Deafblind Fact Sheet: Using Routines in Orientation and Mobility (O&M) Lessons to Encourage Purposeful Movement with Infants and Toddlers

by Marjie Wood, M.Ed., COMS, TVI, Austin Independent School District, Austin TX

"Movement is life. It is in all we do on a daily basis . . . for children, movement is also the natural learning medium.  It is the means by which they explore the environment, learn how it functions, and interact with it." (Rosen, 1997)

"Learning occurs best when the child is a participant and in a manner that initially involves the child's body." (Pogrund and Fazzi, 2002)

Movement is essential to every living being. For our infants and toddlers who are visually impaired, I believe that movement should also be fun. Too often our little ones have experienced being touched and moved for procedures which are negative and painful. As an Orientation and Mobility (O&M) Specialist working with parents and children, conveying the idea that movement can be fun has truly yielded many unforeseen benefits. I would like to share with you some routines I have been using in O&M lessons with babies and toddlers for the past 12 years. Each routine is tailored to each student’s needs and abilities, so I’ve had the opportunity to introduce families to the excitement and fun of moving, and ultimately purposeful movement through the use of routines. Two of the favorite routines are a motor-music routine and a swinging routine. Before trying either one of these, it is always best to talk with the child’s parents, therapists, and other service providers as well as observing them in various situations before planning specific routines. Initially, it is best to have another adult or therapist help you with the transitional movements and static positions.

Motor-Movement Routine

Materials needed:

1. Musical Tape or CD Switch-adapted cassette, CD, or MP3 player with a Big Mac switch and with battery interrupter
2. Ball
3. Wooden textured musical stick
4. Blanket
5. A voice to sing along with the songs

For music, I particularly like Disney Babies: Playtime. I have used it since it first came out in 1998, and it still can usually be found on CD. Each song starts with an instrumental introduction and follows with singing. The instrumental portion at the beginning of each song allows enough time to transition the child in preparation for the song, and can build anticipatory skills. I prefer to use six songs, with the first song dedicated entirely to preparing and transitioning the child for the routine.

Goals and Benefits:  The child will gain skills in the following areas:

• Cognitive: cause and effect; anticipation; body part awareness and positional concepts; communication.
• Motor: kinesthetic and proprioceptive, body awareness; transitional movements; grasping; balance; coordination; trunk and head control.
• Sensory: use of visual skills, tactile skills, and listening skills.

The Routine

The first song is played while the adult prepares the child for the routine. I initially start the music

1. from a distance, and bring the child closer or vice versa. For an object to associate with the activity, I use Winnie the Pooh, which is easy enough for little fingers to grasp. I present the bear saying, “(child’s name), it’s teddy bear time.” We arrange our position and I place the portable recorder in front of the child. We are ready to start our routine before the first song ends. If the child has difficulty in being on his tummy, I often will wait for the second song to begin before attempting that position.
2. “Hickory Dickory Dock” is great for encouraging tummy time. Sometimes we have to try different positions at first. I introduce the Big Mac switch, encouraging the child help press the switch. This can be used as a way to distract the child’s focus from being on her tummy. Concepts of up and down are involved. As you sing along, having your voice go up when singing the word “up”, and down when singing the word “down”. This song is great for body part awareness, especially by giving gentle pressure to the joints.
3. During the “Dancing Arms” instrumental the child makes the transition from on the tummy to sitting in my lap. Singing this song can be great for awareness of arms, shoulders and some stretching, as well as concepts such as up/down, high/low, and circles.
4. The “Ball for Baby” instrumental transition may be auditory, bringing a bell ball toward the child. The child may stay in your lap; transition to the floor either on his side, back, or tummy; over your legs; or even getting onto his knees to work over the ball if it’s large enough to do so. This song is great because you’re not limited in what you can do with a ball. Some of our babies equate balls with therapy. So, I have used them to give input into certain joints or body parts, all the while carefully watching the child’s comfort level.
5. “Little Cowpoke”, one of the children’s and parents’ favorites, has probably elicited the most smiles! We transition our position to having the child straddle my leg. If the child doesn’t have trunk or head control, you will need to support him with your upper body. Sometimes you may need to recline a bit. This is a great bouncing song. While supporting the child’s head and neck if necessary, also try to support his arms. Yes, you’ll look and feel like an octopus, or wish you had that many legs. However, once you’re able to support the child you can not only provide the bouncing, but when it’s time to “whoa” you can also give some feedback to their shoulders. This takes some practice, so do the best you can.
6. During “Itsy Bitsy Spider” we begin by transitioning from a sitting position to prone on the tummy. In this position, the child is again able to be supported over your leg, and can access the Big Mac. I emphasize the concepts of up and down. I like to have this last song be very calming.

Adaptations: This routine can be overstimulating for some children. Knowing your child and what he or she can tolerate is of utmost importance. It’s important that the child learns about the world of movement and fun, rather than trying to get through a routine that will eventually be “fun”. The number of songs can be shortened, and the music can even be stopped when necessary. This routine can be adapted to a variety of children, including both those who are non-ambulatory and those who are walking!

Swinging Routine

Materials needed: Strong blanket that’s large enough for 2 adults to hold while swinging child. Two strong backs Voices for singing.

Goals and Benefits:   The child will gain skills in the following areas:

• Cognitive: cause and effect; anticipation; movement; communication.
• Motor: movement; sequencing of purposeful movement to indicate “more”; transitional movements.
• Sensory: kinesthetic and proprioceptive awareness; use of visual skills.
• Social/Emotional: bonding with parents/ family.

The Routine:  When swinging, two people will hold the blanket. The parent should be in front of the child, so if the child has any vision he or she may have the opportunity to look at the parent. Additionally, the parent can benefit from observing the sheer joy on their child’s face.

When singing I prefer to have two different tunes, one for swinging forward and back, and the second for swinging side-to-side. I usually sing the tune of the direction the child likes to be swung; for example, if Tommy likes to be swung from side to side better, I’ll sing “Side to side, side to side, Tommy’s swinging side to side, side to side, side to side, Tommy’s swinging side to side.” As I sing this, I present him with the blanket we’ll be using. Depending on his ability to move, we’ll either place him or roll him into the center of the blanket. For swinging side-to-side, the adults need to place themselves at the child’s head and feet. Also depending on what the child can tolerate, this is a great time to help the child “transition” from lying to a sitting position before being raised in the blanket. The song is then sung two times, and at the completion of the second round, is gently placed on the floor. I then follow the recommendations for eliciting a response from Every Move Counts.

When the child’s method of communicating is recognized and becomes more consistent, we begin to roll the child off the blanket until he is lying on his back on the floor. We ask if he wants “more”. With the blanket touching his body, any body movement will be recognized as a signal for “more”. With assistance, we slowly and carefully roll him to the center of the blanket and repeat the swinging routine. We usually find that if the child has some vision, he may start to look in the direction of the blanket, or may start to move his body in the direction of the blanket. We make sure to roll the child in and out of the blanket in both directions. Also, we allow the child the opportunity to swing from front to back and side to side. The front-to-back song is also sung with the child’s name being mentioned: “Lila’s swinging forward and back, forward and back, forward and back, Lila’s swinging forward and back.”

As with any activity, whenever we notice discomfort, fatigue, pain, or any adverse reaction, the activity is immediately stopped. But we always try to avoid problems in the first place by initially checking with the parents, therapists, and anyone else who’s involved with the child. Caution also must be taken with children who have g-tubes, shunts, or any medical issues.

Routines can provide predictability, consistency, safety and comfort. Once the child is secure in knowing what’s going to happen, we can also say that routines can be enjoyable, providing children and their families an opportunity to have fun together!

References

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