2018 texas focus: on the move! what do sensorimotor ... texas focus...motor theories motor control:...

Texas School for the Blind & Visually Impaired Outreach Programs www.tsbvi.edu | 512-454-8631 | 1100 W. 45th St.| Austin, TX 78756

2018 Texas Focus: On the Move! What Do Sensorimotor Theories Have to Do with Visual Impairments? Saturday, March 3, 2018 9:45 – 11:15 AM

Presented by

Athena Oden, Physical Therapist

readybodies.com

[email protected]

Developed for

Texas School for the Blind & Visually Impaired

Outreach Programs

http://www.tsbvi.edu/

mailto:[email protected]

2018 Texas Focus – What do Sensorimotor Theories Have to do with Visual Impairments – Oden, A. Page 1

What Do Sensorimotor Theories have to Do with Visual Impairments?

Athena Oden, PT, readybodies.com

Figure 1 Cover of ReadyBodies LearningMinds: Cultivating the Complete Child (3rd edition) by Athena Oden

Slide 2: TSBVI Class of 1915

Figure 2 Class picture of 5 young men. The man in the red circle is Athena's Grandfather.

Figure 3 A TSBVI reunion class picture of 25 people. Two are circled in red; these are Athena's grandparents.


Slide 3:

“Orientation is the process of using sensory information to establish and maintain one’s position in the environment; mobility is the process of moving safely, efficiently, and gracefully within one's environment. .”

The role of the orientation and mobility specialist in the public schools. Everett Hill, Ed.D., Vanderbilt

Figure 4 Class picture of 5 young men.

Slide 4: Sensory Integration “The neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment.

Ayres,A.J.

Sensory Integration and learning disorders

Motor Theories Motor Control: How the control of the movement organized, with all the understanding of previous experiences.


Slide 5: External Senses External- as in- sensing information FROM the environment…

• Vision

• Auditory

• Tactile

• Oral Internal Senses Internal- as in- sensing information FROM the

(body or) self…

• Vestibular

• Proprioceptive

• Motor Control (a product of many of these)

Figure 5 Child walking a playground balance beam

Slide 6: Dynamic Systems Theory

Development IS a process of self-organization among multiple factors, driven by interactions and experiences.

“…and history matters; factors that may not have an obvious relevance to a particular outcome may have a profound, cascading effect.”

Ulrich, Phys Ther. 2010


Slide 7: Where Do We Start?

Figure 6 A child curled on the floor with her face hidden. A pre-cane device is next to her.

Two short videos

Slide 8: The Vestibular System Functions to maintain equilibrium and postural tone.

• Equilibrium comprehension

• Stimulates core muscles (reflexively) for: o control of equilibrium, o increased core strength

This is foundational for understanding:

• directionality

• knowledge of self The vestibular system is like a “Back Door” for children with VI. If vision is not driving them to be upright or explore beyond self, vestibular most likely will…

Figure 7 Therapist holding 2 year old and sitting on a balance ball


Slide 9: The Vestibular System If this information is lacking, they will often self- seek by

• Rocking, Swinging, Jumping

• Rotating own head or they may

• lean forward, not ’know upright’

• be fearful when feet leave ground

• resistant to leaving familiar place

• collapse on floor, refuse to move

• appear to have poor balance

• show a stiff, hesitant gait The vestibular system is like a “Back Door” for children with VI. If vision is not driving them to be upright or explore beyond self, vestibular most likely will…

Figure 8 Child rotating her head as she stands by a sensory wall

Figure 9 Child curled face-down on the floor


Slide 10: The Vestibular System Stimulating the vestibular system:

• Rolling on floor, in blanket or bubble wrap

• Scooter on tummy

• Spinning board or chair or bowl

• Jumping

• Swinging

• Inversion over your lap or pillows

• Rolling off large pillows This can help increase core tone, posture, directionality & knowledge of self.

*It is assumed that proper precautions will be taken in each child’s situation for their particular needs.

*See attached file: Accommodation and Overload Notes by Athena Oden, PT

Figure 10 Adult in a spinning bowl

Figure 11 Child in a hammock swing



Video of Child next to a sensory wall, rotating her head constantly

Figure 12 Child walks while suspended in harness-type gait assist

Slide 12: Vestibular

Figure 13 Therapist sitting on spinning board, holding child and spinning


Figure 14 Child sitting on spinning board for first time independently



Figure 15 Child spinning on board with legs crossed and chest down on knees.


Spinning Routine

Figure 16 Therapist spinning child during regular spinning routine



Figure 17 Child bouncing on knees

Figure 18 Child standing, bouncing and shaking

Figure 19 child rocking back hard in seat of car


Slide 17: The Proprioceptive System Provides joint/muscle. position sense and awareness of movement.

• Movement comprehension

• Stimulates contraction of muscles around joints for: o control of movement o stability during action

• This is foundational for understanding: o position of own body o knowledge of self

‘Heavy Work’ and/or ‘weight-bearing’ – the experience of heavy work is often very limited in our students with VI and/or other impairments

Figure 20 Two yr. old child standing in play yard with feet flat.

Slide 18: The Proprioceptive System If this information is lacking, they will often self-seek by

• bouncing, stretching, waving, tapping

• heavy stepping, rhythmic pounding

• squeezing self, grimacing, flapping or they may

• enjoy tight spaces and tight hugs and tight clothes or shoes

• bounce off of walls, and furniture

• grind teeth, chew on non-food items

• appear lethargic and slow to move

• have a weak grasp and lack of dexterity

• use heavy force when touching others or moving objects. Videos of the toddler bouncing on knees and the child rocking hard against the seat of the car.


Slide 19: The Proprioceptive System Stimulating the proprioceptive system will build understanding of self-movement

• Pushing, pulling; Heavy Work

• Lifting, carrying

• Jumping and kneeling work for legs

• Pulling self up, overhead work for upper body and arms

• All fours and kneeling, wheelbarrow

• Vibration: pillow, tools, toys

• Weighted blankets *It is assumed that proper precautions will be taken in each child’s situation for their particular needs.

*See attached file: Accommodation and Overload Notes by Athena Oden, PT

Slide 20: The Proprioceptive System Types of Proprioceptive input or support:

Video: Child standing and writing on board with therapist supporting her.

Video: Child stepping up onto curb while teacher touches stomach.


Slide 21:

Figure 21 child walking on soft balance beam with adult support

Figure 22 Child kneeling at activity board with adult

Figure 23 Child on spinning board with teacher attending

Figure 24 Child in 3-point stance with PE instructor attending

Activity Checklist for 5 days/week, AM and PM

Activity

Choose up to 5 activities daily

Time

(minutes)

Monday

AM PM

Tuesday

AM PM

Wednesday

AM PM

Thursday

AM PM

Friday

AM PM

Bouncing on ball (sitting) 5-7

Stomach on ball (from t/back/side-side) 5-7

Push Heavy Cart 7-10

Crawl Through Tunnel/ chair/ tables 5-7

Floor activity while on knees and arms over head 5-7

Walking on uneven surfaces 5-7

Jump off trampoline / steps holding both hands 10 times

Bunny hops while walking 10 times


Slide 22: Proprioceptive From lethargic patterns or fitful bouncing to secure ambulation

Figure 25 child standing and laying head on table

Figure 26 Child standing and bouncing

Figure 27 Same child walking in school hall using a cane


Slide 23: Is addressing the impairment the shortest route to function? i.e., to walk:

1. Repeat walking as they do now, or with verbal cues. 2. Stimulate what they lack to walk well:

• Vestibular: upright, core strength, equilibrium

• Proprioceptive: knowledge of own foot placement, cane grip and cane movement, experience in weight bearing

• Motor: strength and self-organization will increase with an increase in vestib, proprio, and training.

Otherwise, we are just doing the repeated ‘task’ of walking, instead of developing the ability to walk.

Slide 24: Developing ability by feeding the systems • Task-training is important. However, we have been “task-heavy” at times.

• Be careful not to use a task as a stimulation. Sitting on a therapy ball may be a task [an endeavor, work to be done] for one child but not another child.

• Feed /fill the systems, and the child, with simple experiences that are not dependent upon their success of the activity.

• Will see greater success in self-organization during an upcoming task.

• (see attached file: Teaching the task vs. Feeding the system)

Slide 25: The Tactile System Provides 2 pathways for tactile understanding; Light Touch and Deep Touch (mouth can be included)

Light Touch • slight touch or movement on skin

• connected to protective system, FFF

• can trigger fear or adrenaline responses

Deep Touch • ie massage, deep squeezing

• connected to the discriminatory system

• heavy pressure that is calming

Oral can be calming (sucking) or alerting (crunching, chewing hard items)


Slide 26: The Tactile System Provides 2 pathways for tactile understanding; Light Touch and Deep Touch (mouth can be included)

Light Touch prefers messy play, may include saliva, diaper, mucous

• hair brushing, gentle light touch on skin, brushing teeth may cause fear and aggression

• constantly touching things or people

• keeps items in mouth or in hand and is upset when items are removed

Deep Touch • pushing on eyes, poking self,

• biting self, pulling own hair

• coincides with frustration or appears to be used for calming

Slide 27: The Tactile and oral System Tactile / Oral exploration

Figure 28 Child sitting in chair, mouthing the handle

Slide 28: The Tactile and Oral System Oral for support and concentration

Figure 29 Child sitting in chair, mouthing the provided kerchief and toy.


Slide 29: The Tactile System Stimulating the Deep Touch pathway will help overide the FFF response of the Light Touch

Deep Touch • provide nesting or swaddling-type resting places with Lycra or other blankets

• massage, firm pressure or grip

• deep pressure over dorsal muscles

• rolling on floor or smooth surface

• rubbing briskly with a towel

• crawling through a fabric tube that gives firm pressure

Slide 30: What are some of the ‘sensory seeking’ behaviors we may see in VI?

• Constant sound/voice/speech – used to find place in the world, orient self, ‘approach’ others

• Extraneous movement – constant for vestibular or proprioceptive feedback to understand own movement, knowledge of space and people around them, rocking to feed vestibular grounding

• Constant touch – an information gatherer, will use more than sighted and often appears repetitive

• Constant contact with others – as foundation to place in space/world, understanding of environment, lack of knowledge of self.


Slide 31: The Systems in behavior? Movement can often be frightening, if:

• Visual information about environment is limited

• Vestibular understanding of movement through space is limited

• Tactile ‘grounding’ is no longer available (no longer in contact with ground, etc)

• Proprioceptive knowledge of own movement is limited

• Auditory is used or avoided. Fear-Fatigue-Frustration = behavior?

Figure 30 Child curled on floor with face hidden

Slide 32:

Figure 31 Building scaffolding containing words; “Visual, Auditory, Motor, Vestibular, Proprioceptive, Tactile and Cognition”. On the left of the building the words “Bottom Up” with an arrow pointing upwards and on the right the worlds “Top Down”.

• Sit in the chair

• Stop making sounds

• Don’t stomp

• Stop waiving hands

• Don’t rock

Bottom Up

Top Down


Slide 33: Dynamic Systems Theory “ Movement cannot be separated from perception and cognition: these processes are continually interacting. The acts of perceiving and planning are always in reference to eventual movement and movement is a part of what is being remembered. Over a lifetime, I believe, these interactions with the world construct our cognition and maintain it.”

Thelen, Movement and Action in Learning and Development, 2004

Slide 34:

Where do we start? How do we get her to engage?

Figure 32 Child curled on the floor with her face hidden

Figure 33 Child bouncing up and down on knees

Slide 35: Vestibular and Proprioceptive

Figure 34 Child sitting on mother’s lap, singing ABC song, while rotating head almost continuously.



Figure 35 Child is rocking independently on favorite rocking horse. Trampoline in background also used independently.


Figure 36 Getting child to leave contact with mother to sit on spinning board.


Figure 37 Getting on favorite rocking horse that has been placed on the spinning board.



Figure 38 Child is now spinning self by sitting on rocking horse and pushing with feet on floor.


Figure 39 Using a scooter in sitting for mobility in classroom

Slide 41: The vestibular system: a spatial reference to bodily self-consciousness

Pfeiffer, Serino & Blanke, (2014), Frontiers in Integrative Neuroscience

• “…the remarkable human experience of being a subject: the “I”.”

• Therefore, the vestibular system plays a critical role for neural representations of spatial aspects of bodily self-consciousness… with respect to the external world [and] in the gravitational field in particular.


Slide 42: Embodied Cognition “To say that cognition is embodied means that it arises from bodily interactions with the world.”

Thelen, Schoner, Sheier and Smith, 2001,The dynamics of embodiment: a field theory infant perseverative reaching.

Slide 43:

Figure 41 A little boy’s first time on spinning board, tolerated very slow spin

Figure 42 Athena applies deep pressure to the little boy’s feet while he is in sitting on legs, feet to aid in standing

Figure 40 Building scaffolding containing words; “Visual, Auditory, Motor, Vestibular, Proprioceptive, Tactile and Cognition”


Slide 44:

Figure 43 A little boy standing independently in play yard, pressure on feet

Figure 44 The little boy plays a somersault game with mom for fun vestibular stimulation


Slide 45:

Figure 45 Child taking steps in a gait trainer following a visual cue.

Figure 46 The child with his back to the wall before he takes his First Steps!


Accommodation and Overload

Notes by Athena Oden, PT

Supplied to Sensory Integration and Motor Focus Group,

Region 13, Beverly Jackson

I know this may not be new news to some of you, but I think in the context of these children and the type of therapy we are doing, we need to keep it in the foreground. The situations I am going to describe here do not always happen, are not always the result, and can occur occasionally in any of the students, but not be a consistent response. We just need to be aware of this, and watch the students to see if these issues might arise.

There are times that the students may accommodate to, or adjust to, the stimulation we are doing if the stimulation is done too often, and too regularly in the same manner. Our body and senses can become accommodated to something that is sustained. For example, you may smell something when you enter a room, but adapt or accommodate to it and no longer smell it. But the next person walks in and notices it! Or may initially notice the vibration of riding in a rough truck, but adjust to it after a while. In the situation of the children we are working with, if they are jumping on the trampoline all day long, that vestibular and proprioceptive stimulation ‘loses its effect’ because the body may have accommodated to it.

There are other times that a student may become overloaded or saturated with a stimulation. We may recognize this if a student throws up from vestibular spinning! But that is not the only way it can be expressed. It can be seen in a multitude of ways if we are watchful. One common response to overloading is ‘shut-down’. For example, the vestibular stimulation (rolling or spinning) is good momentarily. They may only tolerate a little the first time or two. If they seem to enjoy it initially and we continue, we can overload them. The children may do one of two things: (1.) check out, shut down and stare into space, or (2.) explode and throw a tantrum. Watch the children who are non-verbal carefully as this may be their only means of expressing the have had enough.

Vestibular, proprioceptive, tactile, vibration, olfactory, and auditory stimulation-and more-can all produce accommodation or overload.

To prevent accommodation or overload:

• Move into a new activity or stimulation on a little at a time. You can provide it 3-4 times a day if desired. And to increase the stimulation or activity, increase the length of time slightly and increase the number of times per day.

• Vary the method of delivery. If jumping is the proprioceptive work needed, jump on a trampoline, jump on a couch, jump on the floor, jump outside and inside, jump on a bed, jump in the grass, jump off the curb…etc. (Of course, I am assuming you will do what is safe for each of the students.)


• Vary the type of stimulation. If proprioceptive/weight-bearing input into the lower extremities along with vestibular up-and-down linear stimulation (i.e. ‘jumping) is what is needed, try to vary the ways of achieving this. Have them sit on a ball and bounce up and down with feet pushing off the ground, have them a hold a handrail and do squat-to-stand or squat-to-jump depending on their ability, or do a rapidly repeating sit-to-stand-to-sit.


Teaching the task vs. Feeding the system

and What activities would you recommend for improving core strength?

Notes by Athena Oden, PT

Supplied to Sensory Integration and Motor Focus Group,

Region 13, Beverly Jackson

Sometimes, things that we do with the students in terms of stimulation, are difficult enough to be labeled instead as a ‘task’. (Definition: a piece of work to be done or undertaken; and endeavor). For example, asking a student to balance on a therapy ball is a skill requiring the organization of vestibular balance, proprioceptive understanding of arm and leg movement and foot placement, trunk perception and motor control, and head control. Organizing, and responding to, and calling into submission, all of those systems into the one action of “balancing on a ball” is therefore a task. It takes quite a bit of effort and ability.

What we need to do in preparing our student for a task, is to “feed the systems” that will be a part of that, or any, task. Feed the vestibular system by simple rocking, spinning, and rolling, with your assistance, only to experience and perceive - not to control and perform. Feed the proprioceptive and tactile system with crawling, jumping, holding a heavy object, deep pressure, weighted lap blankets, etc. Feed the movement (motor muscle) system of the trunk by comfortably sitting on the floor and rock side to side, front to back, rotationally, etc.

Once we have fed and filled the systems, we can later present tasks that require the orchestration of all of those systems. I know that this is not exactly a ‘black and white’ issue. We are always feeding systems even within the tasks that we do. But for our children with disabilities, we need to saturate the systems with as much information as we can, and limit the use of “tasks” as a stimulation. They have a day filled with tasks that are not simple for them, and the orchestration of the performance is wearing on those sweet little bodies. So, take a lot of time to stimulate, without asking for performance. Then we will see improvement in the daily tasks.

What activities would you recommend for improving core strength?

Core strength is built from a lot of things. But here are some ideas we can work with:

Vestibular stimulation is directly and reflexively connected to core muscles. So, when you are doing the rolling, rocking, jumping, spinning, you are also building core. Isn’t that great?! And try to do more of these in a position that requires some weight-bearing and movement from them:

• burrito roll up and out with a blanket;

• on a scooter on the tummy pushing against floor with hands if possible. If that is not possible, put them on the scooter on their tummy and move the scooter around. It may not need to be very fast, but fast enough that they have to adjust their trunk to stay on - of course, not creating fear! Try supine if you think it is appropriate. There is heavy vestibular, proprioceptive, and trunk work in supine on a scooter.


• sitting on a spinning board, or in a chair that spins. If they will allow it, or hopefully even push it themselves. Follow the instructions in the Ready Bodies, Learning Minds book for intensity and duration.

• jump from a small tramp to the floor

• lie down on a large body pillow and roll off, downhill toward the floor.

• swing on the tummy in a regular sling swing

• Inversion over a ball or your lap is powerful for the systems and the core too. Remember when you would put your infant on their stomach across your legs with their head down? And rock them side to side? Or bounce your legs up and down? Replicate that.

And then there may be some things that just require strength: But I know these may be difficult for our students:

• hold on to mom’s leg while mom moves

• push games- will they push you over while sitting on floor? try to get some resistance that will call in some trunk muscles.

• even as simple as pushing against a Lycra cocoon.

• crawling across a floor full of pillows - or even just rolling, and scooting. It takes a lot of trunk work.


Sample Sensory Activity Checklist

Region 13 Sensory Integration and Motor Focus Group

Week: From ____________ To ________________

Activity choose up to 5 activities daily

Time (minutes)

Monday AM PM

Tuesday AM PM

Wednesday AM PM

Thursday AM PM

Friday AM PM

Bouncing on ball (sitting) 5-7

Stomach on ball (front/back/side-side)

5-7

Spin Board (5x each way on bottom)

5-7

Spin Board (5x each way on stomach)

5-7

Prone on Scooter board (large rotations)

7-10

Prone on Scooter (pull self, break then repeat)

5-7

Roll on floor/mat distance of up to 10 feet back and forth

7-10

Push Heavy Cart 7-10

Crawl Through Tunnel/chair/tables

5-7

Floor Activity while on knees and arms over head

5-7

Walking on uneven surfaces 5-7

Trampoline balance/bouncing 5-7

Jump off trampoline/steps holding both hands

10 times

Bunny hops while walking 10 times

Balance Beam, walking close to wall for support

10 times


Relevant Resources:

Anderson, et al, 2001; The flip side of perception-action coupling: locomotor experience and the ontogeny of visual-postural coupling. https://www.ncbi.nlm.nih.gov/pubmed/?term=The+flip+side+of+perception+-action+coupling

This discusses the acquisition of prone locomotion as a young chil linking to posture regulation based on optic flow.

Freeman, Soltanifar, Baer, 2010; Stereotypic Movement Disorder: easily missed https://www.ncbi.nlm.nih.gov/pubmed/?term=Stereotypic+Movement+Disorder%3A+easily+missed

Interpretation: “Stereotypic Movement Disorder occurs in children without ASD or intellectual disability” In other words, stereotypic movement does not necessarily identify autism or other disorders.

Glauser, et al, 2007; Space-time relativity in self-motion production. https://pdfs.semanticscholar.org/ccb8/bd5586eabceef9bfd95bcbe02ec6af4eee93.pdf

“…vestibular navigation is impaired under conditions of increased cognitive load.” My interpretation: Be cautious about engaging your student in conversation if you are also teaching him to navigate at the same time.

Jazi, Purrajabi, Movahedi, & Jalali, 2012: Effect of selected balance exercises on the dynamic balance of children with visual impairments. https://www.researchgate.net/publication/261870671_Effect_of_Selected_Balance_Exercises_on_the_Dynamic_Balance_of_Children_with_Visual_Impairments

Molloy, Rowe, 2011; Manneristic behaviors of visually impaired children https://www.ncbi.nlm.nih.gov/pubmed/?term=Manneristic+behaviors+of+visually+impaired+children

Results: “The age at which the frequency of these behaviors decreases is associated with the child’s increasing development, thus those visually impaired children with additional disabilities, whose development is impaired, are at an increased risk of developing and maintaining the behaviors."

Moss & Blaha, 1993; Looking at Self-Stimulation in the Pursuit of Leisure, I’m okay, you have a mannerism. http://www.tsbvi.edu/seehear/archive/mannerism.html

A powerful discussion on self-stimulation with mention of all the sensory channels.

https://www.ncbi.nlm.nih.gov/pubmed/?term=The+flip+side+of+perception+-action+coupling

https://www.ncbi.nlm.nih.gov/pubmed/?term=The+flip+side+of+perception+-action+coupling

https://www.ncbi.nlm.nih.gov/pubmed/?term=Stereotypic+Movement+Disorder:+easily+missed

https://www.ncbi.nlm.nih.gov/pubmed/?term=Stereotypic+Movement+Disorder:+easily+missed

https://pdfs.semanticscholar.org/ccb8/bd5586eabceef9bfd95bcbe02ec6af4eee93.pdf

https://www.researchgate.net/publication/261870671_Effect_of_Selected_Balance_Exercises_on_the_Dynamic_Balance_of_Children_with_Visual_Impairments

https://www.researchgate.net/publication/261870671_Effect_of_Selected_Balance_Exercises_on_the_Dynamic_Balance_of_Children_with_Visual_Impairments

https://www.ncbi.nlm.nih.gov/pubmed/?term=Manneristic+behaviors+of+visually+impaired+children

https://www.ncbi.nlm.nih.gov/pubmed/?term=Manneristic+behaviors+of+visually+impaired+children

http://www.tsbvi.edu/seehear/archive/mannerism.html


Pfieffer, Serino & Blanke, 2014; The vestibular system: a spatial reference to bodily self-

consciousness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028995/

Discussion of the systems and how they help develop “the remarkable human experience of being the subject: the “I”. “

Prechtl, Cioni, Einspieler, Bos, Ferrari, 2001; Role of vision on early motor development: lessons from the blind

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2001.tb00187.x/epdf

This is a very important short paper - it is helpful to read the full article. This quote from another article summarizing the Prechtl paper:

“Moreover, It has been shown that totally blind infants presented with a clear delay in head control and abnormal, exaggerated type of ‘fidgety movements’ as well as prolonged period of ataxic features in postural control.”

(via the Introduction of Gori et al. (2015), in Devices for visually impaired people: High technological devices with low user acceptance and no adaptability for children. http://www.sciencedirect.com/science/article/pii/S0149763415302864

Thaler, 2013; Echolocation may have real-life advantages for blind people: an analysis of survey data

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647143/

Also worthy of a full read, but at least the Abstract and the Discussion at the end of the article.

“…possibility for limited popularity of echolocation might be concerns about social stigma…sometimes also referred to as “Blindisms” and they are discouraged from an early age.” (Discussion)

Thelen, Schoner, Scheier, C., & Smith, L.B., 2001; The dynamics of embodiment: a field theory of infant perseverative reaching. https://www.ncbi.nlm.nih.gov/pubmed/11515285

BOOKS Cited Thelen, 2004; “The central role of action in typical and atypical development: A dynamic

systems perspective”. In Stockman, I.J., (Ed.) Movement and action in learning and development: Clinical implications for pervasive developmental disorders. https://books.google.com/books/about/Movement_and_Action_in_Learning_and_Deve.html?id=UTlBXLfb9n8C


https://www.ncbi.nlm.nih.gov/pubmed/?term=Role+of+vision+on+early+motor+development:+lessons+from+the+blind

http://www.sciencedirect.com/science/article/pii/S0149763415302864


https://www.ncbi.nlm.nih.gov/pubmed/11515285

https://books.google.com/books/about/Movement_and_Action_in_Learning_and_Deve.html?id=UTlBXLfb9n8C

https://books.google.com/books/about/Movement_and_Action_in_Learning_and_Deve.html?id=UTlBXLfb9n8C


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Outreach Programs

Figure 47 TSBVI logo

Figure 48 IDEAs that Work logo and US Dept. of Education OSEP disclaimer

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