Visually impaired children who have other impairments and disabilities compose more than one half of all children with vision impairment. The largest groups among visually impaired, multidisabled children are those with

  • hearing problems,
  • motor impairment and
  • intellectual impairment.

Among those who survive, a great number of children have more than two impairments and a few have more than four.

Since the possible combinations of the different impairments and malformations are numerous, only the common types of problem are covered in this manual. The following problem areas are common in all countries:

  • dual sensory impairment in otherwise healthy children, the so called Usher group.

  • vision impairment in hearing impaired, multi-impaired children, the so called rubella- or syndrome-group.

  • visually impaired children with unrelated delays in cognitive development, Down Syndrome is the most common cause

  • vision impairment in children with motor problems unrelated to the cause of the vision impairment, no brain damage

  • vision impairment caused by brain damage that also causes motor impairment. There are often deficits in several sensory and associative functions and delays in cognitive development; brain damage may occur before or at birth or during infancy or childhood due to a wide range of causes.

Multi-impaired infants and children are remarkably alike in all countries. In some developing countries severely multi-impaired infants do not survive and therefore the assessment and teaching of severely multi-impaired children is not as great a problem as it is in the industrialised countries, but children with Usher Syndrome and children with cerebral palsy and other motor problems and visually impaired children with intellectual disabilities are to be found in all countries.

Assessment and management of multi-impaired children requires co-operation between several intervention programs, clinics, hospitals and a large number of specialists in different fields. Quite often it is necessary to carry out the evaluation together with the representatives of several teams, e.g. the vision team, representatives for the school for the deaf or for children with motor problems and for the resource centre for the visually impaired, the local peripatetic teacher and a representative for the organisation paying for the devices and services. This is often a challenging and fascinating task.

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