Benefits of sport for VIP

Introduction

In addition to the more common eye impairment conditions, around 300 other rare known conditions exist. This huge variety brings about the necessity for an individualized approach in each and every case of person with v.i. and consciously avoiding all and any generalizations as to what a certain person can or cannot do.

Based on human’s need for categorization and classification though, there is a grouping of “severely sight impaired” and “sight impaired” depending on “visual acuity” (a person’s ability to see fine details) and “visual field” (the frame, which a person can see in one instant without moving the eyes).

The people from the first category, which is also known as blind, would be unable to perform a job that requires eyesight as an essential element for carrying out the tasks. They are unable to see a demonstration and may become easily disoriented during an activity.

Those who are sight impaired – partially sighted – do have some useful vision, which can be utilized for navigating the world. However, it cannot be presumed that they may be able to follow a demonstration or recognize someone from the distance.

Further categorization according to acuity and field divides people into B1 (no light perception, no ability to recognize hand movements), B2 (acuity of up to and including 2/60[1] and a field of 5 degree or less), B3 (acuity of above 2/60 up to and including 6/60 and field between 5 and 30 degrees), B4 (acuity above 6/60 up to and including 6/24 and no field restrictions) and B5 (acuity above 6/24 and no restrictions as to the field).

Returning to the beginning though, only one in four people with v.i. is blind. The others have usable vision. About half of the students with visual loss became blind before or at birth.

There are various causes for vision loss. The majority of cases are connected to aging. Still, vision loss can occur before or at birth (congenital) or can develop in childhood or later (adventitious).

Among the congenital causes are albinism, retinoblastoma, retinopathy of prematurity. The adventitious causes include cataracts, glaucoma, retinitis pigmentosa, macular degeneration and the cortical visual impairment, which is not an eye problem, but rather a brain problem.

 

1. Motor and fitness characteristics and implications for teaching PE

The lack of vision in itself is not a cause for any other motor or physical characteristics. However, the reduced opportunities to move, which often accompany the lack of vision, may lead to certain motor, physical and fitness characteristics.

Motor delays are often due to the reduced opportunity for tumble and rolling around with their parents, due to the protective instincts of the latter, the child’s own fear of being moved unexpectedly as well as the lack of motivation for movement and observing how others move. In order to avoid or diminish this effect on students with v.i., they should have a chance and be encouraged to move in a safe environment. The supporters (PE teachers, coaches, buddy group members, parents) should encourage them verbally and should physically demonstrate movements. Children with adventitious vision loss do not usually have motor delays. They rather need feedback from observers in order to correct their movements and maintain skills that they once mastered.

Deviations in the posture may include holding their head in unique positions, having a shuffling walk, being tilted forward or having a different body position. This may be common for people who are congenitally v.i., meaning they have never had a chance to observe how others stand, walk or position their bodies. Wrong body posture leads to greater pressure on the spine and on the lower back, which leads to twisting of the body and to other physical problems. Verbal feedback coming from observers to keep the back straight and the head up, will eventually lead to improved body posture and will ultimately lower the stress on the spine, the lower back and legs. The offered verbal feedback should be a gentle suggestion not a request, because in some case the bent head of a child could be due to painful light perception, which the observer might not be immediately aware of.

Balance problems are also possible, due to the lack of visual reference points for aiding stability and the impossibility to check and correct one’s own body image and balance. Numerous existing activities such as dance, yoga or others can be excellent means for developing balance skills.

Walk difficulties may also appear with people who are v.i., demonstrated via shorter strides, a shuffle of the legs, a slower pace, longer pauses and a tendency to turn in the direction of the stronger leg. Walk difficulties can be corrected via running exercises and longer preparatory walks together with the guide before the run.

Together with all of the above, people with v.i. experience overall decrease in their health-related fitness level, compared to sighted people. What is of particular concern according to Buell (1966) is the fact the people with v.i. need greater health-related fitness but at the same time it takes a greater effort from them to achieve the same results as those of a sighted peer. The lack of opportunity to train and difficulty arranging for sighted guides for running for example, can be obstacles to developing and maintaining the necessary fitness level. It is really important for PE teachers to work together with families of children with v.i. in order to find fitness activities whether it is weight training, rope jumping, aerobics, cycling or walking that can be pursued from home in order for the fitness level to be reached and maintained.

As soon as educators understand that the problem children with v.i. face with regard to their physical fitness is not lack of ability but lack of opportunity to experience various physical activities in order to discover their preferred ones, the future involvement of children with v.i. in sports would turn from dubious to much more promising.

 

2. Specifying students’ abilities

Students with visual impairments should be able to perform the same tasks and to hold the same tests and evaluations as their sighted peers. In those cases when mobility limitations are present, the teachers can modify the standards, use assistive devices such as auditory cues for example (see tennis, archery, basketball, hockey, goalball, torball, blind football, showdown and polybat) or sighted guides (see running, water trekking, trekking, paracycling, horse riding, cross country skiing). When measuring and assessing the performance of students with v.i., the teacher may seek answers to the following questions on top of assessing the current performance:

• What can the student see? This clarification can come not only from the student, but also from parents, previous teachers, low vision specialist. This information is important in order for the teaching to happen in the best possible form.
• At what age was the loss of vision experienced and if it was a progressive condition, over what period did it progress? Is it still progressing? This is very important because certain physical skills are obtained at an age of 8 to 10 years. Hence if the vision loss happened after this age, this would mean that the child would need less time preparing for specific activities that are already familiar. This can never be the case for a student with congenital blindness. Using expressions such as “jump as a rabbit” would mean nothing to the child. In cases when the student has no basis of understanding, the teacher will need to do a lot of demonstrations, such as allowing the child to touch and study the body posture and the progression of a certain move (either on him/herself or on a student model), which is necessary for the game or being allowed by the child to make this type of demonstration by sculpting its own body in the different game positions and moves.
• What helps the student see best when there is partial vision? In some conditions bright light is a booster of performance. For others conditions, such as glaucoma and albinism for example, glare poses a problem. The teacher should allow those who feel bad in bright light to use sunglasses or hats when playing outside or adjust the artificial light inside the gym.
• Are there any physical activities, which should be avoided? There are cases, especially when there is remaining sight that needs to be preserved (this is not the case with total blindness where the contraindications are only a few) where some physical activities are contraindicated. A medical consultation should be done in order for the student to only implement activities, which are safe. This is also relevant in case the child has other conditions, which a specific type of physical activity might worsen. For example, exercises with jarring movements are usually considered unsafe for children with detached retina. Contact sports, as well as swimming underwater or diving may need to be modified for students with glaucoma, because the inverted (head down) or under pressure position of the body may additionally increase the intraocular pressure.
• What instructional approach would the child prefer? Some children do not like to be touched. Tactile modeling or physical guidance would be a no go for them and they would need to get clear oral explanations instead. Other young people would not mind being touched in order to understand and master a skill or a movement. Yet, there are others who would actually prefer to touch in order to achieve the necessary understanding. In that case the teacher or a student model should be willing to do the physical demonstration.
• Last but far not least, what are the student’s favorite social and physical activities? For those sports and physical activities, for which various modifications exist, the student should also be asked, which modification he or she prefers. The teachers should be aware of as many opportunities that exist for the student to participate in sports within and outside the school – with family and friends, not only with school mates. Trying various options is crucial, because students may not know their preference until they try out different activities and adaptations. On the basis of these trials, the preferred activities and adaptations should be introduced into the child’s physical education programme (see Camp abilities, School trophy, Blind day, Circuit training)

 

3. The sports’ inclusion spectrum

The inclusion spectrum is an activity based model, conceived by Ken Black back in 1996 and further developed by him and Pam Stevenson in 2007 into a more practical tool for use by sport practitioners. The inclusion spectrum enables coaches to understand what inclusion is and how to include disabled people in sports and physical activities. It basically divides the sports and physical activities into 5 different categories:

• An open simple activity with no modifications, which everyone can join simultaneously. An example is swimming or a common fitness session.
• An adapted activity, in which everyone completes the same task, but with some adaptations (minor or major) to the rules, the playing area or the used equipment. Tennis for players with v.i. where the ball is bigger and slower could be given as an example. VisiBall is also an example of such an activity.
• A parallel activity splits participants into groups according to ability. Each group completes the same task, but at appropriate levels. Football can be used as an example. One group can complete the practice using standard equipment, while a second group can practice passes with a larger ball with bearings.
• A separate activity purposefully places individuals or groups in participation in a different activity. Such an activity could be necessary for the student with v.i. to develop a certain skill or technique. It must be noted that this type of activity should be used incidentally and not all of the time. This could be an orientation and mobility class for parents and children with v.i., having the purpose of teaching the parents some basic rules in moving around with limited vision and at the same time learning shared sports activities to carry out together with the v.i. child. (see “Effective education for families of children with visual impairments and blindness in physical activity environments: A workshop model with a focus on  orientation and Mobility skills” Luis Columna, Syracuse University, USA, Maria Lepore-Stevens, Delaware Division for the Visually Impaired, USA and Erin L.W.K.D. Kavanagh, Olmsted Center for Sight, USA, May 2017, British Journal of Visual Impairment - researchgate.net)
• Disability sport or activity – all participants play a disability specific sport, which is an example of reverse integration. A game of Goalball with sighted participants with masks is a good example.

The game plays, which do not allow participation of non-v.i. players are only those that take place in official competitions, such as the Paralympics for example.

Black and Stevenson specified also the STEP principles, providing sports coaches and PE teachers with a framework for making adaptations of PE classes and sports sessions. These principles include Space (where the action is going to take place and what the teacher/coach should do about it), Task (what is to be implemented by the person with v.i.), Equipment (what adaptations should be considered in that domain) and People (created support or buddy system around the student with v.i.). Lately, an additional S for Speed has been added, turning the list of principles into STEPS. Speed relates to slowing down the pace of a game or sport in order to enable the participant with v.i. to practice and learn it effectively (see tennis, hockey). More specific tips concerning the STEPS principles are provided in the following sections.

 

4. Benefits of sport and physical activity for people with v.i.

Regardless of whether a human being has a certain eye impairment condition or not, sport is a vital necessity, which brings about social inclusion, friendly relationships, confidence and self-esteem, spatial awareness and muscle strength and overall improved health status, such as good cardiovascular and heart condition, greater flexibility, increased endurance, normal weight, etc.

No child should be left outside of sports activities due to an eye condition, because it may thus be robbed of health and social benefits for life.

Modern education is focused on integration, i.e. classes with students of all levels of abilities. Specialized schools are quickly becoming extinct-whether or not this is logical and reasonable will not be a topic of discussion for this material.

So, let us imagine the situation of a class with two students with v.i. in it – a girl with retinoblastoma that has led to the removal of both eyes and complete lack of vision and a boy with retinitis pigmentosa, who still has partial vision. The physical education teacher will have a complex task if he/she wants to have both children involved and active. He/she cannot use the same approach but he/she is equally responsible for the wellbeing of both children. The school has a swimming pool and the teacher has the possibility of developing an adapted basketball activity and he offers these two possibilities to the two students. The girl opts out for swimming as her total lack of vision means that sports relying on eyesight, such as basketball, are not attractive. The boy, whose neighbors play basketball in their back yard, is very much interested in this sport, which would give him access to a certain social group.

If the swimming for the girl appears to require only a tapping on the shoulder when she approaches the end of the pool, the game of basketball does require some further adaptions in order to give the boy the possibility to master the skills and play. During the first class the teacher observes that as soon as the ball is passed to the boy with v.i. someone is quickly stealing it away and his ball possession or shooting possibilities are almost none. The teacher understands that basketball will only make a difference for the boy if the rules are changed. During the next physical education session the teacher instructs the students that the ball has to be passed to all team members before scoring takes place, that there is no defense for 5 seconds when the v.i. boy is in possession, that when he is in possession, his teammates can vocalize their positions, whereas the other team should stay silent until he passes the ball. The class period is divided into 3 parts – the first two parts at the beginning of the class are dedicated to skill practice and the last 1/3 goes for game play. On the day the rules were changed, the boy with v.i. passed the ball 10 times and scored twice.

Developing the type of thinking that directs the attention towards making inclusion in sports possible for all, can impose some hardships for the teachers at the beginning, but once they build experience and confidence and see the long term effects that these adaptations have on their students, the initial effort will pay off big time. Sometimes however, the visual impairment is far from the only barrier the teacher has to overcome. It is often also the emotional and social issues resulting from the way others perceive and treat a student with v.i. In other cases it is also the learned helplessness[2], which results when family members or caregivers are overprotective of the person with v.i., thus undermining independence and personal development. Once again, the PE teachers should be aware of any other conditions or physical disabilities, which the child might have and in case that there are such, additional consultations with other specialists as well as additional adaptations in the offered physical activities may appear necessary. The PE teachers can start by consulting the “Adapted physical education and sport” guideline and getting in touch with the physician of the child. This MOOC however places the focus on sight loss and cannot be considered as a universal instrument for PE of people with multiple disabilities.

Socialization opportunities must not be overlooked, because this would condemn a child with v.i. to a status, where they easily succumb to the feeling of being unable to make and maintain friendships, which leads to keeping close to the teachers and away from the others, seeing the school as an unfriendly place where they are alone and teased or in the best case - ignored. Children with movement difficulties often experience lower self-perception and sense of self-worth, which is very likely to lead to further reduction of movement confidence, which goes beyond the physical and into the psychological domain.

In order for socialization to be advocated and promoted during the PE classes, the fellow students must be aware of their peer’s condition in order to understand and accept the modifications that are being introduced. When teams or couples are set up, the child with v.i. should be given the opportunity to pick a partner or team mates, otherwise there is a good chance that he/she will not be picked by anyone, at least not at the beginning. In those cases when special teachers or helpers of some kind are included in the PE session, they should know when to step out of the picture in order not to inhibit the progress and the natural inclusion of the child with v.i.

 

5. Tips for teaching students with visual impairments in physical education for achieving the above mentioned benefits

PE teachers should be aware that students with impaired vision can do the same activities that their sighted peers do. In some case such minor thoughtful modifications as changing the ball’s color to one that contrasts sharply with the background could be perfectly sufficient in order to enable a student with partial sight to be fully involved in the class. In other cases more complex modifications or even consultations with specialists might be necessary, however, placing a child with v.i. in an inclusive PE class without the necessary support systems in stock does not count as inclusion. Not being able to enjoy basic sports and physical activity movements from a young age, will lead to becoming adults that are uninterested to work on their health-related fitness level and the social inclusion that goes with it.  This will only make them even less active as they grow older. This pattern develops even though people with v.i. do have the capacity to enjoy various physical activities – from rather individual ones such as running, cycling, water trekking, trekking, rowing, sailing or skiing with a friend serving as a guide, to group or team activities such as bowling, dancing (see salsa, traditional dancing), horse riding and many others, that beneficially lead to social networks of friends.

Members of the child’s network – teachers, special educators, mobility and orientation educators, parents, friends, etc. should be consulted for the development of an appropriate support system and can be major factors in successful inclusion. However, an excellent source of information on what the child with v.i. could/should do as sports and with what adaptations, is the child itself as well as, very often, its classmates. 

The child with v.i. should have access to closed and to open sports alike. Open sports are those, which have variables that change often – among those are tennis, volleyball, hockey, football, judo and others, i.e. sports that are unpredictable and accompanied by changing speeds and directions. Closed sports are predictable and consistent. Among the closed sports we can list archery, bowling, petanque, swimming and others. Children with v.i. should be introduced to all games and sports their peers do. Lifetime activities such as running, swimming, wrestling, tandem biking, judo and others should be included as well.

In order to foster achieving independence, the PE teacher can do a number of things starting for example from having a positive attitude towards and concerning all students.  The students, whether they admit it or not, look up to their teachers as far as attitude is concerned. If the PE teacher is truly interested and devoted to equally teaching all students and providing accommodations for the diverse skill levels and disabilities unobtrusively, this would be a signal for the students to pick up the same attitude and thus become more likely to accept and support fellow students with visual impairments or whatever other differences.

The teacher could also encourage the participation of all students in physical activities by creating a safe environment so that students can find out how they feel about various sports and express their fears and concerns freely. There is an excellent example illustrating how important the above is, listed in the “Adapted Physical Education and Sport 6th Edition”. It speaks of a congenitally blind girl who is an excellent swimmer, but has trouble diving and swimming under water. After she was asked what the problem was, she shared that she thought no one would see her underwater. The explanation that water is clear and can be seen through, reassured the girl and she soon learned to swim underwater.

The teachers should consider that the biggest advocates of children with v.i. are their parents. Therefore, if real results are to be expected and achieved, the parents must be used as a resource. The teachers should send the parents photos, reports, assessments of the performance of their children because this would help the parents to better understand their children’s potential and abilities and encourage them to give more freedom and more opportunities for experimentation. This would lead to better chances for their children to discover sports and activities they really enjoy, which would be beneficial in the long run for their independence and good fitness.

The teachers should also challenge the students with visual impairments and use realistic tests that cover process, result and level of independence, recognizing accomplishments and thus encouraging students to make progress. A great example of how this could be done is the Camp Abilities Activities. One of the challenges would also be to expect the student with v.i. to move as independently as possible. This would require proper orientation in the gym, the field, the locker rooms, the equipment itself, etc. and fixing of certain landmarks (e.g. contrasting mats around the walls) that would remain unchanged and would provide the student with v.i. with all necessary orientation instruments for performing as independently as possible. If there are any changes in the setting for the PE class or when a new setting is to be used, the student with v.i. should be given enough time to explore and understand the changes or the format of the new setting. This orientation should preferably be done by a sighted guide, who will be able to give answers to any arising questions as well as details, which the child may not be able to obtain on its own or which it could misinterpret.

When the PE teacher has a very young child with v.i. to work with, he or she should provide additional incentives for developing a craving and love for movements. Swings, jumps, chasing sound balloons, rolling down on slightly inclined surfaces, etc. may really trigger the desire to move even in a child that does not have vision as motivator. 

After having specified what approach the child prefers – verbal explanations or more touch and feel learning – the teacher should bear in mind that he or she should either be more explanatory for even ordinary everyday life things (or use someone else to give the verbal explanations) or more physically involved with the student who is visually impaired. Showing the move or the game would not be enough to fulfill the task.  As far as feedback is concerned, verbal feedback is necessary for the student with v.i., because he or she would not notice a smile or a confirmatory nod, but still would very much need to know how he or she is doing and if anything needs to be corrected. Continuing on the topic, considering that incidental learning is very limited with children with v.i. it would be a good idea for them to have someone explaining to them what is taking place in the surroundings, as well as why it is taking place. Explaining the activities taking place around the child with v.i. would also throw light on the concept of the game and the relevant terminology, which is used.

When the child has usable vision the PE teacher should make sure to position him/herself where he/she will be best seen and at all times, but especially when the game starts, also make sure that the child is on the side where the light would be favourable.

When giving explanations, the PE teacher should always be aware of background noise, which might make it harder for the student with v.i. to catch what he or she is saying – if necessary, the teacher should bring him or her closer to himself.

The PE teacher should use the system of least amount of prompts, depending on the level of complexity of the activity. The system of least prompts means using as little explanations and tactile or modeling interventions from the instructor, combining some of the following:

• Verbal explanations including: explanations in simple terms what the child should do; if necessary repeat in a different way; if there is usable vision, make a demonstration in order to improve the understanding; use clear instructions such as “hold the racket at a height of 8 to 10 cm above your shoulder” and not “hold the racket like this”; include the child as a spectator of game plays and assign someone to explain what is happening on the field, playground. When explaining a game, do not assume that the child with v.i. has picked up the team talk or the sports jargon. Make sure to check that by using the student’s name first and asking if everything is clear or some further explanations would be necessary. Always keep in mind that you can give detailed instructions to the student with v.i. as an audio recording or suitable print and formatting before the PE class[3];
• Demonstrations by the teacher or a peer, including: showing the movement or skill, demonstrated within the child’s field of vision; use another student as a model;
• Provide physical assistance or guidance through the movement, including recording which skills or movements require physical assistance and where on the student’s body the modeling is to be applied; always warn the student before touching him/her, in order not to startle him or her and minimize the assistance as soon as possible;
• Use tactile modeling, which uses your body or the body of a peer for achieving understanding of a skill or a movement; instruct the student with v.i. where and when to touch the model and record this, together with the reasons, which brought this type of learning about;
• Use sound devices – both in the balls used for the games as well as in the targets;
• Use visual cues, based on what the students tell you is best for them. Use brightly coloured cones, coloured tape to increase the contrast or tape over rope in order to mark a spot or line; use brightly coloured balls, mats and goals; modify the gym lighting depending on the needs of the student with v.i. who is participating in the class;

 

Developing a group of buddies (support assistants or peers from the class) can be very useful for a student with v.i., because they can give advice on when the ball should be caught or passed to another teammate; supporters must also be used in order to take over the involvement responsibility or help the PE teacher with it – he or she must pay attention to all students in the class and not focus on one of them at all times. This buddy system encourages communication, promotes social interaction and creates conditions for developing friendships. It is important that whenever possible, the individuals who have the buddy role rotate so that any negative feelings are avoided. The young people who undertake to be buddies develop their own confidence and leadership. Even if it is hardly possibly to have the whole class prepared to step into the role of a buddy (some may refuse, some may feel uncomfortable, while others may not feel ready for such a responsibility, whatever the reason) the PE teacher would need several of those in case of absence and also for guaranteeing the already mentioned possibility for rotation.  

Always keep in mind that no benefit would be worthy if safety has not been taken care of – so allow enough exploration time; allow plenty of practice time, because this will not only teach the child the rules of the game, but it will also help it develop physically, so that trauma is avoided later on and balance and coordination are guaranteed; keep the area clear, remove all hazards and once the area has been explored – do not change it; from the health perspective and vision preservation – check with the child’s physician or ophthalmologist what would be ok and what would not be recommended in the light of the child’s condition. Last but not least, make sure that there is a fire evacuation procedure in place for the sight impaired participant, as well as the institution has proper insurance[4].

It would be wise to have the entire class briefed on the safety procedures and also with general v.i. guiding tips. If a possibility for a visual awareness training of the class exists, the PE teacher should consult with the school administration and have this carried out. 

When playing a fast-paced game if you want to involve a child with v.i. in it, you as the PE teacher can introduce adaptations, which slow down the action, such as pairing a child with v.i. with a sighted one and having them move together at all times (this would certainly slow down the game), use adapted balls (e.g. tennis balls for v.i. players are bigger and slower, it is the same case with hockey pucks), the PE teacher can use rolling instead of throwing or hitting a stationary ball instead of a moving one [5].

 

An example of the process of inclusion of a student with impaired vision in a secondary school

The child: An active 7^th grader who enjoys biking, skiing and swimming. The girl has a retinitis pigmentosa, resulting into progressive sight loss. She still has usable vision though and is adjusting to her current visual ability.

The problem: The girl’s vision specialist states that she can and should be fully involved in her two PE classes each week. The PE teacher however, does not share the same opinion and has the student train on a stationary bike and walk the perimeter of the gym while the others are involved in their regular PE classes. The student with v.i. is becoming seriously frustrated with this lack of proper physical training and involvement in activities with her classmates.

The solution: After a meeting between the headmaster of the school, the vision specialist and the PE teacher, it is decided that she will be fully involved in the sports classes. The school will provide the PE teacher with books or materials for adapted physical education, recreation and sports in order to broaden his knowledge base and to provide him with the necessary ideas. The teacher will do a search on the Internet himself in order to get some further ideas for adaptations in order to support his student in an inclusive setting. On the basis of what the teacher discovers and confirms with the student that is going to be helpful, the school will purchase the necessary coloured and sound balls and will line up the gym and the outside track so that the girl can follow easily. Some additional games and activities will be added to the curriculum, such as aerobics, weight training or skiing in order for the girl with v.i. to be fully included together with her classmates.  At least two of the girl’s friends will be trained as peer tutors in order to assist her in class, considering that the teacher will need to focus on the entire group of students and will at some points overlook what his student with v.i. is doing and whether it is correct. Considering that the girl may need some more time practicing or mastering a certain skill or activity, additional individual PE classes may be organized for her.

Follow up: The teacher was slightly overwhelmed at the beginning due to the new responsibility as well as the new information and skills he had to process over a short time, but achieved a confidence in supporting students with v.i., which made him invaluable to the whole school community.

The girl, who obviously was used to being physically active and was initially frustrated by the lack of opportunities at her school, continued her sports classes with a much greater satisfaction and maintained the good physical and mental shape, which she was striving towards.

 

Bibliography

Joseph P. Winnick (2011) Adapted Physical Education and Sport, publisher: Human Kinetics

Luis Columna, Maria Lepore-Stevens, Erin L.W.K.D. Kavanagh (2017) Effective education for families of children with visual impairments and blindness in physical activity environments: A workshop model with a focus on Orientation and Mobility skills, British Journal of Visual Impairment, Vol. 35(2) 165– 177

Daniel W. Tindall, John T. Foley, Micheal W. Beets, Lauren J. Lieberman (2017) Physical activity levels of children with visual impairments during an adapted sports camp, British Journal of Visual Impairment, Vol. 35(2) 143–153

Lauren J. Lieberman, Monica Lepore, Maria Lepore-Stevens & Lindsay Ball (2019) Physical Education for Children with Visual Impairment or Blindness, Journal of Physical Education, Recreation & Dance, 90:1, 30-38, DOI: 10.1080/07303084.2018.1535340

Buell, C.E. (1966). Physical education for blind children. Springfield, II.: Chales C. Thomas.

“A Guide To Visually Impaired Friendly Sport”, British Blind Sport, www.britishblindsport.org.uk

“Tips for teaching sport to visually impaired students”, Macular society, www.macularsociety.org