Level of Wakefulness
6. A severely visually impaired infant may have so littlevision that he/she is not even aware of the presence of visual information. Theinfant does not open the eyes and looks sleepy. Therefore the infant may be leftin the crib. However, these infants should be kept on lap nearly all the time inorder to learn about the existence of themselves and other people and to become moreactive.
7. In the activation of a visually impaired infants andchildren adult persons play a more important role than in the play of a sighted child.When the child has a company of an adult, the activity level may be quite normal.
8. When some visually impaired children are left aloneto play, playing may stop in the middle of a movement.
9. Visual stimulation can be effectively used to improvethe child's state of wakefulness, to cause arousal.
10. In the morning when we wake up and open the eyes,the visual information (arrow) flows from the eyes through the visual pathways tothe reticular formation, a long network of cells extending from thalamus downto the upper part of the spinal cord (stippled area). Visual information activatesreticular formation and this increased activity is transferred through the ascendingfibres (arrows) to all areas of cortex causing arousal. If there is very little visualinformation, the activity in the reticular formation is low and the general activationof the brain is also lower than normally.
11. When we use visual stimulation, visual informationshould be well structured, use high contrast, simple forms and we need to carefullyavoid overstimulation.
12. Overstimulation is especially dangerous in the prematurelyborn infants. Therefore stimulation needs to be short and the child's generalstate needs to be observed carefully.
13. In the visual stimulation of infants in the incubator,we can use easily washable plastic figures with simple geometric forms and picturesof faces that are known to interest young infants.
14. Infants who have been operated for cataract needto get their spectacles soon after operation, first as temporary paste-on glasses.
15. One of the most effective visual stimuli is theface of the mother. In this case the infant operated for bilateral congenitalcataracts is a twin.
16. The child's own activities may cause the stimulation.Here a big balloon is tied to the child's wrist, then the child's movements causemovement of the balloon. This is very effective visual stimulation: when the childmoves the hand, the balloon moves and when the child moves the hand again, the balloonmoves again. So there is a possibility of the child learning the relationship betweenhis own movements and the change in the environment.
17. Movement of such a big object at near distance canbe seen also by visually impaired infants and experienced exiting. The infant ishaving his/her first lesson: He/she does something, something happens, he/she doesthe same thing and the same thing happens again.
18. We can tie high contrast toys using Velcro on thehand or wrist of an infant. This is also one of my favourite toys during dynamicretinoscopy, i.e. when I try to get the infant to focus at the distance of the retinoscope.
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