Lightboxes in assessment and training/stimulation

Lightbox with visuotactile pictures is an important plaything for severely visually impaired children. The infant in the next video (only in LH Materials CD) had delayed visual maturation and had become aware of vision a week before the video was taken at the age of six months. His head control was poor but he was able to track large high contrast objects. When placed in front of the special lightbox developed in co-operation with Ekeskolan in Örebro, the infant was so absorbed by the sight of the back illuminated picture that he kept his head up for the first time. We were all so overwhelmed by the sudden capability of the infant that we did not stop the stimulation - as we should have done. It lasted far too long a time.

The idea with the big lightbox was to combine visual, tactile and auditory stimulation so that the child would first play with a real object (here frog of thin material, filled with nylon pearls), then with its visuaotactile picture with borders raising 2 mm from the surface and finally with the flat drawing.

A small lightbox has served nearly twenty years as a versatile plaything for young infants. The switches are in front of the lightbox so the infant him- or herself can turn on and off the light. This gives the infant an opportunity to make a decision on whether to have the light on or not and how long to use it. Opportunities to learn to make decisions are rare in the life of disabled children. We tend to make the decisions for them. Therefore play situations involving choices and decision are important.

Little lightbox with visuotactile pictures and with auditory stimuli recorded during the playsituation when the child played with the picture or an object that then is hung in front of the illuminated surface. The auditory material is taped during the play and played when the child watches the object on the lightbox. The use of the auditory material has proven to be too demanding, very few therapists and parents can take the time to prepare the auditory material.

A severely hypotonic child may become so excited by the illuminated visuotactile picture that she keeps her head up for much longer time than she usually is able to.

Lightbox can be used also as a landmark to which the infant is enticed to move. This infant crawled to the lightbox and spent quite some time watching his hands, moving each finger in turn. This was the only situation where he could see individual fingers as shadows against the bright light.

When a young child has lost vision and has only some light perception with projection, playing at the well known lightbox reveals that the child still has eye-hand coordination although exploration is tactile. She did not see even the 2 cm black lines but drew her hand across the lines when she should have drawn it along the lines.

See the video

Older children may use lightbox to see their hands better and to see hand movements when playing with special playthings made for the lightbox.

Since hands are the "second eyes" of the visually impaired children, awareness of them makes it possible to start to use them. A severely visually impaired infant needs guiding in learning to reach out and explore. Although it is the typical to the next period 6-9 months, its foundation is laid during this period 3-6-months. Patricia Sonksen's and Blanche Stiff's book "Show Me What My Friends Can See" (see References) contains nice examples how to guide hands and arm to reach out. As long as the hands and arms move aimlessly at the shoulders, they should be often guided to touch each other in the midline. Bringing hands to midline, creating a concept of midline is an important step in motor development. In some children, bringing hands to midline helps them to bring their gaze to midline.

In functional assessment at this age we remember to assess vision for communication and for awareness of own body and the immediate surrounding space.