guides Habilitation work.

Purpose of Habilitation

• Habilitation is the process of helping visually impaired children and young people to achieve as much independence as possible in their daily lives. We do this by providing personalised training and support in mobility, orientation and independence skills.

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Purpose of Habilitation• Mobility, orientation, movement independence and independent

living skills is provided for children and young people from 0-25 in order to develop personal freedom of movement as individuals, family members, pupils, students and citizens with the needs and rights to express and engage in life opportunities.

Frequently programs are delivered in collocation with other professionals including, OT, Phsyio’s , Speech & Language, QTVI’s and of paramount importance parents.

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Habilitation Quality Standards

Habilitation Specialists work to Habilitation Quality Standards (HQS) http://www.ssc.education.ed.ac.uk/resources/vi&multi/habilitation.pdf

Define processes and assures standards of services that families of children and young people can expect.

Provide a clear framework for Habilitation Specialists to adhere to.

Many of the Local Authorities are Health Trusts across UK recognising HQS to ensure good practice.

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Additional Learning

Additional knowledge, skills and experience required to meet needs of babies and children/ young people with additional or complex needs.

• Significant amount of learning and skills development is achieved through visual imitation, therefore timely intervention at 0-2 years is crucial to limit impact of visual impairment.

• Large number of referrals have additional or complex needs which require alternative methods of assessing, delivery of training and significant resources. The term ‘Independence’ goal can be significantly smaller but greater resources are frequently needed to achieve.

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Additional Learning Some areas of in-depth knowledge that can be key to delivering habilitation.

• Early years and child development• Cortical Visual Impairment – assessing• Functional Vision – babies and complex needs• Early movement • Sensory input and integration– Vestibular , Proprioception & kineasthetics• Other Disabilities including Cerebral Palsy, Autistic Spectrum Disorder and Down

Syndrome – Their impact on early movement and development.• Use of alternative equipment such as resonance board

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Case Studies

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Please see case studies in appendix section.

The following slides provide some areas to consider within the case studies and in the delivery of habilitation programs both in early years and complex needs.

Implications of Visual Impairment on Development

• Display tactile sensitivities• Often do not like lying in the prone position• Underdeveloped trunk rotation• Weaker muscle tone• Slower speed of movement• May be more passive • Delayed body awareness• Difficulty bringing hands to the midline

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Implications of Visual Impairment on Development

• Difficulty in crossing the midline• Difficulty co-ordinating two sides of the body• Lack of motivation to explore/move• Delayed gross motor skills• Delayed fine motor skills• Poor posture and gait• Lack of incidental learning

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Implications of Visual Impairment on Development

• Concepts have to be taught – environmental, positional, directional etc

• Reduced opportunity to develop kineasthetic sense – poor balance

• Saving reaction needs to be taught• Lack of awareness of danger “no fear”• Additional experiential opportunities necessary

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Early MovementEarly movement is not necessarily confined to early years, can be considered to those with complex needs.

• Intervention is often required to encourage movement and motor development.

• It is important that timely intervention is provided to reduce the delay in development.

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Early Movement• Strategies often have to be provided to ensure

that reflexes such as the asymmetrical tonic neck reflex (ATNR) and symmetrical tonic neck reflex (STNR) are integrated into more mature motor patterns.

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Early Movement• Children with a significant visual impairment

can often present with low muscle tone in the trunk or abdomen area.

• Can affect balance, ability to rotate their body and the performance of more complex motor patterns.

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Relying on other senses• Information from the other senses can be:-

– Not under the child’s control– Discrete– Intermittent– Inconsistent– Fragmented– Unverifiable

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Use of Auditory Cues• Use of auditory cues from early age can encourage non-

passive movement• Cause effect • Concept of spatial awareness• Travelling towards a target• Exploration • Tracking skills• Understanding of environments

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ResourcesAssessments Tools:

Oregon Project http://www.soesd.k12.or.us/sectionindex.asp?sectionid=132

Developmental journal for babies with visual impairmentd children

http://www.councilfordisabledchildren.org.uk/media/552269/developmental_journal_for_babies_and_children_with_visual_impairment.pdf

Developmental Journal for Children and Young People with Multiple Needshttp://www.councilfordisabledchildren.org.uk/media/895259/merged-children-and-young-people-with-multiple-needs.pdf

Developmental Journal For Babies and Children with Down Syndromehttp://webarchive.nationalarchives.gov.uk/20130401151715/http://www.education.gov.uk/publications/eOrderingDownload/ES49-Journal.pdf

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ResourcesBooks:

Three titles to get you started:

Reach Out & Teach

Author: Kay Ferrell, published by American Foundation for the Blind

Cortical Visual Impairment – an approach to assessment and intervention

Author: Christine Roman-Lanzty published by American Foundation for the Blind

The Well Balanced Child – movement and early learning

Author: Sally Goddard Blythe published by Hawthorne Press

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ResourcesActivities

A few ideas to help develop movement, sensory and exploration

Resonance Board – Used for early movement• https://nfb.org/images/nfb/publications/fr/fr31/4/fr310416.htm• http://www.jessiesfund.org.uk/wp-content/uploads/2012/08/Resonance-Boards.pdf • http://www.soundabout.org.uk/#/shop/4553518672

Tap Pac – Communication through touch and music

http://www.tacpac.co.uk/

Sticky Kids – Music & Movement

http://www.stickykids.co.uk/home/homepage.aspx

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Appendix Case Study - Ben Ben is three years old and is registered as severe sight impaired as a consequence of Retinopathy of Prematurity. Information gathered from ophthalmology indicates possible light perception in both eyes. Generally he has good health and no other formal diagnosis, so is only seen by the Health visitor and recently by QTVI who has referred to Educational Psychology for statement, as he is due to start Nursery in September. Mum expresses concerns about his reluctance to explore his surroundings and relies on people guiding his hand to objects or requiring toys to be given directly into his hand. When surrounded by a number of toys, even those that make noise Ben will not reach out to locate them. He has been known to sit for hours without self-initiating exploration or attempts to move. Whilst he enjoys food he is still reliant on others feeding him and needs full support for other areas of self-help such as washing and dressing. He will hold a tommy-tipee cup to drink out of, but needs to be given it and often will struggle to grasp it properly. Ben will walk alongside an adult holding their hand, but is really reluctant to trail around furniture and walls independently in the house or at nursery. Without guidance he will just sit on the floor and make know attempt to move even with verbal encouragement. Mum advises that he never crawled. Observing him walking his gait is quite wide and gross motor movement is rigid, there is also some evidence of poor balance even when supported and he tends to walk with his head down. He will follow some actions to movement songs but accuracy of locating body parts and stretching is generally poor.

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Appendix Case Study – Ben continued

Family express some concerns about behaviours Ben has recently started to display, including eye poking, hand flapping and vigorous shaking of the head. He does have a relatively good understanding of speech and is able to communicate his basic needs, however frequently displays echolalia and misuse of personal pronouns. Discussion Discuss potential reasons for Ben's unwillingness to explore and move, as well as some of the habitual behaviours he has started to display. • Assessment method and tools that could be used

• Briefly outline a program of intervention that may address some of these issues, suggesting resources, frequency of support and involvement of other professionals.

• Anny implications or concerns for the Rehabilitation Worker.

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Appendix Case Study – Martin

Martin is two years old and has a significant visual impairment, with a diagnosis of CVI. Martin was born at full term with no difficulties evident. At 9 weeks Martin was admitted to hospital with enteroviral encephalitis. Martin required intubation, ventilation and emergency transfer to the paediatric intensive care unit in a hospital 70 miles away. Recent medical information confirms that he is known to have the following medical difficulties:- Global Developmental delayAbnormal neurological examinationFeeding difficultiesSignificant visual impairment Martin is non mobile and has no language skills. A referral was received by the QTVI within the sensory support team when Martin was 6 months old, the referral to habilitation was made when Martin was 9 months old. At this time there appeared to be no response evident when presented with visual stimuli, this has now developed to Martin visually responding to moving objects and objects presented at approx. 60cm and bold in colour.

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Appendix Case Study – Martin continued

Given this basic information:- • What professionals would you liaise with?

• What assessment tools/approaches would you use?

• What type of programmes of intervention would you consider to encourage independent movement?

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ContactsLisa Petrie – Service Delivery Manager, Blind Children UK Scotland.Lisa.Petrie@guidedogs.org.uk

Peter Lock – Habilitation Specialist , Blind Children UK, Northern IrelandPeter.Lock@blindchildrenuk.org

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