The Development of an Application that supports Body Awareness for Children with Visual Impairments and Additional Disabilities

The following research questions guided the progress of this study:

A DBR was used in this study. Wang and Hannafin (2005) define DBR as a “flexible methodology that focusses on improving educational practices through iterative analysis, design, development and implementation based on collaboration among researchers and practitioners in real world settings” (p. 6). Additionally, Stokes (1997) and Schoenfeld (1999) observed that DBR allows educational researchers to study theory and application. In DBR, an intervention is designed, based on current theory to solve actual user problems. The intervention is put into practice leading to new or revised theories that generate more effective interventions and/or new applications. Smith et al. (2013) argued that the design of practical and implementable special education interventions can be improved by DBR. BAMM team’s goal was not only to design an app but to advance the theory that body awareness can be supported by SMR in the student’s natural setting.

There are different ways to conduct DBR, and the BAMM study followed McKenney and Reeves’ (2012) model. The team comprised professionals with expertise in different areas, with the lead researcher being an itinerant certified O&M specialist (COMS). Other team members were: an itinerant teacher of students with visual impairments, a music therapist and a researcher with experience in working with children with VI and additional disabilities, an autism specialist, a children’s dance instructor and a physical fitness expert, a designer for children’s art and a software developer. It was imperative that the app be developed using the universal design for learning. It needed to be engaging and inclusive of all students.

BAMM’s design proceeded through cycles of three phases: analysis and exploration, design and construction and evaluation and reflection. The initial analysis focused on establishing the content and features of the app. Guided by the principles of universal design for learning, the app would provide a selection of “acts,” each one a combination of a song and movements synchronized to the lyrics of the song.

A board certified music therapist composed a specific song for each act. Text moved to introduction as advised. To create the music for each act, the music therapist chose specific words, composed specific lyrics and used elements of melody, harmony and rhythm to musically facilitate the targeted movement in each act. The lyrics contained language that would reinforce body and spatial awareness (e.g. “hands together, palms touching, in the center”). The instrumental aspects of the music reflected the targeted movement in terms of timing, force and size.

An individualized student playlist was created by selecting appropriate acts from the variety of movements incorporated in standing, prone, supine and seated positions. The ultimate goal was for the app to consist of acts with a range of complexity of movement and language. The initial prototype would consist of simple movement and language.

The idea of designing an engaging character was informed by the need for a model for the movements. The BAMM team thought that the students with residual vision would be attracted to an engaging character that would model movements on the app. After several trials, the final design of the demo character named “BAMMboo” was adopted. BAMMboo is blue, gender neutral, wears a yellow orange top, bright red pants and purple shoes and is visible in the playlist editor shown in Figure 1. The colors selection was based on the fact that children with cortical visual impairments which accounts for 30–40% of VI in children in the USA (Roman-Lantzy’s, 2007) prefer brightly colored objects (Good et al., 1994). The app would provide suggestions for object symbols. These symbols are often a way to communicate with students regarding their preferences about the order of the movements.

Figure 1:

The requirements for the interface included: simple and intuitive creation and editing of individual playlists, the ability to select a picture from the iPad library or take a picture of individual object symbols that would appear beneath the corresponding act within each playlist, the ability to stop and resume playing acts by tapping anywhere on the screen, playlists created by arranging icons that depict starting position or representative pose of each act, uncluttered and visually stimulating screens, the ability to speed up and slow down acts as appropriate and the ability to name playlists and insert photo of choice within playlists icon (see Fig. 1).

A simple reaching movement was adopted from the book “teaching Age-Appropriate Purposeful Skills” (TAPS, 2012) and the factors necessary to develop the act agreed on (e.g. the software used to create the music had to be compatible with the standard audio formats available for iOS). The artist had to have a clear understanding of the movements and the key positions to draw, and for accuracy, movements had to be modeled in three dimensions. Approximately 60 movements of various levels of complexity and in a variety of positions were modeled. This would be the BAMM video library from which all movements of the acts would be selected. All the movements consisted of motions typically used in daily living and did not require above average range of motion, strength or endurance. Through collaboration, trial and error, the first act “In the Center,” a “tune in” act (Maloney, 2016) was designed.

In total, 12 simple movements including, “In the Center” were selected from the video library for use in the first set of acts that would be included in the first prototype of the app (see Table 1). Each movement has a description, functional purpose, concepts emphasized, possible vocabulary and actual vocabulary. Each act had a number and a corresponding video number. “In the Center” was the first act and the relaxation act (Maloney, 2016) was next on the priority list. The remaining 10 acts were randomly sequenced so that team members could be sure to simultaneously work on the same one. Each time an act was selected to be in a student’s playlist, the instructor would have the opportunity to select a picture of an object or tactile symbol from the iPad’s album or to take a picture with the iPad’s camera. When the playlist was used, that picture would appear below the symbol. DBR allows repetition of steps both within and between each phase. Review and revision would occur within each phase before proceeding to the next phase (see Fig. 1). Each iteration of the app would be an outcome of one circle.

It was the goal of the team to have a simple prototype completed for expert review at the 2013 Association of the Education and Rehabilitation of the blind (AER) International conference. BAMM was accepted for presentation at the conference. However, as the conference date approached, it was clear all the acts would not be complete. The team decided to concentrate on the tuning in act (In the Center), the relaxation act (breath) and three other acts in the list. Many of the features on the user interface were not functional yet, but there was enough information within the five acts for attendees to provide input on. The researchers would use the survey conducted by the conference sponsors as a review for BAMM.

In the meantime, the lead researcher identified a student as a potential study participant. Joe (pseudonym) was a six year old male with congenital blindness and severe intellectual disability including DeafBlindness. While an optimal pregnancy is 40 weeks gestation, records showed that Joe was born preterm, at 28 weeks gestation. He also used a hearing aid. At the time of this study, Joe was receiving special education services in life skills classroom. According to his parents, Joe had developed the gross motor skills for walking but had skipped the crawling stage and this seemed to make the transitional movements very difficult for him. Joe had no speech and was not using any AT for communication. He demonstrated alertness by remaining very still (e.g. if someone called out his name). Joe also exhibited self-stimulatory behaviors (e.g. rubbing and hitting his face). Upon consultation the members of Joe’s educational team agreed that he could benefit from moderate physical support to transition from sitting on the floor to standing.

The lead researcher had already been working with Joe on O&M skills in his home and on his campus for over six months. Joe and his family trusted the COMS, who explained what an SMR was to Joe’s parents. The parents understood and agreed with the purpose of BAMM, and hoped to reinforce the skills Joe learned by using it in the home. They signed a consent form as a demonstration of their willingness to allow Joe to participate in the study. There was not coercion involved.

An SMR supported by BAMM would be implemented with Joe. Five acts with slower tempos (80–145 beats/minute) were selected and sequenced starting with a “tuning in” song and ending with a “relaxation” song. An object symbol was chosen for each act and positioned on a chair to the left of Joe while a “finish” basket was positioned to his right on the floor. The routine for Joe involved: unrolling the yoga mat and sitting on it, removing his shoes and socks and placing them to his right, tapping bare feet to feel the yoga mat, transitioning to standing with moderate support and reaching out with his left hand to obtain the object symbol. The object symbols included bumpy balls and fans that provided some sensory input and could remain in contact with his body during the entire movement. All the steps were completed with necessary level of physical support and Joe’s affect was continuously monitored for signs of pleasure or stress. If Joe showed signs of distress, the session would be terminated.