Children with visual impairment

Children with visual impairmentIntroduction:

The view occupies a special place among the senses, since 80% of the information we deal with is visual. The vision allows us to interact on our environment, which allows it to be grasped at a distance, and it is the visual feedback that brings speed and precision in the action, motor or psychic. The sight is a meaning particularly invested fantastically, certainly in connection with ancient myths.

The terms which refer to it are found in many expressions which often refer either to pleasure (see life in pink, to make eyes soft, etc.) or to omnipotence (to shoot eyes, to devour Eyes, etc.). It goes without saying that achieving a child’s visual abilities has consequences not only on an organic level, but also on the parent-child interactions, and indeed on the relationship to the world of this visually impaired child.

Several elements seem to us to be taken into consideration on the pathological and psychopathological level, in the care of a visually impaired child and the accompaniment of his family:

• intensity of visual impairment;

• the onset of this visual impairment (congenital disease / acquired pathology);

• the type of pathology (the scalability or not of the visual impairment, the commitment or not of the vital prognosis).

Intensity of visual impairment:

In the context of visual impairment, two categories of visual impairment must be distinguished: the blind subject and the amblyopic subject. The word “blind” comes from the Latin ab oculis, deprived of eyes, which eliminated the word caecus included in the scholarly training “blindness”. The Greek term ambluôpos, of weak view, gave the word “amblyope”.

Complete blindness is achieved in subjects whose vision is zero in the absolute sense of the term with the abolition of the perception of light. Those with a visual acuity of the best eye is equal to or less than 1/20 after correction or whose visual field is less than 20 ° in the most extensive area. Blind persons thus defined are entitled to the word “blindness” on their invalidity card. All the statistical studies agree to find a proportion of congenital blind people of 1/10 000 births in the so-called “developed” countries, a much higher proportion in the countries of the Third World due to infectious diseases, nutritional deficiencies And genetic pathologies related to inbreeding.

Amblyopes have a visual acuity, after correction, between 3/10 and 1/20. These definitions cover a great disparity of visual impairments and do not take into account the degree of severity of the functional impairment. However, with equal visual acuity, functional vision will be very different depending on whether there is a single eye Or on both eyes (possibility of binocular vision or not), according to the type of damage of the visual field and according to the actual use that each child will make of it.

Visual field damage, due to progressive destruction of retinal cells or damage to the optic nerve, can be either central (and lead to a rapid decrease in visual acuity with a loss of ability to discriminate – discomfort Reading, precision work -); Or peripheral, with a visual field tubular (particularly penalizing in the displacements but which allows for a long time the preservation of the reading “in black”); Or annular, associating central and peripheral involvement with the preservation of an area of ​​vision between the affected areas; Be amputated by quadrant or by half (quadranopsia-hemianopsia); Is broken up by multiple gaps such as a puzzle from which several pieces would have been removed.

Age of onset of visual impairment and different types of pathologies:

Blindness or visual impairment may be congenital or acquired.

Congenital or early life pathologies:

Genetic pathologies:

They are most often expressed at birth. Their severity varies according to visual impairment and whether or not they are part of a polymalformative syndrome.

Like all early childhood diseases, they play a role in mother-infant tuning and genetic etiology takes a special place in the child’s registration in filiation. After René Kaës, Ciccone explored the notion of “transmission fantasy”: confrontation with disability attacks the genealogical, generational link.

The disability produces a break in the bond of filiation, but also allows “the suture of this rupture”: the handicapped child is recognized by his close relatives both as a stranger and as theirs in the search for transgenerational representations. Among the genetic pathologies, the following are described.

Retinopathies:

Evolutionary retinal cells, after a progressive decline in vision, lead to blindness, which can occur either in adolescence or in adulthood, and even late in life. Some are isolated, others are part of a multiple-expression syndrome such as Bardet-Biedl syndrome, usually associated with retinopathy, hexadactyly, moderate to moderate intellectual impairment, overweight, and possible renal disease. It is often the associated clinical signs which lead to the diagnosis from the very infancy (example: an abnormal kidney marked on antenatal ultrasound); Simple retinopathies are diagnosed later, when the child is experiencing difficulty in night vision or in his achievements (in kindergarten or at the beginning of primary school).

Congenital Cataracts:

It is a total or partial opacification of the lens from birth.

Congenital glaucoma:

A malformation that interferes with the circulation of the aqueous humor in the anterior and posterior chamber of the eye causes intraocular hypertension. The first clinical signs are lacrimation, photophobia, megalocornea and / or buphthalmia.

Retinoblastoma:

It is a rare intraocular malignant tumor of the child, which can be uni- or bilateral, revealed by leucocoria or strabismus.

Malformative syndromes:

They may be of genetic origin or not. They affect either the eye alone or the optic pathways (microphthalmia, anophthalmia) or are part of a polymalformative syndrome (eg Fraser syndrome, associating absence of palpebral fissures with severe anophthalmos or microphthalmia, Hearing aids, urinary abnormalities and other organs).

Sequelae of ante- or neonatal suffering:

They may be responsible for reaching the cortical areas of vision (neonatal anoxia) or peripheral involvement (oxygenation of prematurity).

Antenatal infectious diseases:

These include toxoplasmosis, rubella, chicken pox, influenza, etc.

Pathologies acquired:

The most frequent can be grouped as follows.

Tumor pathologies:

Except in the case of retinoblastoma, which is a hereditary disease, it occurs in a child whose development was previously normal. It is not uncommon for the diagnosis of type 1 neurofibromatosis to be made to discover a glioma of the optic pathways. Three elements are of particular importance in accompanying these families:

• the stunning effect parents face on what is “a disaster” for them. All families say, even long after the diagnosis, that their lives have shifted. The life-threatening commitment (which is found in severe neonatal suffering) mobilizes in the young the anguish of imminent death and, in the parents, conflicting and parallel movements of disinvestment and disinvestment;

• Treatment of the child (surgery, chemotherapy, radiotherapy) is complex, painful, mutilating for some, sometimes mutilation is the only way out of the prognosis (enucleation in the treatment of retinoblastoma, In the surgical treatment of a glioma). The child’s body becomes a place of suffering, manipulated by caregivers and medical knowledge, and the parents evoke their difficulty in investing a good distance in this child, who has been told that he is in danger of dying. The sequelae other than the visual impairment are frequent (intellectual deficiency, panhypopituitarism) and participate in the feeling of strangeness that is established between the child and its parents;

• the risk of recidivism reinforces the contradictory investment movements of the parents and the ambivalence of the link.

Traumatic pathologies:

They are essentially sequelled from domestic accidents or traffic with severe head trauma.

As we noted above, we find in these pathologies the effect of sideration related to the eruption of visual impairment in a child. However, visual impairment is often only one aspect of disability and its management is part of a more comprehensive rehabilitation. Once the responsibility of one of the parents is engaged, the family dynamics are disturbed with a weakening of the parental couple which can lead to an explosion of the family unit.

Among the traumatic pathologies, we should also mention Silverman syndrome and shaken babies of Caffey, visual impairment may be one of the sequelae of a subdural hematoma.

Infectious diseases of childhood:

These include meningitis, encephalitis, nosocomial diseases, etc. And particularly in the Third World countries, measles, trachoma, and untreated chronic conjunctivitis.

Psychological and psychopathological consequences:

Perceptivomotor and cognitive implications of early visual impairment:

The only true blind person, on the psychic level, is the congenital blind child, whose visual cortical areas have never been sensitized. Indeed, even if the loss of the vision intervenes from the youngest age, the indelible traces of the oculomotor coordination remain, in the absence of vision.

The child is not considered to be a congenital blind person. The theoretical model of the “Analysis of Systems” developed by von Bertalanffy in 1968 and taken up by Portalier makes explicit the two different types of system according to whether deficient sensoriality has already been used or not: in the secondary blind there are only Modification of the intrasystemic sensory interactions, whereas in the congenital blind subject, there is an entirely different treatment of information, the balance of the system being ensured by the interaction of senses other than vision. Reuchlin and Ohlman have also developed the “theory of sensory vicariance” according to which a subject with a sensory impairment evokes more easily the other sensory possibilities placed at his disposal. The development of the blind child is therefore not the same as that of a “normal” child with less vision, but on a basis integrating visual impairment, in its specificity (congenital / acquired – partial / total).

The motor behavior of the early blind infant differs from that of the infant seeing from the age of three or four months: Bullinger and Mellier have shown that the blind infant invests his hands later, that he sometimes keeps them until an age More deeply embedded in the mouth or eyes, while he continues to shake his legs like a newborn. The absence of a visual link with distant objects does not stimulate motor and exploratory activity in these children as in the sighting infant and some of them keep their arms and hands folded over their bodies for a long time with a Neonatal fingertips.Moreover, these infants, deprived of visual stimulation, remain longer hypotonic and develop later voluntary motor drive, and its corollary, motor exploration: the “four legs” intervenes only towards 1 year / 18 months, Is never acquired in complete blind infants (because it deprives these children of the use of the arms to explore the environment and detect obstacles), and autonomous walking is usually not acquired until 18 months or even 3 years. On the other hand, many sensorimotor developmental items are achieved at the same age by blind and sighted babies (“straighten the head,” “turn on the stomach,” “walk three steps, held by the hand,” etc.). Moreover, the authors note the frequent presence in congenital blind children of “stereotyped behaviors” referred to as blindness: head and trunk swings, fingers or fists sunk into the eyes, echolalia, friction in one hand , Etc. These behaviors found in psychotic children are part of the search for a continuous flow of stimulation to fill the void left by blindness; They usually cease as soon as the child comes into contact or in an activity. It is important, however, to be vigilant and to evoke a personality disorder if these behaviors are excessive, their intensity hinders the relationship or they associate with other evocative symptoms.

The absence of visual cues in congenital blind children results in a significant delay in the concrete “infralogical” operations: conservation of the quantity of matter irrespective of the form of the latter, the representation of displacements in space, Will play an essential role in the mental representation that the young blind congenital has of its environment and therefore of its possibilities of displacement in autonomy. Studies by Millar Rieser and Hatwell have shown that the congenital blind subject organizes space from its own body and not from the visual space around it; A private sight light relies on spatial visual representations to improve its tactile landmarks. Similarly, a child who has seen, even if he does not keep a conscious visual memory, has more facilities in the taking of spatial references than the blind man of birth who shows a lack of adequate orientation in space . We find this difficulty of mastering the relations between space and time in the development of language: vocabulary with a strong visual connotation only makes sense with the congenital blind (colors, light, vast spaces like a place , Being hidden – an object placed under a transparent glass is hidden for the blind child -, etc.) and can be used without really being invested with meaning (“verbalism”). Urwin also pointed to the lack of relevance in the use of social expressions.

Announcement of the visual impairment and its psychopathological consequences Importance of the announcement:

Whatever the time of the announcement of the visual impairment and in particular of the blindness, this announcement breaks into the parental psyche. All the authors agree that the announcement of handicap, here visual deficit, is a dramatic moment for the parents: it causes a narcissistic wound that disqualifies them in their “parents being,” a trauma that deeply marks the relationship And particularly the tuning and attachment processes when this diagnosis is made at the very beginning of life. Ben Soussan speaks of a break in time, between “one before and one after”.

Advances in medical imaging sometimes lead to antenatal diagnosis, which causes a phantasmal development of the pregnancy, and confronts the parents with an impossible choice, requiring psychological accompaniment, between a termination of pregnancy and the reception of a pregnancy, A different child. The announcement in time of perinatality has the most marked traumatic effect, and acts as a privileged trauma on the mother-child dual unit, hindering the two maternal functions of protection and stimulation: Number of children with psychotic disorders among children who are blind at birth is close to 50% (25% to 30% of children with autism).

Numerous studies on the notion of interaction have shown the importance of eye communication in the first few weeks of life. When breastfeeding (breast feeding or bottle feeding), infants fix their mother’s face and appropriate in the mirror of the maternal gaze the emotional nourishment that allows them to build their psychic identity. In the spiral of interactions, the mother feels invested and recognized by her child in this eye-to-eye dialogue.

For Robson, this dialogue, which is the motor of early interactions, and therefore of attachment processes, triggers sensory, tactile, auditory, olfactory and kinesthetic stimulation behaviors that develop later in the mother. The absence of this mutual regard leads to a distortion in the mother-child dyad: blindness sends the seer back to blackness, anguish, death and, like severe visual impairment, is often synonymous with Mother of separation and disconnection of the different sensorialities. Parents feel unable to provide their child with the usual care and attention in the enjoyment of a shared exchange; They can not look at this child who does not see them, nor can they initiate a bodily or sonorous dialogue with the child. It is essential to support very early the multisensory exchanges between the visually impaired infant and his parents because early disturbed interactions are often followed by developmental and behavioral abnormalities. Without psychological support, the parents, prisoners of their traumatic neurosis, live the unseen child as deprived of a creative psychic space and enclose it in repetition: the same games judged not dangerous, the same body stimulations, the same words or repeated phrases Without the child having the space to create and evolve his own language. As the research of Rogers and Puchalski has shown, the development of attachment depends on the modes of interaction within the parent-child dyad, in which the two partners are in difficulty if the child is visually impaired: exchanges Being less rich, the mother looks less at her child and thus misses some signals that this one addresses to her.

Hatwell has shown that blindness is not in itself an impediment to development (even if it finds a predominant delay in the concrete tests of psychometric tests) when the mother of a visually impaired child and a fortiori blind child can use Other sensorialities spontaneously.

The different exchanges are then part of the pleasure of the game and in communication, the child creating his own language.

This child can, like any child, explore, take risks, move away or come closer according to his own desire when his motor skills allow it. His mother accepts his manifestations of anguish in the face of the unknown and helps him transform them into positive experiences of discovery and self-empowerment, rather than moments reactivating the trauma of the ad.

It seems essential to be attentive to the words of the mothers who express a particular anxiety about an infant that they feel is not visually reactive: a somewhat hasty reassurance on the visual abilities of their child, which will prove to be Later impaired visual, reinforces their sense of incompetence, and does not allow them to imagine other ways of communication with this baby.

When the visual deficit is diagnosed only later, the impact of the announcement on the mother-child relationship and the child’s development is linked to the quality of this relationship that has been established It is known that it is subjected to multiple hazards. Moreover, the stakes of the diagnosis, with the involvement or not of the vital prognosis, the intervention of iterative hospitalizations and of complex care modify in fact the relations of this child with its environment and the place it occupies in the ” Imaginary parental and family dynamics. Faced with this trauma, parents and children are confronted with a psychic work that is similar to the work of mourning; Many authors describe several periods in the evolution of the reactions of the child and his parents. The child who loses sight later lives a major upheaval in his relationship to the world: he loses his usual landmarks, and must pass to kinesthetic, olfactory, auditory markers. All activities are affected: displacements, acts of everyday life (lacerating, closing a zipper), relationships with others (decreased interactions and the circulation of information). The fatigue and slowness that follow will persist despite the proposed palliative techniques.

Adolescent with visual impairment:

A special place must be given to the visually impaired adolescent.

Every teenager must integrate bodily, emotional and intellectual changes that allow him to acquire the autonomy necessary for his adult life. Currently, this development is rarely done in the isolation of the young person, but mainly in peer group membership and in the differentiation between the adolescent group and the adult world. We can measure the difficulty of a teenager whose visual environment (and therefore the image returned by the mirror) is non-existent, or blurred, or fragmented by a partial perception, to feel himself in identification with the same. Adjustment to the peer group is particularly complex, and adult-young and, of course, parent-youth relationships play an essential role in encouraging the young person’s visual impairment. It is all the more important to express to the visually impaired adolescent what he induces in his being, that no mirror can send him an echo: his body changes without seeing it change, And similarly he does not see the body of his peers evolving. The gaze has a special place in exchanges between adolescents to spot the other, observe it, seduce it. It is certainly the time of life when it is most difficult to be seen without seeing and not having the means to know whether one is seen or not. The first emotions in love with the young visually impaired anchor more in an olfactory communication, sound or tactile than visual. In our culture, touch is a very eroticized sense, and the visually impaired adolescent must be helped in the use he makes of it, exploration or seduction.

It has been said that every child lives at the time of adolescence “a real transient psychomotor deficit”. The corporeal transformations make it lose this instrument of measurement and reference which is the perception of its environment through its body; There is then a certain awkwardness in the mobilization of this body in space, awkwardness which can be all the more present as the visual positioning can not be made and therefore does not allow the taking of new landmarks.

For the visually impaired adolescent, the establishment of these markers involves the motor and proprioceptive exploration of space, which allows it to reappropriate the environment.

This approach to the environment takes on a particular dimension in the progressive acquisition of psychic and physical autonomy; The visually impaired child and a fortiori blind person is particularly impeded in his discovery of the world. As soon as the walking is acquired, the exploration perimeter of the seeing child is enlarged, and he experiences the distance from his mother by measuring the distance separating him from his gaze. In adolescence, the appropriation of space and displacements is only the culmination of successive stages, which could not be set up for the visually impaired child.

The visually impaired adolescent confronts his parents with a more worrying risk-taking: can he move alone? How far ?

To do what ? Will he be able to protect himself? All these questions, common between a teenager and his parents, are particularly acute here, and the visually impaired adolescent, like other young people, can not be protected from all dangers. An overly restrictive positioning of parents is likely to lead the young person to take action with an endangerment: he will go elsewhere, further, differently from what was foreseen, in order to prove himself capable of doing so , Without measuring the risk taking or on the contrary by measuring it, but imagining thus to demonstrate its autonomy.

At the same time, psychic autonomy is built around the emergence in the visually impaired adolescent of a questioning on the origin of the handicap, on what others perceive of this difference. The absence of an answer to this questioning locks the young person in a renunciation to invest outside and in a withdrawal into himself.

Adolescence is for the young visually impaired and his parents synonymous with renunciation: there is often awareness that the handicap is definitive, that there will be no visual recovery, or even, on the contrary, a worsening of the deficit (In the case of a large number of retinopathies, it is in adolescence that there is a progressive loss of vision, and a change from amblyopia to blindness). Visual handicapped adolescents are confronted with the development of a life project limited by disability (choice of a profession whose exercise is compatible with the visual impairment). The application for recognition of “handicapped worker” and the procedures for obtaining disability compensation at the age of 19 set the handicap situation at the age when other young people are commonly admitted that everything is still possible. Clinical experience has shown that at this point, the impossibility of passing the driving license or driving a two-wheeler takes a special symbolic place. For the young person and his parents, a reactivation of the effect of the announcement of the handicap occurs: the parents no longer feel that they are the parents of a child in the process of evolution, but of a young person who is definitively visually impaired. Feeling of loss of a possible positive evolution can result in a fantastic closure.

A psychological accompaniment is then important to allow this transition from childhood to adult life and the renunciation on the part of the parents and the young person to the model of relations of the childhood.

In conclusion:

We can not overemphasize the importance of psychological support for visually impaired children and their parents. It is essential, whatever the age of the child during the diagnosis, to help these parents, and particularly the mother of very young children, in order to prevent the announcement of the diagnosis from traumatic neurosis , Which would aggravate the sensory disability of the child by favoring the installation of a distortion in the mother-child dyad.

As part of an individual therapy of the visually impaired child or family therapy of the child and his / her family, the therapist must be alert to the lack of visually impaired visual perception for the young visually impaired. These exchanges, if they exist between the other members of the family, must be verbalized by the therapist so that everyone becomes aware of the different channels of communication used. Silence takes a special place since the maintenance of the link for the visually impaired subject is essentially through the auditory canal.

It is also important to support the young visually impaired in their desire for autonomy: the family dynamics is willingly organized in the overprotection of the young visually impaired to avoid any experience imagined as dangerous.

Rehabilitation and palliative techniques:

It is essential to support the development of visually impaired children through different rehabilitation.

Orthoptics:

It is aimed at children who have very small visual abilities and allows them to make the best use of them by improving their functional vision and by introducing visual communication. In the visually impaired infant, it is important for the orthoptist to propose an early assessment (this assessment is possible as early as 6 months or even before) to inform parents about the use of vision by the baby: is there A perception of light, movement, shape, with or without a preferential eye, in a privileged direction or not, with a limited or no ocular action. If the baby is looking aside, it is necessary to explain to the mother that he adopts an attitude of head that allows him better vision and that he does not flee the maternal gaze. Parents should also be given prompt information to assist them in suggesting suitable objects for the child to experiment by themselves: choosing toys whose contrasts (black / white, for example) place the child in Optimal conditions of discrimination.

While developing the efficiency of other senses, it is essential to stimulate the use of vision. In order for the child to make the best use of his visual abilities, the orthoptist helps with spatial planning: the baby must be able to explore narrow spaces and containers in which he feels safe. As part of rehabilitation, the orthoptist allows the child to develop strategies (improving visual orientation, using visual scanning to reduce discomfort due to a tubular visual field, finding a blocking position for a nystagmus , Etc.), to create a space for play or work in order to make the best use of his visual capacities (inclined plane for children readers, adapted lighting, enlargement of a text according to visual impairment, etc.). Finally, the orthoptist also intervenes in the choice and use of appropriate optical aids: hand-held magnifying glasses, telescopic telescopic telescopes, tele-magnifiers, etc.

It is therefore essential that this guidance should take place at an early stage, on the one hand in order to avoid distortions in the parent-child relationship and on the other as a basis for reflection on all the palliative techniques that can be proposed for this purpose child.

Psychomotor rehabilitation:

It allows the child to work his proprioceptive and kinesthetic sensations and use the body’s channels of communication. The material used stimulates the other senses (touch, hearing, olfaction) in the playful way, but in order that the child can perceive the movements of his body and objects in space. The Snoezelen technique is interesting but not indispensable and the simpler methods of sensory stimulation retain their interest. Research has resulted in the development of technical aids for sensory support such as the Kay Ultrasound Guide (GUS), which is mainly used in the Anglo-Saxon countries, which, from the sending of ultrasound, informs the child , By a sound stimulation, on the objects on which the ultrasounds are reflected. The permanent auditory sensory flow is supposed to replace the void left by the absence of visual sensoriality. Some blind infants can be positively stimulated by the GUS (decreased “blindness”, better tonicity, etc.) but there is great variability in acceptance and effectiveness from one child to another and the GUS does seem Be interesting only occasionally to support a new acquisition; The babies refuse it as soon as this new acquisition in place.

Psychomotricity supports the visually impaired child in his motor acquisitions by helping him to find internal security in his movements.

Many sports activities can be adapted to the young visually impaired with the intervention of a guide; We are pointing more specifically to the tandem and the Torr ball, which is a collective sport using a sound balloon and is practiced under a banner.

Education and / or re-education in locomotion:

It developed first in the United States; Its objective is to enable the visually impaired child to travel safely and with a self-sufficiency that is as close as possible to that of sight-seeing children of his age: it is not, therefore, for the visually impaired child To know the paths by heart, but to learn techniques and strategies to avoid obstacles, to perceive the unevenness, to orient oneself in his movements inside and outside, to cross the streets. If the locomotion instructor deems it necessary, a white cane is proposed, either permanently or in certain situations (at night, during crossings, etc.) and requires the training of the rod technique for good management of obstacles. Locomotion is thus an essential factor in the autonomy of the young visually impaired in its movements, but if it mobilizes the possibilities of each one, it also points the limits.

We do not address the question of the guide dog: its attribution requires that the visually impaired person already has a good autonomy in his travels and in his daily life; As a result, there is no attribution of dog in childhood and rarely in adolescence, at least in France.

Some Canadian guide dog schools, on the other hand, work with children.

Help with daily life (AVJ):

The goal is to help the visually impaired child find techniques that enable him to perform the everyday tasks of daily life that become complex without visual identification: find the meaning of his clothes and dress, put a key In a lock, to drink, to find food in his plate, and to cut it, & c. This work is essential to enable the visually impaired child to gain autonomy and to get out of the parental grip. AVJistes are specialized occupational therapists.

Braille:

It is a tactile writing system for visually impaired people who can not read “in black”. Each letter is represented by a combination of one to six points embossed in a matrix two points wide by three high. The computer tool also offers adaptations for the visually impaired: braille tactile range for manual re-reading, speech synthesis, etc.

Care structures:

They are provided according to the age and needs of the children by different structures working at home and at the place of socialization or schooling of the child: service to support autonomy and School integration (SAAAIS); Family coaching and early education (SAFEP); Service for the integration of visually impaired and blind children (SIDVA);Special education and home care service (SESSAD); Or during consultations: early medico-social action center (CAMSP); (CMP).

Visual impairment and schooling:

The visually impaired child may, like any child, be cared for in kindergarten and kindergarten; It is important, however, that the rehabilitation professionals referred to above should intervene in order to adapt the environment and activities to the child. In primary school, and in the course of schooling, it will be necessary to propose to the child documents enlarged or transcribed in Braille, according to his needs. There are sensory education institutions for the visually impaired – the National Institute for Blind Youth (INJA) – school integration for the visually impaired (CLISS-DV), private institutions or managed by associations. As a teenager, and only as a teenager from our point of view, the question of boarding school can be asked: the young visually impaired can thus be asked in a group of peers to be solicited in acts and learnings of the Life, working and experiencing his autonomy, and appropriating, in a personal space, the different palliative techniques that he will need in his adult life.

Since the law of 11 February 2005, it is the Departmental House of Persons with Disabilities (MDPH) which is the unique place to accompany disabled people and their families in their efforts. In collaboration with professionals who know the child, she offers the care and support service that best suits the needs of the child.

Conclusion:

Early and pluridisciplinarity in the follow-up of the visually impaired child seems essential for us to propose not only specific rehabilitation, but also a space for speaking to this child and his parents.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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