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Opening Doors: Technology & Communication Options for Children With Hearing Loss

This new publication, from the U.S. Department of Education, is designed to connect children and their families with assistance as early as possible. It also describes current technologies and communication options for children with hearing loss, including deafness. The publication is available in PDF, Word, and text-only formats on the Department of Education's Web site.

BookShare.org: Membership Driven Site That Offers Electronic Books
Bookshare.org dramatically increases access to books for the community of visually impaired and otherwise print disabled individuals. This online community enables book scans to be shared, thereby leveraging the collections of thousands of individuals who regularly scan books, eliminating significant duplication of effort.

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What about a child with a vision problem, particularly if no one knows about that vision problem? The child may have difficulty seeing a chalkboard, reading a book, writing, participating in sports or any of the other normal childhood activities.
 
Think about it for a moment. A child with a dental problem is likely to complain about pain in their jaw or teeth. A child with a vision problem may complain about a headache, words "dancing" on a page or the child may not complain at all. The child only knows that they are not able to do things that other children can do. The child may compensate for the vision problem by avoiding tasks that require good vision, such as, reading and writing.
 
Get the picture? A child with a vision problem looks a lot like a child with a reading problem, or a self esteem problem. Now comes the tragic part, there are millions of children who suffer from undetected vision problems.

Juvenile Macular Degeneration: Stargardt’s Disease
From Web MD and other sites

Juvenile macular degeneration (JMD) is the term for several inherited and rare diseases that affect children and young adults. They include Stargardt's disease, Best disease, and juvenile retinoschisis. They can cause central vision loss that often starts in childhood or young adulthood.

 
These conditions come from gene changes passed down in families. Unfortunately, there’s no treatment. Visual aids, adaptive training, and other tools can help young people with vision loss remain active. Researchers continue to look for ways to prevent and treat JMD.

 
Genetic counseling can teach parents about these eye problems and sort out the risks for their children. Counseling also helps families understand how their loved one's vision is affected.

 
JMD damages the macula, the tissue in the center of the retina at the back of the eye. This area provides the sharp central vision that lets us do things like read and drive. It also allows us to see color and recognize faces. There are a variety of inherited diseases that can lead to JMD.
 

Stargardt's Disease

 
It's the most common form of JMD. It's named after German eye doctor Karl Stargardt, who discovered it in 1901. It affects about one in 10,000 children in the U.S. Although the disease starts before age 20, people affected may not notice vision loss until age 30 to 40.

 
Signs: It’s usually diagnosed by yellow-white spots that appear in and around the macula. If they cover the back of the eye, then it is called fundus flavimaculatus. These deposits are an abnormal buildup of a fatty substance produced during normal cell activity.

 
Symptoms: Include trouble reading and gray or black spots in central vision. Loss of sight comes on slowly, then affects both eyes. Once vision reaches 20/40, the disease moves faster, until vision reaches 20/200, which is legal blindness. Some people lose vision quickly over a few months. Most people will have vision loss ranging from 20/100 to 20/400 by the time they’re 30 or 40.

 
Over time, the abnormal accumulation of this substance can damage cells that are critical for clear central vision. In addition to central vision loss, people with Stargardt macular degeneration have problems with night vision that can make it difficult to navigate in low light. Some affected individuals also have impaired color vision. The signs and symptoms of Stargardt macular degeneration typically appear in late childhood to early adulthood and worsen over time, but can start earlier.

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Children with Convergence Insufficiency are sometimes diagnosed with Learning Disorders or Dyslexia
Overview (from the Mayo Clinic) (Also see Learning Disabilities and Dyslexia)

 
Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. This condition causes one eye to turn outward instead of inward with the other eye creating double or blurred vision.
Convergence insufficiency is usually diagnosed in school-age children and adolescents. It can cause difficulty reading, for which parents or teachers might suspect the child has learning difficulties rather than an eye disorder.
Symptoms
Not everyone with convergence insufficiency has signs and symptoms. Signs and symptoms occur while you're reading or doing other close work and might include:
• Tired, sore or uncomfortable eyes (eyestrain)
• Headaches
• Difficulty reading — words seem to float on the page, you lose your place or you read slowly — which might cause you to avoid reading or not complete schoolwork
• Double vision (diplopia)
• Difficulty concentrating
• Squinting, rubbing or closing one eye

From the Optometrists Network:
Convergence Insufficiency (CI) is the leading cause of eyestrain, blurred vision, double vision (diplopia), and/or headaches.1
HIGHLIGHTS:
• Convergence insufficiency is a common near vision problem that -- due to recent scientific research -- is gaining public recognition.
• Convergence insufficiency disorder interferes with a person's ability to see, read, learn, and work at near (close distances).
• In the past, convergence insufficiency disorder has often gone undetected because testing is not included in (1) pediatrician's eye tests; (2) school screenings; or (3) basic eye exams1.
• A person can pass the 20/20 eye chart test and still have convergence insufficiency.
• Treatments range from passive (prism lenses) to active (office-based vision therapy)1-4, 8
• Scientific research by the National Eye Institute has proven that office-based vision therapy is the most successful treatment.8
• Home-based pencil pushups therapy appears to be the most commonly prescribed treatment5, but scientific studies have shown that this treatment is ineffective.3, 6, 8
• Eye surgery is rarely, if ever, recommended.1, 2
• While clinical results show that Convergence Insufficiency can be treated at any age, current scientific research has been completed on the pediatric and young adult populations only.1, 2, 4, 8

FREQUENTLY ASKED QUESTIONS:
What is Convergence Insufficiency?
Convergence Insufficiency (CI) is a common binocular (two-eyed) vision disorder in which the eyes do not work at near easily. An eye teaming problem in which the eyes have a strong tendency to drift outward when reading or doing close work (exophoria at near). If the eyes do drift out, the person is likely to have double vision.
To prevent double vision, the individual exerts extra effort to make the eyes turn back in (converge). This extra effort can lead to a number of frustrating symptoms which interfere with the ability to read and work comfortably at near.
"Convergence insufficiency (CI) is a common binocular vision disorder that is often associated with a variety of symptoms, including eyestrain, headaches, blurred vision, diplopia [double vision], sleepiness, difficulty concentrating, movement of print while reading, and loss of comprehension after short periods of reading or performing close activities."
Archives of Ophthalmology. 2008;126(10):1336-1349
What are the Symptoms of Convergence Insufficiency?
A person who has convergence insufficiency may show and/or complain of the following while doing close work (i.e., reading, computer work, deskwork, playing handheld video games, doing crafts, etc.):
• eyestrain (especially with or after reading)
• headaches
• blurred vision
• double vision
• inability to concentrate
• short attention span
• frequent loss of place
• squinting, rubbing, closing or covering an eye
• sleepiness during the activity
• trouble remembering what was read
• words appear to move, jump, swim or float
• problems with motion sickness and/or vertigo
It is not unusual for a person with convergence insufficiency to cover or close one eye while reading to relieve the blurring or double vision. Symptoms will be worsened by illness, lack of sleep, anxiety, and/or prolonged close work.
Many people who would test as having convergence insufficiency [if tested] may not complain of double vision or the other symptoms listed above because vision in one eye has shut down. In other words, even though both eyes are open and are healthy and capable of sight, the person's brain ignores one eye to avoid double vision. This is a neurologically active process called suppression.1
Suppression of vision in one eye causes loss of binocular (two-eyed) vision and depth perception. Poor binocular vision can have a negative impact on many areas of life, such as coordination, sports, judgment of distances, eye contact, motion sickness, etc. Consequently, a person with convergence insufficiency who is suppressing one eye can show some or all of the following symptoms:
• trouble catching balls and other objects thrown through the air
• avoidance of tasks that require depth perception (games involving smaller balls traveling through the air, handicrafts, and/or hand-eye coordination, etc.)
• frequent mishaps due to misjudgment of physical distances (particularly within twenty feet of the person's body), such as:
o trips and stumbles on uneven surfaces, stairs, and curbs, etc.
o frequent spilling or knocking over of objects
o bumping into doors, furniture and other stationary objects
o sports and/or car parking accidents
• avoidance of eye contact
• poor posture while doing activities requiring near vision
• one shoulder noticably higher
• frequent head tilt
• problems with motion sickness and/or vertigo
If untreated, in some cases, convergence insufficiency can lead to an outward eye turn that comes and goes (intermittent exotropia).1, 2
How Common is Convergence Insufficiency?
Convergence insufficiency has a reported prevalence among children and adults in the United States of 2.5 to 13%.1-3, 7
Detection and Diagnosis of Convergence Insufficiency
Convergence (eye teaming) and accommodation (focusing) tests are the important diagnostic tools. A basic eye exam or screening with the 20/20 eye chart is not adequate for the detection of convergence insufficiency (and many other visual conditions). A person can pass the 20/20 test and still have convergence insufficiency. A comprehensive vision evaluation by an eye doctor who tests binocular (two-eyed) vision and who can refer or provide for in-office vision therapy is recommended for all individuals who do reading and deskwork -- particularly students of any age.
Convergence insufficiency disorder frequently goes undetected in school age children because proper testing is not included in (1) eye tests in a pediatrician's office; (2) school eye screenings; and/or (3) standard eye exams in an optometrist's, ophthalmologist's or optician's office1.
According to Dr. M. Bartiss, O.D., M.D.,
"Patients typically present [themselves for testing and treatment] as teenagers or in early adulthood, complaining of gradually worsening eyestrain, periocular headache, blurred vision after brief periods of reading, and, sometimes, crossed diplopia [double vision] with near work. Fortunately, in most cases, convergence insufficiency is very amenable to orthoptics and vision therapy.2
Regarding Dr. Bartiss' observations: while the good news is that convergence insufficiency responds well to proper treatment, the bad news is that --- due to pervasive lack of testing for convergence insufficiency -- many people are not getting the help they need early in life. And many are never helped. Children, teenagers and adults who remain undiagnosed and untreated tend to avoid reading and close work as much as possible or use various strategies to combat symptoms (such as, using a ruler or finger to keep one's place while reading or taking frequent breaks, etc.).
Treatment of Convergence Insufficiency
Treatments for CI can be categorized as active or passive:
• Active treatment: A multi-site randomized clinical trial funded by the National Eye Insitute has proven that the best treatment for convergence insufficiency is supervised vision therapy in a clinical office with home reinforcement (15 minutes of prescribed vision exercises done in the home five days per week). The scientific study showed that children responded quickly to this treatment protocol...75% achieved either full correction of their vision or saw marked improvements within 12 weeks.8
• Passive treatment: Prismatic (prism) eyeglasses can be prescribed to decrease some of the symptoms. Although prism eyeglasses can relieve symptoms, they are not a "cure" and the patient typically remains dependent on the prism lenses. In addition, adaptation problems can lead to the need for stronger prescriptions in the future. Scientific research as well as optometric and ophthalmological textbooks agree that the primary treatment of convergence insufficiency should be vision therapy.1
Pencil Push-ups: While a 2002 survey of ophthalmologists and optometrists indicated that home-based pencil-pushups therapy is the most common treatment, scientific research does not support this method. Studies done on pencil pushups have shown it to be ineffective in eliminating symptoms.3, 6, 8
Surgical Care: The decision to proceed with eye muscle surgery should be made with caution and only after all other efforts have failed.1, 2
________________________________________
References:
1. Cooper, J, Cooper, R. Conditions Associated with Strabismus: Convergence Insufficiency. Optometrists Network, All About Strabismus. 2001-2005.
2. Bartiss, M. Extraocular Muscles: Convergence Insufficiency. eMedicine.com, Inc., eMedicine Specialties, Ophthalmology. 2005.
3. Scheiman M, Mitchell GL, Cotter S, et al; the Convergence Insufficiency Treatment Trial (CITT) Study Group. A randomized clinical trial of treatments for convergence insufficiency in children. Archives of Ophthalmology. 2005;123:14-24. Complete article - PDF version
4. Birnbaum MH, Soden R, Cohen AH. Efficacy of vision therapy for convergence insufficiency in an adult male population. J Am Optom Assoc. 1999;70:225-232.
5. Scheiman M, Cooper J, Mitchell GL, et al. A survey of treatment modalities for convergence insufficiency. Optom Vis Sci. 2002;79:151-157.
6. Gallaway M, Scheiman M, Malhotra K. Effectiveness of pencil pushups treatment of convergence insufficiency: a pilot study. Optom Vis Sci. 2002;79:265-267.
7. Rouse MW, Borsting E, Hyman L, Hussein M, Cotter SA, Flynn M, Scheiman M, Gallaway M, De Land PN. Frequency of convergence insufficiency among fifth and sixth graders. Optom Vis Sci. 1999 Sep;76(9):643-9.
8. Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Archives of Ophthalmology. 2008 Oct;126(10):1336-49. References related to exophoria at near, convergence problems, under-convergence, convergence weakness, insufficient fusional convergence, exophoric, eye teaming, eye tracking, visual sensory integration, accommodative insufficient, diplopia, eye muscle weakness, exotropia, exophoria, receded nearpoint of convergence

BLIND VISION Literacy Update: Textbooks for Blind Students "Come Alive" - A standard textbook for primary or secondary school students is a robust learning tool rich with photographs, illustrations, charts, maps-visual images that bring the words to life. Textbooks for blind or visually impaired students are considerably less dynamic. A full book may comprise as many as 15-20 bound volumes. All of the helpful graphic components are useless unless the teacher describes them. Locating a highlighted vocabulary word is cumbersome and difficult. The learning status quo for these students may be changing as the result of a project completed by assistive technology experts at UB.

When Is Learning Difficulty Due to a Vision Problem?
While learning occurs through a number of complex and interrelated processes, vision plays a key role. Many signs, symptoms and behaviors associated with learning disabilities -- Attention Deficit Hyperactivity Disorder (ADHD) and other learning problems -- are similar to those caused by vision problems. This is why it is so important that a comprehensive vision examination be part of the interdisciplinary evaluation of all children who are failing to succeed in school.

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Parents of Blind Children of Michigan - http://www.parentsofblindchildren.org/

This site provides: education, resources and support for parents, teachers and friends of children with visual impairments; information on activities and supports for children/youth with visual impairments; and provides advocacy and educational support for children/youth with visual impairments. Michigan specific issues and events are also discussed.

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Featured Resource: Sight for Students - VSP (Vision Service Plan), a nationwide, non-profit, vision benefit plan, sponsors Sight for Students^TM , a program that provides eye exams and eyeglasses to children of low-income, uninsured families. They quote these statistics, among others: Nearly 30% of children in special education classes, more than 70% of juvenile delinquents, and more than 60% of the individuals enrolled in adult literacy programs have vision problems. This year they will help more than 50,000 children. VSP commits up to 40% of company profits to fund the program.

Vision Connection: Web Site for People Who Are Blind or Have Partial Site - Vision Connection is aiming to become the Yahoo for people who are blind or have partial site. It features large type, legible fonts, reverse contrast, and text only pages for people with partial site, and is designed specifically so screen readers and magnification software can work with it. Provides links to many sites that are easy to use for those with vision impairment or who are blind.

A to Z of Blindness and Vision Loss Now Online American Foundation for the Blind expands web site: Whether you're hoping to find the latest information on accessible cell phones for people who are blind or have low vision, looking for resources to help teach a visually impaired student in your classroom, working for a corporation researching ADA compliance, or are experiencing vision loss and want to learn how to maintain your independence, www.AFB.org has the answer.
 

Lighthouse International - Their mission is to overcome vision impairment for people of all ages through rehabilitation services, education, research and advocacy. Free literature on eye diseases (macular degeneration, glaucoma, cataracts, diabetes, and more) and various resource lists (reading options, adaptive computer technology, financial aid, etc.) Referrals to support groups, low vision services, rehabilitation agencies, state agencies and advocacy groups. Free catalog of low vision aids. Lighthouse Int'l, 111 E. 59th St., New York, NY 10022 or call 1-800-829-0500.

National Organization for Parents of Blind Children - Support for parents of blind children. Serves as both an advocacy and public information vehicle. Offers positive philosophy and insights to blindness and practical guidance in raising a blind child. Newsletter, parent seminars, free information packet, meetings, conventions. Dues $8.
   

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Blind Man Teaches Blind and Disabled Kids To Hunt and Fish - Mike Gates can recall — achingly, painfully — the day he lost his sight. But, "from where I was to where I am today is pretty unbelievable," he says.

For the Blind, Technology Does What a Guide Dog Can’t - T. V. Raman was a bookish child who developed a love of math and puzzles at an early age. That passion didn’t change after glaucoma took his eyesight at the age of 14. Now a highly respected computer scientist and an engineer at Google, he has built a series of tools to help him take advantage of objects or technologies that were not designed with blind users in mind and is now focusing on touch screen cell phones. “How much of a leap of faith does it take for you to realize that your phone could say, ‘Walk straight and within 200 feet you’ll get to the intersection of X and Y,’ ” Mr. Raman said. “This is entirely doable.” “What Raman does is amazing,” said Paul Schroeder, vice president for programs and policy at the American Foundation for the Blind. “He is a leading thinker on accessibility issues, and his capacity to design and alter technology to meet his needs is unique.”
 

Paterson's Ascension Inspires Disabled - When David Paterson takes office Monday to become the nation's first legally blind governor to serve more than a few days, among those watching with the greatest interest will be those who cannot see.
 

Eye-catching System Helps Students Read - Dozens of Miami-Dade schools are diagnosing reading problems by using infrared goggles that chart how students' eyes move. "I know how to read; I know how to pronounce everything," said Rhiannon Chavez, who failed to graduate last month from Michael Krop Senior High in Northeast Miami-Dade because she has not passed the state's reading exam. "The problem is that when I finished, I wouldn't know what I just read." Rhiannon and dozens of her classmates are now enrolled in a program known as Reading Plus, which uses infrared goggles and customized software to track their eyes and train their brains. The same program is being used in many of Miami-Dade's lowest-performing schools -- as well as a handful in Broward and Palm Beach counties -- and administrators are crediting it with impressive gains.

It's Harry Potter Time! Seeing With Your Mind - At the stroke of midnight on Friday, Harry Potter fanatics will descend on bookstores to claim "Harry Potter and the Half-Blood Prince," the sixth installment of J. K. Rowling's best-selling series. Although Ashley Bernard, 12, says she has read the first five books "at least 15 times each," she will not be among the midnight crawlers. Blind from birth, she has always faced a torturous delay of at least three months to get a Braille edition.

Stevie Wonder Uses New Technology For Blind Fans - Stevie Wonder is making headlines for using a special new music video technology for the clip to his song "So What The Fuss." The video will include a second, descriptive audio track, recorded by hip-hop star Busta Rhymes, and will be accessible to people who are blind or have low vision. Two versions of the video will be released -- the first will be a traditional music video, while the second version will be accompanied with the new technology which can air on all SAP-accessible TV channels.

A Guiding Light in Clouded World - Barry Richard, who is nearly blind, once paid $23 for a hamburger and a beer. He intended to cover his check with a $5 bill and three ones but handed the waitress a $20 and three ones by mistake. She accepted the windfall without a peep. Here's what Richard since has learned about handling cash when you can't see.

 CA Assemblyman Seeks More Funds for Visually Impaired Students - In front of a watchful audience of media, politicians and educators Friday, 9-year-old Taylor Rebhahn recited a fictional story she wrote about an elephant named Rose who needed someone to care for her. The fourth-grader didn't read her imaginative story from a piece of paper in front of her or a computer screen. Instead, her little fingers lightly touched Braille coming out of a computer as she read about Rose's sad fate of being picked up by zoo keepers.

Eddie and Maria Bell Have Adjusted Gracefully to Life — and Parenthood — Without Sight - "A few years back, I was assisting a family in Texas who had a teenage daughter who became blind within about a three day span due to medical complications from an infectious disease. By the grace of the universe, Eddie Bell was in town and available to work with the young woman and her family on a one to one basis. We were all so thankful for his expertise, patience and kindness. Sharing his very similar experience and positive attitude about blindness (including the information of the journey that led him to that positive attitude) made all the difference in the world for the young woman who has moved on in her life with courage and grace. Thought the following article might be of interest to some of you too…" - Brunhilde Merk-Adam, Parents of Blind Children of Michigan
 

BLIND VISION Technology Update
BLIND VISION and POBC of Michigan, January 09, 2004
Since the year 2000, the American Foundation for the Blind has published "Accessworld," a publication designed to provide latest assistive technology news and reviews related to blind and visually impaired individuals. Until now, however, "Accessworld" has been a bimonthly, subscription-based magazine. Starting with the January 2004 issue (Vol 5. No. 1), "accessworld" is available free of charge on AFB's web site at www.afb.org. The easiest web address to use to get to the initial Access World "home" page is http://www.afb.org/aw/main.asp which lets you also access back issues. The January issue presents an extensive section on DAISY books and the current efforts to bring DAISY into the mainstream disability community in the United States. The table of contents for the issue can be found at http://www.afb.org/afbpress/pub.asp?DocID=aw0501toc.

GA Special Needs Student is Resolute - In a dimly lighted room, 14-year-old Chelsea Gilliland read aloud as she skimmed her hands along rows of raised dots, letting her fingers see the words. The LaFayette High School freshman is legally blind, hearing impaired and has trouble walking. Despite her physical handicaps, Chelsea has succeeded in school, making all A's and B's.

New Video Releases with Descriptive Narration from DVS Home Video - DVS Home Video®, an initiative of the Media Access Group at WGBH, announces the availability of six new film titles on home video-fully described for viewers who are blind or visually impaired. These feature films, available to order November 24, include Finding Nemo, Pirates of the Caribbean: The Curse of the Black Pearl, Seabiscuit, Matrix: Reloaded, Bruce Almighty and The Lion King-Special Platinum Edition.

U.S. Team Finds Track Success at Blind World Championships - In the highlands a few kilometers north of the old city of Quebec and the majestic St. Lawrence River, more than 900 visually impaired athletes competed the past week at the second International Blind Sports Association World Championships.

Technology transmits sense of touch over Web - Breakthrough by UB engineers could lead to technology that teaches users how surgeons use a scalpel.

Canada Blind teen makes history; Oakville student Legislature's first Guide dog Penny rises to occasion

WA Two State Students Get Rhodes Honors

Press Release: U.S. & Canada Adopt New Braille Terminology
 

Read "A New Way to Read, Not See, Maps"

Special-Ed Law Violated, Judge Rules - The Calvert County school system violated federal law when it failed to provide a blind student with a certified vision teacher last year, a state administrative law judge has ruled.

Switch From Audio Tape to Digital Creates Problem for Recording for Blind & Dyslexic

For Blind Students, Another Challenge - Shortage of Vision Teachers Vexes Schools, Angers Parents.

IL Guests' guests get perks at hotel - Marriott welcomes Seeing Eye dogs along with their masters.

Blind Voters Want Privacy

New Tool Helps Blind Students Learn Math

MI Public schools weak on education for blind - Only 60 teachers in state are certified to teach visually and hearing impaired kids.

Australian Bionic Eye Gives Hope to Blind

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Vision Service Plan’s Sight for Students - Program Targets Children with Undetected Eye Problems.

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