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 - https://www.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 parents of children with v.i.

 

When considering the below listed specific tips, please also go through the tips provided for PE teachers as those are also quite relevant for your direct experiences with the child.

The first thing you need to do is find out how much usable vision the child has. From sight impairment to sight impairment there are huge differences. The child may have no vision at all, just light perception or he or she may have reduced visual fields (not able to see to the sides, or above/below) or he or she may have reduced acuity (things may be blurry, even after correction with eyeglasses). The child may also have a brain-based visual impairment, which is also known as CVI (cortical visual impairment or cerebral visual impairment). This means there might be nothing wrong with the eyes, but that the brain is not able to properly interpret what the eyes see. Parents need to be aware that many people with visual impairments have enough functional vision to travel independently, to read print and successfully carry out their daily routines. Even if the child is totally blind, he or she can still learn many things in order to lead an independent life.

Here some stories of people with impaired vision, who are or have been independent, successful and happy:

• Marcus: Flourishing as an Independent Blind Person (adventitious sight loss): cocenter.org
• Cheryl Orgas – a blind social entrepreneur: milwaukeeindependent.com
• Marla Runyan – a blind athlete (Stargardt’s disease): amazon.com
• Derek Rabelo – a blind surfer (congenital glaucoma): beyondsightmovie.com
• John Bramblitt – a blind painter (adventitious sight loss due to epilepsy): youtu.be
• Christine Hà – a blind master chef (adventitious sight loss due to neuromyelitis optica): people.com
• Pete Eckert – a blind photographer (adventitious sight loss due to retinitis pigmentosa): peteeckert.com
• Srikanth_Bolla – a successful Indian entrepreneur (congenital sight impairment) wikipedia.org
• Avraham Rabby – a US diplomat and advocate (adventitious sight loss due to detached retinas): nytimes.com
• Liam Thurlby, coureur de cross-country aveugle (cécité congénitale due à une Microphthalmie) : globalsportmatters.com
• Christopher Downey – a blind architect, planner, and consultant (adventitious sight loss due to a tumor wrapped around his optic nerve): theatlantic.com
• The story of Louis Braille (adventitious sight loss due to mechanical damage and infection): myhero.com
• The story of Helen Keller (adventitious sight loss in early childhood due to meningitis): biography.com

There are vision experts and services available for children and adults with impaired vision, so make sure that your child has been referred to such. Children with v.i. benefit from the support of experts, trained to work with individuals who are congenitally blind or visually impaired. This includes early intervention specialists, teachers of students with visual Impairments, and orientation and mobility trainers. Together with the ophthalmologist, these experts will provide you and the child with information concerning the health relevance of doing sports, and of course, of any potential threats to preserving any usable vision, which should be avoided (e.g. sports or physical activities that are not recommended for a certain condition). This team of professionals can provide information and resources, as well as support to you and your family.

Create as many real experiences for the child as possible. Until the child is grown and confident, it is the parents’ responsibility to support it on the way of building that confidence and independence. The parents need to encourage the child to do things on its own and to help with the household rather than just being served. If the child wants a glass of juice it should know that in order to get it, it needs to go to the fridge, get a box of juice, get a glass from the cupboard, pour some juice, drink it, then wash the glass and put it in the dryer. It should know how often the plants need watering, it should vacuum its room, it should help with the dishes, etc. If all these activities are done in the practical skills classes at school or with the resource teacher, but not affirmed and repeated at home, the child may easily succumb to a state of accepting the service.  

The parents may try to be more physical with the child in a safe environment, try to roll around, tumble and play together. This would give an invaluable agility and readiness to move, which is very visible when missing in a young person or adult. Take the child to various places and expose it to whatever they have to offer. Do not just give a small horse toy to the child. Take it to a horse stable and let the child pat the horse and explore its size and shape. There exist so many stories for misconceptions due to inadequate representation.

Engaging the child in meaningful multi-sensory experiences will prepare it for analyzing and using the various materials not only for recognition but also for orientation, which would be extremely valuable when doing sports.

Find out what adaptations, specific to your child’s vision, can be of help for him or her to move and function as independently as possible. This may include increasing contrast, positioning the child where the light is best, teach him or her to use visual cues or markers, such as a yellow strip at the edge of each stair or around a door, which would be beneficial also when they learn to play a sport.

The parents should encourage the child to explore and move in safe and familiar environments, no matter how tempting it might be to try to protect it as much as possible from the “real” world.  Exploring and learning to move around as independently as possible would be a tremendous benefit. So try to make common spaces as safe as possible (removing things that are easy to trip over, for example.), do not change the environment, remove sharp or toxic items and invite the child to explore the cabinets, drawers and spaces.

Build a support system by getting in touch with other parents and other children with v.i. Other parents will be a wonderful source of information and support, while the children will provide friendship opportunities, possibilities for role model establishment and peer learning.

Take care of yourself and your relationships. Being stressed and in burnout would be of no benefit for anyone. Placing all other members of your family in the background and focusing only on the child with v.i. would put relationships to the test. Be sure to make time for yourself, and for the friendships and activities you enjoy. Nurture your relationships with your other family members and in particular with your partner and your other child or children by having regular one-on-one time, and keep up with their interests and activities.

Have high expectations no matter what signals or straightforward advice you might be getting. Sometimes even from physicians. The children with v.i. who have the highest chances of becoming independent and successful in their lives, are the children of parents who have or had high expectations towards them. 

Never accept down-treatment and presumptions. Do not be offensive to anyone, but do not look lightly upon people talking to you and not to the child, or people raising their voices when talking to the child, or people presuming what you child can and cannot do, etc. You are there together with your child to teach and demonstrate to the others how much your child can do and that it can speak for itself and can hear pretty well in all cases when the hearing is not impaired and can make decisions on its own.

 

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