Chapter 9 - Sensory and Physical Difficulties

9.1 Definition

Sensory needs, which can be hearing loss and/or visual impairment or sensory processing difficulties and physical difficulties, can occur for a variety of reasons, e.g. congenital conditions (some progressive), injury or disease. The important consideration in this area is the degree to which the difficulties impact on a child’s or young person’s ability to access educational opportunities.

9.2 Different forms of Sensory and Physical Difficulties

Hearing Loss

Hearing loss can be sensorineural, conductive or mixed
The levels of hearing loss are mild, moderate, severe or profound. For medical definitions see EHC Criteria below.

Vision Loss

Visual impairment is an eye condition that cannot be fully corrected by glasses or contact lenses
The levels of vision are mild, moderate, severe or profound. For medical definitions see EHC Criteria below.

Multisensory Impairment

Multisensory impairment occurs when there is a hearing loss and visual impairment, which are both educationally significant although they may be at different levels.

Sensory Processing Difficulty

Our bodies and the environment send our brain information through our senses. We process and organise this information so that we feel comfortable and secure. When a child has difficulty coping with these demands, they may have sensory processing difficulties.
A child may be under-sensitive or over-sensitive in the 5 areas:
- Proprioception
- Vestibular
- Auditory
- Oral Sensory
- Tactile

Physical Difficulty

Physical/medical injures can be for a variety of reasons, eg congenital conditions (some progressive), injury or disease.
- A child with a physical difficulty may have a diagnosed medical condition which affects them physically. There may be an undiagnosed condition where the child presents with delayed development or impairment with their physical ability and/or presentation.

9.3 Assessment: Gathering Evidence

Where there are signs that a child/young person may need some support for communication difficulties the class teacher should consider:

The classroom environment and its potential to interfere with learning
The child or young person’s individual needs their presentation and impact on their learning
An early discussion with the SENCo to provide some suggestions of observations to make or strategies to try.

There are some more specific areas that you can look to gather evidence about. The table that follows provides some indications that you might look for that would be helpful to a professional seeking to make a diagnosis of a specific sensory or physical difficulty.

Indications of a sensory or physical difficulty
Difficulty	Indications	Link to:
Hearing loss	Medical diagnosis of educationally significant hearing loss Not making expected progress Greater difficulty with language rich subjects, especially phonics Social relationships suffer.	Reducing the impact of hearing loss on access to learning (available from SSET)
Visual impairment	Medical diagnosis of educationally significant visual impairment Not making expected progress Social relationships suffer Clumsy.	Checklist Making sense of sensory behaviour - Falkirk (external link)
Sensory processing difficulty	Not making expected progress Sensory processing difficulties may make it difficult for the child to engage in educational, functional and play activities and peer relationship development.	Checklist Making sense of sensory behaviour - Falkirk (external link)
Physical	Not making expected progress Poor self esteem & independence Difficulty recording information Reluctance to write Behaviour – challenging or withdrawing Frequent trips/falls.	Motor Skills assessments (available from SSET)

Training can be accessed through the IDP or through the Specialist Sensory Education Team (SSET) and TESS training programmes

9.4 Plan & Do: Strategies and interventions

In considering strategies for initial support prior to an expert diagnosis of a specific need, class teachers may wish to consider some of the suggestions contained in “Have you Tried? – for Communication and Interaction”.

While these suggestions are not all aimed at children and young people with sensory and/or physical difficulties any strategies which reduce distractions and make communication more straightforward will improve the learning environment.

Strategies for initial support
Difficulty	Some support	Lots of support
Hearing loss	Follow advice from the Specialist Sensory Education Team (SSET) including: Checking and improving the listening environment – mainstream classroom checklist/audit Considering seating position Soundfield system	Follow advice from the Specialist Sensory Education Team including: Communicator support to provide access to the curriculum as a reasonable adjustment. Use of specialist equipment as recommended by SSET See: Reducing the impact of hearing loss on access to learning
Visual impairment	Follow advice from the Specialist Sensory Education Team (SSET) including: Checking and improving the visual environment Teacher resources for clarity Simplifying displays Support as a reasonable adjustment	Follow advice from the Specialist Sensory Education Team including: Adaptation of teaching resources Support for curriculum and/or mobility Use of specialist equipment as recommended by SSET
Sensory processing difficulty	Consider the child’s difficulties; make observations of their reactions to particular information and environments. Try and alter the environment to accommodate their sensory difficulty	Consider strategies in Making sense of sensory behaviour - Falkirk (external link)
Physical	Look at the environment and how the child is accessing classroom activities Look at furniture used e.g. is it supportive, is the table the correct height? Use physical resources e.g. Pen grips, writing slopes etc. Consider Alternative Ways of Recording (available from TESS) Access Co-oL (Co-ordination and Learning) Programme training	Implement advice in Occupational/Physio Therapy assessment and report Implement advice from other health professionals/consultants Consider outreach from PDOS – Hope School Outreach Team

9.5 Review: Monitoring and Tracking

On-going review meetings between specialist/class/subject teachers and those delivering intervention to discuss progress and any difficulties etc.
Planned review meetings to assess impact and adapt/change intervention and/or targets if necessary
Regular observations of interventions to monitor quality assurance
Annotated evidence of the graduated approach including provision which is 'additional to and different from'
Regular contact with parents/carers to report on progress and to update on ‘at home’ strategies that will help
Ensure costed provision map highlights additional support being provided
Ensure there has been the necessary EP involvement
Consider referral for an EHC Assessment and Plan

9.6 EHC Criteria

Severity Criteria for an Education, Health and Care Plan

Hearing loss

Hearing loss may be permanent or temporary
Permanent hearing loss is usually sensorineural and can vary in severity
The British Society of Audiology (BSA) descriptors are used for hearing loss.

The descriptors below are based on the average hearing threshold levels at 250, 500, 1000, 2000 and 4000Hz in the better ear. (The hearing threshold is the quietest level at which a sound can be heard)

Hearing loss descriptors
Mid-hearing loss	Unaided threshold 21-40 dBHL
Moderate hearing loss	Unaided threshold 41-70 dBHL
Severe hearing loss	Unaided threshold 71-95 dBHL
Profound hearing loss	Unaided threshold more than 95 dBHL

Hearing loss can have a significant effect on the development of language and communication skills and these may continue throughout a child’s school career.

Factors to take into account when considering an EHC plan for hearing loss:

Severe or profound hearing loss requiring high levels of targeted communicator support
A significant discrepancy between verbal and non-verbal ability scores
A marked discrepancy between the attainments of the child or young person in core subjects and the attainments of the majority of pupils of the same age
Significantly low or delayed language development
Hearing loss significantly impairing social and emotional development or mental health
Significant difficulty in accessing the spoken curriculum.

Vision loss

The National Sensory Impairment Partnership (NatSIP) classification is used for vision loss. The classification applies to corrected vision with both eyes open.

Acuity criteria are for guidance purposes only and a Qualified Teacher of the Visually Impaired (QTVI) should apply professional judgment to decide on the classification. For example, a young person may have a mild reduction in visual acuity but be functioning within a different visual category due to an additional ophthalmic condition e.g. nystagmus, visual field reduction, cerebral visual impairment. The QTVI will carry out Functional Visual Assessments whenever possible to provide information on how a child’s ability to use eyesight is affected in everyday situations such as in the classroom.

Vision loss descriptors
Mild vision loss	Within the range 6/12 to 6/18 Snellen/Kay (LogMAR 0.3 to 0.48)
Moderate vision loss	Less than 6/18 Snellen/Kay (LogMAR 0.5 to 0.78)
Severe vision loss	Less than 6/36 Snellen/Kay (LogMAR 0.8 to 1.00)
Profound vision loss	Less than 6/60 Snellen/Kay (LogMAR 1.02)

A child with a visual acuity of 6/18 or less would usually be defined as visually impaired. A visual acuity of 6/18 means that the child would see at 6 metres what a person with normal sight would see at 18 metres. Some children may be visually impaired with a visual acuity better than 6/18 if they have severely restricted visual fields or deteriorating conditions.

The ophthalmologist uses a combination of visual acuity and field of vision to judge whether someone is eligible for a certificate of vision impairment, and at which level (either sight impaired or severely sight impaired). If the criteria for certification are met then a child can then be registered as sight impaired or severely sight impaired although the registration process is voluntary. The child’s registration document (CVI) is held locally by the social services Sensory Team.

Factors to take note of when considering an EHC plan for vision loss:

Severe or profound vision loss requiring high levels of targeted support to ensure curriculum access
Significant modification of curriculum materials required
High levels of targeted support required for a child to acquire Braille skills
Fluctuating and/or deteriorating levels of vision
Significant difficulty in accessing the physical environment safely
Vision loss significantly impairing social and emotional development or mental health
A marked discrepancy between the attainments of the child or young person in core subjects and the attainments of the majority of pupils of the same age.

Severity Criteria for Physical Difficulties

There must be clear, recorded evidence that the pupil’s physical disability does or could significantly impair access to the curriculum, ability to take part in particular classroom activities or participation in aspects of school life. Indicators of this may include:

Clear and substantiated evidence of how and where the pupil’s physical difficulties limit or restrict access to lessons and other learning activities, despite modifications to the environment and the provision of resources or support within Elements 1 & 2 of funding
Evidence of a marked discrepancy between the pupil’s attainment in core subjects of the National Curriculum and the attainments of the majority of pupils of the same age
A marked discrepancy between the pupil’s attainment in core subjects of the National Curriculum and the expectations of the pupil as assessed by his/her teachers, and external specialists who have closely observed the pupil
Clear and substantiated evidence, based on specific examples, that the pupil’s physical disability has given rise to significant emotional and / or behavioural difficulties.

In some cases, health and safety reasons may necessitate additional adult support for physically disabled pupils to access the National Curriculum.

Process Based Criteria for Physical Difficulties

Statutory assessment will often be requested at an early years level through the Early years process. There may also be reports from the physiotherapist and/or occupational therapist. In some medical conditions, there may be reports from specialist professionals, for example oncology nurse, clinical psychologist or specialist consultant. In order for the Statutory Assessment to be considered, a high level of adult support and significant modifications to the curriculum and/or physical environment will be necessary to enable the child to learn effectively. This should include any support/resources that could be made available through Elements 1 & 2 of the funding.

Fast tracking in the process-based system can occur in rare circumstances, for example, if an accident has led to a long-lasting physical disability or medical condition. Note must be taken of the appropriate time to discuss this with parents (and young person, if appropriate), due to the emotional anguish that they will be undergoing and possible uncertainties around prognosis. If the life expectancy of a pupil is affected by the medical condition, any emotional trauma must be considered in relation to the appropriateness of seeking support through an assessment of SEN.