Once a student is admitted into the Program for the Visually Impaired, it is time to utilize all of the assessments to create an Individualized Education Plan. The vision goals for this plan must be measurable and specific to the educational needs of the student. For example, student A is a second grader diagnosed with retinopathy of prematurity. Her diagnosis is supported by a medical eye report, and the school TVI has completed her Functional Vision Assessment and Learning Media Assessment, which has determined that A will need instruction in Braille. An example goal would be: student A will increase her stamina to read braille with 90% accuracy for 10-minute intervals.
Now that the goal is established, the TVI will plan instructional activities that will help A reach that specific braille reading goal. Books in braille that are relevant to the student's classroom requirements will be utilized in order to assist A in keeping up with classroom demands. This will also provide A with the opportunity to utilize her braille reading skills in a real-world setting. Daily student A will spend one hour with her resource TVI to receive specific instruction in braille and weekly the TVI will informally assess student A's accuracy. A's classroom teacher will assess comprehension skills displayed by A after she reads a passage in braille by asking questions specific to the reading passage. A's progress will be charted by her TVI, but her classroom teacher will be consulted weekly to assure that A is keeping up with the reading demands in her class.
At the end of the 6th week of instruction, the TVI will assess student A's braille literacy skills in order to determine if the goal was appropriate and relevant to A's classroom needs. If student A displays consistent progress that also has improved her classroom performance, instruction will continue as planned. If student A is showing no sign of improvement in her reading stamina and accuracy in braille, then the TVI will need to adjust her instruction according to what student A's needs appear to be from the assessment. Student A's IEP goal remains the same, but how that goal is to be reached will need to be modified so that Student A will start to make progress towards it. The TVI will need to change her instructional activities so that Student A will gain the braille skills she needs in order to improve her accuracy and increase her braille-reading stamina.
This pattern of assess, plan, teach, and assess will continue throughout the school year so that the TVI can keep record of how Student A is progressing towards her IEP goal. At the end of the school year, during the yearly IEP meeting, the goal will be reviewed and determined to have been met or not met. Then the goal will be modified to reflect what the next step in the student's plan should be. Student A's assessment performance will determine the new IEP goals for the following school year.
Sunday, October 27, 2019
Saturday, October 19, 2019
Week #8 - VI Assessments
Admittance into the Program for the Visually Impaired requires specific assessments to be completed in order to determine if a student qualifies for the program. Once the student is in the program, these evaluations must be updated at least every three years. In the following post, I will list individually each necessary assessment that is used to guide professionals in VI in establishing evidence for those decisions.
1.) The Medical Eye Exam: Must be completed by an Ophthalmologist or Optometrist. A formal, medical account of what the student's diagnosis is and what treatment,(i.e. surgery, or medications) course has been taken ; acuity with best correction; field of vision (central or peripheral loss); and whether or not the condition is going to result in a progressive loss of vision.
2.) Functional Vision Assessment, (FVA): Completed by a Teacher of the Visually Impaired (TVI), sometimes with assistance from O&M specialist and vision rehabilitation specialists. This assessment is done via observation, interviews, and individual testing. It helps to determine how the student utilizes his/her residual vision to perform tasks required for him/her to function in the classroom environment and in his/her daily living environment as well as in other real-life situations. A great deal of data is collected over time for this assessment. Observations require the student to be in both indoor and outdoor settings; various types of lighting; various times of the day on different days, and the data must be collected over time to get an accurate idea of how the student responds.
3.) Learning Media Assessment (LMA): Completed by a TVI. Assesses what media the student requires to function in the classroom involving reading and writing skills. Some examples are Braille, large print, and audio books as well as high and low tech assistive devices. This also involves anything needed for writing skills such as note-taking and handwritten classroom assignment needs. Media needs may change for the student depending upon the task, his/her eye condition, skill needs, and stamina to process the stimuli. Data taken in this assessment also must be done in a variety of settings and over time.
4.) Expanded Core Curriculum (ECC): Completed by a TVI. Assessment that collects data on what level of functioning the student has in nine components that make up the ECC. The domains are: compensatory access ( including communication skills), sensory efficiency ( how student utilizes all of his senses to compensate for lack of visual stimuli), assistive technology ( either high or low tech), orientation and mobility ( O&M specialist completes this part), independent living skills, social interaction skills, recreation and leisure; career education, and self- determination.
5.) Orientation and Mobility Screening: Completed by an Orientation and Mobility Specialist (O&M). Screening determines if the vision student requires instruction for orientation and mobility. The assessment covers skills that a student must have to navigate safely and efficiently through his/her environment.
6.) Orientation and Mobility Evaluation: Completed by an O&M specialist. This assessment determines what skills the student needs to acquire to safely navigate and orient him/herself to his surroundings. This evaluation looks at the strengths and weaknesses of the student's ability in order to establish goals for O&M on the IEP.
7.) Clinical Low Vision Screening: Completed by an Optometrist with additional training as a Low Vision Specialist. This assessment is a combination of both medical and functional vision diagnostics. Patient history, visual acuity testing, visual field testing, prescription of optical or electronic devices, and training in how to use devices are part of this assessment. This is done when all medical and functional vision bases have been covered, but the patient continues to have trouble performing tasks visually.
8.) Vision Screening: Usually completed by an eye care professional or a general medical practitioner such as a pediatrician. This is an initial assessment done to discover if an individual has a need for more intensive visual assessment. It notes the appearance of eyes, pupillary response, general fix and follow skills, near and distance visual acuity with an eye chart, ocular muscle balance, color vision depth perception, and compensatory behaviors.
9.) Assistive Technology Assessment: Completed by specialty members of the IEP team. This assessment takes into account all of the data collected by previous assessments of the student to determine what assistive technology should be utilized. This also takes into account the training needed to help the student maintain the device, as well as utilize it.
1.) The Medical Eye Exam: Must be completed by an Ophthalmologist or Optometrist. A formal, medical account of what the student's diagnosis is and what treatment,(i.e. surgery, or medications) course has been taken ; acuity with best correction; field of vision (central or peripheral loss); and whether or not the condition is going to result in a progressive loss of vision.
2.) Functional Vision Assessment, (FVA): Completed by a Teacher of the Visually Impaired (TVI), sometimes with assistance from O&M specialist and vision rehabilitation specialists. This assessment is done via observation, interviews, and individual testing. It helps to determine how the student utilizes his/her residual vision to perform tasks required for him/her to function in the classroom environment and in his/her daily living environment as well as in other real-life situations. A great deal of data is collected over time for this assessment. Observations require the student to be in both indoor and outdoor settings; various types of lighting; various times of the day on different days, and the data must be collected over time to get an accurate idea of how the student responds.
3.) Learning Media Assessment (LMA): Completed by a TVI. Assesses what media the student requires to function in the classroom involving reading and writing skills. Some examples are Braille, large print, and audio books as well as high and low tech assistive devices. This also involves anything needed for writing skills such as note-taking and handwritten classroom assignment needs. Media needs may change for the student depending upon the task, his/her eye condition, skill needs, and stamina to process the stimuli. Data taken in this assessment also must be done in a variety of settings and over time.
4.) Expanded Core Curriculum (ECC): Completed by a TVI. Assessment that collects data on what level of functioning the student has in nine components that make up the ECC. The domains are: compensatory access ( including communication skills), sensory efficiency ( how student utilizes all of his senses to compensate for lack of visual stimuli), assistive technology ( either high or low tech), orientation and mobility ( O&M specialist completes this part), independent living skills, social interaction skills, recreation and leisure; career education, and self- determination.
5.) Orientation and Mobility Screening: Completed by an Orientation and Mobility Specialist (O&M). Screening determines if the vision student requires instruction for orientation and mobility. The assessment covers skills that a student must have to navigate safely and efficiently through his/her environment.
6.) Orientation and Mobility Evaluation: Completed by an O&M specialist. This assessment determines what skills the student needs to acquire to safely navigate and orient him/herself to his surroundings. This evaluation looks at the strengths and weaknesses of the student's ability in order to establish goals for O&M on the IEP.
7.) Clinical Low Vision Screening: Completed by an Optometrist with additional training as a Low Vision Specialist. This assessment is a combination of both medical and functional vision diagnostics. Patient history, visual acuity testing, visual field testing, prescription of optical or electronic devices, and training in how to use devices are part of this assessment. This is done when all medical and functional vision bases have been covered, but the patient continues to have trouble performing tasks visually.
8.) Vision Screening: Usually completed by an eye care professional or a general medical practitioner such as a pediatrician. This is an initial assessment done to discover if an individual has a need for more intensive visual assessment. It notes the appearance of eyes, pupillary response, general fix and follow skills, near and distance visual acuity with an eye chart, ocular muscle balance, color vision depth perception, and compensatory behaviors.
9.) Assistive Technology Assessment: Completed by specialty members of the IEP team. This assessment takes into account all of the data collected by previous assessments of the student to determine what assistive technology should be utilized. This also takes into account the training needed to help the student maintain the device, as well as utilize it.
Thursday, October 10, 2019
Week #7: Guidelines that a student in Florida is eligible for VI services
The guidelines and definitions that determine a student's eligibility for the Program for the Visually Impaired in Florida have broadened since I originally became a TVI in 1993. Back then it was strictly dictated by best visual acuity after best correction or a specific amount of loss of field of vision. Due to the changes in Federal Law through IDEA, the state of Florida has had to expand its definition to include students that have enough lack of ability to learn through sight in educational settings that they require assistance from the Program for the Visually Impaired.
Consequently, this new definition now allows students that were once ignored by the Program for the Visually Impaired to receive services. For students struggling with cortical blindness, or visual issues where the problem is in the brain processing of visual stimuli, not the physical eye itself, this is great news! What didn't change is the need for parental consent, a Medical Eye Report and the need for completed assessments in functional vision, learning media (print, Braille, or audiobooks), and Orientation and Mobility assessment of functional vision. These reports and assessments are the basis for developing an appropriate IEP for students with exceptional needs in visual impairment. The assessments provide evidence that a student is not able to process visual stimuli to the point that it affects his/her ability to perform educationally within the classroom.
Finally, this change in the definition for eligibility for VI services also includes students that have been diagnosed with eye conditions that will progressively hinder their ability to learn visually, (i.e. - retinitis pigmentosa, macular degeneration, or any disease affecting vision loss). Again, parental consent, a medical eye report, and the aforementioned assessments are necessary to keep the students in this case scenario eligible for services from the Program for the Visually Impaired. This change helps students dealing with a progressive loss of vision access to receive the appropriate assistance needed to prepare them to perform in their educational setting.
Consequently, this new definition now allows students that were once ignored by the Program for the Visually Impaired to receive services. For students struggling with cortical blindness, or visual issues where the problem is in the brain processing of visual stimuli, not the physical eye itself, this is great news! What didn't change is the need for parental consent, a Medical Eye Report and the need for completed assessments in functional vision, learning media (print, Braille, or audiobooks), and Orientation and Mobility assessment of functional vision. These reports and assessments are the basis for developing an appropriate IEP for students with exceptional needs in visual impairment. The assessments provide evidence that a student is not able to process visual stimuli to the point that it affects his/her ability to perform educationally within the classroom.
Finally, this change in the definition for eligibility for VI services also includes students that have been diagnosed with eye conditions that will progressively hinder their ability to learn visually, (i.e. - retinitis pigmentosa, macular degeneration, or any disease affecting vision loss). Again, parental consent, a medical eye report, and the aforementioned assessments are necessary to keep the students in this case scenario eligible for services from the Program for the Visually Impaired. This change helps students dealing with a progressive loss of vision access to receive the appropriate assistance needed to prepare them to perform in their educational setting.
Saturday, October 5, 2019
Weekly Blog #6 - Effective VI Teaching Strategy
This week we discussed effective teaching strategies for teaching ECC concepts to students with visual impairments. I am not currently in a classroom, therefore I will have to draw from memory a lesson that I worked on with several of my students with multiple impairments when I taught in a center school for students with exceptional needs.
Yearly our school participated in a county-wide economics fair. This fair was open to students of all ages and abilities throughout our district. I teamed with other teachers of special needs students in our school, occupational therapists, and speech therapists to help our students with multiple special needs including VI to understand the concept of basic economics. This activity included creating a product, introducing basic money skills, social interactions (selling product) and organization skills, as well as helped to reinforce the skills we were teaching that correlated to our specific subjects.
The classroom teacher presented the basic economics lesson of what it is to create a product, supply and demand, and money skills. As a professional team, we decided to help the students to create Christmas Ornaments from cinnamon dough. Similar to a cooking project, we helped students gather ingredients, create the dough, roll out the dough, use cookie cutters to make shapes, and then bake them. The texture and the smell of the dough was enticing for my students that were reluctant to do tactile tasks. It was a malleable dough that lent itself to allowing my low vision and blind students to have time to explore it while creating it.
We then worked on understanding money skills such as identifying coins and paper money, organizing it, and counting change (if applicable). Another skill we worked on was basic advertising in which we created posters to sell the products. My students with VI worked on texture posters that the O&M specialist utilized in her lessons with them. Placed at various points around the school: the gym, the cafeteria, the front office, the therapy room; the students would locate them and then go into those areas with the product and attempt to sell them. This lead to practicing social skills: greetings, conversations, presenting the product, and gratitude for time with those they interacted with. The VI students had the added element of practicing facing who they were speaking to and practicing proper social skills.
Participation in the economics fair project became very popular in our school for students with special needs. We placed every year in the three years I taught at that school. It was wonderful because it helped students with various ages, exceptionalities, and abilities work towards many of their IEP goals in a cooperative environment. My students with VI looked forward to this activity with anticipation every year.
Yearly our school participated in a county-wide economics fair. This fair was open to students of all ages and abilities throughout our district. I teamed with other teachers of special needs students in our school, occupational therapists, and speech therapists to help our students with multiple special needs including VI to understand the concept of basic economics. This activity included creating a product, introducing basic money skills, social interactions (selling product) and organization skills, as well as helped to reinforce the skills we were teaching that correlated to our specific subjects.
The classroom teacher presented the basic economics lesson of what it is to create a product, supply and demand, and money skills. As a professional team, we decided to help the students to create Christmas Ornaments from cinnamon dough. Similar to a cooking project, we helped students gather ingredients, create the dough, roll out the dough, use cookie cutters to make shapes, and then bake them. The texture and the smell of the dough was enticing for my students that were reluctant to do tactile tasks. It was a malleable dough that lent itself to allowing my low vision and blind students to have time to explore it while creating it.
We then worked on understanding money skills such as identifying coins and paper money, organizing it, and counting change (if applicable). Another skill we worked on was basic advertising in which we created posters to sell the products. My students with VI worked on texture posters that the O&M specialist utilized in her lessons with them. Placed at various points around the school: the gym, the cafeteria, the front office, the therapy room; the students would locate them and then go into those areas with the product and attempt to sell them. This lead to practicing social skills: greetings, conversations, presenting the product, and gratitude for time with those they interacted with. The VI students had the added element of practicing facing who they were speaking to and practicing proper social skills.
Participation in the economics fair project became very popular in our school for students with special needs. We placed every year in the three years I taught at that school. It was wonderful because it helped students with various ages, exceptionalities, and abilities work towards many of their IEP goals in a cooperative environment. My students with VI looked forward to this activity with anticipation every year.
Thursday, September 26, 2019
Week#5 - Reflections
The Week 5 material regarding the role of the teacher of the visually impaired (TVI) and the introduction to the Expanded Core Curriculum (ECC) has been packed with information. In comparison to the first time I experienced this material, back in the late 80's early 90's, where there wasn't really a formal name for the skills we were presenting, it's refreshing to have a clear way to describe what we do when we are working with the visually impaired and blind. Being a TVI is so much more than just adapting materials and teaching Braille. The Expanded Core Curriculum provides an excellent way to describe the skills our area of expertise encompasses. I truly appreciate that change as a better way to articulate my role as a professional.
I found it awkward to explain my role as a TVI in a video to an imaginary administrator. The reason being, I really don't enjoy watching myself or listening to my own voice. I might have done 10 takes just because of an unexpected background sound, (such as a dog barking, or plane flying overhead), or just thinking I didn't sound conversational enough. My worst take was trying to spit out all 9 areas of the ECC in two minutes. I'm positive I would have left an administrator confused had I gone that route. On the other hand, I truly appreciated how easy it was to do! If only all technology could work that simply. Hopefully, I will gain more comfort as I get more experience with this medium.
I was finally able to speak with my mentor, Marielhi this week! She currently works in the elementary school where I was one of the original TVI's working in the pre-k/ Kindergarten vision resource room. Flash forward 23 years and the program has expanded to three vision resource rooms with three TVIs that serve students with visual impairments from pre-k to fifth grade. I found it exciting to hear about how students with VI / blindness are being served through these resource rooms. Marielhi also works part-time at Central Florida Lighthouse for the Blind and Visually Impaired with adults in transition. I'm looking forward to hearing more about that program! I know that Marielhi is going to be a fantastic resource for understanding how this field has grown and developed.
I found it awkward to explain my role as a TVI in a video to an imaginary administrator. The reason being, I really don't enjoy watching myself or listening to my own voice. I might have done 10 takes just because of an unexpected background sound, (such as a dog barking, or plane flying overhead), or just thinking I didn't sound conversational enough. My worst take was trying to spit out all 9 areas of the ECC in two minutes. I'm positive I would have left an administrator confused had I gone that route. On the other hand, I truly appreciated how easy it was to do! If only all technology could work that simply. Hopefully, I will gain more comfort as I get more experience with this medium.
I was finally able to speak with my mentor, Marielhi this week! She currently works in the elementary school where I was one of the original TVI's working in the pre-k/ Kindergarten vision resource room. Flash forward 23 years and the program has expanded to three vision resource rooms with three TVIs that serve students with visual impairments from pre-k to fifth grade. I found it exciting to hear about how students with VI / blindness are being served through these resource rooms. Marielhi also works part-time at Central Florida Lighthouse for the Blind and Visually Impaired with adults in transition. I'm looking forward to hearing more about that program! I know that Marielhi is going to be a fantastic resource for understanding how this field has grown and developed.
Saturday, September 21, 2019
Week #4: Top Ten List for TVI
10.) Consider the parents the experts on their child with VI. Listen to what they are experiencing with the daily living experiences and THEN give instruction or guidance. If you go in like the new sheriff in town, it builds walls instead of a productive, positive relationship.
9.) Don't wait for the child! Start early exposing them to real-world experiences in their community. If the parents need guidance in this area, give reasonable suggestions on how to help them encourage interactions in stores, place of worship, doctor visits, or anywhere they regularly go. As a teacher, you could set up a field trip ( perhaps even a scavenger hunt for sounds, smells, or textures) and encourage parents' involvement.
8.) Consider cultural influence on how the family treats their child with VI. Some families have traditions that dictate how they treat their children regardless of whether the child had an impairment or not. Be sensitive and willing to understand where they are coming from.
7.) Allow the student to get dirty, explore, and make a mess. That is part of the real-world experience of childhood for any child, but it's even more essential to the child with VI. Let them smear shaving cream, play with a sand and water table, do cooking projects that allow them to feel, smell, and taste what the ingredients are. Take them out on the playground and help them learn to explore it. Encourage parents to do this at home as well.
6.) Be genuine with your student with VI. Yes, maintain that professional decorum ( never lose that), but if the child doesn't believe you care about him/her, you will never get them to trust you to guide them through their environment. Make sure you aren't another person treating that child like he/she should be wrapped in bubble wrap. Treat them with the respect and warmth you wish to be treated with because that's basic humanity that everyone needs.
5.) Build relationships with the students family. Like I said in #6, if they don't believe you truly care about the outcome for their child and build rapport, they won't help the student carry over what you are teaching and the whole thing becomes pointless. Make a concerted effort to relay a positive accomplishment their child makes frequently. Encourage them to come to you with any concerns or questions and validate them, don't dismiss them.
4.)Encourage student with VI to do their daily living skills and make sure the family helps carry over those skill to the home. If they are physically coordinated enough to do basic skills, they need to do them to develop a sense of empowerment over their lives. Even if the skill has to be paired down to adapt to other physical challenges, encourage simple steps in the classroom towards independence. Examples would be finding a cubby, or setting a place for lunch.
3.) Remind parents that how their child with VI reacts to new experiences is greatly in their control. If you go in with your own fears, the child absorbs that negativity. Be descriptive in relaying what to expect. Point out the sounds, smells, and textures they can identify. Your energy has a huge effect on how the child will respond.
2.) Make time to allow the child with VI to explore and experiment in his/ her environment. We live in a hyper-busy world, but if the child is rushed, he/she will never develop the skills they need to function. That may mean starting earlier to go somewhere, so a child can help get ready without being rushed. It might mean clearing something off of the schedule to give the child time to practice a needed skill or go on a trip to enjoy a new experience.
1.) Be positive! By the time the student with VI and his/her family reaches you for services, they have been through the wringer. They have heard about their child's dire diagnosis and the worse yet, the child has heard it too. Your job is to empower them with what they can do and better yet, how the child can adapt and learn to navigate in spite of the dire diagnosis. Make thinking outside of the box an adventure that they want to join you on. Give suggestions for fun activities the family can participate in with their child. Communicate often and with enthusiasm, (relaying an activity their child enjoyed participating in is encouraging and builds hope).
Saturday, September 14, 2019
Weekly Blog #3
When a student experiences his/her age of onset of visual impairment has a huge impact on life experiences. A congenital visual impairment does not allow for visual memory to play a part in development and thus can cause the student to be reluctant to explore his/her environment. However, an adventitious visual impairment, while allowing for the experience of vision can also carry other negative psychological effects that impact how the student engages in his or her environment.
The student that loses his/her vision while in elementary school is going to have a different perspective than a student with congenital vision loss. The former would have had at least 5 years of visual memory and experiences to draw from while adapting. That would not be the case for a child with congenital loss and little to no visual memory to gain incidental learning experiences from. Much of early childhood learning is done through observation that leads to exploration. If that child hasn't had the ability to observe due to low vision or blindness from birth, the gaps of understanding the world around him/her are extensive. Learning would be part to whole concepts which wouldn't entirely lend itself to an accurate understanding of complex concepts until the child develops the ability to make higher-order connections.
Middle school is a time of both dramatic physical changes, while also requiring students to keep up with greater educational demands. For the student with visual impairment, depending upon the age of onset of his/her impairment, adapting to the common demands of this age while also gaining proficiency in the Expanded Core Curriculum (ECC) is essential. A student that has no visual memory to draw from is going to need guidance in understanding the social complexities of puberty. He/she will require meaningful instruction that further helps fill in the conceptual gaps that have been caused by not having experienced vision The student that has visual impairment through an adventitious loss will need support not only educationally, but emotionally in order to help them feel comfortable in utilizing ECC skills that he/she may feel reluctant to use.
During the high school years, the focus for students with visual impairment/ blindness should be to gain a greater ability to operate with independence. At this point, the student would have been receiving instruction in the ECC for several years and hopefully, have a greater proficiency in utilizing those skills. Brain development that has occurred by this age should aid both the student with congenital visual impairment and adventitious visual impairment in making those higher-order connections that were difficult prior. Meaningful instruction combined with consistent practice of ECC skills should further close the conceptual gaps that often confuse younger students.
When a student experiences his/her age of onset of visual impairment has a huge impact on life experiences. A congenital visual impairment does not allow for visual memory to play a part in development and thus can cause the student to be reluctant to explore his/her environment. However, an adventitious visual impairment, while allowing for the experience of vision can also carry other negative psychological effects that impact how the student engages in his or her environment.
The student that loses his/her vision while in elementary school is going to have a different perspective than a student with congenital vision loss. The former would have had at least 5 years of visual memory and experiences to draw from while adapting. That would not be the case for a child with congenital loss and little to no visual memory to gain incidental learning experiences from. Much of early childhood learning is done through observation that leads to exploration. If that child hasn't had the ability to observe due to low vision or blindness from birth, the gaps of understanding the world around him/her are extensive. Learning would be part to whole concepts which wouldn't entirely lend itself to an accurate understanding of complex concepts until the child develops the ability to make higher-order connections.
Middle school is a time of both dramatic physical changes, while also requiring students to keep up with greater educational demands. For the student with visual impairment, depending upon the age of onset of his/her impairment, adapting to the common demands of this age while also gaining proficiency in the Expanded Core Curriculum (ECC) is essential. A student that has no visual memory to draw from is going to need guidance in understanding the social complexities of puberty. He/she will require meaningful instruction that further helps fill in the conceptual gaps that have been caused by not having experienced vision The student that has visual impairment through an adventitious loss will need support not only educationally, but emotionally in order to help them feel comfortable in utilizing ECC skills that he/she may feel reluctant to use.
During the high school years, the focus for students with visual impairment/ blindness should be to gain a greater ability to operate with independence. At this point, the student would have been receiving instruction in the ECC for several years and hopefully, have a greater proficiency in utilizing those skills. Brain development that has occurred by this age should aid both the student with congenital visual impairment and adventitious visual impairment in making those higher-order connections that were difficult prior. Meaningful instruction combined with consistent practice of ECC skills should further close the conceptual gaps that often confuse younger students.
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