How is BOS Blind Working in Hungary?*

Transcription

1 How is BOS Blind Working in Hungary?* Beáta Prónay Eötvös Lorand University Budapest Institute for the Psychology of Special Needs *The European Union and the European Social Fund have provided financial support to the project under the grant agreement no. TÁMOP /B-09/KMR Chief researcher: Miklós Győri PhD

2 Research in vision impairment Researchers are isolated & have divergent interests & methods We suffer from low or no research data We access even less research publicated Our field is missing objective instruments in general We mostly rely on our individual experiences & knowledge 2

3 Background of this presentation Research series Prónay WISC, ITVIC, Oregon Project BOS Blind Csákvári PSI III (Parenting Stress Index) SIB-R (Scales of Independent Behaviour -revised BDI 2nd (Battelle Developmental Inventory) SIS (Support Intensity Scale) 3

4 Goal of this research Via research discovering new context. To get comprehensive data about the characteristics of our changing population versus Assumptions based on personal impressions derived from practice Valuable but spontaneous observations of individual abilities and development. 4

5 Michael Brambring Bielefeld Observation Scale (BOS), (1996)

6 Reasoning Recently the population is changing rapidly. We have valuable developmental features reported and generalized from individual assessments. We need objective measurements. Our field needs to combine practical knowledge and research findings Individual approach and research can be usefully combined 6

7 Development & specifics of BOS Blind Brambring & research partners & early interventionists 10 blind (blind 8, light perception 2) child Longitudinal study - 5 years Result: criteria referenced list of developmental items mirroring development of blind infants, toddlers and young children, 0-6 years (NOT DEVELOPMENTAL TEST) Reference criteria - intervals Typical development, typical but in case of blindness, Retarded development 600 different developmental skills, 56 different qualitative aspects of development can be assessed Very much detailed in the first year 7

8 STRUCTURE of the BOS 11 books/scales 1-2. visiting records, case history & course documentation 3a developmental assessment till the age of 18 month (chronological or developmental age)» Posture & balance» Self-initiated movements» O&M» Manual skills» Daily living skills» Cognitive development» Language development» Social-emotional development 3b Problem behaviour in children who are severely retarded Developmental assessment after 12 month» Names of books are the same as the subscales in book 3a 8

9 Introduction of our sample (n=21) considered as the first result 9 subjects younger than 18 month 12 subjects older than 12 month 12 male, 9 female parents are with higher education degrees 13 from Budapest, 8 from the country 18 premature 17 born with caesarean 4 needed revivification 6 from twin pregnancy 16 incubator 17 mechanical respiration 9 breast fed - 12 sucking & 12 difficulty in swallowing 12 feeding difficulties 12 still difficulties in feeding 5 not chewing 8 not eating solid food 5 has one diagnosis, 15 has more than one diagnosis (1 missing data) 16 ROP Ocular 15, CVI 6, both 3 9

10 Non or additional disabilities in % in the sample (n= 21) % Non mild moderate Serious profound Missing data Developmental delay Mental retardation Physical disability Hearing impairment Speech disorder 28,6% (6) 23,8% (2) 9,5% (5) 66,7% (14) 14,3% (3) 14,3% 19,0% 28,6% 9,5% - 23,8% 38,1% ,53% 9,5% 38,1% 28,6% 9,5% 4,8% 14,3% 9,5% 4,8% - 4,8% 28,6% 33,3% 9,5% 9,5% 4,8% 10

11 Used books of BOS 3a

12 subjects 3a Posture & balance 3a Self-initiated movem. 3a O&M 3a Fine hand movements 3a Daily living skills 3a Cognitive developm. 3a Language developm. 3a Socialemotional devel. Results of the paired t-test 3a book Paired t-test 3a Posture & balance 9 *> **< a Self-initiated movements 9 *< ***< ***< **< - - *< 3a O&M 9 **> ***> ***> *> ***> ***> ***> 3a Fine hand movements 9 - ***> ***< - **> *< - 3a Daily living activities 9 - **> *< - *> *> - 3a Cognitive developm ***< **< *< - *< 3a Language development ***< *< *< - *< 3a Socialemocional development 9 - *> ***< - - *> *> *p<0,05; **p<0,01; ***p<0,001 The total percentage of each developmental area showed normal distribution, so we used paired t-test. In the following charts we present the results of the t-tests. 12

13 Paired comparisons of performed percentages in 3a scales Mean in descending order mean weight 3a O&M 70,06 2 3a Daily living skills 47,58 1,5 3a Manual skills 44,58 1,5 3a Social-emotional dev. 41,77 1,5 3a Posture & balance 36,81 1 3a Cognitive development 31,94 0,5 3a Language dev. 27,87 0,5 3a Self-initiated movement 26,17 0 Language development is last but one. Social emotional development on the 2nd place. 13

14 subjects 3a Posture & balance 3a Self-initiated movement 3a O&M 3a Manula skills 3a Daily living ski 3a Cognitive dev. 3a Language dev. 3a Social-emot.de Correlations 3a scale (till 18 months) Pearson-corelation (in case of normal distribution of variables) **: p<0,01; *:p<0,05 3a Posture & balance 9 0,863** 0,684* 0,865* 0,728* 0,758* 3a Self initiated movement 9 0,863** 0,829** 0,905** 0,736* 0,800* 3a O&M 9 0,684* 0,829** 0,879** 0,815* 0,824** 3a Manual skills 9 0,865* 0,905** 0,879** 0,774* 0,911* 0,703* 3a Daily living skills 9 0,728* 0,736* 0,774* 3a Cognitive dev. 9 0,758* 0,800** 0,815** 0,911* 0,768* 0,818** 3a Language dev. 9 0,768* 0,690* 3a Sosial-emotional dev. 9 0,824** 0,703* 0,818** 0,690* High correlation between subscales developmental areas are developing together Self-initiated movement has a close correlation with all other areas except Language development Language development is correlating only with Cognitive and Socialemotional development 14

15 Correlation with variables **: p<0,01; *:p<0,05 counted test age 9 0,743* Number of pregnancy born from? 8 Number of child in the siblings row? 9 Which gestation time? 9 0,732* 0,729* Length at birth (cm) 7 Head circumference at birth 6 0,922** Apgar.1 9 0,910* Apgar.5 9 0,675* How much time in incubator (days)? 5-0,897* -0,949* -0,890* How many days mechanical respiration 8-0,828* -0,752* Days in hospital 9 How was at start of E interention? 9 How many month of EI? 9 How many eye surgery? 8 How many chronic deseases? 3 Apgar1*Testing age 9 0,697* 0,720* 0,906** 0,760* 0,706* Apgar5*Testing age 9 0,813** 0,851** 0,897** 0,730* 0,743* (Apgar1+Apgar5)*Testing age 9 0,683* 0,790* 0,909** 0,683* 0,867** Remarkable between Posture & balance head circumference Less significant between but with high correlation coefficient value: all other areas AND gestation time, time spent in incubator, mechanical respiration Apgar shows a very much remarkable correlation see next chart 15

16 FŐ 3a Posture & balance 3a Self-initiated movements 3a O&M 3a Manual skills 3a Daily living skills 3a Cognitive 3a Language 3a Socioal-emot Apgar- testing age & developmental level Pearson-correlation (when normal distribution of variables) **p<0,01; *p<0,05 Apgar1*testing age 9 0,697* 0,720* 0,906** 0,760* 0,706* Apgar5*test age 9 0,813** 0,851** 0,897** 0,730* 0,743* (Apgar1+Apgar5)/2*Test age 9 0,683* 0,790* 0,909** 0,683* 0,867** Age at the time of testing in itself is not correlating with developmental level, but it is when Apgar values are high at birth. With other words: in case of same test age higher developmental level is correlating with higher Apgar value. 16

17 subjects 4th Posture & balance 5th Selfinitiated mov. 6th O&M 7th Manual skills 8th Daily living skills 9th Cognitive 10th Language 11th Socialemot Correlations 4-11th books Pearson-correlation (when normal distribution of variables) **: p<0,01; *:p<0,05 3a Posture & balance 11 0,784** 0,680* 0,712* 3a Self initiated movement 13 0,784** 0,928** 0,983** 0,756* 0,884** 0,878** 0,821** 3a O&M 13 0,680* 0,928** 0,949** 0,888** 0,926** 0,942** 0,921** 3a Manual skills 13 0,712* 0,983** 0,949** 0,825* 0,924** 0,916** 0,872** 3a Daily living skills 7 0,756* 0,888** 0,825* 0,980** 0,980** 0,932** 3a Cognitive dev. 13 0,884** 0,926** 0,924** 0,825* 0,983** 0,953** 3a Language dev. 13 0,878** 0,942** 0,916** 0,980** 0,983** 0,963** 3a Sosial-emotional dev. 13 0,821** 0,921** 0,872** 0,932** 0,953** 0,963** Significant correlations between subscales (p<0,01), exception: Posture & balance that correlates only with other movement subscales Language correlated in the younger age group only with Cognitive and Social-emotional subscales, In this age group it is catching up, may be it is natural this way Reliability is very high, all Cronbach alfa is over 0,9 17

18 4-11th Book match paires of percentage Mean in descending order mean weight 6th O&M 46,44 2,5 11th Social-emotional dev. 44,15 2 4th Posture & balance 36,73 1,5 7th Manula skills 31,96 1 5th Self-initiated movement 29, th Language dev. 28,25 1 8th Daily living skills 27,18 1 9th Cognitive dev. 17,64 0 Best performance level is in O&M Significantly lower is in Sociol-emotional, and in Posture & balance subscales BUT they are significantly better than Manula skills, Self-initiated movement, Language, & Daily living skills. Poorest performance in Cognitive development Paired t-test p<0,01; p<0,05 18

19 subject 4th Posture & balance 5th Selfinitiated m 6th O&M 7th Manual skills 8th Daily living skills 9th Cognitiv 10th Language 11. Társas és érzelmi viselkedés 4-11th Correlations with variables Independent sample t-test **: p<0,01; *:p<0,05 One disability/additional disabilities 2/10 *** > *> Central VI (yes/no) 7/6 *> *> ***> **> *> **> **> Statistical analyses proved the visible result: There is a strong correlation among all developmental areas and CVI (except Daily living skills) Those who have no CVI have significantly better developmental levels. ROP has no effect on developmental level. 19

20 Summary In very early development we found effect of Shunt, transfusion, breastfeeding-and language development in both directions. At the group older than 18 month these effects are not any more existing BUT the effect of CVI in itself is determining development. Our sample is neither representative nor large enough for generalization, but can influence attention and practical approaches. Our research was an exploratory one. 20

21 Practice and research are both enriching each other. There is a need for evidence based practice. 21

22 Thank you for your attention! 22