Appetite or Likes	Aversion or Dislikes
Gentle vibration	Other children crying or screaming
Music	Icky, sticky stuff on his hands or feet
Food/eating – especially sweet tastes	People messing with his feet
Water play (prefers warm water)	Soft squishy textures
Green and blue things, shiny things	Cold water
Rough Textures
Metal Objects

 

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Pathways to Learning Summary Information:

How well does the child use each sensory channel?  Assign a percentage to each, with 100% being a sensory channel used well to get information, and a lower percentage for a sensory channel that the child is not able to use well.  Describe the child’s behaviors that show the reason(s) you recorded that percentage.

Sensory Channel	%	How do you know?
Vision	20%	Nystagmus, exotropia and suspected CVI – responds to light and a few colors (green/blue)
Hearing	50%	Responds to music and select people’s voices ….. possible auditory processing since he seems more in tuned to pitch/rhythm and has CP/Seizures
Touch	75%	Does not use many exploratory patterns with hands and feet, but does seem very responsive with mouth, lips, tongue
Taste	100%	LOVES to eat
Smell	30%	Seems to recognize food prep just by smell
Movement / Proprioceptive	10%	Unsure – has ONH and may have some issues being aware of own body

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Other Considerations

Include other information that might be important to note in planning, such as seizure activity, special diets, allergies, etc.

• • STUDENT has a seizure disorder with many seizures throughout the day.  Special consideration should be given to materials, need for breaks, duration of activity and so forth. He is also on a Ketogenic diet so special consideration should be given to any foods used.
  • STUDENT is suspected of having CVI and a CVI range might be needed to help pinpoint accommodations to materials and environments.
  • Given diagnosis of Optic Nerve Hypoplasia there may be some additional issues related to body awareness.

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Questions

1.  What are possible attributes of materials that might appeal to his/her top three sensory channels? (Color, shape, texture, size, etc.)
Blue, green Rough like sandpaper, scratchy Styrofoam, emery boards, etc. Slim profiles since grasp is not well developed Things to poke fingers in Likes metal – chains of all sizes Lotion, lightly scented (check with mom about preferences and seizure) Burlap bag of coffee beans, hard candies Water and sand play
2.  What do you currently observe the child doing with his/her hands (e.g., grab and release, bat at fisted, transfer hand to hand, throwing, scratching)?
Scratching, Batting Grasp (but not let go)
3.  What do you currently observe the child doing with arms, feet and legs?
Moves and kicks legs and arms Pushes up with forearms and hands when prone Goes into hyperextension and lifts arms and legs off the ground while in prone
4.  What do you currently observe the child doing with his/her head, mouth, lips and tongue?
Sucks fist Opens and closes mouth and thrusts tongue when being fed. Moves jaw up and down. Combines vocalization with mouth and tongue movements. Moves tongue from side to side. Closes lips over spoon to feed
5.  What kinds of vocal play do you observe? (e.g., babbling, squealing, clicking, etc.)
Grrr sound Squeal Awah sound
6.  What sounds does he/she respond to? (e.g., dad’s voice, computer generated sounds, door slamming, etc.)
Music Mom’s voice
7.  What kind of scents does he/she like or dislike? (types of smells or particular things that smell)
Food smells Check with mom about essential oils and lotions she likes to use
8.  What kinds of foods or flavors does he/she like or dislike?
On Ketogenic diet Likes sweet things
9.  What kind of touch does he/she like or dislike? (e.g., light, heavy, deep pressure, etc.)
Deep or heavy

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Social and Emotional Development

In order to utilize the best educational approach with your student, what Dr. Nielsen calls the Five Phases of Educational Treatment, we need to look at the child’s behavior.  Look at the behaviors described below and place an X in the row(s) where you see behaviors that are demonstrated by your student.

Developmental Age	Child contacts or responds to contact by:	X
Birth-3 months	clutching fingers or some hair of the adult clutching some of the adult’s clothing smacking lips, making “grrr” sounds by nodding, sucking, and grunting can be calmed by being taken in the arms and cuddles transfer of clutching/grasping to biting, pinching may be seen in older children	X
4-6 months	babbling or crying consciously to get adult’s attention or when nothing is wrong may scream or cry most of the day – possible that the screaming is a child’s attempt at babbling may respond to contact by babbling shows anxiety to unfamiliar rooms, persons, toys
6-9 months	molding his/her body into the shape of adults snuggles close to the adult touches adult’s face or puts finger in eyes, mouth likes to be moved from the arms of one familiar person to another imitates the adult’s movements, reaches hand toward light switch after adult turns on light seeing Mom or Dad after return causes joy shows joy when recognizing familiar voices may want to move his or her body the way he or she wants to move their body may be pulling their arms away and, kind of, hiding them may want to sit in a specific way if able to be held by an adult, may want to be held or positioned a certain way
9-15 months	“showing objects” – wants to share interests with adult if adult does not respond, may attempt to establish contact by hitting the adult with the object (banging objects) refuses contact with persons whom he does not feel attached to puts arms around adult he feels attached to wants to drink from adult’s cup or feed adult laughs and babbles in interactions with adult enjoys adult-learner games such as clapping hands and playing with lips may hit themselves or other people moving to the adult (pull to standing, walking or crawling) acts like he/she wants to sit on adult’s lap, but as soon as he/she gets there, wants to get down may lean against the adult briefly, or rest an arm or a hand on the adult briefly
15-18 months	picks up an object and gives it to adult with expectation adult will give the object back if adult will not engage in game, child looks for another adult who will engage in game tests activities that are allowed and not allowed demonstrates strong attachment to one or a few objects often has the need for physical contact, wants to be carried and sit on lap
18-24 months	lends adult most cherished toy engages in building games as a contact game can react intensely to changes in daily routine  throws a tantrum when crossed presents strong feelings of ownership: my mother, my toy plays language games with adults – jingles and rhymes
2-3 years	contacts by hiding and then revealing himself with a shocked attitude  involves adult in hiding games and games of searching for each other  Involves adult in rough and tumble games wants to interfere in activities of an adult demonstrates his will in the presence of other children by claiming ownership of his toy appreciates help with things like dressing and undressing has a strong need for physical contact, holding hands while walking is able to engage in contact with only one adult at a time uses language more often in contacting others has difficulty accepting criticism has difficulty choosing between yes/no, coming/going, milk/juice, etc. can be quite rigid and will change results by demonstrating anger, passivity or withdrawal
3-4 years	contacts by standing next to adult and leaning against him shows great independence, often thinks he can do more than he actually can can become very despaired when he has to receive help from the adult direct physical contact is most often replaced by conversation is eager to help with domestic activities leans against, places an elbow against or looks at an adult to receive a smile or a comment– and then looks at others present to share with them this emotional experience

Describe your general impressions about the individual’s ability to self-regulate, show empathy, manage strong emotions, identify his/her own feelings, read others emotions, and establish and maintain relationships: He is reluctant to work with or tolerate many people.  He loves his paraprofessional and classroom teacher, but just seems to tolerate the rest. Responds with animation to the sound of mom’s voice and is very relaxed with mom, dad, and siblings. Loves to be held and cuddled by parents and paraprofessional. Sometimes pulls hair of adult when interacting. When over-stimulated he appears to go to sleep. Very reluctant to interact or tolerate class peers. Definitely prefers adults.

Ideas for Specific Objects to Include in Instruction:

List the items (Lilli says 70 or more) you want to try using and check to see if the properties match the student’s preferences in his/her best sensory channels as identified previously in this form.  You should consider using multiples of objects with similar but slightly different features. Remember to have a quantity of everyday objects included in the mix.  This can also serve as a shopping list for items you need to find. Our Student’s Pathways to Learning

1. 1. Taste: 100%
   2. Smell: 30%
   3. Hearing: 50%
   4. Touch: 75%
   5. Vision: 20%
   6. Proprioception/Movement: 10%

Item	Vision	Hearing	Touch	Taste	Smell	Proprioception
Burlap bag with beans, rice, coffee beans		x	x		x
Rough scrubbers			x
Emery boards			x
Sandpaper			x
Corrugated cardboard			x		x
Oil filters (clean with heavy cardboard)			x
Metal spoons of all sizes and shapes	x	x	x
Metal measuring cups of all sizes and shapes	x	x	x
Metal strainer	x		x
Shiny blue/green ribbons	x		x
Wooden castanets		x	x
Wooden wind chimes		x	x
Heavy metal or porcelain bells		x	x
Shiny Christmas decorations	x		x
Netting other scratchy materials	x		x
Metal chains of all sizes			x			x
Vibrating toothbrush, hand massagers		x	x
Things with holes to poke fingers into such as spaghetti strainer, candy tray, large metal nuts for bolts			x
Woodpile wood lizard – make of cedar		x	x		x
Blue/green mylar pompoms, ribbons	x		x
Scrub Daddy sponges	x		x
Strands of wooden, metal and plastic buttons	x	x	x
Collection of wooden popsicle sticks	x		x
Beads (wooden, glass, metal)	x		x
Strings of hard candy	x		x	x	x
Seed pod rattles		x	x			x
Balls with holes in them (wiffle, etc.)			x
Metal bowls		x	x
Tipping boards with wooden dowels		x	x
Hair rollers, Velcro, brush, etc. of various sizes			x
Strings and laces with knots of various sizes			x
Chinese rattles with acute points		x	x
Bottle brush, hairbrush and all kinds of stiff brushes			x
Strips of paper, especially metallic glazed paper		x	x
Lollipops made from round sticks dipped in melted sugar and corn flakes			x	x	x
Wire whisks of all sizes and shapes	x	x	x
Forks and spoons	x	x	x
Greaseproof paper, tissue paper, wrapping paper (folded or crumpled)	x	x	x
Key bunches of various shapes and materials	x	x	x
Egg slicers		x	x
Boxes fitted with rubber bands		x	x			x
Potpourri bags			x		x
Scented lotions (especially used in Lotion Routines)			x		x
Leather strips			x	x	x
Strumming instruments (ukulele, dulcimer, guitar, etc.)		x	x			x
Toothpaste (small amounts on toothbrush)			x	x	x
Sugar cane			x	x	x
Harmonicas, penny whistles, etc.		x	x
Aluminum pie pans, trays	x	x	x

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Plan for completing the Functional Scheme:

Decide as a team how and by when you will address all sections of the Functional Scheme.  It is recommended that team members work in pairs on each section for better verification of the student’s use of skills across multiple domains and with multiple people.  Use the chart below to plan who will be responsible for each section.  You may choose the official due date or assign an earlier due date to each section to spread work out across time.  COMS=Certified Orientation and Mobility Specialist, CT=Classroom teacher, Para=Paraeducator, OT=Occupational Therapist, PT=Physical Therapist, SLP=Speech-Language Pathologist, TDHH= Teacher of the Deaf and Hard of Hearing, TVI=Teacher of Students with Visual Impairments. Completing the entire Functional Scheme on an individual learner may take quite a bit of time, especially if the team is just meeting the student. Setting a timeline helps to keep everyone on track and in communication about skills to focus on during instruction.

Section	Name and Title of Participants Responsible for Section	Official Due Date	Team Assigned Due Date
Gross Movement	Kevin Lauder, PT & Elise Davidson, COMS	10/1/18	May 15, 2017
Fine Movement	Cheryl Schultz, OT & Hillary Keyton, TVI	10/1/18	May 30, 2017
Mouth Movement	Cheryl Schultz, OT & Kate Kitchens, Parent	10/1/18	May 30, 2017
Visual Perception	Hillary Keyton, TVI & Elise Davidson, COMS	10/1/18	June 15, 2017
Auditory Perception	Perkins Canton, TDHH & Hillary Keyton, TVI	10/1/18	June 15, 2017
Haptic-tactile Perception	Cheryl Schultz, OT & Hillary Keyton, TVI	10/1/18	May 30, 2017
Smell & Taste	Cheryl Schultz, OT & Hillary Keyton, TVI	10/1/18	May 30, 2017
Spatial Relations	Hillary Keyton, TVI  & Elise Davidson, COMS	10/1/18	June 15, 2017
Emotional Perception	Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent	10/1/18	September 1, 2017
Object Perception	TVI/CT Hillary Keyton, TVI & Matt Scott, CT	10/1/18	September 1, 2017
Language: Non-verbal	Perkins Canton, TDHH & Hillary Keyton, TVI	10/1/18	June 15, 2017
Language: Verbal	Perkins Canton, TDHH  & Hillary Keyton, TVI	10/1/18	June 15, 2017
Comprehension of Language	Perkins Canton, TDHH & Hillary Keyton, TVI	10/1/18	June 15, 2017
Social Perception	Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent	10/1/18	September 1, 2017
Perception through Play & Activity	Kevin Lauder, PT & Cheryl Schultz, OT	10/1/18	May 30, 2017
Developmentally Impeding Functions	Matt Scott, CT & Kate Kitchens, Parent	10/1/18	September 1, 2017
Toileting Skills	Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent	10/1/18	September 1, 2017
Undressing and Dressing	Cheryl Schultz, OT, Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent	10/1/18	May 30, 2017
Personal Hygiene	Cheryl Schultz, OT, Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent	10/1/18	May 30, 2017
Eating Skills	Cheryl Schultz, OT, Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent	10/1/18	May 30, 2017

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Goals, Objectives, Skills – Data for Child Progress Reporting:

You may find it helpful to have a list of goals/objectives and/or skills that will be the focus of data collection for documenting child progress. You can list them for specific environments and activities and post them near each environment so all staff know what behaviors they should take note of during an observation. Or you may have them in a child’s folder so any staff member can select an environment or activity to observe and collect data. This also could serve as the basis for your lesson plan.

Environments or Activities	Goal/Objective or Skills Child Should Demonstrate	# Observed	Other Skills to Watch For	# Observed
Kicking using Essef Board while in hammock swing	Positioned in a swing, hammock special chair or on the floor in supine during independent and interactive play STUDENT will kick with his legs/feet to produce sounds when provided a variety of materials during independent and interactive play at least 10 times within a 15 minute observation period.	||||	Sitting unsupported Vocalizing Listening and experimenting with sounds Making contact with adult through touch and/or vocalization	| – vocalizing to get adult attention
Kicking using an Essef Board and tray of materials when positioned in special chair		|||	Sitting unsupported Vocalizing Listening and experimenting with sounds Making contact with adult through touch and/or vocalization
Kicking in water during foot bath in special chair		|||| ||	Sitting unsupported Vocalizing Listening and experimenting with sounds Making contact with adult through touch and/or vocalization
Bring objects to mouth to explore with lips and tongue in the Little Room	When given a variety of materials in several different learning environments during independent and interactive play (e.g. Little Room, Snack time) appropriate for mouthing and tasting STUDENT will actively bring things to his mouth and/or explore with lips and tongue at least three times during a 15 minute observation time.	||||	Use of hands to scratch and poke hands/fingers to mouth Vocalizing Making contact with adult through touch and/or vocalization	||| – vocalizing
Explore snack and sensory play materials with his mouth during independent play on Resonance Board		||	Use of hands to scratch and poke hands/fingers to mouth Vocalizing Making contact with adult through touch and/or vocalization	|| – vocalizing for contact
Position Board Water or sand table	When given visually preferred (green, blue, shiny) objects on a position board or in a tray, water table or sand table, STUDENT will use a visually directed reach to make contact with desired object at least 2 times within a 15 minute observation period.	|	Grasp and release Batting Scratching	||- batting
Support Bench during independent play	When placed in a prone position using a Support Bench or Resonance Board STUDENT will extend one arm to reach preferred objects in containers at least 5 times within a 15 minute period.	|	Grasp and release Batting Scratching Vocalizing Making contact with adult through touch and/or vocalization	|| batting ||| – vocalizing
Resonance Board during independent play			Grasp and release Scratching Vocalizing Making contact with adult through touch and/or vocalization	II grasp beads, whisk I scratch board
Little Room in independent play	In a variety of learning environments in both independent and interactive play when given objects that make a  preferred sound STUDENT will reach out towards sound producing objects at least 5 times during a 15 minute observation period.	|||| Wind Chimes	Grasp and release Vocalizing Making contact with adult through touch and/or vocalization	|||| – vocalizing
Resonance Board in adult-child interaction		III Seed Pod Rattle (2 x) Beads (1 X)	Grasp and release Vocalizing Making contact with adult through touch and/or vocalization	I – vocalize to make contact

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Team Notes

10/12/18 – MS – Had many seizures today and was very lethargic 10/14/18 – MS – Much better today! Very Active in Little Room and vocalized a lot! Actually vocalized throughout the day. Also tolerated being on his stomach on the Support Bench for 15 minutes. Need to check with parents to see if there was a change in his seizure medications that might account for these improvements.

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