Educational Facilities for Children with Visual, Hearing or Dual Sensory Impairment

A Design Perspective: Catering for the Perceptual Needs of the Children

Gordon N Dutton MD FRCOphth
Paediatric Ophthalmologist
Professor of Visual Science
February 2019

1. Introduction

The development of school buildings for very young children with multiple disabilities and visual or hearing difficulties, or with dual sensory impairment, presents particular challenges in design, equipment and staffing.

It is essential to recognise that the 'Principal User' is the child attending the school, whose needs must be optimally met, if full educational opportunities are to be provided.

Young children with visual and / or hearing difficulties, have a range of special needs that need to be catered for.

These include:

• 1. Physical needs
• 2. Intellectual needs
• 3. Attentional needs
• 4. Visual needs
• 5. Auditory needs

This discussion primarily considers items 3-5 above and to a certain extent, items 1 and 2.

The information it contains has been used to guide the development of two schools for the visually impaired:

Hazelwood School in Glasgow, Scotland and

Blennz School, Auckland, New Zealand

The optimum environment for such children is one that is primarily designed to cater for their very specific needs. The aim is to give them a sense of security, and optimal awareness, so as to provide the key conditions for learning, and for becoming as independent as possible.

This is achieved by taking into account the sensory and mental processing functions of such children (which of course they know to be their normal).

The principle is to recognise and cater for each child's impediments to learning, so as to minimise their adverse impact.

Such an approach leads to enhanced child care and engagement. This requires fewer resources, proving beneficial to children and staff alike, affording optimum long term cost efficiency.

Children only learn when they are content and happy.

They are unable to learn when distressed or frightened. So the school environment needs to be calm in nature, non-threatening and conducive to learning. This requires a recognition of the environments and situations that such children find distracting, disturbing or threatening, and an understanding of how such scenarios can be avoided.

Most building are designed from the perspectives of functionality and aesthetics, as seen through the eyes of the architect and the architect's clients.

The same principles apply to school buildings whose purpose is specific, to meet the learning needs of children with special needs.

So the design should ideally meet the needs of the 'client children', by taking into account what it must be like to see, feel, hear and appreciate how the 'client children' experience their worlds.

This paper provides a set of concept frameworks derived from a wide range of salient literature, that addresses the learning needs of the 'client children'.

2. Summary

The design of schools for children with visual, auditory and additional impairments is considered from the standpoint of how the disabilities of the children impact on learning, and how this impact can be minimised. The following issues are addressed.

• The children and their conditions
• Building design considerations
• Equipment
• Staffing considerations

3. The children and their conditions: their relevance to the design of the building

The children can be divided into various groupings:

• Diagnostic grouping
• Severity of disability
• Age grouping

3.1 Diagnosis

The diagnoses of the children have a direct bearing on the design of the school.

• Children with injury to the brain, or brain dysfunction are likely to comprise the majority of pupils. Survival rates of children receiving intensive care have increased. It is likely that the proportion and numbers of such children will increase owing to increased survival of both very premature infants and children with disorders (such as meningitis) affecting the brain, vision and hearing.
• Children with dual sensory impairment due to eye and ear disorders but with intact brain function comprise a minority, but their requirements are very different.
• Children with dual visual and hearing or central language processing dysfunction due to injury to the brain or brain dysfunction, are also likely to comprise a significant proportion of pupils in the long term

3.1.1 Children with injury or dysfunction of the brain

Damage to the visual part of the brain leads to a number of specific deficits for which special provision is advisable.

Each of the deficits is considered below along with the potential design implications for dedicated schools.

3.1.1.A. Reduced clarity of vision, along with reduced contrast sensitivity is a problem for nearly all of the children. This requires:

Optimal colour contrast, and grey scale contrast within colour (eg light blue and navy blue comprise blue with white or black added respectively) are recommended for boundaries which need to be identified.

These include boundaries between:

• Wall and floor
• Wall and doorways
• Wall and windows
• Successive steps

Thus door frames, skirting board and window frames can be painted with dark colours assuming that the walls and floors are lightly coloured.

All detail in signage and signifiers needs to be designed so that children with a clarity of vision of say 6/120 (20/400) are able to see it, preferably half way between eye level for a standing and a seated child. Signage requires high contrast, wide letter separation and minimum content. Pictorial signage should ideally be three dimensional for tactile analysis as well. Each element of detail within every image needs to be visible to all but the most visually impaired children, for whom the tactile characteristics of signifiers need to be within their limitations of tactile perception and recognition.

Optimal lighting

Many children with reduced visual acuity and impaired contrast sensitivity due to brain injury or dysfunction have considerable difficulties in darkened environments. This is because reduced lighting reduces clarity and can therefore impair access to information, making this more difficult and taking longer. This is highly significant when rate of performance and learning are crucial to success. Low lighting can also impair mobility, by rendering elements of the scene invisible for those with low vision, thus increasing risk.

To avoid glare, optimal natural lighting is best shaded, for example by trees or by being north facing in the northern hemisphere, and south facing in the southern hemisphere, as for art studios, with matt light reflecting colours on the walls.

Apart from exceptional circumstances (see below) artificial lighting throughout the school needs to be bright and diffuse.

Many children with profound visual impairment gaze at lights. This is detrimental to learning because it takes up all the child's attention. We now know from older affected children who have learned to communicate that light gazing is involuntary, very difficult to stop and very uncomfortable. It is also a sign that those affected can only concentrate on one thing at a time. If this is a light, all learning stops.

To prevent such light gazing, no light bulbs or other focal light sources must be visible. There must be no ceiling -mounted lighting in any areas where the pupils are present. Instead wall-mounted uplighting with white reflective ceiling paint provides an effective option.

(A small proportion of children with impaired vision due to brain injury have been found to see significantly better in low lighting conditions. The inclusion of a room without windows, whose lighting can be altered, that can be employed to a range of purposes (see below) is warranted.)

3.1.1.B. Impairment in visual field

The visual field is the area over which one can see. Impairment of visual field is common in this group of children. The area of absent visual field is analogous to the area behind you, except it impinges on the area where one expects there to be perception in typical children.

Absence of the lower visual field is common. When looking straight ahead the ground is not seen. The lower part of a page or computer screen is not seen. It is easier to go up stairs (because the stairs are seen) than to go down (because they are not). (It is no doubt important to have stairs, so that ambulant children learn how to cope with them. However, consideration should be given to reserving stairs for access to staff accommodation and for areas for mobility training.)

Children with lower visual field impairment, who are wheel chair mobile may crash into low obstacles because they are not seen. Such obstacles need to be avoided. Classroom bins for example need to be tall.

Moreover, inadvertent wheelchair collisions into walls and doorways are not uncommon.

Walls need to be designed to cater for wheelchair collision.

To avoid holes in the wall plaster-board must not be used in locations where there is wheelchair usage.

Absence or impaired function of the visual field on the left or on the right side (for both eyes) is also common.

We have seen some children with impaired vision on one side who are very frightened in symmetrical environments like long corridors with symmetrically placed doors. These children had brain damage which prevented one side of symmetrical environments from being seen. (Putting posters up on one wall to decrease the symmetry helped considerably.) Avoidance of symmetry in the design is recommended. A curved corridor allows those who see to one side only to have an awareness of both sides further along the curve.

Absence of the upper visual field is rare but is sometimes seen in this group of children. Information such as signage needs to be at the children's (not adult) eye level.

3.1.1.C. Impaired simultaneous perception of varying degree is present in nearly all the children. Such impairment applies to all elements of perception, hearing, touch and vision.

Injury to the back of the brain at the top on both sides, (the posterior parietal lobes) is very common in the 'client children'.

This part of the brain is responsible for handling incoming information.

We all become overloaded when there is too much information to handle, but affected children with cerebral palsy and impaired vision often have considerable difficulty handling:

• Clutter
• Pattern
• Auditory noise
• Physical discomfort

And approaching people and obstacles can be very frightening because these children cannot accurately map how far away things are.

This means that approaching people and obstacles can appear to 'loom' into view, even when some distance away.

Extraneous auditory, visual, and tactile inputs can therefore be disturbing, and even frightening, to affected children, which precludes all learning for them.

Crowded information, whether it is crowded in time (when information, whether visual, tactile or auditory, is presented too rapidly), or in space (when too much information is crowded into the visual scene or the soundscape) has profound implications for the design of the building, if educational strategies for these children are to be optimised, and the care needs of distress in children are to be minimised.

• All background clutter and decoration needs to be kept to an absolute minimum.
• Many of the children we have seen are easily distressed if there is a lot of visual distraction or background noise, but they are much more relaxed and receptive to learning if they are in a non-crowded quiet calm environment.
• Equipment in the classrooms needs to be kept out of sight, behind plain curtains or inside adjacent store rooms / cupboards.
• (This will also enhance mobility, by diminishing risk of collision and injury.)
• Large north facing windows with low walls beneath them, to allow children to determine the positions of the windows and not bump into them (say 500 - 700 mm to be seen by children with lower field impairment, but not to obstruct the line of sight for wheel chair users) which look out onto grass and trees warrant consideration. Doors that open out onto this environment (with free wheelchair access) could be considered. This visual background is known to have a significant calming effect for most children with visual impairment.
• Contrary to the norm for mainstream schools, too much decoration on the walls can have an adverse effect. For some children it causes distraction, for others it causes distress and for another group it impairs access to any information being presented, because there is too much peripheral visual information to handle.
• This prevents anything being presented being seen.
• The same applies to sound. For some affected children, a lot of noise prevents them from seeing because it overloads the 'RAM of the computer' of the brain in those with cerebral auditory and visual impairments.
• The acoustics of the rooms need to be considered.
• For the 'client children' acoustic damping of the floors, the ceiling and the walls is required to minimise all echoes. The same is needed for the population of children with reduced hearing. It should not be possible to hear distracting sound from: Adjacent accommodation / Central heating systems /Ventilation systems /Outside
• Children with no vision 'see' with their ears, and are highly dependent on the acoustic characteristics of the building and its contents, both to know where they are in the building, and to map the surroundings, therefore there is a need for planned echogenicity as well as acoustic damping. This is provided by Hazelwood school, where the entrances to the classrooms for example have different echoic profiles.
• Sensory rooms have been found empirically to lead to significant improvement in attention for the most severely impaired children. This is because they have profound impairment of simultaneous perception and can only handle a very small amount of visual and auditory information at once. The use of darkness and focal lighting combined with focal sound sources provides the elimination of extraneous sights and sounds, which is required. If such a room or rooms are to be incorporated into the design considerable thought should be given as to their optimal design.
• A lot of equipment which has limited, if any educational value, is on the market and is over-priced. Custom designed equipment which accords significance and meaning, could well prove more effective and be cheaper. This aspect of design warrants further research.
• Some children with profound 4 limb cerebral palsy and apparently no vision can 'wake up', and look around for the first time in their lives, when surrounded by a plain (e.g. orange or yellow) tent or a curtain. This is because all clutter has been eliminated and sound has been muffled. Half hour sessions in such environments can bring about remarkable changes in attention, and visual capabilities. incorporation of such a facility for specific children merits consideration.

3.1.1.D. Impaired visually guided movement is a common accompaniment of impaired simultaneous perception. The visual scene is interpreted in the mind. The messages concerning the 'coordinates' of where things are in visual space are then passed to the limbs. In addition to impaired movement many of the children have inaccurate movement of the limbs and body in 3D space because their mental visual coordinates of their surroundings are not so finely spaced as they are for able bodied children. Enlargement of objects to be handled by the children will allow them to be rewarded by success. This applies for example to door, cupboard and drawer handles. These therefore need to be large and must contrast in colour / contrast from the background object they are attached to.

Focal decoration on the floor can be seen as obstacles by children who have different perception of depth, because they have impaired visual analysis of three dimensions needed to guide their movement through their visual worlds. Floor boundaries which differ can be incorrectly seen as a step by such children. Plain floor surfaces without pattern and without boundaries are likely to prevent such problems.

(They are however, of course required for training in everyday living.)

There is a risk that wheelchair users who are learning for the first time, and those who have impaired visually guided movement will frequently collide with the walls, doorways and obstacles. If this is deemed to be a significant risk for the population who will use the school, appropriate wall resilience will be required.

3.1.1.E. Impaired orientation is another problem that many children have. In order to know where we are going we have to remember where we have been before and to map this information in our minds. Many children with brain damage and impaired vision due to the brain damage also have problems with orientation. These problems are manifest in four situations.

• Route finding can be very difficult and affected children get lost very easily. Both objects of reference and sounds of reference along commonly used routes can help considerably. Children can then learn the sequence of objects and / or sounds which is needed for a specific route. (Setting the sequence to a song can help considerably.)
• Orientation within a room can be lost. It is logical to design the rooms that they will progress through in successive years with similar layouts, avoiding mirror image designs.
• Orientation with respect to what is in which drawer, and in which cupboard, can be impaired. Clear systematic labelling of drawers and cupboards in classrooms, using three dimensional images warrants consideration.
• Orientation in immediate personal space can be a problem. For some children, labelling of place mats with a picture of a knife, fork and spoon for example can prove helpful. The same concept could be considered in such special cases for work stations. Consistency of design is important.

3.1.1.F. Impaired recognition is less common but affects a significant proportion of children. We are able to recognise what we are looking at because our minds contain a complete store of images. We compare what we are looking at with our mental image stores. If it matches the picture in the image store, recognition takes place. If it does not we learn about it for the first time. This concept applies to people's faces and to objects. The image store is at the back of the brain at the bottom (the temporal lobes). If the temporal lobes are damaged this can cause impaired recognition. For such children objects of reference may provide limited information. Reinforcing the stimulus with a matching sound of reference is again warranted. Such an approach of course also applies to all children whose vision is so poor that they are unable to use vision for recognition.

3.1.1.G. Impaired visual memory is common. From the standpoint of being able to recognise which room is which, colour coding could be considered. Other memory cues can be used to enhance the objects and sounds of reference.

3.1.2 Children with dual sensory impairment due to eye and ear disorders

Although these children have intact brain function, the lack of sensory input during early development leads to many problems similar to those outlined above. The design features which are considered above are equally appropriate for this group of children.

3.2 Severity of disability

3.2.1 Severe disability

Children with profound visual impairment or complete blindness comprise those who are mobile and those who are confined to a wheelchair.

The mobile children may gain greater independence by having a wall mounted (or central passageway) hand rail, at the right height, both for guidance and for support. Some children have weakness down one or other side of the body. Support rails therefore may be required on both sides of corridors to allow such children to be mobile in both directions.

Children who are confined to a wheelchair need to be able to move or be moved freely both within the building and outside.

3.2.2 Moderate disability

The environment described above for the specific visual disabilities and for those with severe disability will meet the needs of the other children with moderate disabilities.

3.3 Age grouping

3.3.1 Infants and young children

The critical period for the development of vision, hearing, intellect and social development is the first seven years of life. There is considerable evidence in the world literature that the fundamental building blocks for development are laid down in early life.

The earlier intervention is implemented to compensate for and circumvent disorders which impair access to, and interpretation of information, the more effective it is likely to be. Moreover, the costs of education and long term care are likely to be significantly minimised by early intervention.

The construction of a centre of excellence for training parents and for teaching infants and young children, both in the school and on a peripatetic basis warrants serious consideration. A toy and equipment 'library' also warrants consideration.

3.3.2 Older children

As in schools for the able bodied furniture and toilets will no doubt be designed according to the size of the children, and their potential wheelchair-bound status.

4. Building design considerations

Taking into account the issues described above, the overall design of the school envisaged by this author is as follows

• The building would be built on level ground.
• In the northern hemisphere the class rooms would face from west through to north east. This would avoid direct sunshine during school hours.
• All lighting in areas used by the children needs to be up-lighting onto reflective white ceilings, to prevent children from light gazing, as this precludes all learning.
• The class rooms would have large windows looking out onto paved areas and playground, beyond which there would be a calm scene of parkland and trees. Each room would have direct access to the playground, and could have its own specialised outdoor equipment if required.
• There would be limited decoration throughout the school.
• Classrooms would be small with small numbers of pupils in each one. (An open plan design for educational areas is not advisable, because it precludes learning.)
• There would be rooms for physiotherapy, occupational therapy and vision and hearing assessment, in addition to a communal hall.
• The decoration, lighting and acoustic design of the building should take into account the issues addressed above.
• Staff accommodation could comprise an upper storey. This would provide staircases for mobility training.

5. Equipment considerations

We all have thresholds for perception and action. The design of the building, the decoration, the signage and the equipment provided, should all take into account the fact that the thresholds for perception (primarily touch, hearing and vision) are limited for all the children in the school.

Everything which is designed to allow the children effective access to information, mobility and communication, must be clear simple and bold to fall within the perceptual thresholds of all but the most severely disabled.

Equipment must not be left lying out but must be kept in cupboards or curtain masked areas because:

• A number of children for whom educational space is intended see approaching obstacles as coming to hit them, which creates fear and distress, and also creates additional unnecessary work for staff in the school, who have to calm distressed children.
• Clutter interferes with learning.
• Obstacles can be crashed into, and therefore cause injury.

6. Conclusion

This document represents the personal perspectives of the author, founded upon a three decade special interest in the subject, and international collaborative work worldwide.

It comprises a suggested outline for the future design of educational establishments for children with visual, auditory and intellectual limitations in any combination or degree.

A common objection to such recommendations is that 'children need to live in the real world'.

This is indeed the case, but it is through learning in a protective environment, matched to the needs of the 'client children' that such learning can actually start to take place.

Children with the needs outlined in this paper cannot start to learn in typical school environments.

A 'protected environment' as espoused above, can be extraordinarily enabling, and can culminate in significant degrees of lifelong independence with the great emotional, social and financial benefits that accrue both to those affected by disability and to those looking after them, as well as society at large.