SUSAN BASHINSKI
SLIDE 1\
Welcome. I'm glad you could join us today for a discussion of touch, tactile interactions, touch interactions. Important considerations we need to make as we work with, live with learners who experience deaf-blindness. Well, let's get started.\
SLIDE 2\
Learner's interactions with touch. In a very general sense, every single human being requires tactile input. Research shows that positive touches, positive touching is correlated with good physical health and with good mental health. Some of the most interesting literature that speaks to this particular point comes from the field of geriatric medicine. I'm sure some of you have read some of this or heard about it, how, many times, older individuals who live in assisted living facilities, live alone, nursing homes, they just aren't touched. And for those who-- or they're not touched in a positive, affectionate kind of way. They may be touched to be changed or for medical procedures, but not an affectionate touch. And they've done fabulous research initiating hugging programs where there's just physical contact, hugs given on a routine basis. And the residents', the patients' mental and physical health both improved. I think that's one thing we need to remember about learners with deaf-blindness.\
The way in which we interact with them, from the time that they're very young babies, is different, maybe because of health issues. Many children who are born with deaf-blindness have some congenital disability that puts them in fragile health. They may have a lot of surgeries, medical procedures. We just don't play with them physically in the same ways as we do with typically developing children because they appear fragile. They don't have good stamina or endurance in many cases. We don't interact with them physically and roughhouse play and engage in those kinds of physicality activities. And maybe we want to rethink some of that. Of course, we have to be conscious of kids' health and what could be harmful to them, but we need to consider how we touch, the ways we touch, and how learners respond to the various types of touch. What touch does do for learners with deaf-blindness is to encourage them, assist them to "come out into the world and engage with a partner." I think it would serve us well to take a little bit of a historical perspective, a historical view on this whole notion of, "What do mean, 'come out into the world?'"\
SLIDE 3\
One of the fathers of the field of deafblindness is a gentleman named Jan van Dijk. He developed what was called a movement-based approach to working with learners who had deafblindness. He developed this with his colleagues at the Rafael School in the Netherlands. And everything that he did in his initial groundbreaking research stemmed from his curiosity regarding how children with deafblindness acquired information about the world. Okay?\
SLIDE 4\
And as a part of what I didn't type on these slides, but I think is important - one of my very favorite phrases that I will always remember when I think of learners with deaf-blindness - Van Dyke has said, "We need to invite the kids to live in the external world with us. We need to invite them out of their own bodies." Because kids with very significant hearing and vision loss, they live inside themselves to a large degree because they don't know there's a bigger world out there. So let's keep that on one side of our brains as we continue through this talk today about touch.\
Dr. Van Dyke's orientation, his main themes, were to think of the whole child. He really took very much an early interventionist perspective to intervention and thought of the whole child. Even though many of the learners with whom he worked were older kids, he thought of the whole child; didn't look only at ears, didn't look only at legs, didn't look only at speech. He looked at the whole learner. He examined the inner relationship of the neurologic state of the child, what the child's internal systemic messages were, and external influences in the environment. He worked very, very hard to find ways to reverse a learner's inwardly directed behavior. Again, the children lived inside themselves.\
Most of the kids with whom he worked, and some were babies, but some were many years older, had deaf-blindness as a result of the rubella epidemic in the 60s. So the kids had pretty significant vision and hearing loss, and they lived inside themselves. So he was all about trying to find ways to reverse those children's and young adult's inwardly directed behavior. He targeted reciprocal turn taking - your turn, my turn, your turn, my turn - very important to building a foundation for communication development.\
SLIDE 5\
We are not going to go through all seven stages of Van Dyke's movement based approach. It's a very interesting set of literature to read and to process, but it's the first couple of stages that I think really are worth examining to lay a foundation for our discussion of touch and tactile interaction. I think this reminds me, in a way, of a lot of the discussion that we did in another webinar recording on calendar systems. That's probably because Jan Van Dyke, who created the movement based approach, really is the person who created calendar systems. But in that session we talk about kids need to be able to anticipate what's going to happen to them. They need to be able to predict what's going to happen to them. And it is all linked to emotional security, emotional attachment, feeling safe in the world.\
So when we examine this very first stage of his movement based approach, everything that's highlighted in red here, I think, just flows logically from what we've reviewed about his, Dr. Van Dyke's, sensitivity to emotional security. The first stage of his seven stage intervention approach is called Nurturance. Maybe that's a little touchy-feely for some of you. But you're trying to nurture a relationship. You're trying to establish a trusting relationship, a secure relationship, so that learner, that child, will feel safe with you. So we're going to enter the learner's world.\
From the very, very beginning Van Dyke encourages a lot of touching, a lot of feeling, working in very close proximity to the learner, to enable you as a potential communication partner to determine what that learner's muscle tone is telling us. Very high tone, very rigid tone can be indicative of anxiety, fear, discomfort, insecurity. A relaxed, hypo, low tone can be indicative of comfort, security, feeling good about what's going on. Now, granted this is a generalization. These are generalizations. With children with very severe physical challenges, severe cerebral palsy, their tone can be misleading and I understand that. And so you have to please filter what I'm suggesting to you here through that individuality of each learner to know if you can indeed use the learner's muscle tone as a signal to tell you what's going on internally with that learner; what's going on emotionally; what's going on psychologically with that learner. And again, I really do know how to spell muscle. I apologize for my typo. I try to check these things, but I don't catch my own mistakes all the time. And I do apologize.\
Use hand-under-hand for exploration. Help kids explore their worlds with hand-under-hand techniques. And he says, in things he's written, "Be very careful of the child's hands. Be very careful of the learner's hands during all interactions."\
SLIDE 6\
Resonance. Stage number two. Again, kind of a funny name for an educational intervention. We think of it in sound, and music, and entertainment, but the stage two of Van Dyke's Movement based approach is resonance. Again, he says, "Enter that learner's world." Join the learner in movements she enjoys. If she rocks, rock with her. If she jumps, jump with her. If she flaps, flap with her. But imitate the learner's motion and vocalization. Maintain high levels of physical contact. Have your hands available to touch the learner's arm, to touch the learner's leg, to make contact with your body so that learner knows where you are, can feel your body, can feel your muscle tone. Move together. What's the point in imitating her movement and jumping with her if she doesn't know you're jumping. Hold hands and jump together or whatever the movement may be. If you're rocking, sit beside each other and rock side to side. Sit front to back and rock back and forth, so that learner can see and actually feel your motion. That you're sharing the motion and you are resonating the motion she is making. Make high levels of physical contact.\
Utilize a stop-start-start format. If you're bouncing a learner on a trampoline. Start and bounce, bounce, bounce. But stop to see if the learner will give you some kind of a cue to say, "Start it again." If you are tickling a learner's feet because they like that game, start and tickle. Stop and see if that learner will kick her leg toward you or make a sound, a vocalization to say, "Start it up again." The reason I wanted to highlight these stages of nurturance and resonance, I think they lay for us a foundation of general considerations we need to make when we talk about touch and tactile interactions with learners with deaf-blindness.\
SLIDE 7\
So we would start-- I would encourage you to start with two types of assessment. I would encourage you to start with first, an assessment of the tactile environment, and secondly, an assessment of how an individual learner responds to touch. So let's take a more in-depth look of each of those two types of assessments.\
When you're assessing the tactile environment, the first things you want to examine are how, when does the learner have physical contact with other people, how does the learner generally, generally respond to these physical interactions. Number two, how and when does the learner have an opportunity to touch, explore, handle, use materials, interact with objects? Is it only when somebody presents something individually? Are there things available around the learner's seated area on the floor, in the learner's bed, and the free-time area in the classroom? How and when can he explore and handle and use materials?\
SLIDE 8\
Number three, how is the environment arranged or organized to encourage tactile exploration in movement? A couple of considerations that are very important when we work with learners with deaf-blindness or for families with learners with deaf-blindness. I don't know about you, but sometimes my house is a big cluttered mess. And because I can see, I can navigate my way through the room on the floor by walking around and stepping over all the piles of papers I have to grade or whatever else I have going on in my life at the time; craft projects or whatever you might do. For a learner with deaf-blindness who is insecure or at least not very sure of moving independently, of exploring the world, a room with a cluttered floor is a disaster. A room with a cluttered floor is like saying, "I really don't want you exploring in here." It's like the big red round sign with a slash through it that says, "Not here." There has to be availability for protected movement, safe movement, and exploration without tripping over, running into things.\
Second related consideration is the notion of furniture arrangement. Some classroom teachers really like to rearrange the desks, the furniture, the table in their room every couple of weeks so it won't get boring. Well, for a learner with deaf-blindness, that is really inhibiting the learner's movement and tactile exploration. Families at home, maybe you like to move your furniture, so you don't wear out certain strips of your carpet. But again, the issues of furniture being moved really frequently is really difficult for a learner to feel safe and secure in exploring and moving around in that environment.\
Fourth, in terms of the tactile environment, would like to encourage you to think about what types of adaptations might better facilitate the learners being able to explore, and handle, and manipulate objects. Have only things that can't hurt her. Don't use things with pointed ends, sharp things. Don't use breakable glass. Don't use fragile precious objects that you would be very upset if they got broken. Use things for their durability. Use a variety of textures. Make things available. Help the learner explore.\
These four questions are taken from a very good resource on tactile touch, teaching touch to learners with deaf-blindness. It's referenced here on the bottom of the slide, Chen and Downing. I've provided you with the full reference at the end of this slideshow.\
SLIDE 9\
So after we assess the tactile environment, and I've looked at the learner's responses in a general sense, we really want to hone in on how the learner uses touch and how the learner responds to touch. Okay? So we want to take specific note of how the learner uses his hands, his face, and body movements. What does he do with them? Become aware of the learner's skin. Become aware of the learner's muscle tone. Become aware of the different movements the learner will independently make. Are they always in one direction? Are they always stiff? Are they always big? Are they always small? Is the tone always the same? And does the tone change a lot? Does the learner always keep his face turned away from things, or turned toward other people? What is going on? You really want to make specific observations of what the learner does with hands, face, if the skin is clammy if it's perspiry. If it's dry. If it's dry, it might be hurtful to be touched. Or, if it's cracking or there's a sore, it's really hurtful to be touched and needs attention. It's hard to move if your skin is cracked because when you move that limb or that finger, it hurts if the skin is dry and cracked. We need to be aware of these things.\
I really love this third point. We need to determine how the learner uses her hands and for what purposes. For a learner with deaf-blindness, hands really serve multiple functions. And the more significant the vision and hearing loss, the greater the importance of these functions. First, hands can be tools. They can be tools for exploration. They can be tools for searching. Hands could be sensory organs to get stimulation. To feel cold, heat, scratchy, rough, smooth. Hands can also be sensory organs in terms of sources of sensory stimulation through self-stimulatory behavior or stereotypy. Hands can also be the learner's voice. And if a learner is going to be communicating through gestures, through manual sign, through tactile sign, that learner's hands become her voice. And it's really important for us to sort out what things the learner does. Fall under the category of hands as tools. Hands as sensory organs. Hands as voice.\
You also want to take note of what forms of touch the learner uses. Does the learner only use forms of touch that would seem, on the surface, to be aggressive? A slap, a hit, a pinch. Are the forms of touch, on the surface, do they seem rough and sort of forceful or aggressive. Well maybe, neurologically, there's a reason for that. Maybe the child, the learner, needs deep, firm pressure to be able to get any sensory feedback at all. Or, maybe if the forms of touch are always very, very light and you can't get enough pressure to activate any kind of a switch or not enough strength in the grasp to hold an object, this could be indicative of some type of issue related to muscle tone that needs to be addressed. It could be indicative of some kind of tactile defensiveness or a hypersensitivity to touch. All of those things are really important to which to get answers before we proceed with developing a tactile or touch interaction program.\
SLIDE 10\
The learner's response to touch and tactile information. Does the learner give you awareness when he's touched? Like move his body. If you touch his leg, does he move his leg? Is he aware when you touch his head by moving his head either toward or away from the source of the touch? Is the learner's response a reflexive behavior like a startle? If kids are touched unexpectedly-- if we are touched unexpectedly we have a startle reflex, a startle response. If the learner is touched does the learner seem to attend to that? Like, "Whoa. What was that?" Maybe smile. Maybe frown out of, "Whoa. I don't know what that was." Maybe reach in the direction of the touch. Alerting behavior. This might sound like a contradiction but I think it's a great thing that is sometimes overlooked. Sometimes when they're confronted or they encounter is a better word-- I'm sorry. When a learner encounters some tactile information. One way that that learner might alert is by quieting her whole body. Everything stops. They come into contact with something it's like, "Whoa. I'm going to hold really still here. I wonder what that was."\
Maybe it's recognition behavior. If kids start to give some type of differential response to familiar and unfamiliar people. Like dad's touch is different than mom's touch is different than grandma's touch is different than teacher's touch is different from teacher's assistant's touch is different than baby sister's touch. And if the learner starts to recognize the differences in those people's touch or physical contact with her that's called a recognition type of behavior.\
Discrimination. This just kicks it up another notch really if the learner starts to show preference for a particular type of touch. As I mentioned just a few minutes ago, deep, firm pressure verses light pressure. That can be, honestly, a physiologic preference of some kids and they can be discriminating to react in a negative kind of way to one type of pressure but in a calming, bring it on, give-me-some-more-of-that-touch to the opposite type of tactile input.\
Comprehension behavior. If kids are touched or they come into contact with a certain texture of their favorite stuffed animal with which they like to sleep, the minute they touch it they know what it is and they comprehend, "That's my sleep toy," and they wrap their arm around it. Or if it's when they're touched and they're seated upon the examining table in a doctor's office and they feel the crinkly paper and the cold when they lie-- and they go, "Whoa. I don't like it. I'm in the doctor's office." They comprehend that. Again, they're not going to think in those words but if there's comprehension and then their response would be anxiety or anxiousness because they don't like that. That's a comprehension behavior. It's very important that you do some kind of an assessment of how the learner not only uses touch but responds to tactile information in these various categories. Again, it's that same reference from Chen and Downing that you will see at the end of the slideshow.\
SLIDE 11\
So let's take, after we've covered the general history through Van Dykes's work and the assessments that we need to do to begin to figure out how to effectively use touch and tactile interaction with a learn, what do we do? How do we start? So let's take a look at those questions. In addition to learning many basic tactile skills, kids who experience deaf blindness really can learn and sometimes need to learn to use touch as a formal cue to understand what's going on in their environment. This is an especially important issue for kids with very, very limited vision. They need touch to understand where they are, who's there, what they're supposed to be doing in their various environments.\
SLIDE 12\
So we're going to talk about touch cues. What is a touch cue? A touch cue consists of tactile contact made in a consistent manner, and there's the most important word, made in a "consistent" manner directly on the learner's body to communicate with her. So if you're going to use touch cues, you're going to make tactile contact with the learner's body, and you're going to do it the same way every, single time you're trying to communicate a particular message.\
SLIDE 13\
Why should we use them? Well, the purpose of a touch cue is to communicate a variety of the communication partner's intents. It's trying to feed information into the learner to help the learner comprehend what's going on; to help the learner understand what is going to happen next; to help the learner receive information. And that is to build the learner's receptive communication skills. There's a lot of parallel between the use of what we're discussing today called touch cues, and what is discussed in another recording of the Kansas Deaf-Blind Project called interactions with objects and use of object cues. So you might want to consider taking a look and a listen to that recording as well. Because they serve the same functions, but they're delivered through different media and through different sensory channels.\
Okay. Purpose of a touch cue is to communicate the partner's intent. We're going to use touch cues to try and reduce a learner's startle; to try to ward off the occurrence of challenging behavior; to ward off a surge of anxiety or uncertainty. Simply by helping the learner be able to know what is going to occur next. It's helping the learner anticipate.\
SLIDE 14\
Here's some examples. This isn't rocket science, folks. You may read this and say, "Well, this is so simple. This is silly." But I would suggest to you to please try to think if you're a child if you're a young adult who has limited life experience. Does not hear very well. Doesn't see very well, or anything at all. And you have the child, the young adult lying on a changing table and you're going to change their diaper, wow. All of sudden, things start happening and if you can't see a person coming to you to raise up your legs or to-- it's a scary thing. And, especially, when you consider that one teacher's assistant might do it in one way, a teacher might do it another way. A care provider at home, the nurse, might do it in a different way. How can you get any organization? How could you get predictability? How can you be sure? That child, that young adult, might be thinking, "Well, I don't know what this is going to go, but there's one person who changes my diaper that hurts me every time because she sticks the sticky tabs on my skin and it hurts." And if that learner doesn't know who's doing it, of course, they're going to tense up and then, it's harder to change them because when they tense up they get scissoring going on in their legs. And then, you have to be forceful and it just degenerates from there. So it's simple, but that doesn't mean it's not very important.\
Back to the examples. Tap the child's bottom when the child is lying on his back. I'm going to lift up your hips. I'm going to tap your bottom and say, "Lift up to get your diaper changed." You're going to gently put your two hands on the child's upper arms, pull up very gently and say, "Get ready to stand up. One, two, three." And repeat the touch cue of gently pulling up on the upper arms, "Get ready to stand up." It's like, "Woo-hoo, this is a warning. You're going to be vertical in just a minute, so get your body ready." What we sometimes see, if touch cues are used consistently with a learner, she will begin to ready her own body, to relax, so that it's easier to help lift her to standing. Or, she'll begin to start to help, and even if it's only sort of scooting her bottom a little bit forward in a chair to make it easier to stand up. So kids begin to be able to play an active role in what movement is going to happen to them next, and we call that "partial participation."\
Another type of a touch cue is when you approach that learner to touch the adolescent's left elbow. Every time I'm going to go up to Timmy, I'm going to touch his left elbow. I'm going to say, "This is the way say, 'Hi,' so you know who I am." I don't verbalize all that, but I touch the elbow and say, "It's Susan." One of the most creative things that one family set up, I'd love to say I could take credit for it, but I can't. They used kisses, but they kissed differently. Mama, when Mama came home from work, Mama always kissed the little girl on her cheek, okay? When Daddy would come home from work or being gone, he would kiss the little girl on her nose. When Grandma would come to visit, she would kiss the little girl on her forehead. So it's a greeting, it's a family greeting of kiss, kiss, kiss, but it lets the little girl begin to discriminate and recognize who's kissing. Because when Daddy kisses her nose, she might feel his whiskers. And then, when she starts to know that's Daddy when it's there. And it's Grandma because when I get kissed on my forehead, there's a really strong perfume too. And it helps build sensory organization. Another thing you might just say, because kids who have severe sensory loss, it's hard to give them feedback. Say, "I like the way you're doing that. That's really good work." They don't process that. They don't see your smile. So you rub the middle of the adolescent's back to say, "I like that."\
SLIDE 15\
Considerations when you're going to start to use touch cues. Very important to pay close attention to the two points on this screen. It's very important to investigate if the learner has any severe neurologic disability. Because it really might affect her ability to perceive the touch cue or to receive the tactile information. The learner might have very significant tactile defensiveness. You need to know that going in. And if you've completed those assessments, as I encouraged you to do earlier, you're going to know at least this last part, about significant tactile defensiveness. You would start down the entirely wrong path and it takes us so much longer to unlearn something, particularly to unlearn something that isn't pleasant or that scared us. So we don't want to get started out in the wrong direction. Secondly, be sure if there is any neurologic involvement, physical involvement with this learner at all, to talk with the learner's physical therapist and, or the learner's occupational therapist. These are the folks with expertise in neurologic disability, and sensory processing, and sensory integration. When we're talking about using touch and tactile input, we need their expertise.\
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Other considerations that we as families and teachers can make using our own judgment. When you're going to decide what kind of touch you're going to use and where, what the placement of the touch cue is going to be, you have to carefully select it. You don't want to deliver touch cues on a learner's leg if the learner has no sensory from the waist down. They can't process that cue. You need to think and discuss as a team, as a family, what kind of cue are we going to use: light touch, firm touch, repeated touch, repetitive rhythmic touch. Where are we going to place it? Carefully select type and placement.\
Generally speaking, now again, I was almost afraid to say this because this will not be true in the case of every single learner, but it is true in regard to the majority of learners. So I think we're safe in reviewing it. Generally speaking, a firm touch cue is more effective than a light stroke. Generally speaking, learners are less put off or less startled by a firm touch cue than they are by just a light brush, a light stroke. I think we can each identify with this if we think, "Oh." If there's a little ant, or a mosquito, or a fly, or something that just brushes on our skin, we tend to jump, or startle, or try to brush it off. Whereas if something touches us more firmly, or bumps us, or somebody grabs our hand or our arm, it's not as off-putting initially as that startle of, "Oh, what is that? What's crawling on me? Oh, what is that?" Same is true with the kids we teach, and our children, and our families who have deaf-blindness.\
Touch cues need to be selectively chosen so the learner, not the people that are the partners, but so the learner can differentiate them from routine physical contact, especially if your child needs a lot of physical assistance for grooming, for diapering, for bathing, for feeding. You're going to have a lot of contact with her physically just to get through your day, just to complete the routines of your day. Your bodies are going to be up against each other. You're going to move and manipulate the child's arms and legs as you help him dress and undress. So you want to choose cues to be touch cues that are clearly different from those routine forms of physical contact.\
SLIDE 17\
So let's talk about some advantages and then we have to balance it with disadvantages of using touch cues. Advantages first. Touch cues don't require any motor skill on the learner's part to be able to receive a touch cue. Is there neurologic functioning involved? Absolutely. But there's no motor skill required to the learner to receive a touch cue. They're very easy to develop. Touch cues can support participation in familiar, daily routines. It's time to take a bite of food. It's time to get your diaper changed. We're going to put your coat on. We're going to take your shoes off. We're going to comb your hair. We're going to go and get the books off the shelf. We're going to go down the hall to the music room. All of those kinds of things. They support participation. And generally speaking touch cues have a very-- maybe not very. Let's say touch cues have a relatively low demand on the learner's cognitive skill, on the learner's memory skill, and certainly on the learner's representational skills.\
SLIDE 18\
But the balance. There are disadvantages of using touch cues. Number one is the place where we're most vulnerable. People who interact with a particular learner might not utilize the touch cues in a consistent manner. That's a problem. If the family, I explained to you earlier, start kissing their little girl. Grandma decides to kiss on the back of the neck, and mom kisses on the nose, and dad kisses on her hand. It's like, "Woah. What happened? My whole system blew apart here because it's mom on the cheek, dad on the nose, grandma on the forehead. I got it. I understand." You can't change it up. All right? Yes. You are not trying to take all the spontaneity out of your interaction with your own child or with a learner in your class, but for these touch cues, you can't get creative with them. If a team has decided with a family on a certain set of touch cues to say, "We're going to cue you this way when we take you out of your chair. We're going to cue you this way when we put you in your chair. We're going to cue you this way when we're going to give you a bite of food. We're going to cue you this way when we're going to change your diaper." Everybody needs to do it the same way, every time. There still will be differences among people. And some people's skin is oily. Some people's skin is rough. So on and so forth. But the motion and the placement of the cue needs to be delivered in a consistent manner.\
Secondly, using touch cues might be uncomfortable for either the partner or the learner because of personal differences or personal culture. I mentioned, previously, that I'm a real touchy person. So for me to use touch cues with a learner, it's very comfortable. I hug my friends. I touch my young adult son. When he comes in I put my arm around him, or I give him a kiss, or sometimes more even than he wants me to do. But I touch people, not in an offensive way. But because I'm very comfortable with that and I show my comfort with them, my like of them, my pleasure of being with them by touching them. Some people aren't that way. I have a good friend who, even after she had known me for years and years, and babysat for my children when they were little, I tried to hug her and she would just get stiff. She would just get stiff because she wasn't comfortable. I finally quit trying to do that. But some people aren't comfortable with touching so you need to think that through, you need to have a conversation about that. And I think if we explain to teacher assistants or members of the team that, "This touch, in this way, to pat Johnny's bottom, to pat Johnny's tip when he's going to be diapered, it's really important for Johnny to learn to organize his world, to learn who's doing something to him, and what in the world is going to happen to him." It will help people develop at least a minimal level of comfort. Sometimes there are differences with culture and you just have to have an honest conversation, get it out in the open, name the elephant in the room. And if you can't get around it, then you're going to choose different types of cues or choose different people to deliver those cues.\
Thirdly. Touch cues can only convey limited content. They're not very detailed. They can't communicate a lot of abstract concepts. So it is limited. They're powerful, but they're limited. And if touch cues are poorly selected or poorly used, the learner may be startled or just confused. And I think we've talked about that sufficiently.\
SLIDE 19\
Interaction strategies. I think this is about the third time I've said this so, hopefully, it communicates the point. I think it's really important. We need to consider the learner's preferences and the learner's culture, and the family's culture and the family's preferences when we're selecting the type of cue and the placement for a touch cue. A newer point that I haven't yet mentioned, but is equally important, is never, ever, ever force a learner to accept a touch cue or to engage in mutual touch conversations. If kids just are really averse to it and they just are very uncomfortable with certain kinds of touch or hand-under-hand, or physical assistance through things, don't grab those kids' hands and forcefully put them through the activity. Remember, for a learner with deaf-blindness, hands are tools and sense organs and voice. And if they're consistently pulling their hands away from you, interpret that as a voice saying, "Uh-huh, not now. Not like that." That doesn't mean you give up forever, but you back off and you try it again with a different sort of touch, with a different firmness of touch, on another time and another day. We have to respect the learner's preference at that point in time.\
SLIDE 20\
A couple of resources, actually, it's all through Project SALUTE. It's a wonderful website. Successful Adaptations for Learning to Use Touch Effectively. That's what SALUTE stands for, one more acronym for the Special Ed soup.\'a0Successful Adaptations for Learning to Use Touch Effectively. Go to that site and go to "What we've learned" information sheets. Fabulous information about using, developing touch cues.\
SLIDE 21\
Key points to remember. In summary, we want to always remember, when you're approaching a learner, let her know you are there. I don't think any of us will think we're sneaking up on somebody and not telling them we're there, but it's like, if they can't see you and they can't hear your footsteps, you have to make a concerted effort to always let the learner know you're there. One of the simplest ways to do it is with a touch. For me, with certain learner, it's a touch on the left elbow. With another learner, it's taking their hand and putting it on my watch, on my forearm. Always identify yourselves to the learner, every single time you're with her, even if she has partial sight because you don't know. Kids who have cortical vision impairment, you never know how the vision is working at that particular time. Identify yourself. Let her know you're there. Always let the learner know what's going to happen next, especially what's going to happen to her body next. Use touch cues. Use object cues.\
There is nothing that I have seen in classrooms that bothers me more than a teacher assistant or a teacher or a related service provider walking up behind a child who uses a wheelchair and just starting to push that child's wheelchair across the room. I just want to scream and yell at them, "What are you doing? This kid doesn't know you're there and all of a sudden, he's flying across the room." You need to come up. You need to identify yourself. You need to give some cue of, "We're going to go. I'm going to push your chair now. Are you ready to go?" Or somebody that will walk over to a child who's in some piece of positioning equipment and just grab him and pick him up. It's like, "What in the world is happening to me?" It would feel like I'm in one of those giant claw machines and a claw is picking me up off the ground and I don't know what's happening to me. It's not fair. It's not right. So always identify yourself, let the learner know you're there, and cue him or her to say, "This is what is going to happen to your body now." Every single time you act on that child's body, every single time, let them know what you're going to do.\
SLIDE 22\
Whenever possible, allow the learner the opportunity to make choices in an activity. Utilize a tactile cue to let the learner know when you're available for interaction. One of the most creative things I've seen is come up with some kind of texture or some kind of fabric that you're going to put on some oil or perfume or lotion. It's a scent that you always wear and leave it with that learner. Either leave it on the learner's wheelchair tray, velcro it to the tray, put it in the learner's pocket, put it on some Velcro on the learner's clothing and leave that cue with the learner, tactile smell, whatever so that the learner will know you're available for interaction because they can't see you when you're 12 feet across the classroom. They can't call to you when they need you, or they might be calling to you and if they can and you've stepped out, the thing that's tricky about this if you're going to utilize a tactile cue to always let the learner know when you are available. If you have to step out into the hall, if you have to step into the restroom, if you're called to the office, go get the cue and tell the learner you have to go away for a few minutes or you have to leave now depending on how much cognitive skill the learner has, but take the tactile cue away when you are not available for interaction. Always find a way to let the learner know when an activity is finished.\
This is discussed a lot more in the Kansas State-Deaf Blind Project Webinar and Routines. But you can always let the learner know when activity is finished through a particular type of touch cue. Always let the learner know when you're leaving. That's like the bookend. This list of key points started with always let the learner know when you're there, always let the learner know when you are leaving. Even if you don't use a tactile cue that you leave with the learner when you're available, always let the learner know when you're leaving.\
SLIDE 23\
The reference I promised to provide: This is a fabulous book. It comes with a DVD also. If you want to see these things in action from AFB Press, take a look at it. These ladies can provide you with just a wealth of information about using touch and tactile cues in a very constructive way.\
I thank you for your attention today. If you have questions, please feel free to contact the Kansas Deaf-Blind Project staff. If they have questions, I'm sure they can contact me or put you in touch with me. I certainly appreciate your attention. Thank you.\
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