Identifying Physical and Sensory Needs (VI/HI/MSI)

Vision impairment in children and young people is a low incidence, high impact disability and can take many forms, with widely differing implications for a child/young person’s education.

The effect of visual problems on a child/young person's development depends on many factors including the severity, type of loss, age at which the condition appears, and overall functioning level of the child/young person. Many children/young people who have multiple disabilities also have vision impairments. Wearing glasses which correct vision or having a colour vision defect alone may not necessarily result in any special educational needs.

Children and young people who are born with a vision impairment have very different needs to adults who acquire a sight loss and have had many years of full vision. Significant vision impairment can delay early childhood development and learning; including social communication, mobility, and everyday living skills.
Most teaching approaches take vision for granted, so making sure that children/young people with vision difficulties achieve their full educational potential can present significant challenges.
In order to understand and address these challenges, schools need specialist advice from qualified teachers of children with vision impairment (QTVI) from the Sensory and Physical Support Service.

Hearing impairment can have a significant impact on a child’s educational development in some cases resulting in learning delay and reduced curricular access. This will usually require careful monitoring by schools and the Hearing Impairment Team. Hearing Impairment spans a range from mild/moderate to severe/profound. It can be temporary or permanent.
Most students with hearing impairment will have been diagnosed at the pre-school stage and will have accessed some level of support from the Hearing Impairment Team and Health colleagues. It is possible for some students to acquire hearing loss late in life through accident or illness or a genetic condition.

A significant proportion of students have some degree of hearing difficulty at some time. Temporary hearing loss in the early years is usually caused by the condition known as “glue ear‟. Such hearing losses fluctuate and may be mild to moderate in degree. They can compound other learning difficulties.

Occasionally a significant hearing loss may be caused by a long-term conductive loss in both ears. Significant permanent hearing losses are usually bilateral (both ears) and sensori-neural (due to problems with the auditory nerve or the cochlea) in origin.
They may be severe or profound and may give rise to severe and complex communication difficulties. A permanent loss in one ear and a temporary loss in the other may also cause significant hearing impairment.
Listening to language through hearing aids and cochlear implants and the visual concentration required following lip reading and sign language is very tiring. Studies have shown that deaf students are also at higher risk of developing social and emotional difficulties compared to hearing peers.

Many students with hearing impairment may require some of the following:

• Flexible teaching arrangements;
• Appropriate seating, favourable acoustic conditions and lighting;
• Adaptations to the physical environment of the school;
• Adaptations to school policies and procedures;
• Access to alternative or augmented forms of communication;
• Access to amplification systems;
• Access to areas of the curriculum through specialist aids, equipment.
• Regular access to specialist support from the Hearing Impairment Team.

Physical Disability

Physical disability is defined as a “limitation on a person's physical functioning, mobility, dexterity or stamina” that has a 'substantial' and 'long-term' negative effect on an individual’s  ability to do normal daily activities. (Equality Act,2010).  However, the effects of physical disability on a persons experience of life and learning varies even for children with the same diagnosis or condition.

For some the influence of their physical impairment may be mild, whilst for others, the effect  may be profound impacting on every aspect of development. For others, their disability may be hidden, such as arthritis, or very evident necessitating a range of individual equipment and assistance from others.  Others may have degenerative conditions or their symptoms may fluctuate across the day.  Some children and young people will have additional difficulties which could include visual or hearing impairment, autistic spectrum conditions, epilepsy or additional medical, communication or learning needs.

Whilst every individual is affected by their unique physical needs in a different way children and young people with a physical disability may often have difficulty in:

• accessing the physical environment
• using equipment and facilities safely
• taking part in learning tasks and assessments
• doing practical tasks and activities, e.g. food technology
• recording ideas and thoughts legibly or to time
• achieving independent work
• developing self-care skills
• communicating with others
• managing fatigue and pain
• interacting socially
• processing and regulating sensory information
• developing positive social emotional mental health (SEMH) & wellbeing

However, with the right support, knowledge and understanding coupled with high expectations and careful planning and a CAN DO attitude children and young people with physical needs can achieve the same as their peers.

• What is a physical disability? PD Net website

What might I see in children with physical or sensory (VI/HI/MSI) needs?

It is likely that VI /HI /PD needs will already have been identified, with advice available as appropriate. However, the following indicators may signal an unmet sensory or physical need…

• Difficulty accessing resources
• Lack of engagement
• poor attention and concentration (may appear dreamy or distracted)
• Work unfinished
• Misunderstanding
• Poor presentation
• Clumsiness/ delayed gross/fine motor skills
• Unusual ignoring shouting out
• Unclear speech
• Frustration
• Lack of confidence/ self-esteem
• Headaches
• Anxiety at certain times
• Poor organisational skills
• On-going continence problems
• Poor self-help and independence
• Poor attendance which interferes with retention of learning and general progress (possibly due to medical appointments)
• Fatigue
• Eye rubbing
• Poor eye-hand coordination
• Holding items close

When would you move to SEN support for Physical and Sensory (VI/HI/MSI) needs?

Schools should seek to identify pupils making less than expected progress given their age and individuals circumstances.

This can be characterised by progress which:

• Is significantly slower than that of their peers starting from the same baseline
• Fails to match or better the child’s previous rate of progress
• Fails to close the attainment gap between the child and their peers
• Widens the attainment gap

For the majority of CYP, HI/VI/MSI/PD needs will have already been identified prior to starting in a setting and support plans will have been agreed but for those who present with previously unidentified physical and sensory needs the following pathway is advised:

• Referral to appropriate medical professionals e.g. audiology, orthoptics, physiotherapy etc
• Referral to Sensory and Physical Support Service, once a medical diagnosis has been given - Oldham Connect

Assessment by the setting may include:

• Observation
• motor assessment
• Fine motor assessment  
• EYFS Development Matters
• ASQ
• Risk assessments and care plans that are co-produced with parents and the child
• refer to appropriate medical professionals to check hearing, sight or for any physical needs
• Monitor and evaluate effectiveness of interventions

Meeting Physical and Sensory needs