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O&M Skills and Expectations for Students with VI & Complex Support Needs

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Presented by Suzanne Dinwiddie (TN Deaf-Blind Project) on 12/6/2023 TN VIVA 2023-2024 Session Description: All students with VI should have access to appropriate orientation & mobility services. Presentation & discussion will include key sources of data and appropriate scope and services/skills for students with VI or DB with multiple or complex disabilities.

Show Transcript

are you recording all right good morning everybody this is Alan Wong with the Tennessee School for the Blind here with another Tennessee via visual impairment virtue Academy professional learning session we're really excited to have you guys here post-thanksgiving Prix winter holidays and just really glad that everyone is here to spend their time with us really excited that today we've got Suzanne Dinwiddie of the Tennessee death one project to share about Owen M considerations and priorities for kids with complex support needs and so I really appreciate you guys taking the time to join us and tuned in and see what she's got to share let's see just in case you guys plan on requesting credit for your wife participate today we have a link in the chat that you can use to go to a page and request those credits in for those who are here the opening code is travel travel I'll type that into the chat all right and Suzanne that's all I really got thank you so much for your time and your willingness to do this for us and I'll let you take it away thanks let me get my computer setup can everybody see my screen it it's on the right one of the Great. Orientation in Belleville children with complex needs one of my favorite topics and I'm going to talk a little bit today I'm assuming we all have a basic knowledge of kids with complex needs and cortical cerebral impairment so I won't be doing a lot of information we all already know about but I am passionate about King and child moving self-initiated movement is a component key component to learning and if your restricted in your movement your restricted in your learning and we want to get our kids going so I'm going to describe the child on talking about the Indian Ophthalmology has done a research a lot of the International Studies have done a lot more research than the United States and it determine 70% of all children with complex learning medical nage have quarter of cold cerebral daily parent this is not going to be raining but if you've got a complex kids you need to try some of these strategies and see if they were Millie Smith is not the primary Avenue for learning for these kiddos if you're giving verbal instruction it is insufficient touch and auditory supports are the basic First Learning Avenues and and if you cortical cerebral dish on Pyramid 52% of those children have auditory delays movement is really Austin adult initiated our kids are passive so we need to work I'm getting our kids interactive and then acted in our environment their environment patterns of movement developed by repetition I'm going to steal a story from my friend patients Richie is she I think it describes it perfectly if you are a snows here and use the first time ever came to the top of the tail and a head Christine snow going down and the skier attempts and goes down makes it all the way down and is successful in his goal he thinks I'm going to try this again so when he goes back up to the top of the hill he does I seen where I've been before this is the way I'm going again and again and again you repeat the same action that gives you the result that you're looking for to the point that it can be difficult to change the past cuz there's wrecks so those rats are almost think of neurological Pathways that I do kids develop when they have a movement that gets them it's purposeful too extraneous body movements turn on and turn off visual information and I really think about dr. Rachel peeling and the UK who is an ophthalmologist that also focuses on CBI that has the term a rock to block spin to see she talks about some of her kids that she sees rocking with on the autism spectrum disorder as an attempt to block made peripheral vision and spinning to see is activating the Vision Source so we need to look at our body movements of our kids and what they look like when they're trying to use turn off their vision cuz our little guys cannot visually just to Dynamic settings in so everytime we touch a child news it can be challenging to their visuals I got this from Chris Russell and I really like it and I like the way he has been divided up visually was very easy for me to understand and Chris Russell at work used to work a lot with Christine Roman has divided the three phases of CDI in 24 divided phase two and a half but for movement orientation Mobility Services Reasons I'm going to focus on the movement so the child is what we consider in Phase 1 of cortical cerebral visual impairment look at the majority of the learning Avenue ITS Tactical and auditory and remember again auditory delay in receiving information so the orientation there is about 2 ft distance from the from the child you really need to think about how there and exploring themselves and anything within their touch Vision does not support any self-initiated movement if they're moving it's not visually motor more than likely laterally Phase 2 is about up to you forfeit distance and there is some movement now this is a real area object permanence which is so important for movement because that's part of the motivation it's out of my view I remember I had it where is it I want so these are the kids that you're really working on putting. just right out of there right out of the range of touch trying to get them to move light fixture you can see up to 68 you're really using a lot of visual information if these kids are in the class you may actually be able to start a learning experience in a small group or without their without objects that are not within their reach their vision is such as you can start using some visual cues to help them phase 3 you can see it's predominantly Vision but then that face 3 is when we see a lot of meltdowns a lot compensatory behavior for movement because they're using their Vision but every time we change environments people pacing of materials language that were using our communication modes we have to go back and have support that they had not had to use it may he take more color this man more Define spaces and you get a lot of visual fatigue so all that describe the kid with complex needs describes a child with CBI and how it gives challenges to movement just going to get some so we're on the same page what I'm talkin about so the move it when we think of it we really think of the door what strain is designed to update current information and routes as a child says a person's moving through space but this is not stored information this is in the moment I'm walking through the rain and I'm taking individual info Station 2 to use it and it helps create an unconscious 3D map of their little world and surrounding does that Mental Math doesn't match the reality then there's going to be a disconnect between the brain body will be lack of ability to move purposefully and there's going to be a real disconnect with vision in the lower limbs and the Brain processes images that are moving in a different total placement images that are not moving so exhibition teachers are assessments really need to reflect and Report how they use your vision when there's and sitting is totally different when they're moving the visual abilities in the supports that are needed and that's important for the onm instructor inability to see fast moving objects did you see objects moving alongside the student which is important because where are we oh yes we're walking alongside the student so from them to even be able to keep up with us may be challenging and good morning visual looming I like that word actually recognizing that something's moving towards us and we can tell because it's getting bigger as it comes towards it our children unable to recognize this because there's a lack of understanding of depth and depth perception and movement an open space if anybody has heard me talk you know I say this and if he webinar open space disconnect that brain-body connection that has to be in constant communication and it is negatively affects movement and getting through the environment so we need to make sure where our children are located in their environment to get them moving and keep that brains body connected so those compensatory behaviors may not, I wanted to get some background on let's talk let's have some fun and talk I want you to see this little guy he is 5 years old he has cnv he was diagnosed with CBI 3D range was 2200 phase 3 this is the way he likes to sit and as you can tell with that posture he is biting regular issues he has a profound chin up eyes down position that he uses to see and he's totally out of touch that sloppy body language and that sloppy body language is a real red flag to visual field preferences and they can't get him to do anything this is a child that is like a bull in a china shop and because of is a body language he has a really hard time he needs to go back to early Phase 2 really stretch he has to be anchored his body has to be anchored he has to use color he has to limit how much many objects he can have he needs to have to find space and really supported seating so he really needs it nobody supported to be able to reach out and the format 3D picture mental image of his work space but that is exhausting to him he needs a really brakes for you need to be able to have a space where he can Lounge maybe like you see on the picture on the left and this needs to be established before there can be a really good walking pattern this is also a child that would not respond to any language to redirect it or understanding the body placement this is kid that needs touch and needs external support to understand where he is so when lose. See that chin up is like a pinball machine walking down the hall in the first their first response is a classroom teacher was to take his hand and walk real slow in the middle of the hall and when she did that it didn't allow that chin to go straight up so we could see the ceiling lights and when the slower you walk the more child will dear so we did just doing human God walking at age appropriate pace and helping him with that skewed center of gravity when that chin goes up at health center of gravity is gone and with just Simple Touch of human God he can walk along and keep Pace with his peers of these because things are going to be talked about what kind of identification do we can make kids with complex needs but we're also going to look at some mobility issues that we're facing with that and that's we're going to talk about visual field preferences Mixed Field preferences the complexity of difficulty with distance viewing new and unfamiliar environments in difficulty with array crowding Club clutter and that disconnect between those thighs and legs but on this particular but I wanted you to look at this little guy made this is about the mix preferences and Perkins it says 82% of kids with CDI which means our kids with complex needs have singing Asian string business and maybe I have an Actuator motor with nystagmus it maybe those field losses that have you as cute head turn and I did what station on this kid last week and as you can tell this kid was not moving independently depended on adult intervention to move initiation but on his left eye the right side of the train he could access Visual information in his peripheral filled up to 36 in a way which is really good that's a lie that left I almost midline 14 to 18 in and of course that's important cuz that direct gaze mean is going to the down the ventricles string did the temporal lobe which is the filing cabinet for information for when you're getting that Direct understanding and then the right eye this child used when he was doing things on the right side again 14 to 18 in so where do we start with this kid with it with making him an active participant in his world to want to pursue and take a simple greeting routine of course you start a Honda best Asian sides left side and can see you with the peripheral vision that I was three feet away so we can anticipate you coming which is a very important learning skill that is not seeing your face he needs color he needed to touch touch the child and underhand and that is when the movement I would use would be bringing his hand and myself to write almost midline so he access me and with his central vision and this is really good unless of course we're maybe two auditory which shuts down division or too loud overstimulate since that shuts down division and again difficulty with the facial recognition but with that we can see that what we want to focus on is positioning and items where to begin and providing the the adults providing the movement to get the child to scan to track to the interactive visually and informative faith in his environment and I talked about difficulty with facial recognition and I have been into I've movements lately because of Rachel and Leah and Whitefield because they got me down another Rabbit Hole I love this picture of a person scanning the face and you can see where they're focusing on the Salient features of eyes a mouth and eyes are just covering Colfax trying to see and identify this picture this person are kids with CBI this is the way the eyes track that's what we need to know for the oculomotor we need to know what weather using we need to know what visual feels they don't have access to and what I find most interesting is if you look on the left side of the picture which describes the right side of her face you can see that this person really looked at that left I got the mail but when you started on the right side look how scattered it is that person would never recognize that child again especially if she took off that scarf or had her hair down and changed other as features about her but these are the kids were talking about so what kind of visual information are you going to use with this child how you going to quit that job and movement because vision is not going to be accurate and successful and all forms so they can even have clinically measured full vision deals and not access them using because it's neurological they have limited courses makes a great impact on movement and kids with CV I require information to present be presented in a way that matches their visual field and this is also when you get a lot of those non-traditional movement patterns established because of that visual. preference and we say preference because it may not be a documented Medical Loss but a preference neurological and where the brain is remembering the information and this is what they look like the bottom scooters cuz we know our kids don't like to rotate their trunk they're back scooters because they can be independent because they can keep their views their vision and once they change it's like that dorsal strain when you turn your head you change that mental map and they're unable to do that make those Dynamic visual changes the kids with the chin up ice dam throw off at center of gravity and make it to where they need more external support for that they don't like to change positions if you're assessing the kid and they're turning their whole body or their whole head as you get them to track you need to do wonder why not saying they will have a visual field preference but that's a red flag that's floppy body language like the little boy we just saw those feet and legs and those feet and eyes are not going to be connected and it's going to take touch and support to get them walking in a group and then there's the kids with no absent or altered reciprocal swing if you're walking with a kid that does not have a reciprocal swing you really need to look into it and all our kids are complex needs have those untraditional positions in walking okay that means retinal r p diabetic retinopathy retinal disc LP that has had laser correction color match a generation cryo retinal retinopathy macular holes or puckers all of those are going to have little blips visual field that we need to watch for that's going to affect their movement and scanning for information optic nerve optic atrophy onh neuritis at swelling of the optic nerve and of course thing from the optic nerve has to go through the thalamus which filters out anything it doesn't understand that takes in the sensory information that's the most prominent that it understands which may be auditory at the vision is incomplete over on the right you see all the different conditions that cause visual field loss or preference we need to know that a traumatic brain injury about 50% have been diagnosed with CBI and they have him the option it can be temporary but if it's a traumatic brain injury once that damage has healed and it will matters what is left to see what the f tumors sticklers charge so we need to look at the medical information and if you have any child with any of these conditions or disorders we need to really think about how they're using the visual field let's see if this works out on this fascinating stop my share I'm going to share something else so has anybody work with kids that that we talked about it you think probably has the that might describe that do you want see my cloud strategy to see okay hold on I did that incorrectly that is what I want you to see but not right now hold on stop share I can show you this first now do you see thermo-tec nauseam you'll see the transcripts down here if you can't hear him well and also we have the closed caption that should also do it it's about a 40-second clip it really shows what they it looks like when you can only see one thing at a time putting Parts together to make holes and the inability to locate those Lawrence Ender Dragon is it going to control I really did not know they may have trouble maintaining the fixation they may want to look at one thing and their Vision go to another really thinking about that a child with this kind of complex environment so we're putting that all together to get a picture of who were working with and the challenges we have for the movie and that's that guidance we we talked about the sloppy body language the trips falls under are overstepping When approaching different depths changes difficulty grass pushing pulling besides in off and again does non-traditional compensatory movement develop so let me take that pistol Chiefland this is a three-year-old who is trying to get into entering preschool in the surrounding County and I'm working with the guy and a PT and as you look on the picture you'll see on the left they have the red discolite they have a chance or tan de shun script couch and tan wall and they've put orange cone a rabbit a lighted cone the bags down there the paper and pencils down there to describe and this little girls challenges is she had she's tied to oxygen so they're always going to be an adult present because she has his long tube that carried was like a mini suitcase and she had to have and she has a really pronounced chin up she can crawl and we put this down here trying to see what she would crawl to First and a I got to guess what it is what do you think the first thing is she's going to go put it in chat how much Austin call it out where can we get this video I can just stay in this cuz nobody tell me Susan you can get that busy a video on the Gordon Dutton CDI Scotland really powerful closest item Anita saying they're going to the closest item season Save-A-Lot let's watch where this little munchkin go the one thing she's not supposed to have the pan it was placement all the other likes nondescript it was that little blue back pain on the white paper and she made a beeline for it's also where she keeps her eyes they were trying to get her to have more chin up using her vision while she is moving and I find that fascinating she is independent when she crawls she can find her way through the house she can get her toys or die trying to transition her into an upright movement they have a walker The Walker is a reverse Walker so it's really nice her head goes automatically down and she uses no vision when she walks so they came to me and they wanted her to get up right that's look at the second slide okay one thing this is the physical therapist I want you this is what I want you to look at it hallway has lights on it we're trying to get her to see where she'd can visually find these items when she's up right she it's tied to her oxygen again and her trick to let's talk about supports for this child and what happens I'll probably stop along the way okay hello first of all you said chin up ice down and dust Agnes starts Now when she's stationery and sitting you're not getting this Douglas like that so her hands are up around her shoulders that Pete he's trying to do hand underhand and what they want is for her to walk up and touch any of the lights on either side this is open space to this little kid one step that chain goes back now she watch again are Gazette nystagmus in trying to determine how far and what she can see why she knows they've controlled her upper body that center of gravity chin going up is more exaggerated and it controlled her hands so she can't reach for it if she wanted to it's it's not it's it's not to say there to say they need a vision teacher to help monitor this it would be getting that positioning down by her wasted don't maybe being actually on the floor or something that she can scoot around with maybe they needed to use the walker in this position some kind of support maybe start with a standing position where she stationary standing position where she can touch wall that gets her some trunk support it could be a high desk that comes up to her death at to her chest or she can lean and use it but what's cheese upright visual abilities are limited and her movement is limited always going to be tied to a person one thing we did we put on gave her a I don't have a video of it cuz I didn't she was in your room. Walker I put on my black Dollar Tree apron with my yellow duck with light on it it was a Batman tummy level which is about her eye level and that was walking in front of her about four feet trying to get her to visually attend two digit division to move towards while she was upright moving I would like to tell you it was successful they're still working on it she tends to turn her head away to avoid that visual information so this child G at 2 division in that movement in the legs together but work is this little girl she's a super crawler I get that does she it independently upright in a chair what's your vision like when she's just sitting upright versus standing upright and does she transition herself from sitting to standing she did not transition her SEPTA sitting to standing descending even sitting she loves that trunk support and she can look at it and reach something right in Arms Reach but she wants it up close and she still really passive when she uses her vision but as you saw when it's something really motivating the little Chiclet can move so it's getting her friends and I would love to any ideas getting her to addition to that different body position it is has just been trying that's what I needed ideas made biblical and I think the people need to know that the transition for our kids without vision is like then that 9 to 12 months but it may be 2 years watch it with vision and she can really get some of these transition positions and once you start moving their body you have messed up what they can see and they are not to spend successful and they need motivation and they need a reason to do it those lights were really reason enough but if you got me don't hold my hands if you want me to go look at something and reach it the bed is the trick cuz you need to keep them safe but you need to you got any other ideas what else would you do Suzanne I have a question to I'm sorry going back to what they do is talk when she was going to that pee and is she consistently go to the piano was that a one-and-done when she called to that pain and she did not offer her that pain several times what we do do is put other small things that were dark on the floor and what we found through this was that's where her vision was that's where she was interested it was not anything on the couch so I am suggesting it is location and it did not need the lot because that's where her visual field was but you can tell you're hooked up really hard and this is what happens with our kids here's a little nugget look at where the adults are applying external support that our kids needs so but on the left not only is it steps and open space her hands are up over her head and she has no use of her fingers She is totally passive there is nothing and she is not learning how to say Chesley go down steps on the right this little town is so small and she can Trail but she has fatigue issues we need to be down on the stool providing at at the waist or the occasional in a minute support to keep her walking and if she's tired we need landmarks that provide balance that provide orientation where they can actually stop and stand and regroup cuz they kept they can't use their visual other moving so we need to think are landmarks if we've got complex kids those landmarks need to be more than a visual a reminder where you are and needs to be arrested it needs to be for orientation at needs to be for stability and needs to be for bounce so they look different is that what do you think the balance between moving their body and using their Vision if you have to focus on one thing first you know what I'm saying like that little girl you can move their body but they're not going to use their vision and it lets things with your own body they're not going to use your vision so I sometimes think. do we worry as a vision teacher this is hard for me to say but do we worry too much about them using their Vision before we've got those bass body movements down in a safe comfortable way it's hard to do both at the same time because your pants cuz you're like they're going to be too and they're not doing this anymore to do anything but the desire for that parents and and is it for the older kid I'm going to speak to it as an Eminem person is it snowing in person I want them moving if they're not using the vision yet that's where they are so we can get them moving and that's where you adapt to your the external supports that they continued I've got a few more pictures that may show some of those supports and then you stopped their bodies so they can use their Vision so you move without your vision you have a landmark where you can stop once you stop you can activate that visual system and then you move again so it's got to be shorter ranges more landmarks to find Space external supports with amd's trailing a Walkers and she loves your vision when she didn't is he up and visit, things you did this is from Leigh Ellen and what they did with this child put up at his backpack on him and minimal items in there just to give that sensory input sensor input goes in to our kids who are complex need that sensory input they're coming into the body so the motor can go out and it may be continuous or maybe intermittent so when they're do you can I see these kids teacher show in the middle Trails but also uses diagonal to keep afloat movement going safely and knowing where she is I picked this picture on the right because his own image structures we need to be careful because when we introduce a a adaptive Mobility device and Pre-K get that face forward and gives him a little bit more stability on where they are and movement but when they transition to a cane you're putting them out in open space they have to be strong enough to hold that hand in the right position and we need to be careful and do dying up do diagonal or Constant Contact because once you pick up that cake to do touch technique it's it's you've lost contact again and it maybe even in a blink of an eye too much to lose that Constant Contact so we need to think of a daptiv ways throughout the whole I need to hurry up you're some more adaptive this child on the left this is where she gets her lunch everyday she can't carry to try and walk she can't use her vision and walk but if you give her that cart she can look she can drive keep face face board and she put her try on it the child in the middle walk all the way through her playroom halfway through there's an ottoman she stops you can tell she's doing her little distributor thing Shera groups in Chico's on guy on the right Independence Trails when he gets to that black ASL sign he put both hands on the wall using the left hand for support the right hand goes to the doorknob so he's moving he's functional is operating within his environment tell us of the things I'm talking about and this helps them use their vision and if we have to talk about the balance in the brain Body Connection this is a child as much older is still on a Pre-K but adaptive Mobility device I think pre-cana is a bad word when you get older because she can't her brain and body connected when they give her a cane she loses where she is in space and then complexity oh my God mad taken says it is more interfering than any other CBI quality is not about us it's about complex complexity and your vision will shut down and you will not be oriented I am confused this I got the out of a magazine had this as a cute little thing to do and when you walk into that room you're going to it's going to require additional support that are not needed in a simplified high-contrast set can you imagine the depth perception when you trying to walk on that rug for example this child is getting it at a distance Acuity 2200 high contrast one at a time simplified object 2200 you put the same information in a crowded room lesson 7 ft away you can see the lady in gray holding the house Leah car can you get him to look at it shorter distance and in a different environment totally different a cutie so if you're doing a vision you better be talkin he's better getting those cutie in a variety of different set so what did the teacher do look how she's so smart she divided the wall into yellow and black she put her his schedule there he can get this visual information he is a visual person but he couldn't walk to it without that and then when he does cafeteria work they did different security there it's when everybody out and he actually got better than 2200 in the cafeteria so what we need to do is an example of I'm trying to think of what I am looking at my piece of paper what I said assessment of course I can't find it is he needs high contrast he needs the environment is the most important thing for him is what I look connected to it and then Matt Teigen complexity this is where I'm going to say how much what time do I have 8 minutes yeah 70 minutes I'm going to come back to this if I have time that it is something so intentional Movement we want wismec component in every routine they needn't remember that fatigue stress and a disconnect of the brain body is going to really interrupt their visual library and their ability to do their Mobility skills cuz it stressful the one thing you will learn and do it in and need to continue this is stress and how to deal with a child stress as soon as stress because you're getting them to do things that are less comfortable for them and are motor skills are system scaffold in the development and if there's parts missing future learning is compromised when we skip over stuff and if we have all lessons at the frustration level is the limit the mobility of all this laughing squirrels in that environment in that in the classroom on the right if his visual abilities to use that information is that distance was that background that is high frustration there is no learning and there's no motivation we'll talk about wheelchairs we need Ellen M and movement on wheelchair so we need to make sure they are active participants are going to introduce symbols and vocabulary before we go in a route we're going to label all the parts of the landmarks you have a landmark do you any good if you don't touch and confirm it and the rafts that it's adult initiated we need to make them active participants such as a transfer and propelling their own chair I'm thinking of a child you an hour teacher who no longer moves her own wheelchair but we need say what are you looking for what is next when you touch cues to indicate a movement or direction we need to make them responsible for where they're going in for them to tell us we need a working at the child with the wheelchair and you're going through a door and you like the back in don't just whip it around you need to slow down with that trying to get that really messes with their vestibular system and it needs to be embedded throughout the day and catching up. I'll go to this one and this is one way to do this is a travel Journey on the bottom the the symbols are tactile for the person the riding is for the adult so everybody has the same says the same thing it says turn right I'm in the blue hallway go logo the child is feeling the turning right getting a right tap on the shoulder and every adult that work with that child on that Hall uses the same words so he's an Arctic he can say which way do I go you turn right auditory of visual Learners you take those key component sequence them and once you get to that area like the lobby here Blobby here's the picture where we do this is where we turn right touch your right shoulder so I'll down the hall to the library and just this person had this and do their way lol but I have additional is she weird again I'm going to talk about this you'll feel this is a child in a wheelchair we did a visual field test on this child father was really at but he that child's head goes down in the wheelchair does not look up and we did a visual field to really realize she is not noticing anything besides note is the floor a little bit on the edges and she is they pushed her down the middle of the hall so this is where we put the landmarks every safety on the floor on the right side so she travels on the right side so the more confined space they follow the arrows and at the end of the hall there's a red square that's when she knows to stop when she stopped She looks up did don't helping her with her chair she's propelling her own chair two stops talks to her cuz she can't talk to her while she's moving ask her where she goes next is child can verbally tell you so you may use a touch you while they're moving but you stopped for verbal and auditory information never thought to put the landmarks on the floor and we the father she's not lifting her head when she moved because you can't see anything when she does too far distance just insecurity she can't do it she can see the floor and this is what happened look at this this is the same little nugget look at her every morning I am still see that head goes down but they have workout naturally occurring landmarks which of course is preferable if the child can do it what is embedded in the daily routine to practice functional purposeful movement and I love that good for her and she has to go up that ramp and there's so many adults that want to help and they don't let them okay I would have instructors can really assist you all students regardless of complexity deserve vision and o&m Services I just need to say that you need it I'm going in to consult with your educational those critic skills that are essential to participate fully in the environmental setting designing movement components portions throughout the day assistants and successfully completing daily Ralph when they're getting for transitions or a new mode of travel they need our help here some good resources I want to stop sharing because I just want to share one thing that I did with Dedrick are one child who walked bent over and what is we're trying to brainstorm for the functional assessment purposeful movement and so what Deidra did in the head higher desk so in the information was up higher which forced him to be more upright which encouraged him also and his movement to be more upright and then you had Linda 's walk that child to what Mobility other besides Linda did that child use to walk to lunch I think that was it I don't think he had any type of a I don't think it was a wheelchair to but he did a human guy we had to push it on wheelchair cuz he could walk but that use the wheelchair for extended travel and so we had to push his own wheelchair external supports keeping Facebook you have to maintain that posture that we're really in really is that so that was that was quick any of your guys and working with the really complex kids you got a question for I got to get them moving and we want we accept non-traditional we want to build on that it's how I feel about it the bottom scooter I've got one bottom scooter that we cannot get to won't crawl and is going straight to a walker if was in a wheelchair and now it's going straight to a walker because that's still kind of you can still keep that torso kind of Steph hey hey I'm sorry I didn't know other people I just got some great people on here they know more than me that would be good Amy what do you have anything to add are you listening yes I'm on my phone now you're doing you know everything Amy was my mentor she is the one that taught me that I have to use it has to be functional it has to be meaningful or it's not going to happen to movement not going to happen what is the Sam okay do you have anything to add these are all great on in we have some famous own ends in Tennessee I sometimes struggle with kids with complex me vision is a tvi and as an o and m instructor so that's not my strong suit so that's why I'm here to learn and I've been doing it for many years but that is where I really struggle now in teaching kids who have very complex especially if they are they have Mobility you know just what their hands and of course with their legs and feed the cognition component to so yeah it's just that I am working with a group of good related service Personnel helps to we can kind of I think we try to train are related service Personnel in Montgomery County about see that you know that b c d i and that has helped them to I think Renee serve children with complex needs Innovations in complex needs to so so I don't know who's boss I have stuck along with battery has stayed alive Suzanne thank you so much so much for everything you've shared today it was cool to see some of our awesome onam folks from across the state has been today so hopefully everyone here lives has gotten some great things to take back to their students and think about how they can you really think through all of us metals of you know looking looking at all the little details and not jumping to conclusions or and what not let me stop this recording today and for the rest those who are tuning in in this will be this will be uploaded as soon as we can to the resource center website see if I can do that

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