AN EDUCATIONAL INTERVENTION IN A STUDENT WITH INTELLECTUAL, VISUAL, HEARING AND MOTOR DISABILITIES

ABSTRACT

This paper presents the design, implementation and evaluation of an educational intervention program for a student with a diagnosis of severe hearing loss, congenital blindness and intellectual and motor disability. The aim of the intervention is to improve the child’s connection with the environment and to work on anticipating events in his daily life. For that purpose, three areas of development are mainly worked: adaptive, motor and cognitive. The results obtained in pretest and posttest evaluation reflect slight improvements in the three areas after the intervention, and therefore, an evolution in the student’s developmental age. Some of the most relevant conclusions are that individualized work with people with multiple disabilities positively influences their development, and that there is a lack of standardized assessment instruments adapted to the characteristics of people with multiple and severe disabilities.

Keywords:
blindness; hearing disability; special education

RESUMEN

En este trabajo se presenta el diseño, la implementación y la evaluación de un programa de intervención educativa para un estudiante con diagnóstico de hipoacusia severa, ceguera congénita, discapacidad intelectual y motriz. La finalidad de la intervención es mejorar la conexión del niño con el entorno y trabajar la anticipación de acontecimientos en su vida diaria. Para ello se trabajan principalmente tres áreas de desarrollo: adaptativa, motora y cognitiva. Los resultados obtenidos en las evaluaciones pretest y postest reflejan ligeras mejoras en los tres ámbitos tras la intervención, y por tanto, una evolución en la edad de desarrollo del estudiante. Algunas de las conclusiones más relevantes son que el trabajo individualizado con personas con discapacidad múltiple influye positivamente en su desarrollo, y que existe una falta de instrumentos de evaluación estandarizados que se adapten a las características de las personas con discapacidades múltiples y severas.

Palabras clave:
ceguera; discapacidad auditiva; educación especial

RESUMO

Neste estudo apresenta-se a configuração, a implementação e a avaliação de um programa de intervenção educativa para um estudante com diagnóstico de hipoacusia severa, cegueira congênita, deficiência intelectual e motora. A finalidade da intervenção é melhorar a conexão da criança com o entorno e trabalhar a antecipação de acontecimentos em sua vida diária. Para isso trabalham-se principalmente três áreas de desenvolvimento: adaptativa, motora e cognitiva. Os resultados obtidos nas avaliações pré-teste e pós-teste indicam melhora nos três âmbitos após a intervenção, e por tanto, uma leve evolução na idade de desenvolvimento do estudante. Algumas das conclusões mais relevantes são que o trabalho individualizado com pessoas com deficiência múltipla influi positivamente em seu desenvolvimento, e que existe uma falta de instrumentos de avaliação estandardizadas que se adaptem às características das pessoas com deficiências múltiplas e severas.

Palavras-chave:
cegueira; deficiência auditiva; educação especial

INTRODUCTION

Multiple disabilities are the result of the comorbid presentation of significant difficulties in two or more areas of a person’s development, the most common being intellectual, motor and sensory.

In the educational field, work with students with multiple and severe disabilities focuses mainly on objectives related to improving their life quality. Specifically, it is usually oriented towards the acquisition of strategies for communication, socialization, independence and interaction with the immediate environment, since they are integral factors in the life quality of an individual (Foreman, Arthur-Kelly, Bennett, Neilands, & Colyvas, 2014).

When working with students with multiple disabilities, the adult must provide the student with access to information and provide opportunities for interaction with the context by establishing a communication system (Boas, Ferreira, De Moura, Maia, & Amaral, 2016; Foreman et al., 2014).

Fellinger, Holzinger, Dirmhirn, Van Dijk, and Goldberg (2009) highlighted that people with deaf blindness need to have a structured environment and anticipation of daily activities. When faced with new situations, the companion must announce through tactile signs what is going to happen in order to reduce anxiety levels. According to Bruce and Borders (2015), the intervention with people with multiple disabilities has three focuses: subject, companion and environment.

The objective of this work is to present the design, implementation and evaluation of an educational intervention program for a student with visual, hearing, intellectual and motor disabilities.

METHOD

Participants

The intervention is aimed at an eleven-year-old child with a diagnosis of severe hearing loss, visual, intellectual and motor disabilities. Some notable behaviors are the lack of expression of basic needs, lack of exploration of the environment and contact rejection with unknown objects and people.

A multiprofessional team from the specific special education school in which the student is enrolled participates in the intervention, composed of: tutor, educator, physiotherapist, therapeutic pedagogy teacher, psychopedagogue and student intern. In addition, there is the family collaboration to get information related to the student.

Evaluation instruments

Battelle Developmental Inventory (Newborg, Stock, & Wnek, 1984). It evaluates five areas: personal/social, adaptive, motor, communicative and cognitive. The results are reflected in equivalent development ages for each area.

Guía en los zapatos de los niños ciegos (Lucerga, & Gastón, 2004). It is an instrument aimed at children’s caregivers with severe visual disabilities. It gets together the most significant objectives in the children growth by age groups and development areas. Within each area, up to ten objectives are included that allow the child’s development to be guided towards another stage.

Intervention

The main objectives of the intervention are to enhance the student’s connection with the environment and work on the events anticipation in their daily life. The intervention is carried out in the child’s educational school (in their reference classroom and the multisensory stimulation classroom). The duration is 5 months, with 3 weekly sessions of 90 minutes. Box 1 shows the areas, items, general and specific objectives covered in the intervention and some examples of educational activities proposed for this (based on a pretest evaluation).

Box 1
Areas, Items, Objectives to Cover in the Intervention and Examples of Proposed Activities.

Before the intervention, the implementers established a simple communication code with the student. In order to start an interaction, the same object is always used. To start an activity, touch the student’s shoulder. When the child does the exercise, his cheeks are touched as reinforcement. The end of exercise is marked by crossing the student’s arms over his chest.

RESULTS

The effectiveness of the intervention program has been evaluated by comparing the results of the pretest and posttest evaluation, reflected in Boxes 2 and 3.

Box 2
Equivalent Age of Pretest and Posttest.

Box 3
Achieving Objectives According to Guía en los Zapatos de Los Niños Ciegos (Lucerga & Gastón, 2004).

CONCLUSIONS

Three main conclusions are derived from the implementation of the intervention program described. Firstly, the intervention has produced a slight improvement in the child’s adaptive, motor and cognitive areas. Therefore, it could be stated that their evolutionary development improves with individualized attention.

Second, according to Foreman et al. (2014), in an intervention of this type, the communicative skills of the implementer are significantly influenced. Thus, one of the key aspects of this program has been the communication code established with the student. This has contributed to improving communication between the child and the implementers, to interpreting the student’s responses and, therefore, to increasing the reliability of the evaluation.

Finally, this study shows the lack of standardized instruments to evaluate cognitive, motor, sensory and communicative functions in people with multiple disabilities. In our case, the Batelle Development Inventory (Newborg, et al., 1984) does not fully adapt to the student’s situation, so some items could not be assessed. Although the Guía en los zapatos de los niños ciegos (Lucerga & Gastón, 2004) does adapt to visual disabilities, it does not consider deaf-blindness or intellectual disabilities.

This agrees with what was previously concluded by authors such as Vaan, Vervloed, Knoors and Verhoeven (2013) who explain that most standardized tests, questionnaires and development scales do not take into account the effect of the comorbidity of different disabilities.

This work has some limitations: the limited duration of the intervention; It is a case study, so the results are not generalizable; and the evaluation instruments are not totally adequate. As a future line of research, we propose that the intervention covers the development of the child’s communication not only as a receiver, but also as a sender.

REFERENCIAS

• Boas, D. C. V., Ferreira, L. P., De Moura, M. C., & Maia, S. R.; Amaral, I. (2016). Analysis of interaction and attention processes in a child with congenital deafblindness. American Annals of the Deaf, 161(3), 327-341. Recuperado de: https://www.jstor.org/stable/26235278
  » https://www.jstor.org/stable/26235278
• Bruce, S. M., & Borders, C. (2015). Communication and language in learners who are deaf and hard of hearing with disabilities: Theories, research, and practice. American Annals of the Deaf, 160(4), 368-384. Recuperado de: https://www.jstor.org/stable/26235228
  » https://www.jstor.org/stable/26235228
• Fellinger, J., Holzinger, D., Dirmhirn, A., Van Dijk, J., & Goldberg, D. (2009). Failure to detect deaf-blindness in a population of people with intellectual disability. Journal of Intellectual Disability Research, 53(10), 874-881. https://doi.org/10.1111/j.1365-2788.2009.01205.x
  » https://doi.org/10.1111/j.1365-2788.2009.01205.x
• Foreman, P., Arthur-Kelly, M., Bennett, D., Neilands, J., & Colyvas, K. (2014). Observed changes in the alertness and communicative involvement of students with multiple and severe disability following in-class mentor modelling for staff in segregated and general education classrooms. Journal of Intellectual Disability Research, 58(8), 704-720. https://dx.doi.org/10.1111/jir.12066
  » https://doi.org/10.1111/jir.12066
• Lucerga, R., & Gastón, E. (2004). En los zapatos de los niños ciegos: guía de desarrollo de 0 a 3 años Organización Nacional de Ciegos Españoles.
• Newborg, J., Stock, J. R., & Wnek, L. (1984). Inventario de Desarrollo Battelle Madrid, España: TEA Ediciones.
• Vaan, G. D., Vervloed, M. P. J., Knoors, H. E. T., & Verhoeven, L. T. W. (2013). Autism spectrum disorders in people with sensory and intellectual disabilities symptom overlap and differentiating characteristics. En: M. Fitzgerald (ed.), Recent Advances in Autism Spectrum Disorders (pp. 479-500). Londres: IntechOpen. https://dx.doi.org/10.5772/53714
  » https://doi.org/10.5772/53714

• The translation of this article was financed by the Department of Didactics and School Organization of the University of Valencia.
• 2
  This paper was translated from Spanish by Ana Maria Pereira Dionísio.

Publication Dates

• Publication in this collection
  18 Dec 2023
• Date of issue
  2023

History

• Received
  29 Oct 2020
• Accepted
  26 Dec 2020