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TEACHING STRATEGIES USED BY TEACHERS

TO ENHANCE LEARNING TO LEARNERS WITH

MULTIPLE DISABILITIES IN FOUR SELECTED

COUNTIES IN KENYA

By

WANG’ANG’A ANNE ROSE WANJIKU

E83/21627/2010

A RESEARCH THESIS SUBMITTED FOR THE AWARD OF

THE DEGREE OF DOCTOR OF PHILOSOPHY (SPECIAL

EDUCATION) IN THE SCHOOL OF EDUCATION OF

KENYATTA UNIVERSITY

AUGUST 2014

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DEDICATION

This thesis is dedicated to the teachers, parents and caregivers of learners with multiple

disabilities.

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ACKNOWLEDGEMENT

I am grateful to Kenyatta University for giving me an opportunity to pursue my doctorate degree

programme. My sincere gratitude goes to my supervisors Professor G.K. Karugu and Doctor

Evariste Karangwa who devoted a lot of their time patience and guidance towards the completion

of my study. I wish to acknowledge all the lecturers in the department of Special Needs

Education Kenyatta University for their encouragement. My thanks go to Professor G.K Njoroge

from the University of Rwanda, Dr. Francis N. King‟ori of Freb pharmaceuticals Kiambu and

Professor Gathogo Mukuria from the University of Nairobi for their advice and encouragement.

My deep appreciation goes to my son Morris Mithamo and my daughter Elizabeth Waithera for

their unfailing support. Above all, I wish to thank the Almighty God through whose grace I was

able to realize this long cherished dream.

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TABLE OF CONTENTS

Title Page…………………………………………………………………………………..1

Declaration………………………………………………………………………………..2

Dedication………………………………………………………………………………...3

Acknowledgment………………………………………………………………………... 4

Table of contents………………………………………………………………………….5

Abbreviations and Acronyms……………………………………………………………11

Abstract………………………………………………………………………………….13

CHAPTER ONE: INTRODUCTION

1.0 Introduction…………………………………………………………………………....14

1.1 Background of the Study……………………………………………………………...14

1.2 Statement of the Problem……………………………………………………………...19

1.3 Purpose of the Study…………………………………………………………………..20

1.4 Objectives to the Study………………………………………………………………..21

1.5 Research Questions……………………………………………………………………21

1.6 Significance of the Study……………………………………………………………...21

1.7 Delimitations and Limitations…………………………………………………………22

1.8 Assumptions of the Study…………………………………………………………….23

1.9 Theoretical and Conceptual Framework………………………………………………24

1.9.1 Theoretical Framework……………………………………………………………...24

1.10 Conceptual Framework……………………………………………………………..26

1.11 Operational Definition of Terms……………………………………………………28

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction………………………………………………………………………….30

2.1 Instructional Methods for Learners with deaf blindness….........................................30

2.1.1 Curriculum Adaptations for learners with deaf blindness ………………...............43

2.1.2 Teaching Resources and Support Services for Learners with deaf blindness…......46

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2.1.3 Environmental Adaptations Required for Learners with deafblindness..................49

2.2 Instructional Methods for learners with autism and blindness………………………51

2.2.1 Curriculum Adaptations for learners with autism and blindness ….........................56

2.2.2 Teaching Resources and Support Services for Learners with autism blindness…...57

2.3 Instructional Methods for learners with cerebral palsy intellectual disability……….48

2.3.1Curriculum Adaptations for learners with cerebral palsy intellectual disability…...59

2.3.2 Teaching Resources and Support Services for learners with cerebral palsy

intellectual disability………………………………………………………………69

2.3.3Treatment and Therapy for Learners with cerebral palsy intellectual disability…...75

2.3.4Adaptations for Learners with cerebral palsy intellectual disability ………………79

2.4 Training needs of specialized personnel for learners with multiple disabilities……..82

3.0 CHAPTER THREE: METHODOLOGY

3.0 Introduction………………………………………………………………….............88

3.1 Research Design……………………………………………………………………..88

3.2Variables………………………………………………………………………….......89

3.3 Location of the Study……………………………………………………………….89

3.4 Target Population…………………………………………………………………....90

3.5 Sampling Techniques and Sample Size……………………………………………...91

3.5.1Sampling Techniques………………………………………………………….........91

3.5.2Sample Size…………………………………………………………………………93

3.6 Construction of Research Instruments…………………………………………….....84

3.7 Pilot Study……………………………………………………………………………95

3.7.1Validity……………………………………………………………………………..96

3.7.2Reliability…………………………………………………………………………...96

3.8 Data Collection Techniques……………………………………………………….....97

3.9 Data Analysis………………………………………………………………………...98

3.10 Logistical and Ethical Considerations……………………………………………...99

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CHAPTER FOUR: DATA PRESENTATION ANALYSIS AND DISCUSSION

4.0 Introduction………………………………………………………………………….101

4.1 Demographic data of the respondents……………………………………………….101

4.2 Instructional Methods for learners with multiple disabilities………………………..103

4.2.1 Teachers Responses on the instructional Methods for learners with multiple

disabilities………………………………………………………………………..109

4.3 Curriculum Adaptations for learners with multiple disabilities ……………………115

4.4 Available teaching resources for learners with multiple disabilities……………….116

4 .4.1 Teachers responses on available teaching resources for learners with multiple

Disabilities…………………………………………………………………….. 116

4.4.2 Headteachers responses on available teaching resources for learners with multiple

disabilities………………………………………………………………………...120

4.5 Support Services for learners with multiple disabilities……………………………121

4.6 Training needs of teachers handling learners with multiple disabilities……………124

4.7 Strategies to improve teaching……………………………………………………...130

4.7.1 Headteachers recommendations………………………………………………….134

CHAPTER FIVE: SUMMARY CONCLUSION AND RECOMMENDATIONS

5.0 Introduction…………………………………………………………………………138

5.1 Summary of Findings……………………………………………………………….138

5.2 Implications of the Findings………………………………………………………..144

5.3 Conclusion………………………………………………………………………….144

5.4 Recommendations…………………………………………………………………..145

5.5 Suggestions for further research……………………………………………………147

REFERENCES……………………………………………………………………….148

APPENDICES………………………………………………………………………. 164

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LIST OF TABLES

Table 3.1 Study Framework for the Target Population…………………………………91

Table 3.2 Sample Size…………………………………………………………………..92

Table 4.1 Teachers‟ professional qualification across gender………………………….102

Table 4.2 Teachers‟ experience across learners‟ impairments………..…………………103

Table 4.3 Instructional Methods used for Learners with deaf blindness………………..104

Table 4.4 Instructional Methods used by teachers for learners‟ with autism blindness…106

Table 4.5 Instructional Methods used by teachers for learners‟ with cerebral

palsy intellectual disability………………………………………………… 108

Table 4.6 Teachers responses on instructional methods used for learners with

deafblindness……………………………………………………………….109

Table 4.7 Teachers responses on instructional Methods Used for learners with

autism blindness……………………………………………………………111

Table 4.8 Teachers responses on instructional methods used for learners with cerebral

palsy intellectual disability………………......................................................105

Table 4.9 Teachers responses on available teaching resources used for teaching learners

with deafblindness…………………………………………………………113

Table 4.10 Teachers‟ responses on available teaching resources available for teaching

learners with autism blindness……………………………………………..118

Table 4.11 Teachers responses on available teaching resources for educating

learners with cerebral palsy intellectual disability…………………………119

Table 4.12 Teachers‟ responses on support services given to learners with cerebral palsy

intellectual disability………………………………….................................122

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Table 4.13 Teachers responses on training needs of teachers educating learners with

deafblindness……………………………………………………………..125

Table.4.14 Teachers responses on training needs of teachers educating learners with

autism blindness…………………………………………………………127

Table 4.15 Teachers responses on training needs to teach learners with cerebral palsy

Intellectual disability ………………………………………………………128

Table 4.16 Recommendations from teachers educating learners with deafblindness….130

Table 4.17 Recommendations from teachers educating learners with autism blindness.131

Table 4.18 Recommendations from teachers educating learners with cerebral palsy

intellectual disability………………………………………………………133

Table 4.19 Recommendations from head teachers on ways of improving learning to

Learner‟s with deafblindness………………………………………………..134

Table 4.20 Recommendations from head teachers on ways of improving learning to

Learner‟s with autism blindness…………………………………………...135

Table 4.21 Recommendations from head teachers on ways of improving learning to

Learner‟s with cerebral palsy intellectual disability……………………….136

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LIST OF FIGURES

Figure1.1. A Diagrammatic Representation of the Conceptual Frame work…………..26

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ABBREVIATIONS AND ACRONYMS

AB: Autistic blind

AAC: Alternative Augmentative Communication

AFB: American Foundation for the Blind

APA: American Psychiatry Association

ASL: American Sign Language

AAIDD: American Association on Intellectual and Developmental Disabilities

CARS: Childhood Autism Rating Scale

CAI: Computer Assisted Instruction.

CASE: Conceptually Signed English

CPID: Cerebral palsy Intellectual disability.

DFB: Deaf blind

DSM-IV: Diagnostic Statistical Manual for Mental Disorders Fourth Edition.

FLASA: Florida Association of Speech language Pathologists and Audiologists

Convention.

IEP: Individualized Education Programme

KIE: Kenya Institute of Education

KISE: Kenya Institute of Special Education.

KU: Kenyatta University

KNEC: Kenya National Exams Council

MDT: Multidisciplinary team

MOVE: Mobility opportunities via education

MSD: Multi Sensory Deprived.

NCST: National Council of Science and Technology

NIMH: National Institute for the Mentally Handicapped .

SN: Special Needs.

SI: Sensory integration theory

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SNE: Special Needs Education.

SPSS: Statistical packages for Social Sciences

VAK: Visual Auditory and Kinesthetic Learning Styles.

VI: Visually impaired

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ABSTRACT

The purpose of this study was to investigate the teaching strategies used by the teachers

educating learners with multiple disabilities in the counties of Baringo, Kiambu, Kisumu and

Nairobi in Kenya. Multiple disabilities are a combination of two or more disabilities. In this

study learners with multiple disabilities include; cerebral palsy intellectual disability, autism

blindness and deaf blindness. The study adopted a triangulation mixed method design. The study

targeted a sample of 9 headteachers and 57 teachers educating learners with multiple disabilities.

Purposive sampling was used to sample the respondents. Piloting the instruments was done in

schools that were not involved in the actual study. The research instruments that were used

included interviews, observation guides and questionnaires with a Likert scale. Reliability of the

instruments was determined by test-retest method. Content related validity was used as a

measure to determine validity. The study used descriptive statistics for the quantative data where

tables of frequencies, mean, standard deviation, and percentages were used to analyze data.

Qualitative data were analyzed using descriptions and thematic text. Results revealed that

majority of the teachers teaching learners with deafblindness used the following instructional

methods; tactile Kenyan sign language, task analysis, Tadoma, sign language among others.

Majority of teachers teaching learners with autistic blind used the following instructional

methods; braille, pre-braille activities, oral methods among others. Majority of teachers teaching

learners with cerebral palsy intellectual disability used the following instructional methods; use

of task analysis, activities of daily living, and real objects among others. The choice of the

instructional method was determined by the needs of learners. Results also revealed that teachers

were inadequately prepared to teach learners with multiple disabilities because their training was

for a specific disability. The curriculum for learners with autism blindness and cerebral palsy

intellectual disability was found to be ineffective. Teachers educating learners with deaf

blindness used the final draft of an adapted curriculum from Kenya institute of Curriculum

Development. Teaching resources and support services were found to be inadequate. The

following were the recommendations that were made following the study findings to improve

teaching; training teachers, provision of a functional curriculum, provision of adequate support

services, provision of enough teaching resources among others.

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CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

This chapter presents; background to the study, statement of the problem, purpose of the study,

research objectives, research questions, significance of the study, delimitations and limitations,

assumptions, theoretical and conceptual framework and operational definition of terms. Multiple

disabilities means concomitant impairments such as intellectual disability-blindness, intellectual

disability-orthopedic impairment, the combination of which causes such severe educational

needs that they cannot be accommodated in special education programs solely for one of the

impairments (Hallahan, Kauffman & Pullen, 2012). Children with multiple disabilities have a

combination of various disabilities that may include; speech, physical, mobility, learning,

intellectual disability, visual, hearing, brain injury and possibly others. Along with multiple

disabilities, they can also exhibit sensory losses, behavior and social problems. Children with

multiple disabilities will vary in severity and characteristics. These students may have difficulty

attaining and remembering skills or transferring these skills from one situation to another.

Support is usually needed beyond the confines of the classroom. Programming for these children

will be based on the characteristics they display (Watson, 2003; Heller, Forney, Alberto, Best &

Schwartzman, 2009).

According to Hosken (2008), it is difficult to define the term severe and multiple disabilities

precisely because no one definition covers all the conditions that special educators and

psychologists know about. Usually these students have intellectual disability that is accompanied

by other disabilities such as extensive physical disabilities and delayed language skills. Some of

them however have normal intelligence even though their physical and language disabilities may

mask it. There are two major themes in this definition, the extent of the disability is beyond

moderate levels, and there are two or more disabilities occurring simultaneously. Most of the

students served in programmes for severe and multiple disabilities have severe intellectual

disability. Teaching strategies are the methods used to allow learners to access the information

being taught.

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The teaching strategies determine the approach a teacher may take to achieve learning objectives

(Turnbull, Turnbull &Wilcox 2002). “Instructional methods are the how to” in the delivery of

training. The methods used in any learning situation are primarily dictated by the learning

objectives decided up upon by the course developers. In many cases, combinations of methods

are used to facilitate the learning experiences (Hosken, 2008). The goal of a comprehensive

program for learners with multiple disabilities should be one of increasing their independence.

The functional skills assessment will identify the areas of need and provide structure to address

those areas. The first skills to be taught are those which the learner needs most often in order to

function more independently in a least restrictive environment. Some of the issues to consider

when making skill selections are: Learner‟s health and safety, future programs, level of

independence, age appropriateness and logistics of instruction (Sense International India, 2010).

In developing the learner‟s Individualized Education Plan (IEP), it will be necessary to consider

the need for instruction across several areas of learning, such as sensory development, motor

skills, communication skills, cognition, social development, self care, daily living and

community living activities, recreation or leisure time and vocational skills. For the learner to

benefit from specialized instruction, it may be necessary for some learners to receive appropriate

related services.

In implementing an educational program, attention should be given on the instructional

techniques used, the functionality of the skills taught and the age appropriateness of the

instructional materials and activities used (Best, Heller & Bigge, 2010; Hardman, Drew &Egan,

2005). There are a number of factors affecting choice of teaching strategies for the multiple

disabilities. They include type of disability, level of severity and learner‟s age level among

others. The techniques and materials used to teach learners with one type of disability may be

quite different from those used for another disability. The more serious the disability, the more

likely the learner is to be educated in a special setting (Cartwright, Trudgil & Mansfield, 1995).

There are several components to an effective instructional programme. They include:

Assessment, curriculum, methodology and ongoing evaluation. Assessment is usually seen as the

beginning of instructional models. The teacher needs to know whether there are any medical or

physical factors that will limit performance or affect what should be taught and how it should be

taught. The teacher also needs to know what capabilities the learner possesses as well as deficits

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and excesses demonstrated and the point at which instruction should begin. Thus there should be

a direct correlation between what is on the test and the curriculum content. The curriculum

should be extensive, ideally consisting of an exhaustive number of items within each curriculum

area. These items should be stated in behavioural terms. Since it is probably impossible to

develop an exhaustive list of behaviours, teachers should always view items as open ended so

that skills can be added or modified as needed for each individual learner. The curriculum for

learners with multiple disabilities includes: the following general skills areas: self care,

socialization, communication, motor, pre-academic and leisure or vocational (Scutta, 2011;

Aslop, 2002; Ellis, 1986).

The history of the education of learners with multiple disabilities can be traced to persons such as

Anne Sullivan Macy (1866-1936) a teacher who used tactile finger spelling to teach Hellen

Keller who was deaf-blind. Hellen Keller became the first learner who was deaf-blind to get a

Bachelors of Arts degree. Laura Bridgman a learner who was also deaf-blind was taught by the

director Perkins Institute of the Blind among others (American Foundation for the Blind (AFB),

2013. According to Deaf blind International (2003), the prevalence of severe and multiple

disabilities is no more than 0.1% to 1.0%. According to the World Bank, the prevalence rate of

multiple disabilities in Kenya is under 1% (Mont, 2007). Globally, research studies have been

carried out on multiple disabilities such as autism blindness; whereby in Norway they found out

that the prevalence of blindness among autistic people was relatively high (National Autism

Programme, 1998).

In Britain, a research project was carried out on the curriculum access for learners with deaf

blindness. The study found out the importance of teaching strategies which were primarily

communicative and which enabled the child to both anticipate and gain a clearer understanding

of what the task demanded. The study also found out the need for teachers to have access to a

wide range of specialist strategies especially where they are working with pupils with the most

complex needs thus teachers need to be able to adapt more generic strategies to meet the specific

needs of an individual. Some of effective strategies identified in the study included; signing,

speech, music prompts and objects of references (Porter, Miller, Pease, 1997). In America, a case

study was carried out on training a learner who was autistic blind to communicate through signs.

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The child was able to acquire a function sign vocabulary relying primarily on the tactile

kinesthetic and auditory modalities. The newly acquired skill had a beneficial impact on the

child‟s general functioning (Konstanareas, 1982). In Africa, studies were carried out on learners

who are deaf with multiple disabilities in developing countries such as Kenya, Malawi,

Cameroon, Nigeria, Uganda, and Somalia among others. In Kenya, they found out that there

were learners with deaf and multiple disabilities in special schools for the Deaf. For instance, in

Njia special school in Meru North District. They found that no progress had been carried out on

how to deal with the learners who were deaf with multiple disabilities (Shettle, 2004).

A study carried out by the Kenya Institute of Education (KIE) in 1980 on additional disabilities

among 896 children enrolled in special schools for the physically disabled revealed that there

were learners with multiple disabilities(Ndurumo, 1993).The question is whether these learners

with multiple disabilities in our schools are being provided with appropriate instructional

interventions for their diverse needs. The approximate number of learners with multiple

disabilities in the counties of Baringo, Kisumu, Kiambu and Nairobi is about 300. According to

the National Bureau of Statistics (2009), the total population of people in the four counties is

6,286,121. The percentage of people with multiple disabilities is about 0.05 percent. The

Kochung Report (2003) found out that there was lack of reliable statistical data on learners with

Special needs in Kenya. It is most likely that this percentage may be higher due to the following

factors namely, lack of accessibility in certain areas, lack of sensitization regarding learners with

disabilities, among others. This state of affairs is detrimental to learners‟ acquisition of education

and denial of their rights to education. According to the Deaf blind pilot project report (1992-

1996), the population of the deaf-blind in Kenya has not yet been established and an awareness

of the condition among the communities and the authorities concerned. For instance education,

health, administration and social services is still limited, therefore education facilities for these

persons are very few resulting in such learners being placed in either schools for the Deaf or the

visually impaired. The question is whether the learners with deaf-blind are receiving the

appropriate instructional intervention strategies to cater for their diverse needs. In Kenya,

learners with multiple disabilities are found in some of our special schools, special units and in

regular schools (Kochung Report, 2003). Learners with cerebral palsy are categorized under the

physically disabled and are thus educated in schools for learners with physical disabilities and

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also in schools for learners with intellectual disabilities. Learners with autistic blind may be

found in special schools for the blind and in some special units. In major special schools such as

Thika primary school for the Blind, Likoni school for the Blind among others, a „’special class’’

in the special school has been set aside for learners with multiple disabilities. In Thika primary

school for the blind, the special class is referred to as the „’green class’’. It is not clear what

instructional methods are used to cater for these learners diverse needs in the “special class”. A

special class is a class that is set aside for learners with multiple disabilities. Learners with deaf

blindness are found in some special units and in Kabarnet special school for the Deaf blind.

The Ominde Report (1964) advocated for teacher training to include a component of Special

Education (SE) to meet the needs of learners with Special needs (SN). Kenya is cognizant of the

need to provide specialized training to teachers. This is evidenced by several institutions that

have been set up to offer special education training. These institutions include; Kenyatta

University, Maseno University, Kenya Institute of Special Education (KISE), Moi University,

Pwani University among others. The question is whether and to what extent the curricula used in

these institutions are customized according to the specific educational needs of the learners in

relation to the level and type of disability such as multiple disabilities. The training of special

education teachers in Kenya has been categorical based on the four major areas of disability

namely, hearing, visual, physical and. It is not clear whether teachers are able to differentiate

instructions when faced with learners with more than one disability. In 2006, KISE started

training teachers to teach learners with deaf blindness; however, there are other learners with

multiple disabilities such as autism blindness, cerebral palsy and intellectual disability among

others that require teachers to be retrained to help them cater for these learners‟ instructional

needs. According to Rule 6 of the United Standards Rules on the Equalization of Opportunities

for Persons with Disabilities (1993), education should be provided in an integrated school setting

and in general school setting. It is not clear what is being done in Kenya in order to ensure the

specific education needs of learners with multiple disabilities are mainstreamed, since they are

found in all our school settings. Besides, the Koech Report (1999) reveals that a large number of

teachers in special schools need to be retrained to cope up with knowledge evolution and

teaching techniques in special education. It is not clear whether teachers have been retrained or

updated to cope up with new knowledge and teaching strategies in specific disabilities such as

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multiple disabilities. The Kochung Report (2003) reveals that learners with multiple disabilities

can follow a specialist curriculum. A specialist curriculum remediates problems of learners such

as communication, mobility among others. It is not clear whether the curriculum for learners

with multiple disabilities has been adapted or modified to cater for the diverse needs of the

learners. Furthermore, the National Policy on Special Needs (2009), a Ministry of Education

policy launched in 2010, shows that the only documented multiple disabilities is deaf-blind it is

not clear why other learners with multiple disabilities such as autism blindness, cerebral palsy

intellectual disabilities among others are not specifically included. The background information

available points out to the deficient efforts to mainstream the needs of learners with multiple

disabilities in all our school settings. In this context, the instructional environment is a factor of

interest. The study sought to investigate the teaching strategies used by teachers for learners with

deaf blindness, autism and blindness and cerebral palsy and intellectual disability in the counties

of Baringo, Kisumu, Kiambu and Nairobi in Kenya.

1.2 Statement of the Problem

Studies carried out by Shettle (2004), Kochung Report (2003), Deaf blind pilot project (1992-

1996) and Kenya Institute of Education (KIE) (1980) revealed that there were learners with

multiple disabilities in schools for learners with single disabilities. However, the studies did not

cover the teaching strategies teachers used for learners with multiple disabilities. Many of the

Kenyan special schools and units combine learners with multiple disabilities into one group

irrespective of the fact that different multiple disabilities will require different instructional

methods, specialized personnel, different teaching resources, different support services and

different curriculum adaptations among others. For instance, some learners with multiple

disabilities are found in programmes for specific disabilities like in Njia special school for the

Deaf in Meru North in Kenya. The learning needs of learners with multiple disabilities are not

adequately addressed because teachers are trained to teach learners with specific disabilities on

the four major areas of disability namely; hearing, visual, physical and Intellectual disability

consequently, if teachers are posted in special schools where learners have multiple disabilities

other than the category in which they have been trained, they are unable to differentiate

instructions accordingly. According to the Kochung report (2003), learners with multiple

disabilities can follow a specialist curriculum. However the Kochung report (2003) found out

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that many subject areas of the 8-4-4 curriculum were neither adapted nor a specialist curriculum

prepared for the areas where they were required. Consequently, the instructional needs of

learners with multiple disabilities are not adequately met. According to the National Bureau of

Statistics (2009), the total population in the four counties is 6,286,121 Million. The approximate

number of learners with multiple disabilities is about three hundred. The percentage of learners

with multiple disabilities is 0.05 percent. The Kochung report (2003) found out that there was

lack of reliable statistical data on learners with special needs. It is most likely that this percentage

may be higher due to the following factors namely; lack of accessibility in certain areas, lack of

sensitization regarding learners with disabilities, among others. This state of affairs is detrimental

to learners‟ acquisition of education and denial iof their rights to education. In some special

schools for learners who are visually impaired, a “special class” within the special school has

been set aside for learners who are blind with multiple disabilities. In the view of the fact that

learners with multiple disabilities are combined in our educational settings, their special

educational needs may not be taken into consideration and we shall be denying these learners

their right to education which considers each child‟s unique abilities and learning needs as

clearly stipulated in the Salamanca World Conference on Special needs of 1994. If the

instructional methods, human resources, teaching resources, support services and the curriculum

are not customized to their specific educational needs, then opportunities available for these

learners to attain some level of independence as dictated by their diverse needs will be

foreclosed. This in the long run will make it difficult for these learners to lead an independent

life in their homes and communities thus increasing their dependence on their parents which may

have adverse input on national development. This study seemed to merit investigation in the

view of the fact that Basic education is a right to all children regardless of disability, sex, colour,

race or social status as stipulated in the Universal Declaration of Human Rights of 1948. From

the foregoing statement the study sought to investigate the teaching strategies used by teachers

educating learners with deaf blindness, autism and blindness and cerebral palsy and intellectual

disability in Baringo, Kiambu, Kisumu and Nairobi counties in Kenya.

1.3 Purpose of the Study

The study investigated the teaching strategies used by teachers educating learners with multiple

disabilities in the counties of Baringo, Kiambu, Kisumu and Nairobi in Kenya.

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1.4 Objectives of the Study

The specific objectives of this study were:

1. To investigate the instructional methods used by the teachers educating learners with

multiple disabilities. (deaf-blind, autism blindness, and cerebral palsy intellectual disability).

2. To find out the curriculum adaptations that had been effected for learners with multiple

disabilities. (deaf-blind, autism blindness and cerebral palsy intellectual disability).

3. To find out the available teaching resources for learners with multiple disabilities. (deaf-

blind, autism blindness, and cerebral palsy intellectual disability).

4. To find out available support services for learners with multiple disabilities. (deaf-blind,

autism blindness, and cerebral palsy intellectual disability).

5. To find out the training needs of teachers educating learners with multiple disabilities. (

deaf-blind, autism blindness , and cerebral palsy intellectual disability).

1.5 Research Questions

1. What instructional methods are used for teaching learners with multiple disabilities?

(deaf- blind, autism blindness and cerebral palsy intellectual

disability)?

2. What curriculum adaptations have been effected for learners with multiple disabilities?

(deaf-blind, autism blindness and cerebral palsy intellectual disability).

3. What are the available teaching resources for learners with multiple disabilities?

(deaf-blind, autism blindness and cerebral palsy intellectual disability).

4. What are the available support services for learners with multiple disabilities?

(deaf-blind, autism blindness, and cerebral palsy intellectual disability).

5. What are the training needs of teachers educating learners with multiple disabilities?

(deaf-blind, autistic blind and cerebral palsy intellectual disability).

1.6 Significance of the Study

The findings of the study will hopefully benefit teachers, learners, parents, members of the

society, policy makers and curriculum developers. To the teachers, it will be of benefit to them

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because they will understand the appropriate instructional methods for the various multiple

disabilities such as cerebral palsy intellectual disabilities, deaf-blind and autism blindness. For

these learners, their diverse needs will be taken into consideration by all education stakeholders.

To the parents, they will understand the various interventions and learning needs for their

children and work as co- therapists with the schools. The study will hopefully make contribution

to the curriculum developers and policy makers to understand the nature of challenges facing

learners with various multiple disabilities and come up with suitable instructional approaches and

suitable curricula for the various multiple disabilities. The study will also help in sealing

knowledge gaps as it will add new knowledge on the instructional methods for learners with

multiple disabilities.

1.7 Delimitations and Limitations

The study focused on nine major special schools and units where learners with multiple

disabilities are found within the counties of Baringo, Kiambu, Kisumu and Nairobi in Kenya.

The four counties were purposively sampled because they have special schools and units having

learners with deaf-blind, autism blindness and cerebral palsy intellectual disability and are also

accessible. One school and two special units for learners with deaf- blind within the four counties

were used. They included: Kabarnet special school, Maseno Deaf blind unit and Kilimani Deaf

blind unit. Two schools and a special unit where learners with autistic blind could be found

within the four counties included; Kibos school for the blind, Thika primary school for the blind

and Kilimani unit for the visually impaired. Three schools where learners with cerebral palsy

intellectual disability could be found within the four counties included: Joyland Special School,

SA Joy Town Special School and Nile Road Special School. The pitfalls the researcher faced

included: Lack of enough time, lack of adequate information on various multiple disabilities and

lack of enough money to facilitate the researcher and the research assistants in transport and

accommodation within the four counties.

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1.8 Assumptions

1. Teachers educating learners with multiple disabilities may be facing challenges on the choice

of instructional methods to use for learners with multiply disabilities.

2. That teachers may be facing challenges of an appropriate curriculum for learners with multiple

disabilities.

3. The training level of special education teachers educating learners with multiple disabilities

may be posing challenges on the teaching of learners with multiple disabilities.

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1.9 Theoretical and Conceptual Framework

1.9.1 Theoretical Framework

The study was based on the instructional approaches and learning theories for learners with

multiple disabilities by Dr. Lilli Nielsen and Dr. Jan Van Dijk. Dr. Lilli Nielsen developed the

theory of “Active learning” maintaining that learners who are visually impaired with multiple

disabilities learn best by being actively involved in their environment without direct adult

intervention. She encourages educators and families to design the environment in such a way that

children are motivated to reach out and explore their surroundings using materials such as a little

room and a resonance board (Nielsen, 1998). Dr. Nielsen‟s little room is a core active learning

environment, providing a resonant, warm, rich and a safe place for children to engage. When

properly populated with acoustically responsive toys, it naturally feeds back to the child for

every movement. The resonance board has a thin plywood panel that vibrates every movement a

child makes on it. There is a folding resonance board with a continuous hinge intended for the

itinerant therapist (Nielsen, 1998). Active learning approach enables the child with multiple

disabilities to learn in the same way that very young children without disabilities learn by doing,

rather than being trained or taught. In this approach the child is provided with opportunities to

learn through active exploration and examination of the environment. Teachers and parents set

up developmentally appropriate environments that encourage the child to touch, move and

explore to the child‟s actions and sounds and interact with the child according to his or her level

of interest and development. Active learning works with even the most significantly delayed and

disabled children (Nielsen, 1998).

Dr. Jan Van Dijk in his approach to working with learners who are deaf-blind, also emphasizes

the importance of establishing a relationship and learning to read the child‟s subtle

communication as a first step. Similarly he uses coactive movement following the child in

interaction. He/she develops anticipation through building structured activities and routines, and

then slightly changes something in the routine to introduce novelty and learning. All along his

goal is to build the child‟s self esteem and confidence in his abilities to do for himself and to

interact with others. Specific communication skills are tied to these experiences as concepts are

developed through experiential learning. (Van Dijk, 2001). Routines and turn taking interactions

in the early stages play a critical role in the child‟s development. For instance, all children

25

participate in basic care giving activities such as bathing, diapering and feeding. Through these

care giving activities that occur daily, the child begins to establish a memory and can anticipate

events. Later on, through participation in simple turn taking games that are done in a routine

way, the child is able to cause the adult to do something pleasurable by taking an action of his

own. Still later in his development, the child is able to take part in simple series of actions that

result in some desired outcomes through more structured routines. Finally the child develops

independence in completing the steps of the routine he has spent time “helping‟ the adult to

complete (Van Dijk, 2001). The implications of these theories to the study is that failure to

provide adequate attention to the quality of education given to learners with special needs, by not

availing the necessary teaching resources, skilled personnel, environmental adaptations,

curriculum adaptations and appropriate support services among others many learners with

Special Needs may fail to obtain meaningful schooling. They will therefore reap minimum

benefits in terms of cognitive development and independence.

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1.10 Conceptual Framework

Fig 1.1 A diagrammatic representation of the conceptual framework

Support services

Source: Researcher‟s own adaptation

Teaching strategies for Learners with Multiple

Disabilities

Independent variables

Instructional methods

Curriculum adaptations

Teaching resources

Support services

Specialized personnel

Dependent variable

Learning

Expected Outcomes

A happy and a productive life

Independence, functional skills, positive self image, confidence,

communication skills among others.

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Explanation of the conceptual framework

The study was based on the Active learning theory on instructional and learning theories for

learners with multiple disabilities by Dr Lilli Nielsen and Dr Van Dijk. The theory encourages

educators and families to design an enriched environment for learners with multiple disabilities.

An enriched environment enable learners‟ to explore the surroundings using teaching resources

such as the little room and a resonance board thereby enhancing learning among learners with

multiple disabilities. In this study, an attempt was made to find out how the teaching strategies

influence learning. For instance, if the instructional methods are customized to the specific needs

of learners with multiple disabilities in relation to the level and type of disability learners will be

positively motivated to participate in learning. If the curriculum is adapted to suit the individual

needs of learners, the teaching objectives will be achieved thereby enhancing their academic

performance. If the teaching resources and support services are adequate, learners will improve

in their learning. Independent variables are the factors that explain variation in the dependent

variable (Kombo &Tromp, 2006; Orodho, 2005; Creswell & Plano Clark, 2011). The

independent variables are the causes. In figure 1.1 the teaching strategies are the independent

variables. The teaching strategies include; instructional methods, teaching resources, curriculum

adaptations, support services and trained personnel. The effect of teaching strategies to learners

with multiple disabilities is learning which is the dependent variable. The resultant outcomes will

be independence, functional skills, positive self esteem, positive self concept, self determination,

confidence, cognitive development among others.

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1.11 OPERATIONAL DEFINITION OF TERMS

Disability: It is a restriction in the ability to perform a normal activity of daily living which

someone of the same age can perform.

Functional /Specialist curriculum: This is a curriculum that caters for the diverse needs of

learners with deaf-blind, autism blindness and cerebral palsy and intellectual disability.

Impairment: It is any loss or abnormality of psychological, physiological or anatomical

structure or function.

Learning: This refers to relatively permanent change in behavior as a result of experience or

practice.

Learners’ Diverse Needs: These are variations of abilities and differences found among any

group of learners in a group.

Multiple disabilities: These are a combination of two or more disabilities for Instance, autism

blindness, deaf blindness, and cerebral palsy intellectual disabilities among others.

Regular school: This refers to the mainstream school which follows the curriculum that is

prepared for the average ability learners.

Special educational needs: These are educational needs which vary from one child to another.

Special Needs Education: This is education which provides appropriate modification in the

curricula, teaching methods, education resources or the learning environment.

Specialized personnel: These are individuals who are specially trained in the specific area to

competently handle learners with deaf blindness, autism blindness and Cerebral palsy intellectual

disability.

Special School: This refers to a school that is built and organized to provide educational services

to learners with one type of disability.

Special Unit: This term describes a classroom that is located in a regular school, but is set aside

for educating learners with a specific type of disability.

“Special class”: This is a class set aside in major special schools for learners with

multiple disabilities.

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Structured teaching: This is how the classroom environment of learners with deaf blindness,

autism blindness and cerebral palsy intellectual disability is organized by developing appropriate

routines, appropriate activities, appropriate instructional strategies and the way the physical

environment is set up to promote successful behaviour and skill acquisition.

Support services: These are special services offered by other professionals apart from teachers

such as speech therapists, sign language interpreters among others and members of the

communities, environmental adaptations, adaptive computers, alternative communication, or

assistive technology given to learners with deaf-blind, autism blindness and cerebral palsy

intellectual disability.

Teaching: This refers to the interaction in which the learner the materials and the environment

participates.

Teaching strategies: These are the personalized instructional approaches or

methodologies that cater for the individual needs of learners with multiple disabilities.

They will also include; support services, structured teaching, a functional curriculum,

teaching resources and specially trained personnel among others.

Multidisciplinary team: This is a team of experts that is involved in the education programming

of an individual learner with special needs.

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CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter reviews literature related to the study under the following sub headings:

Instructional methods for learners with deaf blindness, autism blindness and cerebral palsy

intellectual disability, curriculum adaptations, teaching resources, support services and training

needs of specialized personnel for learners with multiple disabilities.

2.1 Instructional Methods for Learners with Deaf Blindness

Deaf blindness means simultaneous hearing and visual impairments; the combination of which

causes such severe communication and other developmental and educational needs that cannot

be accommodated in special education programs solely for children with deafness or children

with blindness (Hallahan, Kauffman & Pulllen 2012). The term deaf-blind is used to describe a

heterogeneous group of people who may suffer from varying degrees of visual and hearing

impairment, perhaps combined with learning and physical disabilities which can cause severe

communication, developmental and educational needs. A learner with deaf blindness is a Multi

Sensory Deprived child (MSD) who has been denied the effective use of either his or her distant

senses (Mc Innes & Treffrey, 1982). Children who are deaf-blind miss information that would

normally be received by the use of distance senses of vision and hearing. Distance senses allow

individuals to take in information immediately and are the primary channels through which most

people collect information (Prickett & Welch, 1995). Learners who are deaf-blind may receive

distorted or incomplete information from their senses because of their sensory loss. The “near”

senses of touch, smell and taste do provide some information, but they require the learner to be

in close contact with the item, and these senses may not provide adequate information, for

instance, it can be difficult to gain understanding of large items such as a tree or a mountain or

distant objects like a cloud without the use of distant senses (Heller et al., 2009). Due to the loss

of information from distant senses, children who are deaf- blind receive information that usually

results in delays and difficulties in concept development and skill development. The

development of these areas is further hampered by the lack of incidental learning that occurs

from vision loss.

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Incidental learning is unplanned learning that results from seeing or engaging in other activities

(Aslop, 2002; Heller et al., 2009). Learners with deaf blindness will need more time to learn

concepts with adults providing ample opportunities and systematic instruction. Learners with

deaf blindness will often have developmental delays in the area of mobility and motor skills. The

loss of vision makes it difficult for young children to monitor their own environment or copy

other people as models. Milestones such as crawling and walking are usually delayed.

Orientation problems can occur due to difficulties in creating a mental map of their surroundings

(Heller et al., 2009; Best et al., 2010). One of the major areas affected by having deaf blindness

is the area of communication. Communication delays and difficulties typically occur usually

resulting in the need for augmentative and alternative communication.

Augmentative and alternative communication can range from the use of gestures and objects to

sign language or electronic communication devices (Heller et al., 2009). When the learner with

deaf blindness has additional impairments such as severe cerebral palsy (CP), the learner‟s

attempts at communication may be easily missed. This difficulty in communication often leads to

secondary behavioural challenges (Holte et al., 2006). The exact characteristics of the learner

who has deaf blindness will depend on the etiology, the severity of the sensory losses and the

individual make up of the child. In addition many learners who are deaf-blind also have

additional disabilities such as cerebral palsy, intellectual disabilities, health impairments and

developmental delays. The teacher will need to learn about the unique characteristic of each

learner with deaf-blind to determine how best to meet his or her needs (Heller et al., 2009;

Mcletchie & Riggio, 1997).

At the University of London Institute of Education in Britain, a research project was carried

out on the curriculum access for learners with deaf-blind by (Porter et al.,1997). The four

objectives of the research project were to gather information on the range of strategies used by

teachers working specifically with pupils who are deaf-blind. To identify how teachers made

decisions about the type of strategy to use with a particular pupil or group of pupils with

reference to modification and adaptations including involvement of pupils and parents in the

process. To examine the effectiveness of different strategies used with the different pupil groups

on the basis of the criteria identified by teachers in their decision making. To collect detailed

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case study material to illustrate the use of effective strategies with reference to different areas

of the curriculum for each pupil group. The research instrument used was a questionnaire and it

was designed to provide background information to illustrate the context in which they worked

including the nature of setting, levels of staffing, type of curriculum offered, specialist teacher

training, key aspects of the curriculum, how learning was organized and also to identify the

strategies teachers used with learners who were deaf- blind, how they learnt about them and

what influenced their choice (Porter, Miller &Pease,1997).

A total of 82 pupils aged 2 to19 years took part in the study. All had measurable dual sensory

loss. Over half of the participants, 58 % had some useful, functional vision. A fifth of the

pupils, 20%, received no or limited information through the sense of sight and just under a

tenth, 9% received no or limited information through both senses. Only limited information was

provided on the remainder of the samples, 13%. Almost two thirds of the children, 65% attended

schools for children with physical disabilities. Almost a quarter, 23% were in sensory provision

(including specialist Deaf-blind unit and classes). The smallest group, 12% were attending

mainstream schools. All the children were following the national curriculum whereby 11% were

at a key stage commensurate with their age. The rest were working at levels below this, with just

over half the pupils working within or towards key stage one of their curriculums. In total,

teachers identified 145 strategies. Over the course of a week, they used on average thirty

different strategies (Porter et al., 1997). The strategies ranged in specificity and included those

developed with the particular needs of learners with deaf-blind in mind, such as objects of

references, joint action routines and coactive movement, generic strategies adapted to meet the

needs of learners with deaf- blind such as demonstration, speech and role play, strategies

reflecting the culture in which the teacher worked, for example, teachers in sensory settings used

strategies specific to the needs of children with sensory loss, for example signing and auditory

enhancement. Each group of teachers favoured slightly different strategies. Teachers in

mainstream schools generally used demonstration and physical positioning in relation to sound.

They emphasized strategies which focused largely on task presentation and which enabled pupils

to take part in the same curriculum as that provided for the whole class. Teachers in sensory

settings used a mixed approach which combined methods of task presentation, such as imitation,

with the formal system of communication such as signing and speech.

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Teachers in schools for children with severe learning difficulties or physical disabilities used

strategies which helped the child to succeed through physical intervention. These included

physical prompts, physical positioning in relation to sound and vision, physical contact and in

addition speech. This last group of teachers tended to use fewer strategies Teachers gave a

variety of responses to describe their decision making about the strategy they used. Specialist

training was an indicator. Those with the most specialized training in deaf blindness were best

able to describe what influenced both “within child” factors such as level of sensory impairment,

developmental level, interest and environmental factors including levels of lighting, availability

of space and staffing. A top ten list of effective strategies was identified, four of which included

signing, speech, music prompts and objects of references which were associated with sessions

where teachers met their stated objectives. All effective strategies promoted communication with

the child and provided access at differing levels. The effectiveness of the top ten strategies was

also examined in relation to each group of pupils. For pupils receiving the national curriculum

with access, the most effective strategy was physical positioning being in relation to vision,

sound and speech. For pupils receiving a modified approach to the national curriculum, the most

effective strategies were signing, speech, objects of reference and musical prompts. For pupils

receiving a developmental approach to the national curriculum, the most effective strategies were

choice making, signing and objects of reference. The case studies demonstrated the teachers‟

decision making and how strategies can effectively be used in combination to meet stated

teaching objective or goals (Porter et al., 1997). These case studies reflect the true complexity of

selecting and adapting teaching strategies to meet individual needs. The research findings

highlighted the following: The importance of strategies which were primarily communicative

and which enabled the child to both anticipate an activity and gain a clearer understanding of

what the task demanded. The study found out the need for teachers to have access to a wide

range of specialist strategies especially where they are working with pupils with the most

complex needs whereby there is need for teachers to be able to adapt more generic strategies to

meet the specific needs of an individual pupil. They also found out the need for teachers to have

knowledge of teaching strategies to ensure they are confident in making adaptations in

accordance with the child‟s development and other needs. They also found out the value and

importance for teachers access to information and sharing expertise with others in the field. They

34

also found out the importance of being able to provide intense one to one teaching to maximize

the effectiveness of using strategies for learners with deaf-blind. This study has crucial

information for the present study because the study was looking for the instructional methods for

learners with multiple disabilities. The present study intended to verify whether the same

instructional methods can be applicable in our educational settings.

In America, at the Texas school for the blind and visually impaired a research project was carried

out on the teaching strategies and content modifications for the child with deaf blindness.

Children with deaf blindness have unique educational needs. Although they are deaf the

adaptations needed for their learning style will differ from the child who only has deafness. The

intent of the study was to demonstrate some of the basic differences in educational approaches in

order to address each of these disabilities. To understand what this meant they examined a

variety of issues which were addressed among three different children with disabilities in a

regular pre-schooler class. One born with a severe hearing loss, one born with visual impairment

resulting in activities of 20/600 and one born with a combined severe hearing loss and visual

impairment resulting in activities of 20/600(Moss & Hagood, 1995). A visual acuity of 20/600

means that an eye can see at the distance of 20feet what a normal eye can see at 600feet, or in

other words, an object that a normal eye can see at600 feet away must be brought to within

20feet in order to be discerned by the eye with a visual acuity of 20/600. For the child with

hearing impairment, most of the same teaching strategies used to instruct children who do not

have a disability would be appropriate as the child learns from what he sees and what he does.

Instructions in a large group can be very beneficial for this child because he can prepare for his

response while waiting for his turn. Adaptations for teaching communication and auditory

training goals include small groups or individual instruction. Real experiences should be the

basis of units that are taught, however this child would probably be able to relate storybooks, role

play and discussion to real experience. The teacher may also rely on print, pictures, gestures and

movements to support or give instruction. Issues for the child with hearing impairment include

difficulty with English language structure which can affect the development of reading and

critical thinking skills (Moss & Hagood, 1995).

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During auditory training the child might try to discriminate between the sound of a pig and cow

makes or point to the appropriate picture of each animal in the old Macdonald song. Speech or

speech reading might focus on the names of farms animals. At the end of the week his class may

visit a working farm for his week long study of farm animals. For the child with visual

impairment the same instruction strategies could be used. However, his learning will take place

primarily through his own actions or experiences and information he receives auditorily. He can

learn many things through group instruction with minimal support (Moss & Hagood, 1995). The

child with deaf blindness requires considerable modifications to teaching content and different

teaching strategies. He cannot learn from what he sees like the deaf child does. He cannot learn

from listening like the blind child does. He learns only by what he does. This means that no

learning is taking place for him while waiting for others to take their turn. For this reason, a

small group or individual instruction becomes more critical. Large group instruction is only

valuable if he or she can be consistently active. This child also may have problems experiencing

new things. Encountering the world without benefit of vision and hearing requires a great deal of

trust. Bonding with the child is critical for the instructor; therefore, it is important to evaluate the

child‟s response to an individual when determining who will be the primary provider of

instruction. He may be withdrawn or passive, content to stay in one place and let the world come

to him. Things often magically appear and disappear before him. Cause and effect are elusive.

People do things to him but not necessarily with him. There is little explanation of events before

they occur. For this reason it is important to make interactions balanced (my turn, your turn) to

encourage him to be responsive. Instruction that is always directive requires no response from

him. Safety is also of critical importance to this child with deaf blindness. Not only must the

environment be made safe for him, but he must feel safe in order to move around on his own. If

he does not, he is likely to stay glued to one spot resisting interaction with his environment and

the people in it. Instruction and support from an orientation and mobility specialist is very

important. She may need to help staff evaluate the environment of hazards and develop travel

routes for the child to use. She may work directly with him to orient him to that environment and

provide training on travel techniques and travel equipment (Moss & Hagood, 1995).

The curriculum focus for the child with deaf blindness will differ from that of the child with only

a single sensory impairment. The deaf education focus may be primarily on using language to

36

code existing concepts. The curriculum focus for a child with visual impairment may be

more oriented towards building concepts and experiences which can provide a firm

cognitive foundation for language. The curriculum focus for a child with deaf blindness should

be on bonding and developing interactions and routines for expanding the frequency and

functions of communication. This child with deaf-blind will not learn about objects or actions

incidentally. He cannot tie together the fragment input he receives without interpretation and

instruction from others. He must be taught to use and accept this instruction. Developing a

communication foundation for learning is a priority. Typically communication is tactile in

nature using signals, objects, gestures and later on sign language or tactile symbols or some

combination of forms. Language for a learner with deafblindness is developed through the use

of routines, calendar systems, and discussion boxes among others. The child with deaf blindness

may first need to be moved co-actively through an activity to know what is expected of him.

After he understands what is expected, this support would be faded to avoid building

prompt dependence because concepts develop so slowly for this child, there should be a

focus on making learning functional (Moss &Hagood,1995). The study has crucial information

for the present study which was investigating on the curriculum adaptations for learners with

deafblindness in the selected counties in Kenya. The present study intended to verify whether the

same curriculum adaptations can be applicable in our educational settings. At the state of

Washington in America a research project was carried out on a new way to set up a program for

the deaf-blind learner. The aim of the study was to come up with a program in order to help

learners with deaf-blind to be fully integrated into the school environment. The programme

would give the students an assortment of communication tools. These tools include American

Sign Language (ASL), English, Braille, touch typing, tactile sign and computer technology. If

the learner with deaf-blind has enough vision to use ASL it may be his first language. He should

also start to learn tactile sign which will become very important if vision loss is progressive. At

the same time he needs to learn English to understand how it relates to and differs from visual

and tactile sign languages (Robinson, 2009). To be fully integrated into our English speaking

society, people with deaf blindness must be able to use English as well as ASL.

The emotional and psychological aspects of learning different modes of communication are as

important as academic training. The learners with deaf blindness should come to view difference

37

as a source of strength rather than a cause of despair. Parents and teachers usually insist that they

should depend solely upon print and visual signing through the first years of school, the child

may fight against learning Braille and tactile sign later on. It is crucial for siblings and parents to

learn ASL and tactile sign so that everyone can communicate with the learner who is deaf-blind.

The earlier the intervention begins, the sooner the child can learn more sophisticated

communication systems (Robinson, 2009). During this phase, a child can be introduced to a

computer that has talking software and a Braille display. Ideally, instruction in ASL, tactile sign

and use of a white cane are well underway by the time the child turns three. He should also be

receiving pre-print, pre- braille and pre-technology training. At this age teaching needs to occur

through real life experiences, just as it does for children with sight and hearing. For example, the

teacher hands the child an object such as a cup of juice. The child drinks the juice. The teacher

signs a sentence, “You drink juice”. Then the teacher presents the same sentence in tactile sign.

Finally, the child types the words on the computer in written English and touches the words on

the Braille display. He also begins to learn the commands for the talking software that eventually

can become his voice. At first, all this instruction is a constant spoon feeding of information, but

the child soon begins to understand him. By age five, a learner who is deaf-blind with this

training will have the same English language skills as his sighted and hearing classmates. He will

use braille, typing and speech output software to communicate. In order for the learner with

deaf-blind to succeed at school, it is vital for the teacher to learn the use of speech access

software, such as Dragon naturally speaking or speech in Microsoft word. When the teacher can

communicate with the child directly, the interpreter eventually can leave the classroom. The

child will be learning on his or her own with the rest of the learners. On the desk in front of him,

the student has a computer with a braille display and talking software. The teacher wears a

microphone. As the teacher speaks, her words appear on the monitor in front of the learner and

on the brailled display. If the student has a question he can raise his hand, type his question on

the computer and have the talking software speak his words. The teacher answers the question by

speaking into microphone which sends her words to the computer. The student reads the

teacher‟s comments on the brailled display and the lesson goes on. To handle classwork the

student reads information in braille. If he has some sight, he uses enlarged print to see pictures or

graphs (Robinson, 2009).

38

He types his work on the computer and e-mails it to the teacher. The teacher uses e-mail to send

her response back to the student. Once the learner with deaf blindness has good touch typing

skills an additional keyboard can be hooked to his computer. The keyboard makes it possible for

the learner with deaf blindness to interact easily with his classmates. This ease of communication

is founded upon the learner‟s knowledge of English. If the learner with deaf blindness knows

only ASL or tactile sign, communication with non- signers is very difficult. Speech software has

little value and the child must depend on an interpreter with him wherever he goes. By learning

all the communication tools (ASL, tactile sign, English, braille, touch typing and technology) the

learner with deaf-blind can enter the world of learning. If every teacher learns to use speech

software, the learner can fully be a part of the school community. To have teachers and others

embrace such learning possibilities calls for a great deal of thought transformation The study

found the importance of teaching learners with deaf-blind all the communication tools and

technology to enable the learner to enter the world of learning. The present study intended to

verify whether the communication tools and technology can be applicable in our educational

settings.

At the California State University in America, a research project named SALUTE (Successful,

Adaptations for Learning to Use Touch Effectively) was carried out on the tactile learning

strategies for children who are deaf- blind. The goal of the project was to identify, develop

and validate tactile instructional strategies for children who have hearing loss and no

functional vision, plus additional cognitive and physical disabilities. Gaps were found on

what was known about tactile methods and also about the use of touch by children who are

deaf-blind. They include, hand over hand guidance which is a common strategy in which an

adult puts his or her hand over a child‟s hand to help the child explore an object, act on an

object or make a gesture or sign. This strategy should be used only when necessary and be

able to keep his or her hand on top of the adult‟s with sensitivity to the child‟s reactions.

Some children dislike having their hands manipulated and feel threatened by the lack of

control. Others can become passive and prompt dependence (Chen, Downing &Rodriguez 2001).

Movement of the hands from one point to another and area of the body ( hand over hand

guidance) may be essential as a strategy for children who have severe physical disabilities

because they often need assistance to manipulate and explore objects. Coactive signing is a

39

type of adapted signing in which an adult physically guides the child to produce signs using

a hand over hand strategy which involves gradually withdrawing the adult‟s hand until the

child‟s fingers touch the surface of the object or texture being explored (Chen et al.,2001).

Body signing is where the signer produces signs on areas of the learner‟s body other than

the hands for instance, the sign of EAT may be placed against the lips. Body signs are based

on manual signs that are symbols or words. Many children who are deaf blind with additional

disabilities have very short attention spans and limited communication play‟‟. The majority of

hearing adults who communicate with them are usually limited in their sign language unless they

have a background of deafness. For these reasons, most children who are deaf- blind who

have additional disabilities are exposed to key word signs rather than to American sign

language or manually coded English . For example, “want play‟‟ are key word signs for “do

you want to play‟‟ Object cues were also used. These are objects or parts of objects used in

activities that are associated with a particular person. They are used to give information, make

requests and provide feedback. Initially object cues should be used during selected activities

so that the child can easily make association between an object and the activity it represents.

For example, a small cardboard container of juice may be used to represent “time for snack”

(Chen et al., 2001).

Touch cues or tactile signals are important communication strategies to use with young children

who are deaf-blind during early stages of communication development. The intended meaning of

a touch cue is derived from the specific context and situation. The use of touch cues should be

consistent. A child will not be able to decipher the meaning of a touch cue if different people

use it for a variety of messages. For example, patting or tapping a child on the shoulder may

express any of the following positive feedback (great job!), a request or directive (sit down),

information ( your turn). The study has crucial information for the present study, because it was

specifically gathering information on the various instructional strategies used by teachers for

learners with deafblindness in special schools and units in four selected counties in Kenya. The

present study intended to verify whether the tactile strategies are applicable in our Kenyan

educational settings.

40

According to Huebner, Nelsen &Bietz (1995), the Deaf blind Manual Alphabet is the best way to

communicate with someone who is deaf-blind. The Deaf blind Manual Alphabet is a method of

spelling out words onto a deaf-blind person's hand. Each letter is denoted by a particular sign or

place on the hand of the learner who is deaf-blind.It is also known as finger-spelling. One can

learn it quickly by doing the following: Stick out your index finger (that's the one next to your

thumb) on your right hand. Fold your other fingers out of the way. Think of this finger as your

pen. You are going to use it to write - not on paper, but on your friends left hand who is deaf-

blind which they will hold out for you. First learn the vowels. They're easy. Just remember the

order A,E,I,O,U. For A, touch the tip of your friend's thumb. For E, Touch the tip of the index

finger. For I, is the middle finger. For O, is the ring finger. For U, is the little finger. For YES,

Just tap twice on your friend's palm. For NO, (or cancelling what you just said) do a rubbing out

movement on your friend's palm. For A, touch the tip of your friend's thumb. For B, bunch the

tips of your fingers and place them on your friend‟s palm. For C, use your index finger to make a

circular movement that starts on the inside of your friend's thumb and ends at the top of his or

her index finger. For D, form a D shape using your thumb and index finger and placing it on

your friend's index finger. For E, touch the tip of the index finger. For F, form an F shape using

your first two fingers together, place across your friend's index finger. For G, clench your fist

and place it on your friend's palm, little finger downside.

For H, lay your open hand across your friend's palm and move it over the fingers and off the

hand. For I, is the middle finger. For J, touch the tip of your friend's middle finger and draw your

finger down to the palm and up the thumb. (Think of this as the letter I with a tail).For K, bend

your index finger and lay the top half of it against your friend's index finger. For L, just lay your

index finger across your friend's palm. For M, lay your first three fingers across your friend's

palm. For N, lay your first two fingers across your friend's palm. For O, is the ring finger. For P,

hold the tip of your friend's index finger between your finger and thumb. For Q, completely

circle the base of your friend's thumb with your thumb and index finger. For R, bend your index

finger and lay it across your friend's palm (Huebner et al., 1995). For S, grasp your friend's little

finger with your index finger. For T, touch the edge of your friend's palm, at the side away from

the thumb. For U, is the little finger. For V, make a V shape with your first two fingers and lay it

on your friend's palm. For W, grasp the upper edge of your friend's fingers, bending your fingers

41

around them. For X, make a cross by laying your index finger over the top of your friend's index

finger. For Y, place your index finger in the joint between your friend's thumb and index finger.

For Z, either: place your finger tips against your friend's palm. Or place the outer edge of your

hand across your friend's palm (Huebner et al., 1995).

An Individualized Education Program (IEP) helps to make short and realistic expectations from

the child. Assessment is the first step. All the IEP‟S teams decision must be based on the

assessment data. The learner must be assessed in all areas of his performance. This is done by

observing the learner across settings carrying out and being involved in various tasks. Interviews

with people associated in the child‟s daily routine also support the assessment process. The

present levels of performance are taken from the child‟s assessment data. It will state clearly

what the child is able to do. This comes from remarks on the child‟s performance in areas such

as brushing, toileting, social interaction, academic areas among others (National Institute of the

Mentally Handicapped (NIMH). The annual goals are then listed in measurable terms. These are

the goals that will be achieved at the end of the academic year. The next step will be developing

short term measurable objectives. It will also explain under what condition the learner will do

what and how long the training period will be.

The role of the teacher is to discuss and formulate goals that are realistic, achievable and

developmentally appropriate for the child. Besides the mother, other professionals are also

involved in the educational process of the child. They include; speech therapist, physiotherapist,

orientation and mobility specialist, vision specialist, orientation and mobility instructor, art and

music therapist, psychologist and a host of others depending upon the needs of the child and the

availability of trained resources in the area. Each member of the multidisciplinary team has a

specific role to play starting with assessment program, evaluation and follow- up action. The

planned and coordinated effort of the entire team helps the learner to move along the educational

program. The teacher remains the main person in contact of the child as well as coordinating the

information between the different professionals involved in the education process. A learner with

deaf blindness will learn best in a real life in the appropriate time, giving the learner the

motivation and reason for learning. The multi sensory approach can be used to teach learners

with deafblindness. This approach makes use of all sensory abilities of the child that is seeing,

touching, smelling and movement. The teacher can also use resourceful persons from the

42

community. They can teach something essential to the learner. Motivation or reward is a very

important part of learning. In designing a task, the teacher will ensure there is appropriate

motivation for the learner. The most successful motivation is to complete the task itself. This is

why many learners are successful at learning to feed themselves. The best rewards are the

learner‟s own pleasure at success, and the teacher‟s pleasure. The teacher will always show

pleasure and the child will gradually learn to recognize this and find it rewarding on its own. A

learner getting dressed may be rewarded with a tickle each time an item is put on (Sense

International, India, 2010; NIMH, 2003; Aslop, 2002& Best et al., 2010). Direct instruction in

daily living areas is often needed for learners who are deaf-blind since incidental learning

cannot occur. Instruction often needs to include eating skills, table etiquette, personal

grooming, clothing care, food preparation, house care, shopping and other areas. Specific

skills may be taught such as judging the amount of food on a spoon by weight,

determining if hair is in place by touch, labeling and storing clothes so that they will match,

labeling cans of food to determine what they are, learning how to fold money to

determine the denominations of the bills for shopping and others (Heller et al.,2009).

Tadoma is tactile lip reading or tactile speech reading. Tadoma is named after the two children to

whom it was taught, Winthrop „Tad‟ Chapman and “Oma” Simpson. Tadoma is a skill used by

the congenitally deaf-blind person. The listener will place his or her hand on the cheek of the

speaker with the thumb resting on the throat, such that he or she feels the vibrations and the

mouth movements so that he or she is able to follow the conversation (NIMH, 2003).

Augmentative communication systems such as objects of reference and pointing are used to

support a learner who is deaf-blind in recalling events. For instance, a teacher can show a real

plate or a model of a plate to indicate lunch time (Chen, 1995,; Aslop, 2002).We use any means

to communicate with a learner who is deaf- blind, adapted to the senses he/she can use. The

different modes of communication reflect the person‟s capacities, and the development of the

learner; that is both cognitive potentials of the learner and the senses he can use in different

situations. With a learner who is deaf-blind one expands from objects to tactile drawings and

sometimes to Braille with learners who are deaf-blind with residual vision. A teacher can move

from objects, to drawings or pictograms and writing. In addition, a teacher often present signs

both tactually and visually depending on the situation and development of the child (Chen, 1995:

Aslop, 2002). Activity based scheduling is another teaching strategy for the learners with deaf-

43

blind that incorporates tasks into the timetable that will actually help the child to learn a set of

skills to perform the particular task (NIMH, 2003). Individuals who are deaf-blind and have a

cognitive disability may not effectively communicate their desires and choices of what to eat

even when provided with the opportunity to do so, because of their frequently limited

communication skills. Choosing what to eat should take place where the learner eats. The

boundary in which the choice making activity takes place should be defined through the use of

appropriate aids and cues. Providing boundaries minimizes the visual motor and cognitive

requirements of orienting and reaching (Campbell, 1987).

In Africa, studies were carried out on learners who are deaf with multiple disabilities in

developing countries such as Kenya, Malawi, Cameroon, Nigeria, Uganda, and Somalia among

others (Shettle, 2004). In Kenya the researcher, found that at the Njia Special School in Maua,

Kenya, which is a school for both special education and deaf education they had some learners

who were 'just Deaf' as well as some who had multiple disabilities. They also found that the

Kaaga School for the Deaf in Meru, Kenya, which is a 'Deaf school‟ also had some learners who

were deaf with multiple disabilities but it is not specifically focused on the education of such

children”. The study found that no progress had been carried out on how to deal with learners

who are deaf with multiple disabilities even though they were found in the various special

schools for deaf children (Shettle, 2004). The study did not show the teaching strategies for

learners who were deaf with multiple disabilities. This study sought to fill the gaps by

investigating the instructional methods used by teachers for learners with deaf blindness in some

selected special schools and units in Baringo, Kiambu, Kisumu and Nairobi in Kenya.

2.1.1 Curriculum Adaptations for Learners with Deaf blindness

Curriculum adaptation refers to the modification of the regular curriculum to suit individual

learners with special needs (Lewis, 1981). Curriculum modification, as described by Koga and

Hall (2004), results in “modified contents, instructions, or learning outcomes for diverse students

needs” (pg.2.) A curriculum for learners who are deaf-blind need to reach the goal of a child

towards personal adequacy, social competence and economic independence and more

significantly make his life a lot happier and healthier. The content of the curriculum is very much

determined by the individual needs of the learner who is deaf-blind. When a curriculum

44

approach takes into account the pupils current individual needs and his future needs and is

designed to meet his needs, it is known as a functional curriculum. The instruction in the

functional curriculum focuses on the individual needs of the child as compared to the

expectations from him in his immediate family and community development. The functional

curriculum uses the learner‟s interest and strengths as the basis for planning intervention

strategies. The curriculum framework begins with the child, family members and other

significant others of the child‟s life who play a role in the intervention programme for the learner

with deaf blindness.

The curriculum addresses the needs of the learner with deaf blindness in the following areas:

Independent living activities; in the early stages the parents and the teacher will do the activities

together coactively, later the learner learns to do it by himself or herself. This area includes:

Training in cooking, washing clothes, brushing teeth, orientation and mobility among others and

maintaining the learner‟s own belongings (Ellis, 1986; Sense International India, 2010& Aslop,

2002). The FIELA Curriculum was designed by Dr. Lilli Nielsen, a pioneer in learning

techniques for teaching learners with multiple disabilities and creator of the learning approach

called Active Learning. FIELA is made from words flexible, individual, enriched, level and

appropriate (Nielsen, 1998).The premise of Active Learning is that all children learn through

their own actions, on their own initiative. According to Nielsen, if given the opportunity to learn

from his own active exploration and examination, the child will achieve skills that become part

of his personality, and so are natural for him to use in interaction with others, and for fulfillment

of his own needs, and will gradually make him ready to develop to be as independent as possible.

The FIELA Curriculum requires: Precise observation of all areas of a child‟s development level

in all areas and the structuring of the child‟s learning activities based on the child‟s own needs

and preferences. The educator‟s role is to provide enriched learning environments, respect the

child‟s need for sufficient time and quietness for learning, and to be ready to share the child‟s

experience when the child is ready to share it (Nielsen, 1998). Kochung report, (2003),

established that the 8-4-4 curriculum does not take care of all learners with Special Educational

Needs (SEN). The curriculum was noted to be rather rigid, demanding and with the same

expectations for all learners. The Kochung Report (2003) noted that this arrangement

disadvantaged learners with SNE since there are some learners such as the gifted and talented

45

who can complete the curriculum in less than the specified time while others may need a long

period to do so.

Koech Report, (1999) posits that the Kenyan school curriculum is inappropriate in that there is

lack of clear policy guidelines and legal status on special needs provisions, inadequate teaching

facilities, equipment and services for learners with disabilities and inadequate teachers who use

rigid teaching approaches which may only benefit the average learners among others. According

to the Policy on Special needs, a document launched by the Ministry of Education in 2010, the

curriculum materials for children with special needs of all categories especially the severely

handicapped, are inadequate at all levels of education. The curriculum also lacks flexibility in

terms of time, learning resources, methodology, and modes of access, presentation and content.

There is lack of sufficient trained personnel for curriculum development. In addition, there are no

clear staffing norms and recommendation on pupil teacher ratios in institutions and programs for

special needs education. According to KIE (1987), learners with multiple disabilities will require

a specialized curriculum. A specialized curriculum refers to the curriculum where the regular

curriculum is exhaustively and significantly modified to suit the target group of children.

Severity of the disability is the primary determinant of whether or not to come up with a

specialized curriculum. The modifications include: a rationale for modification, mode of

presentation of materials, modifications of the teaching methodologies and emphasis on the use

of an Individualized Education Plan. About forty to 60% modifications or adaptations is on the

content of the regular curriculum and the use of specialized materials and equipment.

Modifications of the regular curriculum require collaboration on the part of the special educator,

the regular educator, and other specialists involved in the learner‟s program. Community based

instruction is also an important characteristic of educational programming, particularly as

learners grow older and where increasing time is spent in the community. School to work

transition planning and working towards job placement in integrated competitive setting are

important to a learner‟s success and the long – range of his or her life (Rainforth & Macdonald,

1997). The study sought to investigate the curriculum adaptations that have been effected for

learners with deaf blindness in four selected counties in Kenya.

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2.1.2 Teaching Resources and Support Services for Learners with Deaf Blindness

For learners with deaf blindness, it is desirable to provide educational services in a traditional

manner. This is a model where skills traditionally taught by one discipline are shared with others

who work directly with the child (Rain forth & York, 1997), According to Campbell (1987),

transdisciplinary teams designate a “primary programmer” who implements the intervention

programmes in collaboration with various specialists who have designed them on the basis of

specialized assessments. The transdisciplinary team model is characterized by sharing

information and skills across discipline-specific boundaries. This approach uses an indirect or

integrative approach where one or two persons (usually the teacher) act as the primary

programme provider, and other team members act as consultants (Snell &Janney, 2000). This

model minimizes the number of people who will work with a child on a daily basis and provide

opportunities for cross-training of staff. It is important to consider programmes and services that

will enhance probabilities for the learner who is deaf-blind to lead a happy and a productive life

(Miles & Riggio, 1999). Related services are of great importance and the appropriate therapists

such as speech and language, occupational, physical, behavioural and recreational therapists

among others need to work closely with the classroom teachers and the parents. Other support

services include: Orientation and mobility, adapted physical education, vocational training,

computer technology training, behavioural consultation, audiology, health services among

others. Orientation and mobility helps deaf-blind learner to know where he is in space and where

he wants to go (Martinez & Moss, 1998). Learners with sensory loss may use several

assistive devices to help with daily living needs. For instance, learners with a hearing loss

may use close captioned television,(Closed captioning allows persons with hearing disabilities to

have access to television programming by displaying the audio portion of a television

programme as text on the television screen), vibrating or flashing alarm clocks or flashing

door bells. Hearing ear dogs are also available. Learners with visual impairment may use

special money readers, special devices that buzz when a beverage is near the top of the

glass among others (Heller et al.,2009).

Wehman & Parent (1997), identified several categories of assistive technology identified and

they include: mobility (wheelchairs, lifts, adaptive driving controls, scooters, laser canes, seating

and positioning (assistance in choosing and using a wheelchair), computers (environmental

47

control units, word processors, software keyboard).Toys and games software and switch operated

toys) activities on daily living feeders, lifts, memory books, watch, alarms, communication

(talking toys, reading systems and talking boards). Learners with severe and multiple disabilities

can benefit from any one or more of these assistive devices or activities. For those who are

unable to use speech and need an additional communication mode, augmentative communication

can be used. It involves adapting existing vocal or gestural abilities into meaningful

communication, teaching manual signing such as American Sign Language (ASL), static

symbols or icons(such as Bliss symbols) using manual or electronic communication devices such

as electric communication boards picture cues or synthetic speech(artificial human speech in a

computer. Orientation and mobility skills are also needed for learners who are deafblind.

Orientation refers to the process of using one‟s senses to determine one‟s position in

relation to other objects in the environment and mobility refers to the ability to move

about in one‟s environment (Emerson & Corn , 2006). Orientation and mobility instructors

teach the learner the skills that will enable them to safely and independently move around

their environments. Mobility aids may be needed such as a specially designed cane, dog

guides, electronic travel devices or a sighted guide. Some learners with additional

physical disabilities will learn mobility techniques using their wheel chair (Emerson & Corn,

2006).

Learners with deafblindness may exhibit stereotypic behaviours such as body rocking &

eye rubbing that occur in excessive quantity, frequency and intensity. A careful assessment is

needed to determine the extent to which these behaviours interfere with learning, inhibiting

social interaction, or cause physical damage to the learner. The teacher may permit

stereotypic behaviours to occur in certain locations (such as rocking in a rocking chair) and

inhibit others ( such as eye rubbing). Stereotypic behaviour may be managed in any number

of ways from simple verbal reminders to the implementation of a behaviour plan that is

agreed on by the educational team to ensure consistent implementation across settings

(Emerson & Corn, 2006). Adapted physical education is a diversified programme of activities

specially designed for an individual who meets eligibility criteria for special education or related

services and is not able to safely participate successfully in the regular physical education

48

programme. The modifications in the adapted physical education include; changing rules,

equipment and time limit (Hardman, Drew & Egan, 2005).

According to the New Hampshire Association of the Blind in the United Kingdom, the services

offered to the learners with deaf blindness include; deaf and hard of hearing services,

counselling, information and referral peer support, personal care attendants, sign language

interpreters services, skills training, transportation services and multisensory interventions

through consultation. There are also consumer advocacy groups that unite people with

disabilities and their allies to work towards better accessibility and quality of life. Other support

services include a support service provider who accompanies the deaf-blind consumer on errands

at community events. Support personnel and service animals provide access to communication

interaction and environmental sights and sounds to a person who is deaf-blind (Archibold, 1994).

Implants are increasingly being used for individuals who cannot benefit from the use of hearing

aids. The success of implantation is very individual. Different types of implants serve different

individual needs and functions: Cochlear implant is a surgically implanted electronic device that

provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. Middle

ear implants are for individuals with conductive or mixed hearing loss; they are microphones that

transmit sound from the middle to the inner ear. Bone-anchored implants are for a variety of

hearing losses; they conduct sound from an implant in the skull behind the ear to the inner ear.

Auditory brain implants are for individuals who don‟t have adequate auditory nerves; they are

electrodes applied to the brain stem that provide electrical signals leading to a sense of hearing

and resulting in support for lip-reading (Vaughn Bos &Schum,2007). A Sensory Room is a place

where children with special needs can explore and develop their senses and skills. The multi-

sensory room can have many different features ranging from soft play areas, padded floors and

walls and interactive equipment which make dramatic changes to the sensory room environment

using sound, lighting and fragrance (Hopcroft, 2010). A multisensory room can engage children

who can learn through play. From following bright lights, shapes and patterns with their eyes to

press buttons to make the sensory room change colour or even change colour to music. Due to

the flexible functionality of the multisensory room, it can also be used to calm and de-stress.

Children become interested in their environment. The overactive can be calmed and the inactive

become interested. The partially sighted can see the vivid moving colours. Those mobile, can

49

chase the slowly moving images. The whole room can change colour by applying pressure to

simple switches or pressure pads. Colours can move or change simply by making a noise and for

those with severe special needs the sensory room can be set to automatically change programme,

giving a constantly changing and interesting environment that is probably the most pleasant

environment they have ever experienced even if all they can do is lay and enjoy. A hydrotherapy

pool may be used to maintain health in children with special needs. Hydrotherapy pools help

children with special needs to relax and in doing so may result in tension being released from

muscles, alleviate pain and calm the nervous system. A Hydrotherapy pool is an ideal concept

for children with special needs. Depending on the level of interaction required, hydrotherapy

pools can contain a number of features to stimulate the senses (Hopcroft, 2010).

2.1.3 Environmental Adaptations required for Learners with Deaf blindness

Several strategies may need to be used to optimize the visual functioning of a learner with a

visual impairment. These include; arranging the environment to optimize the visual characteristic

of objects, teaching the use of optical devices and training the use of

residualvision(Corn,Anderson,Bachofer,Jose&Perez(2003);Wolfe,Sacks,Corn,Erin,Huebner &

Lewis (2002). There are five major environmental dimensions that can be modified to assist the

learner with a visual impairment to access his or her environment through the use of vision:

colour, contrast, time, illumination and space (Corn et al., 2003). Teachers should take into

account the colour of items being used in the classroom. Some learners with low vision may be

able to see bright coloured items with greater ease than other colours while other learners with

low vision may not see bright colours clearly. The use of contrast should be considered when

teaching a learner with visual impairment since contrast can make an item easier to visually

discriminate for instance, black print on white or yellow paper may assist the learner visually.

Some learners with visual impairments will perform better if given time to respond. That is

because learners with visual impairment often need more time to access the item being presented

and explore it in order to identify it (Easter brooks & Baker, 2004).

Learners may benefit from the use of additional light or reduced writing in order to see items for

instance, some learners with retinal detachment (where part of the retina detaches from the back

of the eye) may benefit from increased illumination. Reduced lighting and lighting from behind

50

the learner may be needed with learners who still have cataracts to reduce glare and promote

maximum visual functioning. Some learners with visual impairment can perform better if there

are changes in space, specifically how they are positioned in the classroom, for instance, a

learner with poor acuity may perform better in the front row of the classroom (Corn et al., 2003).

Learners with a peripheral field loss (tunnel vision) may be better situated if seated in the back of

the room where more of the classroom can be seen. Some learners will also benefit from material

enlarged for instance, large print or large items or using an optical device that enlarges items

when looked through however, enlarging items may be more difficult for learners with reduced

peripheral field of vision since an enlarged item may not fit in the learner‟s visual field (Corn et

al., 2003). A second major adaptation that assists learners to access their environment with their

remaining vision is the use of optical devices such as magnifiers and telescopes that enlarge

normal sized items and print. Some optical devices minimize items in order to better visualize

them. Learners with low vision may be trained to more efficiently use their vision through vision

training programs. These programs are designed to use the systematic presentation of stimuli and

instruction to optimize a learners visual functioning. The vision teacher along with the rest of the

education team will typically teach the learner to use his or her vision to the maximum extent

possible. Learners who are unable to use their vision functionally will need to use their sense of

touch and other senses. Learners will be encouraged to manipulate items and discriminate items

on the basis of various features. Discrimination usually starts with gross, for instance differences

in shape and texture and size and progress to finer discriminations. As the learner gains mastery

over using the sense of touch the teacher will need to modify classroom materials for instance

use of actual items models or tactile graphics to allow the learner to use this sense to enhance his

or her learning (Con et al., 2003). Learners with hearing impairments may benefit from several

environmental and instructional modifications as well as auditory devices.

Environmental and instructional modifications include: Modifications to the auditory

environment and use of listening devices and modifications to the visual environment and

modifications of materials and instruction. Typical classrooms can be very noisy places because

of background noise and poor acoustics. To hear the teachers voice clearly, hearing children

require a signal-to-noise(S/N ratio + 10, where teachers voice is at least 10dB (decibels) louder

than the noise. Children with hearing losses require an S/N of at least +15 (Seep, Glosemeyer,

51

Hulce, Linn & Aytar, 2000). With a personal frequency modulation unit (assistive listening

device), the teacher wears a wireless microphone, and the student wears a wireless receiver

incorporated with a hearing aid. The microphone amplifies the teacher‟s voice 12-15dB above

the classroom noise and is not affected by distance (Vaughn, Bos &Schumm, 2007). To help

improve acoustics, the classroom may be modified with carpets, drapes and other sound

absorbing materials on the walls and floor. The classroom should have lower ceiling with sound

absorbing tiles. Double-pane windows and solid floors reduce reverberation as well. The learner

should be seated away from noisy equipment such as plumbing, air conditioners and over head

projectors, as well as from windows where traffic noise is evident (Seep et al., 2000).

According to Lane, Hoffmeister and Bahan (1996), learners who are deaf and hard of hearing are

visual learners even those who are benefitting from their listening devices. For this reason, it is

important to manage the visual environment as it is to manage the auditory environment. Seating

arrangement should be considered carefully when a learner has a hearing loss to enable learners

to see the teacher as well as classmates. This will allow for speech reading (Stivalet, 1998). The

teacher should be alert for signs of fatigue in the learner since attending to the interpreter, using

residue hearing and attending to the material can be tiring. A very important modification to the

auditory environment is the use of hearing aids, cochlear implants and other listening devices

that amplify sound (Amlani, Rakerd & Punch, 2006). The individual needs of each learner with

deaf blindness will need to be assessed to determine the best way to arrange the environment.

Learners who are deaf-blind will typically need some combination of the visual and hearing

modifications to meet their needs (Heller et al., 2009). The study sought to find out the available

teaching resources and support services for learners with deafblindness in selected special

schools and units in Baringo, Kiambu, Kisumu and Nairobi counties in Kenya.

2.2 Instructional Methods for Learners with Autism and Blindness

A learner who has autism and blindness is a child who has a combination of both autism and

visual impairment. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition)

(DSM- IV) (American Psychiatric Association (APA), 1994) defines autism as a disability

„‟Characterized by severe and pervasive impairment in several areas of development: reciprocal

social interaction skills, communication skills or the presence of stereotyped behaviour, interests

52

and abilities‟‟. Individuals with this disability have considerable disability in interacting with

others socially and in communicating verbally. They also often engage in self stimulating

behaviour and can have a very limited number of routines and interests. Children with visual

impairment are learners with problems in the structure and functioning of the eye. Visual

problems range from total blindness to only slight visual impairment. Children who are visually

impaired are classified into two main categories and they include children who are blind and

children with low vision (Hallahan & Kauffman, 1997). Children who are blind have either

totally lost their sense of vision or those who are only able to perceive light. The second category

includes individuals who are able to tell the difference between darkness and light.

Educationally, children who are blind are those who learn through Braille without the use of

vision, although they may perceive light, which is an advantage and can be used for orientation

and mobility (Hallahan & Kauffman, 1997). Educators give an educational definition and say

that anybody with low vision is still severely visually impaired after correction, but may increase

visual functioning through the use of optical aids, environment modification or low vision

techniques (Corn &Koenig, 2002).

In America, a case study was carried out on a pre-schooler with autism and blindness in

order to unlock the mystery of communication. It was presented as a poster session at the

2003 Florida Association of Speech Language Pathologists and Audiologists Convention

(FLASA). The objective of the study was to describe how Augmentative Alternative

Communication (AAC) strategies were used with this learner. The rationale for teaching both

AAC strategies is provided along with AAC objectives, directions for implementation,

feedback for correct and incorrect responses, list of needed materials, when strategies should

be implemented and by whom. The case study was carried out with a child named Paul who was

4 years old, and non- speaking. He had been diagnosed with autism spectrum disorders and

congenital blindness. Paul began pre- school at 2 years, 5 months of age. His level of autism

was assessed to be in the severely autistic range based on the Childhood Autism Rating

Scale (CARS). He exhibited delays across all developmental milestones and atypical

behaviours such as self stimulatory behaviours (i.e. flopping his wrists or flipping objects for

hours if interrupted ),hypersensitivity to certain textures and lack of initiation of

communication. He screeched in protest and actively resisted when transitioning to non preferred

53

activities. He demonstrated immediate and delayed echolalia of environmental sounds and

speech. He appeared to make no distinction between speech sounds versus non speech sounds.

He walked with stiff legs and small guarded steps at a slow pace due to his blindness. To help

Paul and with the help of a vision specialist and lots of creativity the pre-school educational

team was able to adapt many traditional visual support strategies used with children who

have autism and normal vision into tactile support systems for our student who was blind. The

goal was to teach the child to independently use speech to make requests since the child had

not yet attached meaning to the words he echoed. The child was taught sign language thus he

learned that words had meaning. He was able to attach meaning to words and use single words to

make simple requests. Two treatment methods were used in the study. The first treatment method

was the use of object symbols. The objects were glued to card board squares so the child could

distinguish these objects as tactile communication symbols. It became apparent very quickly that

this system would not be successful due to the child‟s self - stimulating behaviour of flipping

objects with his hand. He was not able to learn to use the communication symbols because his

self stimulating behaviour of flipping objects interfered with his ability to recognize the object

symbols. Individuals with blindness from birth do not understand gestures such as waving or

sign language because they have no concept of sight or that other people have sight to receive the

gesture or sign. It is therefore difficult to teach sign language for this reason and thus the best

way to approach it would be to teach him to use two handed signs (Lilienthal, 2009).

A second treatment method was designed to teach Paul, by the use of two handed sign language.

By using two handed sign language paired with speech the method proved successful. In the two

handed sign language method signs are produced using two hands touching each other and

the child would receive tactile feed back when he produced a sign. Single handed signs

provide little tactile feedback and may require more sophisticated fine motor skills than

two handed signs. Teaching began with hand over hand assistance to produce a modified sign to

request a “goldfish cracker” during snack time (Lilienthal, 2009). Goldfish cracker was chosen

as the first item to request because it was highly motivating for Paul. The sign for “Goldfish

cracker” was actually an approximation of the American Sign Language sign for “fish”. The

sign was modified so Paul would hold the palms of both hands together and move them

forward like a swimming fish. Paul was reinforced immediately after each production of the sign

54

with a goldfish cracker. Once he learned how to produce the sign independently to request gold

fish crackers it was time to teach him to discriminate between two different signs. He now had a

way to communicate when he wanted more goldfish crackers. The American Sign Language sign

for “cookie” was introduced. This was another two handed sign to provide tactile feedback. This

sign was highly motivating for him and was taught during snack time. Paul was immediately

reinforced after each production of the sign with a piece of a cookie and he soon learned to

produce the sign for cookie. Two more words; a push on the swing and listening to music

adapted two handed signs were taught to request highly motivating actions. Paul quickly learned

these signs and was able to independently produce the signs to make requests. To promote

generalization of these skills to the home environment, family members, vision specialist and

baby sitter were trained on the use of the two handed signs. Everyone who worked with Paul at

school and home were given pictures of how to produce the adapted signs so, everyone who

worked with Paul would facilitate the correct production of each sign. Paul began to

independently produce signs to request these four highly desired items or actions.. Paul was

taught to say the word associated with the sign. He had excellent verbal imitation skills so he

was given a phonemic cue ( saying the first sound of the word) in a soft voice and as he

began to imitate the word was completed. As soon as he finished saying the word in imitation

his behaviour was reinforced with the desired item or action. Within two months time, Paul

began to independently and consistently use single words to communicate for these four desired

items and actions and no longer used his signs. The brief use of sign language unlocked the

mystery of communication for Paul and he rapidly learned to generalize this skill to other words.

He was now using single words to communicate his basic wants and he understood that words

had meaning and power (Lilienthal, 2009). The present study intended to verify whether the

same instructional methods can be applicable in our Kenyan educational settings.

In America, as published in the Journal of Autism and Developmental Disorders a case

study was carried out on training a learner with autistic blind to communicate through signs.

The study was done on a 10 year old girl using tactile kinesthetic and auditory modalities. The

visual, auditory and kinesthetic learning styles (VAK) uses the three main sensory receivers:

visual, auditory and kinesthetic (movement) to determine the dominant learning style. According

to VAK one or two of these receiving styles is normally dominant. This dominant style defines

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the best way for a leaner to learn new information by filtering what is to be learned. The

learner in the study had the auditory and kinesthetic tactile receivers as the most dominant

receivers thus auditory and kinesthetic activities were included in her mode of learning.

The style was integrated into the learning environment by beginning new material with a

brief explanation of what was coming and concluding with a summary of what had been

covered. The Socratic method of teaching whereby learners are questioned to draw as

much information from them was incorporated and then the knowledge gaps were filled by

the teachers expertise (Konstanareas, 1982). Auditory activities such as brain storming among

others were incorporated and also plenty of time was left to debrief activities. Debrief activities

allowed the learner to make connections of what she had learned and how it applied to their

situation. Kinesthetic learning activities were included in the learner‟s style of learning. Since

learners who are kinesthetic learners tend to lose connection if there is little or no external

movement, music was incorporated with the learning activities and also frequent stretch breaks

(brain breaks) were provided (Konstanareas,1982). The present study intended to verify whether

the same instructional methods can be applicable in our Kenyan educational settings.

In America, a research study was carried at the National Federation of the Blind (NFB) Jernigan

Institute in Baltimore on the teaching of skills of blindness to children with additional

disabilities. The researcher found that teachers have to choose appropriate methods for teaching

to meet diverse needs of learners who are autistic blind. Their learning needs should be

supported systematically. She came up with a plan of educating learners with autism and

blindness. In phase one, she provided all the supports commonly found in the classrooms of

sighted learners with autism. Some of the supports include: visual aids, visual schedules, routines

and touch cues among others. She developed a schedule for the class that was consistent as

possible. The schedule was translated into a tactile form. Since the learners could not yet read

their names, each learner was assigned a personal tactile symbol. The symbol appeared on all of

the learners belongings next to their name in braille. Positive behaviour supports was

incorporated as part of the classroom management plan. The classroom was free from clutter and

the learning areas in the room were well, defined so the learners could easily predict the

activities that would take place in each area (Shaheen, 2009). In phase two, everything that

appeared in the classroom in print also appeared in braille. Braille books were put on the shelves

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in the reading corner. Every surface in the room was adorned with a braille label or a tactile

symbol. Braille writers were brought into the room and placed where the learners could reach

them easily. Braille basic concepts were taught. The stories were brailed and illustrated with

homemade tactile graphics which often included real objects. In order to provide more learning

opportunities, braille was incorporated into other parts of the day. Each of the learners had

reward systems that incorporated a token board. The board had six tactile circles, set up like a

braille cell into two columns of three. Each time the learner earned token for appropriate

behavior she or he placed in one of the circles. The learners counted their tokens according to the

numbering system for the braille dots (Shaheen, 2009).

Other phases of the plan included acquiring orientation and mobility assessments of the students,

teaching appropriate social skills, teaching the beginner abacus and other basic math skills and

teaching simple social studies concepts. Adjustments were made as problems surfaced. They

collaborated with related services providers, administrators thus the plan became more refined

and effective. All learners possess the capacity to learn and learners with multiple disabilities are

no exception. It is the job of the educator to find the proper strategy to teach a learner; it is not

the job of the learner to conform to traditional methodology (Shaheen, 2009). The present study

was crucial to this study because the researcher was finding out the instructional strategies for

learners with autism blindness in four selected counties in Kenya. The present study intended to

verify whether the same instructional methods can be applicable in our educational settings. The

study sought to find out the instructional methods used by teachers educating learners with

autism blindness in selected special schools and units in Baringo, Kiambu, Kisumu and Nairobi

counties in Kenya.

2.2.1 Curriculum Adaptations for Learners with Autism blindness

According to Hatlen (1996), learners with visual impairment including those with multiple

disabilities will require an expanded core curriculum. The core curriculum consists of knowledge

and skills related to academic subjects. The expanded core curriculum incorporates the basic

subjects and adds the following; compensatory or functional academic skills including

communication modes, orientation and mobility social interaction, independent living skills,

recreation and leisure skills, career education, use of assistive technology and visual

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efficiency skills. Compensatory skills are those needed by the visually impaired learners in order

to access all areas of the core curriculum. Functional skills refers to the skills that the learners

with multiple disabilities learn that provide them with the opportunity to work, play, socialize

and take care of personal needs to the highest level possible. Communication needs will vary,

depending on degree of functional vision, effects of additional disabilities and the task to be

done. Learners may use Braille, large print, print with the use of optical devices, regular

print, tactile symbols, a calendar system, sign language or recorded materials to communicate

(Hatlen,1996).

Orientation and mobility is a vital area of learning. Learners will need to learn about themselves

and the environment in which they move from basic body image to independent travel in rural

areas and busy cities. The existing core curriculum does not include provision for this

instruction. Social skills, career education and leisure skills must be carefully, consciously, and

sequentially taught to the visually impaired learners with multiple disabilities. This is because

they are not incidentally learnt (Hatlen, 1996). A curriculum for learners with autism and

blindness should help the learner to reach levels of performance that are appropriate and planned

for him (Shaheen, 2009). The study sought to find out the curriculum adaptations that have been

effected for learners with autism blindness in the counties of Baringo, Kiambu, Kisumu and

Nairobi in Kenya.

2.2.2 Teaching Resources and Support Services for Learners with

Autism Blindness

According to Boyce & Hammond (1996), learners who are autistic blind who exhibit needs in

the social emotional area must have programmes that address the full range of their cognitive,

emotional and social developments. Learners with social emotional needs must also be

encouraged to become competent and self- confident learners. In terms of early intervention and

the setting of appropriate and positive expectations, these programmes may actually be

preventative in nature. Programmes may include social skills programmes and conflict resolution

programmes. Learners who are autistic blind may have speech impairment and they need early

identification through a systematic approach. The persistent nature of speech impairments (e.g.

articulation or phonological disorder) requires access to services for learners at all grade levels.

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Some learners with speech impairment have associated difficulties in other areas of development

(reading and writing, learning, intellectual, social emotional, behavioural and sensory. The close

relationships among phonology, language and literacy development are central to the classroom

focus of speech intervention and support services (Boyce & Hammond, 1996).

Learners who are autistic blind also require support due to visual impairment. The level of

support depends on the severity of the eye condition and also the results of a functional vision or

tactile assessment that is conducted by the Vision Program Assessment team. They are taught to

read and write braille and also orientation and mobility by the various specialists. Learners who

are visually impaired rely heavily on adaptive technology to access the curriculum. For example,

a laptop computer with a screen enlargement programme or speech out programme, a braille

embosser (printer), a scanner, a portable braille note taking device and a global position system.

Advances in adaptive technology have helped learners who are visually impaired access the

curriculum independently and quickly (Boyce & Hammond, 1996). Most of the diets used to

treat children with autism were originally constructed for children with attention deficit disorder

and hyperactivity. The diets were adapted for the treatment of autism by some dieticians who

believe that it is a lack of tolerance for certain food substances that lead a child with autism to

food selectivity and idiosyncratic eating habits (Richman, 2005). Four things should be removed

from a child‟s diet who has autism, these include; gluten, casein, monosodium glutamate and

aspartame (Breton, 2001). Learners who are autistic will require auditory training. In auditory

training, an audiogram identifies frequencies to which the child with autism is hypersensitive.

Once these frequencies are determined, they are eliminated from an audio recording that the

child listens to through headphones during therapy sessions. Advocates of auditory training

speculate that hypersensitive hearing causes aggression, hinders children from interacting with

others and impairs their ability to attend to instructional situation (Grandin, 1995). Sensory

integration is usually given by occupational therapists to learners with autism. According to

Grandin (1995), sensory integration is the neurological process that organizes sensation from

ones own body and from the environment and makes it possible to use the body effectively

within the environment. Sensory integration is often recommended for learners who engage in

inappropriate responses to sensory stimuli for instance, tapping and body rocking. According to

Richman (2005), fine arts therapies have been shown to be calming, and have helped learners

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with motor coordination difficulties and emotional issues. Such therapies can also be effective in

reducing difficult behaviours from autistic learners on a short term basis. Hydrotherapy is also

used with learners who are autistic. For learners with autism, wet heat helps relieve pain,

improves circulation, and promotes relaxation (Richman, 2005; Hopcroft, 2010).

According to Rudy (2010), some children on the autism spectrum may have low muscle tone, or

have a tough time with coordination and sports. These issues can interfere with basic day-to-day

functioning and they're almost certain to interfere with social and physical development. They

will therefore require the services of a physical therapist. Physical therapists may work on with

very young children on basic skills such as sitting, rolling, standing and playing. Occupational

therapists and physiotherapists often work together to assess and develop specific gross and fine

motor skills: major movement skills, like walking or clapping; and more delicate movements,

like holding a spoon or pushing a button. They can help the learners with autism improve their

physical dexterity (Ministry of Education Special Programs Branch, 2000). Speech-Language

therapy is given to learners who are autistic. Speech Language pathologists are professionals

trained to evaluate and develop programmes for individuals with speech or language problems

(Best et al., 2010). The speech-language pathologist will work with the other professionals to

identify communication goals for the child‟s specific needs (Ministry of Education Special

Programs Branch, 2000). The study sought to find out the teaching resources and support

services for learners with autism and blindness in selected special schools and units in Baringo,

Kiambu, Kisumu and Nairobi counties in Kenya.

2.3 Instructional Methods for Learners with Cerebral Palsy Intellectual disability

A learner who has cerebral palsy and intellectual disability has a combination of cerebral palsy

and intellectual disability. Cerebral palsy can be defined as a group of non progressive disorders

characterized by impaired voluntary movement of posture resulting from a brain injury or brain

defect occurring before birth, during birth, or within the first few years of life (Beers, Porter,

Jones, Kaplan & Berkwits, 2006; Miller, 2005). Cerebral palsy is often accompanied by

disorders of sensation, communication, perception, and behavior as well as epilepsy (Bax et al.,

2005). Common to all individuals with cerebral palsy is the difficulty controlling and

coordinating muscles. This makes even very simple movements difficult. Cerebral palsy may

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involve muscle stiffness (spasticity), poor muscle tone, uncontrolled movement, and problems

with posture, balance, coordination, walking, speech, swallowing and many other functions.

Intellectual disabilities, seizures, breathing problems, learning disabilities and hearing and vision

problems are often linked to cerebral palsy (Ratanawongsa, 2004).

Cerebral palsy has several different etiologies and different types of motor impairments for

example Spastic and Athetoid). Cerebral palsy is non progressive but the symptoms of cerebral

palsy may get worse (Beers et al., 2006; Blair & Stanley, 1997). For instance, movement may

become more inhibited over time because of the development of contractures (shortening of

muscles), or sitting may become difficult because of the development of scoliosis (curvature of

the spine).There are two main types of cerebral palsy that is pyramidal and extra pyramidal. The

pyramidal and extra pyramidal systems are the two principal systems of the brain and spinal cord

that control movement. The pyramidal system is primarily concerned with strength and control

of fine movements of the arms and legs, especially the hands and feet. The extra pyramidal

system is primarily concerned with more basic aspects of movement and exerts greater control

over muscles of the body, shoulders and hips, although it also controls muscles in the arms and

legs (Ratanawongsa, 2004). When there is damage to the pyramidal system of the brain during

gestation or within the first few years of life spastic cerebral palsy occurs. Spastic cerebral palsy

is the most common forms of cerebral palsy, occurring in over 70% of those with cerebral palsy

(Beers et al., 2006) Spastic cerebral palsy uses a topographical classification system to connote

the location and number of limbs affected. The most common types are diplegia, hemiplegia and

quadriplegia. In spastic diplegic cerebral palsy, the legs are primarily affected and there is some

arm involvement. Depending on the severity, the knees may tend to come tightly together, the

legs may tend to cross over each other (Scissoring) and the child may walk awkwardly and on

tiptoe. In spastic hemiplegic cerebral palsy only one side of the body is affected. The arm and the

leg on the affected side have increased muscle tone. The leg muscles are tight, the child is on

tiptoe and the arm may be drawn into a bent position at the elbow (Heller et al., 2009; Best,

Heller& Bigge, 2010). In spastic quadriplegic cerebral palsy, the four limbs are involved, the

legs usually more severely than the arms. The trunk and the face may be involved as well.

Speech is typically affected. There are other types of topographical designations used to describe

spastic cerebral palsy, although they are not as commonly encountered. Some of these include

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monoplegia (one limb), paraplegia (legs only), triplegia (three limbs) and double hemiplegia

(arms more involved than the legs) (Heller et al., 2009; Best et al., 2010). Damage to the basal

ganglia a part of the extra pyramidal system of the brain can result in abnormal patterns of

movement or very rigid muscle contractions. When they occur during gestation or within the first

few years of life, it is referred to as dyskinetic cerebral palsy, known as Athetoid cerebral palsy

the second most form of cerebral palsy, occurring in about 20% of children with cerebral palsy

(Beers et al., 2006). Athetoid cerebral palsy may present as abnormal, involuntary movements

that may be slow and writhing (athetosis) or rapid, random and jerky (Nehring, 2004)

Abnormal developments or damage to the cerebellum a part of the extra pyramidal system of the

brain during gestation or within the first few years of life can result in ataxic cerebral palsy. In

ataxic cerebral palsy, there is difficulty in the co-ordination of voluntary movement and

problems with the balance. In Dystonic cerebral palsy there are strong muscle contractions with

the recurrent movement patterns. A single area of the body for instance a joint may be affected,

or it may be more generalized and affect most of the body (Miller, 2005). For instance a limb

may involuntarily move into an abnormal position and remain there for a period of time

(Nehring, 2004). No matter which type of cerebral palsy a child has, there will be abnormalities

of movement because normal movement requires a co-ordination of muscles. There is a range of

severity of cerebral palsy and various classification systems that have been used with some

describing the severity as mild, moderate, profound and severe. In addition to abnormal motor

movements, the child with cerebral palsy will have persistent primitive reflexes. Further

difficulties in movements are present when contractures occur. Contractures are permanent

muscular shortenings in which the muscle length is reduced or there is a fixed resistance to

movement (Sankar and Mundkur, 2005). This reduces the child‟s range of motion and ability to

move the limb fully. Contractures can be very debilitating and can result in minimal use of limbs.

The lack of co-ordinated muscle movement and the persistence of primitive reflexes found in

cerebral palsy may affect the oropharyngeal muscles those controlling the mouth and throat.

Speech may be slurred and poorly articulated (dysarthria), making it difficult to understand in

some cases, it can be so severe that no speech may be present (Anarthria) (Sankar and Mundkur,

2005). Cerebral palsy can also affect the non-verbal forms of communication. Facial expressions

may be strained, and difficulty with the head control may impede making eye contact. This may

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be mistaken for lack of interest. A learner with severe spastic cerebral palsy may want an item

and reach for it but knock it away because of abnormal motor movements. Children with cerebral

palsy may be gifted, have normal intelligence, or have intellectual disabilities overall, there is a

significant incidence of intellectual disability in children with cerebral palsy, with some accounts

of up to 60% of intellectual disabilities (Sankar and Mundkur, 2005).

Certain types of cerebral palsy have been associated with an increased incidence of intellectual

disability. Persons with spastic diplegia and athetoid cerebral palsy may have no intellectual

disabilities. Children with spastic quadriplegia, however have a higher association of intellectual

disabilities or learning disabilities than persons with spastic hemiplegia (Russman & Ashwal,

2004). Approximately 2% of the general population is affected by intellectual disability, whereas

up to 25% of the children with cerebral palsy are affected by intellectual disability. Early

intervention and special education programs can reduce the impact of intellectual disability.

Programs can tailor the curriculum so that learners can learn at a rate that gives them confidence

in their emerging new abilities. Therefore, parents must recognize their child‟s developmental

strengths and weakness so that they can help plan an education program that help achieve their

child‟s potential (Westwood, 2003). According to the American Association on Intellectual and

Developmental Disabilities(AAIDD)(2008) intellectual disability is a disability that is

characterized by significant limitations both in intelligence and adaptive behavior expressed in a

conceptual, social and practical adaptive skill. The disability originates before the age of 18

years. The diagnostic criteria for intellectual disability identifies a learner with intellectual

disability as having a significantly sub average intellectual functioning with an intelligent

quotient (IQ) of approximately 70 or below on an individually administered IQ test (for infants, a

clinical judgment of significantly sub-average intellectual functioning. The intellectual disability

also show concurrent deficits or impairment in present adaptive functioning, that is the person‟s

effectiveness in meeting the standards expected for his or her age or by his or her cultural group;

in at least two of the following areas: communication, self care, home living, social or

interpersonal skills, use of community resources, self direction, functional academic skills, work,

leisure, health and safety. The onset of intellectual disability is before 18 years of age. The code

used to diagnose learners with intellectual disability is based on degree of severity reflecting

level of intellectual impairment. Mild intellectual disabilities have an IQ of 50-55 to

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approximately 70. The moderately intellectually disabled have an IQ level of 35-40 to 50-55.

The severely intellectually disabled have an IQ level of 20-25 to 35-40 while the profoundly

intellectually disabled have an IQ level of below 20-25. Those with intellectual disability

severity unspecified is when there is a strong presumption of intellectual disability but the person

intelligence is untestable by standard tests (Tasse, 2013). In Kenya an intellectually disabled

child is one with a limited level of intelligence and deficits in adaptive behaviour. This condition

arises between conception and 18 years of age (Ministry of Education, 1995).

Learners with cognitive impairment require special and intensive instruction and this instruction

needs to begin early. When the target of instruction is specifically identified and is taught

directly, and progress is specifically evaluated systematically and consistently, learners with

mental retardation achieve well. School age with mild to moderate intellectual disability tend to

be functioning at what Piaget referred to as the concrete operational stage. According to Piaget,

the concrete operational stage runs from 7-11 years (middle to late childhood). Although a child

at this stage reasons in a logical way the reasoning is limited to things that are physically present

or concrete. The need to see and touch objects during this stage has important implications on

teaching of primary school children (Westwood, 2003). It is expected that learners with moderate

and severe intellectual abilities will progress through the sensory motor stage and have cognitive

understanding and abilities that include the ability to map the environment visually and

auditorily; to reach, grasp, lift, transfer, place and release objects; to understand that an object

exist even if it cannot be seen and will pursue searching until they find it ;and to use attached

tools, for instance, finger feeding, zippers, pumpsoap,wind up toys or faucet and unattached

tools, for instance, pencils, T.V, remote control or keys. Most learners with moderate intellectual

abilities will achieve abilities of the pre-operational stages, including classifications

generalization and seriation (Bukatko & Daehler, 1998).

Many learners with moderate and severe intellectual disabilities are functioning at the pre-

alphabetic stage of reading. At this stage learners do not understand that letters represent the

sounds in words, although they do know that print represents spoken messages. They remember

words such as names of family members and signs by configuration and general visual

appearance and depend on the context in which words occur to recognize them. They have no

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strategy other than rote memory of visual patterns or recognition of a word in its physical or

environmental context to read it For example, they read “McDonalds” on the sign because of the

golden arches rather than the initial “m” in the name (Ehri,1998;Moats,2000).This is not because

they ignored the letters in the signs but because they did not store the letters in memory as part of

the connections that prompted their reading of the signs (McGee, Lomax & Head,1988). The

most common instructional practice and the majority of reading research conducted with learners

with significant intellectual disabilities focuses on sight-word instruction, where learners go

through repeated practice to recognize and read words on the basis of the configuration of the

letters. A sight word approach is used because of learners‟ articulation difficulties and the

complexity and abstraction of letter sound correspondence in the English language. The words

selected for instruction are functional words that will facilitate access to independence in current

and future environments. Learners are taught words and phrases in the formats they appear in

the natural settings. The words and phrases provide information for instance signs and product

labels, directions for instance, pull, stop and exit. Safety warnings for instance, do not enter and

caution and those that affect job performance (McGee et al., 1988). Learning of learners with

significant intellectual disabilities is a result of systematic, direct instruction. Direct instruction is

teacher directed. It involves the use of behavioral instructional strategies for instance,

reinforcement, response prompting, shaping, fading and task analysis and management of the

learning environment so that it provides opportunities for learners errorless responding,

systematic movement from partial participation in tasks, increasing independent performance

and decision making based on ongoing data collection(Heller et al.,2002). In addition to learning

through direct instruction, these learners benefit from observational learning employing

modeling in which correct imitation of a model by the learner is reinforced. Learning through

observation enables group instruction (Collins, Gast, Ault & Wolery, 1991). Shaping is

reinforcing successive approximations of a behavior until the entire behavior is mastered. For

instance, teaching Tom to say „mmm‟ then „ma‟ then mummy (Ministry of Education Special

Branch Programme, 2000). Antecedent prompts are materials and instructions presented to a

learner to encourage the correct performance of a behavior when the naturally occurring cues are

not sufficient to produce correct behavior (Best et al., 2010). Response prompts provides

guidance assistance in the actual performance of behavior. There are many different types of

response prompts. Some of these are verbal cues (telling the student the step) verbal instructions

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(providing more directions on how to do the step) gesturing and modeling among others Best et

al., 2010).The use of adults, peers and non- disabled peers as models is effective for social,

motor and some communication and problem solving skills (Mercer & Snell, 1977; Snell &

Brown, 2006 & Westling, 1986). There are several strategies that may be used to increase

attention, memory and retrieval of information. Some of these include using visual imagery,

mnemonic devices, rehearsal strategies( a rehearsal strategy uses repeated practice of information

to learn it) elaboration strategies, advanced organizers, attention cues example, antecedent

prompts, prior knowledge activation strategies and other learning and metacognitive strategies

(Ormrod, 1999; Shiffrin, 1999). In addition to the problems with movement and speech many

learners with cerebral palsy tend to tire easily and have difficulty in attending to tasks for more

than brief periods of time, take a very long time to perform physical actions of pointing at or

picking up an object. Many need to be fed and toileted by a parent or an aide and, require special

physical positioning. In order to make best use of their coordinated movement they require

padded “wedges” or other specially constructed cushions to enable them to be positioned

correctly for work and they rely on the teacher or an aide to lift and move them (Westwood,

2003). Learners with intellectual disabilities require more time to learn to attend to the relevant

dimensions of a task (Mercer & Snell, 1977; Zeaman & House, 1997). Generally, it has been

found that learners with significant intellectual disabilities are less liable than typical learners to

perceive, select and group relevant stimuli and discard irrelevant stimuli (Cha & Merill, 1994).

The teacher must employ behavioural instructional strategies such as antecedent prompting, in

order to focus learners attention for example, a teacher would draw a learners attention to the

first letters of the words “saw and was” by making them larger or different colour in order for the

learner to learn to read them correctly; a teacher would draw a learner‟s attention to the label for

a sweater by attaching a red ribbon in order for the learner to learn front and back for dressing.

Without such prompting, there will be long periods of trial and error by the learner (Best et al.,

2010; Heller et al., 2009). When the curriculum is appropriate, a child is less likely to

experience stress and appropriately appreciate his or her own achievements. Skill development,

not high scores on intelligence tests, should always be the goal. Even though the disabled

learner‟s pace of learning may be slower than other learners, the achievements are just as

meaningful. Parents of learners with cerebral palsy who also have intellectual disability must

remember that they learn new skills more slowly than other learners and find it harder to master

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advanced skills such as reading, mathematics and complex problem solving. They also may not

be as motivated as other learners to learn new skills, but it does not mean that they cannot learn.

Given a good educational programme and support from family and friends, almost all learners

can make important, steady progress in intellectual abilities (Wheless, 2004). The mathematic

ability of learner‟s with significant intellectual disabilities is circumscribed by their limited

cognitive ability to deal with abstractions. The primary framework for content and process of

mathematics instructions is concrete in a functional curriculum. To meet the needs of these

learner‟s mathematic instruction begins with a foundation of basic skills. The natural occurrence

of mathematics for these learners is with manipulations embedded in functional activities rather

than being able to recite addition and subtraction facts. In an embedded approach to functional

approach to instruction, mathematic skills are taught in the context of daily activities such that

the priority for the instruction increase the learner‟s independence activities.(Ford, Schnorr,

Meyer, Black & Dempsey,1989; Snell & Brown,2006). Research on instructional strategies with

basic skills has demonstrated learner‟s with moderate intellectual disabilities, learning number

identification, rate counting, counting objects; equality and comparison of sets and basic

computation (Butler, Miller, Lee, & Pierce, 2001; Mastropier, Bakken & Scruggs, 1991; Vacc&

Cannon, 1991; Young, Baker & Martin, 1990). Successful use of “dot notation” system, similar

to the published Touch Math materials (Kramer & Krug, 1973) and use of a number line

(Sandknop, Schuster, Wolery & Cross, 1992) have been demonstrated to increase addition and

subtraction performance. However, for many learners, it is more efficient to teach computational

performance by teaching the use of a calculator, which improves efficiency and accuracy of

timed performance (Matson & Long, 1986; Snell & Brown, 2006). Early math skills involve the

use of manipulatives of such things as sorting, counting and computational skills. Learners with

poor fine motor control may need larger manipulatives that are positioned within the learner‟s

range of motion. Software programs also exist that allow learners to move items on a computer

screen with the click of a switch. Several math programs exist that not only assist in practicing

new math skills ranging from counting to Algebra but also provide access to learners requiring

alternative input devices, alternate output and screen modifications. Assistive technology also

exists for functional math skills such as time and money skills. Several software programs

address these areas often with features to make them more accessible. Special money calculators

are available that allow the learner to select dollars or various coins to come up with the total

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amount (Heller et al., 2009). For learners who have cerebral palsy and intellectual disability, in

order to fully cater for limitations in intellectual functioning teachers need to provide instruction

in a number of skills outside the general curriculum. These skills are more functional in nature

but are absolutely essential for the future independence of the individual. Additional skills areas

include money concepts, time concepts, independent living skills, self care and hygiene,

community access, leisure activities and vocational training. General curriculum areas should not

be neglected, however, and there are some promising practices to help support these learners in a

number of academic areas. One effective early literacy strategy with these learners is pre-

linguistic milieu teaching (Fey, Fitzgerald, Friel &Lapan, 2006). According to Fey et al., (2006),

prelinguistic milieu teaching is a technique that ties instruction to the specific interests and

abilities of the individual learner. This language acquisition instructional strategy also helps

support effective self determination as a key component of the training which is a frequent

required behavior from the learner. Breaking down larger tasks into their specific component

parts is also an effective technique for teaching any number of skills for learners with cerebral

palsy and intellectual disability. More complex concepts and activities can be taught over time

and as the learner master‟s one component of the task, another is added to the routine. This type

of task analysis can be taught using a variety of instructional supports, from physical and verbal

prompting to observational learning. The specific instructional strategies and materials used by

the learner should be aligned to learner‟s own interests and strengths. Useful strategies for

teaching learners with mental handicap and cerebral palsy include the following techniques:

teach one concept or activity component at a time, teach one step at a time to help support

memorization and sequencing, teach learners in a small group, or one on one if possible, always

provide multiple opportunities to practice skills in a number of different settings, use physical

and verbal prompting to guide correct responses and provide specific verbal praise to reinforce

these responses(Fey et al.,2006). The ability of learners with moderate and severe intellectual

disabilities to synthesis information and skills is limited (Westling &Fox, 1995). They have

difficulty perceiving the relationship between parts and whole. The teacher should not teach

isolated skills and expect the learner to organize the information for use. Skills must be taught

within the contexts embedded within the environment and activity in which they will be

performed.

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The acquisition of skills requires an instructional strategy that breaks down task chains into

component steps and skills so that each can be taught directly (Heller et al., 2009). Other

teaching strategies for learners with intellectual disabilities include a learning strategy and

providing explicit instruction. Learning strategy focuses on how the learners learn, rather than

specific content. This includes any technique that helps a student learn and complete the task

independently (Mercer & Mercer, 2004). Some of these include songs or rhymes, mnemonics,

self instruction and self monitoring. Providing explicit instruction is a teacher- led approach that

typically consists of three main components; demonstration and modeling, guided practice and

independent practice (Dangle & Keel, 2006). In the first component the teacher models the

target behavior. In guided practice, the teacher may use a continuum of assistance, based on

individual student needs (Mercer & Mercer, 2004).In independent practice the learner practices

the skill without assistance but still receives feedback as needed. For example, if the learner is

learning how to use a vending machine, the teacher may first demonstrate use, and then

systematically guide the learner. The student is then allowed to practice the skill independently

providing feedback as needed (Mercer & Mercer, 2004).

In Kenya, in an effort to determine the number of children with multiple disabilities in schools

for the physically disabled children, Kenya Institute of Education found that 34.9 % of the

children who had enrolled in the six major schools in 1980, had multiple disabilities. The

disabilities included; visual problems, hearing problems, learning disabilities and intellectual

disability (Ndurumo, 1993). The study did not show the instructional strategies that teachers

were using in enhancing learning for learners with physical and multiple disabilities. This study

sought to find out the instructional methods used by teachers teaching learners with Cerebral

palsy intellectual disability in some of our special schools and units in Baringo, Kiambu, Kisumu

and Nairobi counties in Kenya.

2.3.1 Curriculum Adaptations for Learners with Cerebral palsy Intellectual

Disability

For curriculum development, skills selected for instructions must be those that occur frequently

in the learners lives so that they have repeated opportunities for practice. For instance, reading

words should be selected from environmental print encountered in the community. Skills that are

used often and in various settings will naturally occur and therefore enhance memory functions

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(Ellis, 1970; Westling and Fox, 1995). Learners with significant intellectual disabilities learn few

skills within the time available in school, require more instructional (trials) to learn those skills

and therefore more time to learn, and require more time to recoup lost skills (Brown et al.,

1989).These learning characteristics require the careful selection of learning objectives, and

those selected must have a direct effect on the learner‟s life. Context and environment are critical

factors for instruction (Brown et al., 1989). To the extent possible, instruction should take place

in the setting in which skills are to be used with natural materials and with a variety of people.

Learners with cerebral palsy may need adaptations to the classroom and modifications of the

curriculum. These can include changes such as preferential seating for hearing or vision

problems or taping lessons to replay at a later time. He or she may need more time to complete

written assignments or note taking assistance from a peer or a teaching assistant. A learner

might need to take tests orally and take frequent breaks for muscle fatigue. The success of a

student relies on a support team to provide for the learner‟s needs. Regular and special education

teachers are a part of this team as well as occupational and physical therapists, a speech therapist,

the parents and a school administrator. The child might need a personal assistant or teaching

assistant as well (Kartha, 2011; Heller et al., 2009). According to the Kochung Report (2003);

KIE (1987), learners with multiple disabilities can follow a specialist curriculum. Specialist

curriculum remediates the problems such as communication, mobility among others. This study

sought to investigate the curriculum adaptations that had been effected for learners with cerebral

palsy intellectual disability in the counties of Baringo, Kisumu, Kiambu and Nairobi.

2.3.2 Teaching Resources and Support Services for Learners with Cerebral

Palsy Intellectual disability

Depending on the level of the cerebral palsy, special equipment and adaptations are needed to

allow the learner to function optimally in the school setting. Some learners with mild cerebral

palsy may be slower in writing assignment and need more time, while learners with more severe

cerebral palsy may need to use a computer with alternative access to complete assignment

(Heller et al., 2009). Allowance may need to be made for large and poorly coordinated

handwriting. Some may need keyboard to type or word process their assignments. For some,

adapted devices such as pencil grips and page turners may be required. Papers may need to be

taped firmly to the desktop. Computers with adaptations such as switches or touch panels, rather

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than a keyboard or mouse are useful both for presenting academic work and as a medium of

communication with others (Westwood, 2003). For individuals who have trouble grasping a

pencil, pencil grips or larger writing utensils (fat mechanical pencils or pencils wrapped in pipe

insulation) may provide an easier grasping surface. If a learner has Athetoid movements or

tremors weighted writing utensils may help reduce the extra movements and allow for better

writing control. Hand braces may provide extra stability or eliminate the need to grasp the pencil

while writing. Adapted paper that has darker or larger lines may be needed, papers may also need

to be stabilized by tape, clipboard, slant board (Writing surfaces that change the angle) or a

nonslip material (Example rubber self liner or Dycem) (Heller et al., 2009).

Some learners have difficulty writing by hand. These learners may benefit from small portable

word processors (Example Alpha smart) or laptop computers. The device may also be adapted

with different access features or devices to make it accessible. For example, some devices will be

equipped with talking word processors that give auditory feedback to what is being typed. Some

learner‟s with physical disabilities may benefit from word prediction software that provides a

selection of words as the student types in order to decrease the number of keystrokes and

increase typing speed. For example if the student is trying to type the word difference she begins

by typing “d” and several words that begin with “d” appear in the word prediction list (Example

did, does and don‟t).If her word is not on the list, she types another letter and word prediction

supplies words and so on until the desired word is provided. The learner can select the word or

continue typing (Heller et al., 2009).There is a number of existing software packages designed to

support learners with cerebral palsy and intellectual disability in the classroom. One promising

approach in literacy software utilizes universal design for learning principles. This approach

combines reading for meaning with direct instruction for decoding and understanding. The

resulting software consists of an audio and video based curriculum that can be adjusted by the

teacher to meet the specific academic capacities of the learner. Ultimately, any software that can

tailor content to address the interests of the learner can be useful in supporting learning for an

individual with cerebral palsy and intellectual disability, given that the instruction can be adapted

to meet the needs of the learner (Turnbull et al., 2002). Some learners with fine motor difficulties

have trouble isolating and turning one page at a time. This may be addressed through putting

spaces between the pages by attaching page fluffers (pieces of materials such as sponge or

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weather stripping) to each page. Some learners may use end of a pencil, a mouth stick or an

electronic page turner to turn pages (Heller et al., 2009). Books can also be accessed

electronically through the teacher scanning them into the computer or using commercially

produced electronic books. Having books on a computer can provide access for learners with

physical disabilities who cannot manipulate a book and help those with reading difficulties

(Heller et al., 2009). The use of real materials or actual tools in a natural environment is an

essential component in the effective instruction of learners with cerebral palsy intellectual

disability. Although these materials would be labeled as “low tech” teaching resources, they

serve to both motivate the learner and facilitate generalization to multiple environments. For

example, the use of manipulative or concrete objects for a math lesson (Turnbull et al.,

2002).There are several assistive devices that may be required for a learner with cerebral palsy to

benefit from his education program. This may include devices for augmentative and alternative

communication among others. Argumentative and alternative communication (AAC) refers to

communication that is used to enhance a learners existing verbal communication (for instance,

Argumentative or Alternative serve as the learners primary form of communication. Sevcik and

Romski (2000) states that, “AAC incorporates the individual full communication abilities and

may include any existing speech or vocalizations, gestures, manual signs and aided

communication. AAC is truly multimodal, permitting individuals to use every mode possible to

communicate.” Individuals with physical and multiple disabilities often use several different

types of communication depending on the setting, need and familiarity of the communication

partner (Patel, 2002). For example, a learner with a severe spastic cerebral palsy who has

dysarthria may use word approximations and gestures with his family members who understand

him well, use an electronic AAC device in the classroom and use pictures on paper on the

playground. AAC enhances a child‟s development of verbal abilities (Romski and Sevcik, 2005).

Even if a learner‟s speech is understandable to those who know him well, AAC should be

considered when native listeners cannot understand the learner‟s speech. For learners who have

severe communications problems, the teacher may need to adapt the presentation of material.

Material may be presented in a multiple choice to allow the learner to choose the answer or the

learner may indicate the response by eye gazing the answer presented by using a scanning device

(Heller et al., 2009). Special pencil holders or grips might be needed or a student may need a

computer for his or her writing. A learner with cerebral palsy might have trouble communicating

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since speech is controlled by muscles. A speech therapist will work with the classroom to design

the best communication system for the learner. Some schools have an assistive technology team

that specializes in current technology and devices available for classroom use (Heller et al.,

2009; Best et al., 2010). Some learners with cerebral palsy and intellectual disability can use

pictures, and some communication boards which are designed to match the learner‟s cognitive

and receptive language skills and should be continually monitored and evaluated so that it can be

modified with the learner‟s expanding and changing needs. For the learners who cannot use the

computer as a result of physical limitations in their hands or arms, avenues should be explored

for obtaining adaptive access software (including unicorn keyboard, touch pads or foot

controlled mouse), special switches, power pads, eye controlled input systems, touch screens and

foot mice to assist in ensuring communication is possible for the learners with cerebral palsy

intellectual disability (Keller, 2005).The learner should be taught proper transferring techniques

and the personnel be trained in correct lifting and handling techniques. A nurse, physical

therapist or occupational therapist is a good resource for learning proper techniques. If the

learner weighs more than 35% of the adult body weight, the adult should not attempt the lift

alone. For example if an adult weighs 120 pounds, she should not lift a child by herself who

weighs more than 42 pounds. If the adult weighs 185 pounds, the weight limit for a one person

lift would be 65 pounds (Heller, Forney, Alberto, Schwartzman & Goeckel, 2000). The

environment should be arranged to minimize the distance the adult must carry the child. Proper

positioning for learners with physical disabilities is critical to facilitating typical and functional

movement patterns, thereby encouraging child skill development and independence. Sometimes

learners with physical disabilities will need special adaptive positioning equipment or devices in

order to maintain a functional position during typical activities at home or school. Some

equipment includes wedges, a prone stander, and special wheelchairs among others. Parents,

teachers and therapists should work together to determine what positioning devices are needed

for individual children. The physical therapist and occupational therapist work with the

classroom teacher and teaching assistant on positioning ,handling and daily activities (for

instance feeding and toileting) (Heller et al.,2009). The child with cerebral palsy may need to be

positioned in several different types of adaptive equipment, the purpose of this equipment is to

promote good body alignment, prevent contractures and deformities, promote movement and

comfort, lessen effects of abnormal muscle tone and reflexes, improve circulation ,decrease risk

73

of pressure sores (Decubitusulars) decrease fatigue and promote bone growth (Jones and

Gray,2005). Positioning also provides access to the environment and facilitates performance of

certain activities. There is a correspondence between activities and specific positions for

instance, a boy with cerebral palsy positioned in a side lyer (equipments that props the person up

on his side) may have better use of his left arm, allowing him to participate in the group activity

by using a switch (Wheless, 2004). The ability to move about provides learners with opportunity

to interact with their social and physical environment. Learners with physical or multiple

disabilities will need some type of mobility device. This may range from devices to assist with

crawling to those that assist with transportation. Devices can range from a cane for walking,

support to a car that has been especially adapted for an individual with a severe physical

disability. To assist in crawling or creeping, some children can use a scooter board. Scooter

boards are typically small, square pieces of wood covered with plastic and cushioning material

that have four casters in the corners of the board to allow the board to move in all directions.

Scooter boards may support the trunk (allowing the child‟s arms and legs to move) or be

constructed longer to support the entire body (allowing only one arm movement).Children are

typically strapped in, lying on their stomach (Heller et al., 2000; ;Best et al.,2010). To assist with

walking, there are several different mobility devices, including canes, crutches and walkers.

There are two main types of crutches that may be used: Auxiliary crutches (which are full length

crutches that provide support up to the armpit) and Lofstrand or forearm crutches (which are

crutches that extend to the forearm) learners needing more support may use a cane. Individual

with more severe physical impairments may learn to propel themselves using a powered scooter

or a powered wheelchair. Some wheelchairs adjust from a sitting to a standing position (Heller et

al., 2009). Mobility devices are now being introduced early because several positive effects

attributed to the use of powered mobility devices, such as improved head control, trunk stability

and arm hand function; increased motivation in other forms of movement; increase in

communication, exploration, social interactions; and self esteem and no ill effects on motor

development (Judge and Lahm, 1998). Activities of daily living may require adaptations or

assistive technology to allow the learners to participate to the maximum extent possible. (For

instance, tooth brush and tooth paste holders may be used to assist with tooth brushing). A

dressing rack and adapted clothing fasteners may help the learners dress; push pull sticks may

help with putting on socks. Environmental control devices that allow the child activate items

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with a switch (for instance, turning on lights or television) may be useful (Heller et al., 2009).

Age at which toilet success is achieved is partly dependent on the severity of the(CP) and

cognitive functioning of learners with an intellectual disability ,the teacher will need to use

systematic instructions in toilet use for instance, trip training strategies after determining from

the physicians that there is not any medical reason impending bladder or bowel control.

Learners may have such difficulties as a tongue thrust (causing food to be pushed out of the

mouth) a bite reflex (causing the spoon to be bitten) and chocking (Heller et al., 2009). Children

with arm involvement may be unable to bring the spoon to their mouths or be unable to hold

utensils. Some devices used for feeding such as adapted dishes, cups and utensils may be

necessary.

Some learners will be unable to eat enough orally because of their oral-motor dysfunction and

will need gastrostomy tube feedings (Feeding through a tube directly into the stomach) (Sullivan

et al., 2005). The teacher needs to be alert for any difficulty the learner may have with social

interactions. Learners with cerebral palsy may become socially isolated because of their

appearance and often because of poor social skills. The teacher may need to provide social skills

training. Learners with cerebral palsy may also exhibit frustrations and have behavioral outbursts

when they cannot communicate effectively or are unable to accomplish a task because of their

unintentional movements. Teachers need to be sensitive to the learner‟s needs, provide

augmented forms of communication and provide alternative ways of accomplishing tasks(Heller

et al.,2009; Best et al.,2010). Individuals with cerebral palsy require assistive technology to

perform light management activities such as self care, domestic, prevocational and community

activities. Self care skills that may require assistive technology include activities such as eating,

drinking, dressing, brushing teeth and washing (Heller et al., 2009; Best et al., 2010). Adapted

spoons may be necessary to those with difficult eating. For instance spoons may be fitted with a

strap to fit around the hand for a person who cannot grip, they may be a different shape or they

may be weighted to steady certain types of abnormal motor movements. Adapted bowls and

plates may be necessary for instance, scoop dishes or dishes that adhere to the table, cups may

need handles or part of a side of the cup cut out for the nose to fit when the individual cannot tip

his head back). Individuals who have good head control but are unable to use their arms may

benefit from a switch mechanical feeder (Heller et al., 2009; Best et al., 2010). Adapted clothing

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may be needed for someone with a physical impairment to promote ease of dressing (for

instance, clothing with Velcro fasteners) people with limited motor abilities may need to use

dressing sticks to help them pull down their pants, shoes with Velcro may be easier for

individuals with cognitive or physical impairments (Best et al.2010; Heller et al., 2009). There

are many adapted items that may be used to maintain proper hygiene for instance; toothbrushes

may have built up handles to hold better or a grip to go around the hand so that the user does not

have to maintain a grip. Hairbrushes with longer handles may assist individuals with limited

movement or shortened limbs. These items are available from companies or can be homemade.

Careful assessment is needed to determine if the technology is appropriate (Best et al., 2010;

Heller et al., 2009). Some individuals with disabilities may use a service animal, such as a

specially trained dog, horse, monkeys, cat or other animal. Service animals may assist learners

with physical disabilities in such tasks as carrying materials, fetching and returning dropped or

needed items, opening doors, turning switches on and off, feeding and pulling wheelchairs up

ramps or across distances (Zapf and Rough, 2002).

2.3.3 Treatment and therapy for learners with Cerebral palsy Intellectual Disability

Treatment of learners with cerebral palsy and intellectual disability varies according to their age,

the severity of their symptoms and type of cerebral palsy. Common steps include: corrective

lenses orthotics (mechanical aid that is used to support or assist movement of a weak part of the

body), braces or corrective surgery for affected limbs, injections of tiny doses of botulin toxin to

relieve spasticity and treat movement disorders, medications that reduce spastic tension in

muscles, speech therapy, physical and occupational therapy, psychological counseling to assist

with adjustment issues, referrals to appropriate resources including a neuropsychologist for the

development of an Individualized Educational Plan (IEP) (Wheless, 2004). The members of a

treatment team for a child with cerebral palsy will most likely include the following: A

physician, such as pediatrician, pediatric neurologist, or pediatric physiatrist, who is trained to

help developmentally disabled children. This doctor, who often acts as the leader of the treatment

team, integrates the professional advice of all team members into a comprehensive treatment

plan, makes sure the plan is implemented properly, and follows the learner‟s progress over a

number of years. An orthopedist is a surgeon who specializes in treating the bones, muscles,

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tendons and other parts of skeletal system. An orthopedist is often brought in to diagnose and

treat muscle problems associated with cerebral palsy (Heller et al., 2009).

A physical therapist designs and puts into practice special exercise programs to improve strength

and functional mobility. An occupational therapist, teaches the skills necessary for day to day

living, school and work. A speech and language pathologist specializes in diagnosing and

treating disabilities relating to difficulties with swallowing and communication. A social worker

helps individuals and their families locate community assistance and education programs. A

psychologist helps individuals and their families cope with special stresses and demands of

cerebral palsy. An educator may play an especially important role when mental retardation or

learning disabilities present a challenge to education ((Donkervoort, Roebroeck, Weigerin, Van

der Heijden-Maessen& Stam, 2007). The goal of treating cerebral palsy is to develop maximum

independence. The child with cerebral palsy benefits from physical, occupational and speech

therapy‟s positioning devices; orthotic devices; medications and sometimes surgery to improve

motor function. Physical and occupational therapies provide support to children with cerebral

palsy. Most therapy attempts to reduce the abnormal movement patterns and encourage normal,

purposeful movements in an active and functional manner. In addition, speech language therapy

may be able to improve speech production, although augmentative communication will be

needed by many individuals with severe spastic quadriplegic cerebral palsy (Wheless, 2004).

Neurodevelopment treatment approach was developed by Berta Bobath, a physical therapist in

1960. In neurodevelopment approach the therapist uses a “hands- on” approach, placing hands

on specific body parts in order to help align body segments and initiate, guide, or prevent

unwanted movement. The ultimate goal of neurodevelopment treatment is to inhibit a child‟s

atypical patterns of movement and facilitate typical movement patterns, including requisite

postural reactions. Therapy balls are frequently used in treatment sessions to encourage

adaptive postural responses to movement. The aim of treatment is to help the child develop new

patterns of movement. Training and involvement of other team members (family, therapists,

and teachers) is encouraged in the approach in order to plan and execute a well co-

ordinated treatment program. However, good handling techniques on the part of the therapist

are essential to the approach. Their treatment focused on children with cerebral palsy with

atypical muscle tone.

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Sensory Integration theory and therapy is currently applied to children with a variety of

neurological impairments, such as cerebral palsy for better central nervous system organization.

The approach facilitates the child‟s ability to make adaptive responses to specific sensory

stimulation (including, tactile, vestibular, and proprioceptive stimuli) while engaging in

purposeful activity. Sensory integration is directed towards improving the brains capacity to

perceive remember and plan motor activity. Sensory therapy frequently uses activities that

provide vestibular stimulation to influence balance, muscle tone, ocular-motor responses,

movements against gravity, postural adjustments and arousal or activity level. Suspended

equipment, as well as resistive activities, and weighted objects are often used in Sensory

integration therapy to encourage adaptive postural and movement responses (Effgen, 2005;

Montgomery & Connolly, 2003; Smith, Roley, Blanche, & Schaaf, 2001). The mobility

opportunities via education curriculum was developed in the 1990‟s by Linda Bidabe, an

educator, and John Lollar, a physical therapist to help children systematically develop motor

skills. The program provides naturally occurring practice of functional motor skills while

the learner is engaged in educational or leisure activities. In the programme, activities are

selected for instance, using a public restroom or eating in a restaurant), and they are task

analyzed to determine the physical skills needed to do these tasks for instance, transition

from standing to sitting position or walking backwards. Each of these physical skills is

divided into four levels of success ranging from skills acquisition with independent

mobility to skill acquisition that would improve bone health and functioning (Miller, 2005).

The goal of treatment for individuals with neuromuscular scoliosis(a curvature of spine) is to

correct or prevent progression of the spinal distortion that can cause pain, difficulty sitting,

or compromise in lung volume and affect other body systems (Miller, 2005). The three most

common approaches to treating scoliosis include observation, bracing and Surgery. Very Mild

Curves may only require close observation and x-rays to determine if the curve is progressing.

This is especially the case when the curve is idiopathic and may not be progressive (Heller

et al., 2009). The use of a brace (also known as Orthosis) to prevent further worsening of an

abnormal curvature has shown promising results in some individuals with idiopathic

scoliosis in particular. Bracing is typically used with growing adolescents who have not

reached skeletal maturity and have a moderate curve (Herring, 2002). The most common

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surgery for scoliosis is a spinal fusion with instrumentation (i.e. rod) and bone graft. In this

surgery prebent (rods) are attached to the spine in certain locations by hooks or screws (or other

means), and the spine is carefully straightened. Small pieces of bone graft for instance, from

the hip, are placed between the vertebrae to fuse them together, keeping the spine straight.

This is referred to as a spinal fusion. The rod(s) keep the spinal column straight while the

bone graph grows and makes the spine solid, preventing a curve. The spine remains flexible

where it has not been fused. Modifications are dictated by the learners needs. They will require a

support team to provide for the learner‟s needs (Donkervoort et al., 2007). The learner with

cerebral palsy may also need to use various braces or splints (Othoses). By applying an orthotic

splint or brace, the muscle group is placed in a more functional position. This helps maintain

proper alignment, improves range of motion and decreases the development of contractures. To

prevent toe walking and the shortening of the Achilles tendon, a short leg splint may be worn.

Specific equipment is prescribed according to the type of motor problem, the child‟s size and

weight and the nature of the activity. Equipment such as side lyers, wedges, special seating

devices and prone standers is commonly used. Other equipment such as scooters, bikes, walkers

and wheelchairs may assist with mobility. Often, modifications are made to those mobility

devices to allow for proper positioning. Wheelchairs for example, may have special inserts to

keep the knees apart (abductor pad) or the body aligned (lateral supports). Head support may be

necessary as well. Some wheelchairs are motorized to allow independent movement for children

with upper arm involvement. A physical therapist should help describe or modify this mobility

equipment, which should help the learner be as independent as possible (Wheless, 2004).To help

improve hand function, a resting hand splint or hand cone may be used. They must be carefully

monitored by therapists for the correct fit as the child grows. Close adherence to the times the

orthosis is supposed to be worn is important if treatment is to be effective (Heller et al., 2009).

Several medications may be taken to control excess muscle tone and promote relaxation of the

muscles. Two commonly prescribed oral medications are Valium (Diazepam) and Dantrium.

Side effects may occur including drowsiness, excessive drooling and changes in memory,

attention and behavior (Verroti, Greco, Spalice, Chiarelli and Iannetti, 2006). Careful monitoring

on the side effects and effectiveness are necessary to make any needed adjustments in dosage or

to try new treatments. Baclofen has been found to be useful in the management of spasticity and

is often delivered by an implantable pump (Verroti et al., 2006). Complications can occur with

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the pump (example infection or catheter tube breakage) and side effects of the medications

(example hallucinations and Psychosis if the medication is suddenly withdrawn (Miller, 2005).

Another medication that may be used is Botulinum toxin, which reduces excessive muscle tone

in spasticity and dystonia (Pellegrino,2007).Botolinum toxin works best in children requiring one

or two muscles to be injected (Herring, 2002). It can be effective for up to 3 to 4 months (Verroti

et al., 2006). Side effects include muscle weakness and pain during injection. Surgery may be

needed to increase range of motion, decrease discomfort, or increase functional use of a body

part. Individuals with cerebral palsy are especially at risk of developing contractures, which

shorten muscle length and decrease range of motion of a joint. Several different surgical

procedures are designed to treat contractures. One common surgery is used to correct the foot

deformity of the ankle that results in the child being on tip-toe. In this surgery, the Achilles

tendon (heel cord) is lengthened, resulting in the foot being placed flat on the ground. It may

assist in walking (Kreulen, Smeulders, Veeger and Hage, 2006). There are many other surgical

procedures used to improve the range of motion in the arms and legs due to contractures. The

surgical goal of treating children with spasticity in the arms is to release the spastic deformity

and reposition the arm to improve its functional use (Kreulen et al., 2006).The hamstring

muscles in the legs may be released to help with sitting and walking. Surgery to release the

tendons and muscles that result in hip deformities may be needed. These surgeries are aimed at

preventing hip dislocation and allowing the child to assume a sitting position. Neurosurgical

procedures have also been used to treat cerebral palsy. These procedures involve surgery on the

central nervous system. One such procedure known as selective posterior dorsal rhizotomy,

involves cutting a certain percentage of specific spinal roots that cause severe spasticity of the

legs (McLaughlin, Bjornson, Temkin, Wright &Reiner, 2002). Every child with cerebral palsy

may need a different kind of therapy, according to the severity of the disorder. They will require

a support team to provide for the learner‟s needs (Donkervoort et al, 2007; Best et al., 2010).

2.3.4 Adaptations for learners with Cerebral palsy Intellectual Disability

Adaptations are alterations to a task (or material used in the task) that provide access to a task to

facilitate participation in a task for which an individual does not have the requisite abilities

(Bryant & Bryant, 2003). Adaptations include modification and accommodations.

Accommodations refer to changes to the task to accommodate for a disability that does not alter

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the performance standards, where modifications refer to changes where the content level or

number of skills is altered (Beech, 2006). An adaptation also encompasses assistive technology

and alternative performance strategies that are non typical ways of performing a task, such as a

learner who writes by holding a pencil with his or her teeth. In order to meet the needs of

learners with physical, health or multiple disabilities, it is important that appropriate adaptations

are identified (Heller, Forney, Alberto, Schwartzman & Goeckel, 2000). This begins by

examining the target performance of the task and the learner‟s performance of the task. Any

discrepancy between the target outcome and learner‟s performance is examined in terms of the

reason for the discrepancy (for instance, atypical motor movements and motor abilities resulting

in restricted range of motion, vision loss affecting access to the task, poor physical endurance,

health issues regarding frequent discomfort resulting to inattention to the task, learning

difficulty regarding understanding task requirements, lack of appropriate communication or poor

motivation(Heller et al.,2000). Based on the reason identified for the discrepancy between target

performance of the task and learner‟s performance, appropriate adaptations are selected using a

team approach. The teacher will need to involve the related staff like the occupational and

physical therapists and speech language pathologists, parents and the learner in the selection of

the adaptations as well as the evaluation of their effectiveness. It is important that all individuals

working with the learner understand the adaptations and work together to consistently implement

them. Getting input from all team members while planning adaptations and making sure that

proper training of each adaptation takes place helps to get the right adaption-user match and

helps reduce the possibility that adaptations are unnecessarily abandoned (Bryant & Bryant,

2003).Adaptations must be individualized for the learner to adequately meet the learner‟s unique

characteristics and should aim at promoting effective learner‟s participation and increasing

learner‟s independence. Adaptations cannot be made for a group or category of learners because

in the area of physical disabilities, two learners with the same diagnosis may have significantly

different physical abilities (Heller et al., 2009). Sufficient time must be given to determine if an

adaptation is effective. It is unlikely that an adaptation will be effective after one trial (Baumgart

et al., 1982). The possible adaptations that will be needed in a classroom to assist a learner who

has a physical or multiple disability will fall into several areas: Mobility and seating

arrangement, student positioning to optimize movements, adaptations to work surfaces, special

positioning of materials on the work surface due to restricted range of motions, assistance or

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adaptations to materials and modifying activities or tasks in the classroom because of fatigue.

Some learners with physical or multiple disabilities will have mobility problems and have

difficulty getting to their desks (or areas in the classroom).To address this issue, aisles may need

to be widened or assistance may be needed (including assisting the learner into transferring into a

chair or moving a chair up to a desk (Wadsworth & Knight, 1999). Cut out desks may be used to

allow the wheelchair to fit under the table and provide additional arm support. Other tables may

need to be lowered for best fit (Heller et al., 2009). The team may need to carefully consider the

layout of the room and how the learner will move to different locations. Seating arrangements

should take into account assistive technology devices used by learners and the ability to access

classroom area. For instance, some learners may need preferential seating and be near the front.

Proper positioning is critical for learners with physical disabilities since good positioning can

maximize movement for instance, better arm movement can occur when proper positioning is in

place for learners with severe cerebral palsy (Wadsworth & Knight, 1999). Good positioning is

also important to decrease health problems for instance; skin breakdown in a learner with severe

scoliosis (a curvature of the spine). Some learners will require an adapted chair or wheelchairs

that provide support and positioning. Once the learner is properly positioned the learner may

have difficulty accessing the work surface because of atypical arm or hand movements. In this

instance the work surface may need to be adapted. Some learners will have improved movements

if the work surface is slanted through use of a slanting table top, slant board or a three-ring

binder. If the material slides all over the surface, it will need to be stabilized using a tape, Dycem

or a rubber shelf liner. It is important to realize that the work surface area includes not only the

desk but also the height, slant and size of the work surface area that learners may access using

other parts of the body, such as their feet (Wadsworth & Knight, 1999). Once the work surface is

correctly adjusted, the best placements of the materials will need to be determined on the basis of

the learner‟s range of motion. This refers to the distance the learner is able to reach with his

hand, foot, mouth stick or other body parts to access materials or by having the learner touch

various areas on the work surfaces or other items such as a keyboard or pictures or an

augmentative or alternative communication(AAC) device (Heller et al.,2009). It should be

specified on the adaptation checklist if a learner will need to have materials handed to him or if

he requires alternative access or if the materials need to be modified to make it easier for the

learner to manipulate them. (For instance, some learners have atypical movements that are

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uncontrolled or that have extraneous movements. Some learners will experience fatigue or lack

of endurance as they manipulate materials or engage in any activity. For instance a learner with

severe spastic (CP) activating a switch over and over again. Rest breaks should be provided. If

the rest breaks are needed, the teacher should specify on the checklist when they occur and for

how long and what the learner does during the break (Heller et al., 2009). Environmental

adaptations of the classroom should be put in place in order to ensure the teaching process of

learners with cerebral palsy and intellectual disability runs smoothly. By adapting and modifying

the learning room design, is one of the key areas for these learners to ensure effective instruction:

The room should have two doors, one in the front and one near the back. Chalkboards and easels

should not be higher than 24 inches from the floor to enable learners on wheelchairs to see. The

doors should have automatic door checks allowing the door to remain open for wheelchairs and

clutch walkers. Doors should have long grasping bars rather than door knobs. Toilet facilities

should be near the learning environment and floors should be of nonskid type (Donkervoort et

al., 2007). Teachers will need to facilitate toilet training by having appropriate adaptations in

place. Adaptations such as handrails and a properly fitted adapted toilet are important to decrease

fear of falling and allowing the child to relax to allow elimination to occur. The learner will also

need a way to communicate that he needs to use the rest room (Heller et al., 2009; Best et al.,

2010). This study sought to find out the available teaching resources and support services for

learners with cerebral palsy intellectual disabilities in selected special schools and units in

Baringo, Kiambu, Kisumu & Nairobi counties in Kenya.

2.4 Training needs of specialized personnel for Learners with Multiple Disabilities

In America, a research project was carried out under the Perkins National Deaf blind

Training project on the competencies for teachers of learners who are deaf-blind. The aim

of the study was to improve educational practices by ensuring teachers have the basic

competency in all the areas addressed in the knowledge and skill statements in the teaching

of children with deaf blindness. The skills and knowledge areas in the study included the

following areas of deaf blindness: personal identity, relationships and self esteem, concept

development, communication, hearing, vision, orientation and mobility, environment and

materials and professional issues (Reiman,Malley &Klumph, 1998). Children who are deaf-

blind require highly specialized and personalized teaching approaches because of their

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combined vision and hearing losses . Although children who are deaf-blind have the same

basic needs as all children, the combination of sensory loss accompanied by other

disabilities creates additional highly complex challenges. The extent of vision and hearing

loss varies within the population of children who are deaf-blind. Most have residual use of

either vision or hearing, while others have no usable vision or hearing. Each child is unique but

all share communication challenges and the potential isolating effects of combined vision and

hearing loss (Reiman et al, 1998). Teachers, support personnel and caregivers who are essential

to the lives of infants, children and young adults who are deaf-blind must have excellent training.

There are various competencies that can work as effective tools to identify needs and implement

training in a cohesive way. Communicating with individuals who are deaf-blind is a unique

experience. The language, mode, style, speed, aids and devices used to facilitate communication

are different from person to person (Reiman et al, 1998). The study was crucial for the present

study because it was looking for the competencies required by teachers teaching learners with

deaf-blind. The present study intended to find out whether the same competencies are applicable

in our Kenyan educational settings. Teachers who instruct learners with multiple disabilities

must possess specific competencies that encompass instruction, physical management of

learners, educational environment, and health maintenance, use of assistive technology,

augmentative communication and curricular adaptation (Best, Heller &Bigge, 2005; Council for

Exceptional Children, 1998; Heller, Fredrick, Dykes, Best, & Cohen, 1999; Heller & Swinehart-

Jones, 2003). According to Best et al., (2010), teachers of learners with multiple disabilities must

have more than curricular knowledge and instructional strategies to be effective educators. They

must have knowledge about a variety of disabling conditions and their implications for function.

They must possess the empathy and knowledge required for working with families who may be

coping with highly emotional situations including chronic illness, frequent hospitalizations and

perhaps terminal outcomes. In this process, they become partners with families and collaborate

with them to meet the shared goal of learner‟s success. They must collaborate successfully with

personnel from many disciplines, including therapists, doctors, nurses, speech-language

specialists, and others while they function as a resource for teachers in general education.

Finally, teachers must also be advocates for their learners, and they must always envision the

goal of self-advocacy for learners and their families. To reduce the functional impact of

disability, teachers and others who work with individuals with multiple disabilities must develop

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knowledge, skills, and abilities that extend beyond standard pedagogy. They must have a

thorough understanding of typical development in motor, sensory/ perception, cognition,

communication, language/social/ emotional and self-care domains. Their knowledge and skills

must include the ability to accommodate and modify the general education curriculum. They

must be able to incorporate essential knowledge and skills for personal self-reliance into the

education program, including domains of functional living skills, physical task performance,

fundamental and assisted communication and individualized preparation for transitions (Best et

al., 2010). The competencies of a teacher who is deaf-blind according to the Council of

Exceptional Children (1995) include; knowledge on deafblindness, personal identity,

relationships and self-esteem, concept development, communication and hearing-vision. On deaf

blindness a teacher should know the critical roles of vision and hearing in all learning (e.g.

communication, concept development, motor development and movement). The complex and

unique effects of combined vision and hearing losses upon all learners who are deaf-blind(e.g.

communication, challenges in accessing information, orientation and mobility, diversity within

the population of learners who are deaf-blind(e.g. differing etiologies; varying ages of onset of

deaf blindness, varying degrees of vision and hearing losses, additional disabilities among others.

On personal identity, relationships and self- esteem, the teacher should have knowledge on the

potential impact of deafblindness upon attachment bonding between learners who are deaf-blind

and their primary care givers among others. On concept development the teacher should have the

knowledge and skills on the potential impact of the combined effects of vision and hearing losses

upon the development of concrete and abstract concepts. On communication, the teacher should

have knowledge and skills on the development of communication partnerships between learners

who are deaf-blind and others for instance, assessing and adapting to learners pace/timing of

communication e.g. (considering physical limitations, vision and hearing losses, processing time,

motor planning and medical conditions) among other skills. On hearing-vision, the teacher

should have knowledge and skills on the structure and functions of auditory and visual systems

and how they interrelate in the learning process. For example, assessing and explaining the

educational implications of visual and auditory impairments‟ upon the learner among other

skills. On orientation and mobility, the teacher should have knowledge and skills on the

influence of vision and hearing in motor development. For example, collaborating with

orientation and mobility specialists and other appropriate specialists (e.g. occupational therapist,

85

physical therapist), in adapting strategies to encourage the learner to move safely and

independently. The teacher should have knowledge on technology to enhance orientation and

mobility skills among others.

On environment and materials the teachers have knowledge on the visual, auditory, tactile and

olfactory information in various environments that influence learning. Some of the skills the

teacher should have include; making appropriate visual adaptations to accommodate for specific

visual impairments‟(e.g., reducing lighting for learners with Colobomas,increased lighting in

dark areas for learners with retinitis pigmentosa, making appropriate adaptations to enhance the

learner‟s auditory functioning in a variety of physical environments(e.g., background noise

reduction, volume modification and adjustment of room acoustics(addition of carpet, draperies

etc]among other skills. On professional issues, the teacher should have knowledge on the history

of practices, people and events that have impacted or impact the lives of people who are deaf-

blind and their possible relevance to current educational practices. The teacher should have

knowledge on resources of support services (e.g., interpreters, counselors, intervenors) for

learners who are deaf-blind and their families; curricula specific to, or adapted for learners who

are deaf-blind(e.g. daily livingskills,vocational,earlyintervention;provide information and

education to team members including families about the uniqueness of the disability of deaf

blindness among others. According to Boyce & Hammond (1996), the competencies of teachers

educating learners with autism blindness should have the opportunity to develop the core skills

that enable them to teach all learners. These core skills include; planning and teaching for

inclusion and access to the curriculum, behavioural management and an awareness of the

emotional and mental health needs of pupils (to build their self-esteem as learners) assessment of

learning skills, and understanding of when professional advice is needed and where to find it,

designing an appropriate learning environment, development of language and designing of

appropriate learning and communication environments. According to Leyser (1985), the

competencies needed by special and general educators for providing an appropriate education for

disabled children include areas such as general competency areas of professional orientation,

knowledge, Curriculum, instructional strategies, learning resources, assessment, evaluation of the

student‟s progress, classroom management and communication. Other competencies often listed

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are learning styles, motivation, administration, referral, professional values, goal setting, and

classroom climate and acceptance.

According to the National policy on special needs (2009) a ministry of education policy, there is

lack of sufficient trained personnel for curriculum development. In addition, there are no clear

staffing norms and recommendation on pupil teacher ratios in institutions and programmes for

special needs education. There is inadequate provision of trained teachers in SNE and other

personnel. Most of these personnel lack adequate skills and knowledge for effective service

delivery. Most training institutions do not address the SNE learners in their training approaches.

Kochung Report (2003) found that 80% of the teachers working with children with special needs

in education are not trained in SNE. Lack of trained SNE teachers was noted as a critical issue

that is affecting the provision of special needs educational service. The Kochung Report (2003)

found out that only 20% of teachers in special needs educational programmes are trained in SNE.

It was further noted that with the exception of the graduates from Maseno University, most of

these teachers lack the necessary proficiency in Kenyan sign Language and Braille. According to

the Kochung Report on special Needs Education Appraisal Exercise (2003), there was lack of

statistical data on special needs education, hence the need for training and in servicing of

teachers. A survey by Kenya Institute of Special Education (1987), on the training needs of

teachers in special schools and programmes in Kenya to establish the levels of trained; gender

and type of trainings in the special schools revealed that a good number of teachers in the special

institutions have no basic training in special education. Insufficient number of trained teachers

has an effect on teacher-learner ratio in learning institutions. The study sought to find out the

training needs of teachers educating learners with multiple disabilities in the counties of Baringo

Kisumu Kiambu and Nairobi.

Summary of the reviewed studies

In this chapter, relevant literature was reviewed regarding teaching strategies used by teachers to

enhance learning among learners with deaf blindness, autism blindness and cerebral palsy

intellectual disability in four selected counties in Kenya. The chapter has reviewed literature

generally on teaching strategies for learners with multiple disabilities and particularly in Kenya.

Many of the primary sources from other countries were on the teaching strategies for learners

with deaf blindness and autism blindness. The studies were crucial in this study because it was

investigating the instructional methods for learners with multiple disabilities in four selected

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counties in Kenya. The present study intended to verify whether the same instructional methods

can be applicable in our Kenyan educational settings. The studies done in Kenya by Shettle,

(2004), KIE, (I980), Kochung Report, (2003), Deaf blind Pilot project (1992-1996) established

that there were learners with multiple disabilities in schools for learners with single disabilities.

However the studies did not cover the teaching strategies that were used by teachers to enhance

learning for learners with multiple disabilities in the counties of Nairobi, Kiambu, Baringo and

Kisumu in Kenya. Without empirical research conducted in the area of teaching learners with

multiple disabilities, it may be difficult to understand their instructional methods, their

curriculum adaptations, their teaching resources, support services and the training needs of

teachers educating learners with multiple disabilities. The current study intended to fill the gaps

by investigating on the instructional strategies, curriculum adaptations, teaching resources,

support services and training needs of teachers to facilitate learning for learners with multiple

disabilities in the selected special schools and units in the counties of Nairobi, Kisumu, Baringo

and Kiambu in Kenya.

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CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter highlights the methodology adopted for the study. This covers; research design,

variables, location of the study, target population, sampling techniques and sample size,

construction of research instruments, pilot study, validity, reliability, data collection techniques,

data analysis, logistical and ethical considerations.

3.1 Research design

The study adopted a triangulation mixed methods design. The use of both qualitative and

quantitative approaches is a triangulation as noted by (Denzin, 1994; Patton, 2002; Creswell &

Plano Clark, 2011). “A mixed method is defined as a research in which the investigator collects

and analyzes data integrates the findings, and draws inferences using both quantative and

qualitative approaches in a single study or a programme of inquiry” (Tashakkori & Creswell,

2007b, p.4). The purpose of a triangulation in this study was to simultaneously collect qualitative

data from the interviews and observations and quantative data from questionnaires, merge the

data and use the results to understand the teaching strategies used by the teachers educating

learners with multiple disabilities (Creswell & Plano Clark, 2011). One data form supplies

strengths to offset the weaknesses of the other form (Denzin, 1994; Creswell & Plano Clark,

2011; Patton, 2002). Morse (1991), States that the purpose of a triangulation mixed method is to

obtain different but complimentary data on the same topic” p.122.

Creswell & Plano Clark (2011), states that the use of mixed methods is “practical” in that the

researcher is free to use all the methods possible to address a research problem. It is also

practical because individuals tend to solve problems using both numbers and words, combine

inductive and deductive thinking and employ skills in observing people as well as recording

behavior. The use of mixed methods also enhances confidence in the validity of the findings

(Somekh & Lewin, 2005). The qualitative data from the interviews and observations and

quantative data from the questionnaires were used side by side to reinforce, enhance, elaborate or

compliment data from the other source (Creswell& Plano Clark, 2007; Rossman &Wilson, 1985;

Greene, Caracelli & Graham, 1989). The use of qualitative methods allowed study participants to

provide responses that reflected their frame of reference, language and provided richer

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descriptions that complimented the information gleaned by quantative means (Creswell &Plano

Clark, 2011).

3.2 Variables

The independent variables are the instructional methods, curriculum adaptations, support

services, teaching resources, specialized trained personnel among others. The dependent variable

is learning.

3.3 Location of the Study

The study took place in nine selected special schools and units within the counties of Baringo,

Kiambu, Kisumu and Nairobi in Kenya. The schools were purposively selected because they

have learners with multiple disabilities and their long tradition in handling learners with multiple

disabilities. The schools included: Kabarnet special school for the Deaf blind which was

established in 1980 and is located in Baringo County. It is the only special school for learners

with deaf- blind in Kenya. It has 23 learners, 26 teachers and one head teacher. Kilimani Deaf

blind unit was established in 2002 and is located within Kilimani Primary School in Nairobi

County. Kilimani Deaf- blind unit has 14 learners, 6 teachers and one head teacher. Maseno Deaf

blind unit was established in 1995 and is located within Maseno special school for the Deaf in

Kisumu County. Maseno Deaf blind unit has 13 learners and 4 teachers in the Deaf blind unit

and one head teacher. Special schools and units where learners with autism blindness can be

found include: Kibos School for the blind which was established in 1963. It has 12 learners in the

“special class” and 2 teachers of the “special class‟‟ and one head teacher. It is located in

Kisumu County. Thika School for the blind was established in 1962 and is located in Kiambu

County. It has 10 learners in the “special class” and 3 teachers for the “special class”. Kilimani

unit for the visually impaired was established in 1986 and is located within Kilimani primary

school in Nairobi County. It has 13 learners and 2 teachers in the pre- unit for learners who are

visually impaired and one head teacher. Special schools where learners with cerebral palsy

intellectual disability can be found include: Joy land Special school for the physically disabled

located in Kisumu county and which was established in 1974. It has 23 teachers and 12 learners

with Cerebral palsy intellectual disability and one head teacher. Salvation Army Joy town school

for the physically disabled was established in 1967 and is located in Kiambu County. It has 25

teachers and 16 learners with cerebral palsy intellectual disability and one head teacher. Nile

Road special school for the physically disabled was established in 1969. It is located in Nairobi

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County. It has 25 teachers and 13 learners with cerebral palsy intellectual disability and one head

teacher.

3.4 Target Population

A target population is a group of individuals with some common defining characteristic that the

research can identify and study. It is within the target population a sample is selected (Creswell,

2008; Orodho, 2008). The target population for this study was made up of teachers educating

learners with deaf-blind, autism blindness, cerebral palsy intellectual disability, and head

teachers in the selected special schools and units within the counties of Baringo, Kiambu,

Kisumu and Nairobi in Kenya. The total target population in the four counties representing

learners with deaf-blind was 36 comprising of 33 teachers, and 3 head teachers. The total target

population in the four counties representing learners with autistic blind was 10 comprising of 7

teachers, and 3 head teachers. The total target population in the four counties representing

learners with cerebral palsy intellectual disability was 77 comprising of 74 teachers, and 3 head

teachers. The total target population for learners with multiple disabilities was 123.

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TABLE 3.1

Study Frame Work for the Target Population

3.5 Sampling Techniques and Sample Size

3.5.1 Sampling Techniques

The study adopted purposive non random sampling to select the sample. Non random sampling

is that sampling procedure which does not afford any basis for estimating the probability that

each item in the population has, of being included in the sample (Krathwol, 2006). Purposive

sampling was used to sample teachers and head teachers.‟ Purposive sampling is handpicking the

cases to be included in the sample on the basis of one‟s judgment of their typicality. In purposive

sampling, the goal is to select cases that are likely to be “information rich” with respect to the

purposes of the study. The intent is to achieve an in-depth understanding of selected individuals

(Creswell, 2008; Orodho, 2005; Kombo & Tromp, 2006 &Mugenda, 2008). In Kabarnet Special

School for the deaf-blind, 6 teachers were sampled on the basis that they had Diploma training

on deaf blindness from Kenya institute of Special Education. Four other teachers were

purposively sampled on the basis of more teaching experience on deaf blindness. In Maseno

Deaf blind unit, all the 4 teachers teaching learners with deaf-blind were purposively sampled. In

Multiple

disabilities.

Teachers

Head

teachers

Target

population

Deaf-

Blind

33 3 36

Autism

Blindness

7 3 10

Cerebral

Palsy

Intellectual

disability

74 3 77

Total 117 9 123

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Kilimani Deaf blind Unit, all the 6 teachers teaching learners with deaf-blind were sampled. In

Thika school for the Blind, 3 teachers teaching in the „„special class‟‟ for learners with multiple

disabilities were sampled on the basis of teaching experience. At Kibos School for the Blind, the

two teachers teaching learners with autism blindness were selected on the basis of teaching

experience. At Kilimani Unit for the visually impaired, the 2 teachers in the special unit were

selected on the basis of teaching experience. In Joyland special school for the learners with

physical impairment, ten teachers were sampled on the basis of teaching learners with multiple

disabilities who are in the “Special Class” in the school. In Salvation Army Joy town special

school for learners with physical impairment, 10 teachers were selected on the basis of teaching

learners with multiple disabilities in the “Special Class”. In Nile Road special school for learners

with physical impairment, 10 teachers were selected on the basis of teaching learners with

multiple disabilities in the “Special Class”.

Table 3.2 Sample size

Multiple

disabilities

Teachers

Head

Teachers

Sample

size

Deaf Blindness 20 3 23

Autism Blindness 7 3

10

Cerebral palsy

intellectual

disability

30 3 33

Total 57 9 66

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3.5.2 Sample Size

The number of teachers of deafblindness was 23. The number of teachers of learners with

autism blindness was 10. The number of teachers of cerebral palsy intellectual disability was 33.

The total sample size for the study was 66 comprising of 9 head teachers and 57 teachers.

3.6 Construction of Research Instruments

The study used researcher made interview guides, questionnaires with a Likert scale and an

observation guide. The interviews were constructed using a pre-determined set of questions.

Semi structured, open ended questions were used because they encourage a free response from

the participants (Creswell, 2008). The first question item on the interviews was to provide

information on the instructional methods used by teachers for learners with multiple disabilities

namely, deaf blindness, cerebral palsy intellectual disability and autism blindness. The second

question item was to provide information on curriculum adaptations that had been effected for

learners with deaf blindness, autism blindness and cerebral palsy intellectual disability. The third

question item was to provide information on the teaching resources for learners with deaf

blindness, autism blindness and cerebral palsy intellectual disability. The fourth question item on

the interview schedule was to provide information on the support services offered to learners

with deaf blindness, cerebral palsy intellectual disability and autism blindness.

The fifth question item was to provide information on the training needs of teachers teaching

learners with deaf blindness, autism blindness and cerebral palsy intellectual disability. Follow-

up questions or probes were included in the items. According to Spradley (1980) probes or

follow up questions are important in an interview to clarify the initial questions and to provide an

alternative answer to a question. An observation guide was constructed to guide the researcher

to observe and collect information on the instructional methods used by teachers educating

learners with deaf blindness, cerebral palsy intellectual disability and autism blindness, how the

teachers developed an individualized education programme, the teaching resources, support

services, specialized equipment, classroom organization, the curriculum used, and the physical

environment of the schools serving learners with multiple disabilities. Observations enabled the

researcher to record information as it occurred in schools (Creswell, 2008). Observation is the

process of gathering open-ended, first hand information by observing people and places at a

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research site. The researcher adopted the role of a participant observer to take part in the

activities in the setting (Spradley 1980). Observations can effectively complement other

approaches and thus enhance the quality of evidence available to the researcher. The

observations may be more valid than questionnaires or interviews (Malhotra, 2006). Interviews

and the observations enabled the researcher to gather qualitative data. A questionnaire with a

Likert scale was constructed to enable the researcher to collect quantative data. A questionnaire

is a formalized set of questions for obtaining information from the respondents. A Likert Scale is

the most popular attitude scale type which measures subjective variables (Kothari, 2004). The

Likert scale was constructed after reviewing the literature. The first step in designing the Likert

Scale was to define the attitude to be measured (Yount, 2006).

In this study the researcher measured the attitude or the opinion of the respondents‟ on the

instructional methods they used for learners with deaf blindness, autism blindness and cerebral

palsy intellectual disability. The response format was a five point Likert type scale and consisted

of 67 items, fifteen of which were demographic questions. Three questionnaires were constructed

for the three multiple disabilities namely; deaf blindness, autism blindness and cerebral palsy

intellectual disability. The Likert Scale for learners with deaf blindness consisted of 19 items and

5 demographic questions while that of learners with autism blindness consisted of 17 items and

5 demographic questions and that of learners with cerebral palsy intellectual disability consisted

of 16 items and 5 demographic questions. The questionnaire with a Likert Scale consisted of a

number of statements followed by several levels of agreement, strongly agree, agree, no opinion,

disagree and strongly disagree. The respondent indicated his or her agreement or disagreement

with each statement in the instrument by ticking an appropriate number. Each response was

given a numerical score, indicating its favorableness, and the scores were totaled to measure the

respondent‟s attitude. A score of 1 denoted strongly disagree, score of 2 denoting disagree, score

of 3 denoting undecided, score of 4 agree and score of 5 strongly agree. Scores above 3 denoted

that teachers engaged in various instructional methods while scores of below 3 denoted that

teachers rarely or never used the various instructional methods. Each of the 3 questionnaires

with a Likert Scale was divided into two sections containing close ended and open ended

question items. The close ended items enabled the researcher to obtain demographic information

such as gender, number of years in the school, teaching experience and professional

95

qualification, while the open ended questions assisted the researcher to gather information

relating to the respondents opinion on the instructional methods they used for learners with

multiple disabilities. Creswell (2008) and Morgan (1985) underscore the importance of using a

variety of interview schedules to collect data from a population for colloborative information.

The questionnaire enabled quantative data to be collected in a standardized way so that data are

internally consistent and coherent for analysis. A questionnaire ensures standardization and

comparability of data across interviewers, increase speed and accuracy of recording and

facilitates data processing (Malhotra, 2006; Creswell, 2008).

3.7 Pilot Study

Prior to the actual data collection, the three research instruments, that is the interview guide,

observation guide and a questionnaire with a Likert scale were subjected to a test on their

validity and reliability through a pilot study. Piloting enabled the researcher to check for

ambiguity and appropriateness of sentence structure of the question items in order to get similar

responses from all respondents (Orodho, 2005; Creswell, 2008; Kothari, 2004). Piloting enabled

the researcher to evaluate the suitability of the instruments especially on the clarity of

instructions contained in the instruments question items and the relevance of the question items.

The responses from the pilot study were analyzed and items with ambiguities addressed

appropriately. Piloting also enabled the researcher to detect any flaws in the administration of the

research instruments (Wiersma, 1986). The purpose of piloting was to discover weaknesses in

the instruments, check for clarity of the questions or items and also elicit comments from

respondents that assisted in the improvement and modification of the instruments.

The researcher piloted the research instruments in three schools with similar characteristics to

the research sample, but not including the special schools and units in the actual study. Piloting

was done at Kitui Deaf blind unit, St. Lucys‟ School for the blind and at Masaku special school

for learners with physical impairments. Five teachers of Kitui Deaf blind unit were asked to

answer research questions from the interview guide, and in the questionnaires with a Likert scale.

The head teacher answered questions from the interview guide. Ten teachers of Masaku Special

School were asked to answer the questions from the interview guide and the questionnaire with a

Likert scale. Two teachers of St. Lucys‟ School for the blind answered the questions from the

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interview guide and the questionnaire with a Likert scale. The head teacher answered questions

from the interview guide. The researcher did the observations using the observation guide.

3.7.1 Validity

Validity is the extent to which a test measures what it is supposed to measure (Creswell, 2008;

Gay, 2003&Orodho, 2005). Content related validity was used as a measure to determine validity.

Content validity refers to the degree to which the sample of the test represents the content that

the test is designed to measure (Donald, 2003). Given that content validity is examined by expert

judgment (Creswell, 2008), the interviews, observation guide and a questionnaire with a Likert

Scale were scrutinized and approved by expert lecturers in special education. The question items

should measure what they are supposed to measure (Kombo and Tromp, 2006; Orodho, 2005;

Mugenda& Mugenda, 1999; Creswell & Plano Clark, 2011). Content related validity was used to

evaluate the extent to which the question items were clearly understood by the respondents to

enable them give responses to the issues raised in the question items concerning the teaching

strategies used by the teachers for learners with multiple disabilities.

3.7.2 Reliability

Reliability is the degree to which approximately the same results would be obtained if the test

were administered again. It is the consistency with which the test measures what it is supposed to

measure. Unless a test is valid it cannot be reliable (Creswell, 2008; Orodho, 2005). In this study,

reliability was determined by the test- retest method. (The same test was administered to the

same group after a lapse of two weeks). The reliability established when the research instruments

were administered for the first time to the respondents was; Questionnaires 0.61

Interview schedules 0.63

However, when the research instruments were administered to the same respondents a second

time after two weeks the reliability was found to be as follows:

Questionnaires 0.63

Interview schedules 0.65

A comparison of the respondent‟s responses of the two trials was made using Pearson‟s product

moment correlation (r) formula which states that the greater the consistency the higher the

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reliability of the research instruments (Orodho, 2005; Gay, 2003, Wiersma 1986 &Creswell,

2008). According to Pearson‟s‟ product moment correlation formula shown below, any research

instruments whose co- efficiency range between 0.5 and 1.0 can be considered reliable and can

be used for a research study. Since the research instruments for this study had co-efficiencies

ranging between 0.61 and 0.65 they were considered as reliable and hence used to carry out the

research study. The Pearson correlation was employed to compute the correlation coefficient in

order to establish the extent to which the contents of the interviews and questionnaires were

consistent in eliciting the same responses every time the two instruments were administered.

Pearson product moment correlation formula

3.8 Data Collection Techniques

The researcher used an interview guide, a questionnaire with a Likert scale and an observation

guide to collect data from the respondents. To collect the data, the researcher was assisted by 2

trained research assistants that had previous data collection experience. The researcher and the

two research assistants distributed the questionnaires to the special schools and units. To ensure

efficiency and effectiveness, they agreed on the time and also telephone follow up was done to

remind the respondents. The interview guide was administered by the researcher and the 2

research assistants using an audio-tape and note books for recording the observations. The two

research assistants interviewed teachers in Joyland special school for the physically disabled,

Maseno Deaf blind unit and Kibos School for the Blind. The researcher administered the

interviews at Joy town special school for the physically disabled, Nile Road special school for

the physically disabled, Kilimani special unit for the visually impaired, Karbarnet special school

for the Deaf blind and Kilimani Deaf blind unit. Appointments were set in consultation with the

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heads of schools and this created consistency in data collection. Care was taken not to interfere

with the normal teaching schedules. The observations were made at the special schools and

special units for learners with multiple disabilities in the following areas: class room

organization, instructional methods, curriculum used, teaching materials, development of an

individualized education programme, physical environment and various support services in use,

among others. The researcher and the research assistants observed the instructional methods

teachers used for educating learners with multiple disabilities during class time in the nine

selected special schools and units for two days a week for every school. The questionnaires with

a Likert scale collected quantative data. The interviews and observations collected qualitative

data.

3.9 Data Analysis

The qualitative data from the interviews and observations were analyzed using descriptions and

thematic text (Creswell & Plano Clark, 2011). Data from the field was organized and transcribed

by typing text from observations and interviews into a word processing document. A preliminary

analysis of the data was conducted by reading through it to obtain a general sense of data. The

data was then coded and codes were used to develop themes in the context of the research

questions. Coding is a major analysis of qualitative data. The process of coding is one of

reducing text database to descriptions and themes. Data was transformed into a simplified form

that could be understood in the context of the research questions (Krathwohl, 1998; Miles &

Huberman, 1994; Flechtling, Sharp & Westat, 1997). The data was grouped into themes using

content analysis and thematic analysis. Content analysis involves coding the data for certain

words or content. Thematic analysis is grouping the data into themes that will help answer

research questions (Taylor-Powell Renner, 2003). After identifying themes the data was

organized in tables. Enumeration was done on the data. Enumeration is the process of

quantifying data. Enumeration was helpful in clarifying words that the researcher used in the

report such as many, some or few. The number helped to clarify what frequency meant. This way

the data helped to identify systematic patterns and interrelationships across themes or content

(Miles & Huberman, 1994; Flechtling et al., 1997).

The findings were reported in narrative discussions or commentary quotes and descriptive

examples from interviews and observations were used to illustrate the points and bring data to

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life (Asmussen & Creswell, 1995). From the report, the researcher made an interpretation of

meaning of research. Interpretation involves making sense of data or the” lessons learned” as

noted by Lincoln & Guba, (1985). Interpretation was done by making comparisons between the

findings and the literature (Creswell, 2008). The research was then validated through

triangulation as a validation procedure (Creswell & Miller, 2000; Lincoln & Guba, 1985).

Triangulation is a technique for judging the accuracy of data and requires the use of multiple data

sources or multiple data collection (Creswell & Miller, 2000; Lincoln & Guba, 1985). The

collected information from the interviews was used to complement, clarify or colloborate the

quantative data from the questionnaire responses (Patton, 2002; Creswell & Plano Clark, 2007 &

Classen et al., 2007).

The quantative data from the questionnaire with a Likert scale was analyzed using descriptive

statistical analysis. Descriptive statistics involve tabulating graphing and describing data

(Orodho, 2005; Kothari, 2004). Included in the descriptive statistics are frequencies which

showed the number of teachers that responded at each level of the Likert scale, the percentages

of the teachers in each item and the maximum possible score in the form of means and standard

deviation. The researcher using the statistical Packages for Social Sciences (SPSS) computer

programme, standard version 17.0 calculated the mean and standard deviation which were

relevant to the research study so as to compute verifiable findings. According to Kombo &

Tromp (2006) data analysis is complete only when respondents‟ views and opinions have been

incorporated. Data from the observations were analyzed descriptively and interpreted based on

the study objectives. The information from the qualitative and quantative data was then

integrated in the interpretation of the overall results (Creswell, 2009).

3.10 Logistical and Ethical Considerations

The researcher obtained a research permit from the National Council for Science and

Technology (NCST) which was established by the Science and Technology Act.Cap.250 of the

laws of Kenya under the Ministry of Higher Education Science and Technology (MOHEST)

Utalii House, Nairobi through the Dean, Graduate School, and Kenyatta University before

administering the research instruments in the field. The researcher made preliminary visits to the

special schools and special units having learners with multiple disabilities to establish rapport

with the head teachers‟ of the institutions and also to discuss the relevance of the study. Other

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considerations included, getting informed consent from the respondents before interviewing

them, using information only for disclosed purpose, respecting their right to withdraw at any

time and treating the respondents with dignity.

.

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CHAPTER FOUR

DATA PRESENTATION ANALYSIS AND DISCUSSION

4.0 Introduction

This chapter presents the demographic data of the respondents and an analysis and interpretation

of data that were collected during the fieldwork. The analysis and interpretation have been done

within the framework of the objectives that this study sought to address. The core objective of

this study was to investigate the teaching strategies used by teachers educating learners with

multiple disabilities in the counties of Baringo, Kiambu, Kisumu and Nairobi in Kenya. The

study findings were presented based on the following study objectives:

i. To investigate the instructional methods used by the teachers educating learners with

multiple disabilities (deaf-blind, autism blindness, and cerebral palsy intellectual

disability).

ii. To find out the curriculum adaptations that had been effected for learners with multiple

disabilities). (deaf-blind, autism blindness, and cerebral palsy intellectual disability).

iii. To find out the available teaching resources for learners with multiple disabilities

(deaf-blind, autism blindness, and cerebral palsy intellectual disability).

iv. To find out available support services for learners with multiple disabilities (deaf-blind,

autism blindness and cerebral palsy intellectual disability).

v. To find out the training needs of teachers educating learners with multiple disabilities).

(deaf-blind, autism blindness, and cerebral palsy intellectual disability).

4.1 Demographic data of the respondents

The study targeted a sample of 9 head teachers and 57 teachers educating learners with multiple

disabilities in the counties of Baringo, Kiambu, Kisumu and Nairobi. Of the 57 teachers, 20

were educating learners with deaf blindness and 3 headteachers, 7 were teaching learners with

autism blindness and 3 were head teachers while 30 teachers were educating learners with

cerebral palsy intellectual disability (CPID) and 3 head teachers.

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Table 4.1: Teachers’ professional qualification across gender

Professional

qualification

Deaf- blind Autistic blind Cerebral

palsy

intellectual

disability

M F M F M F No. %

Certificate (SNE) 0 0 0 0 0 1 1 1.8

Diploma (SNE) 8 2 0 0 1 7 18 31.5

Degree (SNE) 2 6 1 5 1 15 30 52.6

M.E.D (SNE) 0 2 0 0 0 5 7 12.3

ECDE 0 0 0 1 0 0 1 1.8

Total 10 10 1 6 2 28 57 100.0

As shown in Table 4.1, majority of the teachers, 30 (52.6%) had attained a Degree in Special

Needs Education, followed by 18 (31.5%) who had a Diploma in Special Needs Education.

There were 7 (12.3%) teachers with Masters‟ degrees in Special Needs Education while one

teacher (1.8%) had a Certificate in Special Needs Education and Early Childhood Education

certificate. Teachers‟ professional qualifications have implications on the teaching strategies

used in educating learners with multiple disabilities. The majority of the teachers had Bachelors

or Masters Degrees in Special Needs Education in a specific disability while some few teachers

had a Diploma in deafblindness. Among the 57 teachers, 44 (77.2%) were females while 13

(22.8%) were males. The table further shows that there were an equal proportion of male and

female teachers teaching learners with deaf blindness However, there were more female than

male teachers among those teaching learners with autism blindness and cerebral palsy

intellectual disability. Teachers interrogated said that male teachers perceive teaching as a career

for the female and they don‟t like performing activities such as, bathing, toileting, feeding and

diapering learners with multiple disabilities. The finding that there were more female than male

teachers in the sample is supported by previous research such as Rice & Goessling (2005) and

Wood (2012). Rice and Goessling (2005) found that the percentage of male students who

complete an undergraduate degree in the field of special education continues to be much lower

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than that of female graduates. They further established that low status, low salaries, the

perception of teaching as women's work, potential complaints of child abuse and sexual

harassment, and a lack of male peer group factor into this low percentage. Rice and Goessling

(2005) argued for the need to train and recruit more male teachers to be positive role models for

all children. Similarly, Wood‟s (2012) study recommended that more male teachers are needed

not only in special education settings but all elementary schools in general.

Table 4.2: Teachers experience across learners’ impairments.

Teaching

Experience

Learners’ impairments

Deaf- blind Autistic blind Cerebral

palsy

intellectual

disability

Total

%

5-10 years 5 2 1 8 14.0

11-15 years 13 3 25 41 72.0

16 years and above 2 2 4 8 14.0

Total 20 7 30 57 100.0

Table 4.2 shows that majority 41 (72%) of the teachers had taught for 11-15 years while 8 (14%)

each had working experience of 5-10 years and 16 years and above. It is therefore clear that

majority of the teachers had over 10 years of teaching experience.

4.2 Instructional Methods used to Educate Learners with Multiple Disabilities

The first objective of the study was to investigate the instructional methods used by the teachers

educating learners with multiple disabilities. (deaf-blind, autism blindness, cerebral palsy

intellectual disability). To address this objective, teachers were asked to indicate on a five-point

Likert scale various instruction methods they engaged in when educating learners with multiple

disabilities. The responses on the scale ranged from Strongly Agree to Strongly Disagree with a

score of 1 denoting strongly disagree, score of 2 denoting disagree, score of 3 denoting

undecided, score of 4 agree and score of 5 strongly agree. The mid-point of the scale was a score

of 3 indicating that one was neutral. Scores above 3 denoted that teachers engaged in various

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instructional methods while scores below 3 denoted that teachers rarely or never used the various

instructional methods.

Table 4.3: Instructional methods used for Learners with deaf blindness

Instructional methods SA A UN D SD Mean Std

Dev. f % f % f % f % f %

Use of real objects 20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Task analysis 20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Hand over hand guidance, tactual

sign language

20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of speech paired with

Kenyans sign language

20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Tadoma/body language/lip

reading

20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.0 .000

Use of Kenyan sign language 20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of object of reference 20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of Lilli Nielsen resonance

board

20 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of teaching teachable

moments

19 95.0 1 5.0 0 0.0 0 0.0 0 0.0 4.95 .224

Use of speech paired with Braille 18 90.0 2 10.0 0 0.0 0 0.0 0 0.0 4.90 .308

Use of routine, calendar system

and discussion boxes

18 90.0 2 10.0 0 0.0 0 0.0 0 0.0 4.90 .308

Use of experience and picture

board

18 90.0 2 10.0 0 0.0 0 0.0 0 0.0 4.90 .308

Behavior management 2 10.0 14 70.0 4 20.0 0 0.0 0 0.0 3.90 .553

Use of tactile diagrams 3 15.0 11 55.0 3 15.0 3 15.0 0 0.0 3.70 .923

Making a choice 0 0.0 1 5.0 11 55.0 3 15.0 5 25.0 2.40 .940

Use of Deaf blind manual 2 10.0 0 0.0 0 0.0 1 5.0 17 85.0 1.45 1.234

Key: SA-Strongly Agree A-Agree UN-Undecided D-Disagree SD-Strongly Disagree

As shown in Table 4.3, the mean scores obtained by the teachers ranged from 5.00 to 1.45.

Teachers obtained mean scores of 5.00 in ten of the methods listed in the table, meaning that

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they strongly agreed they used them when educating learners with deaf blindness. These methods

included; use of real objects; task analysis; tactual Kenyan sign language; Tadoma, lip reading,

body language; use of speech paired with Kenyan sign language; use of Kenyan sign language;

use of object of reference; and use of Lilli Nielsen resonance board. Results revealed that

teachers were using a variety of instructional strategies when teaching learners with deaf

blindness. This shows that learners had a diversity of needs. This is supported by Porter et al.,

(1997) whose study on curriculum access to deaf-blind children found the need for teachers to

have access to a wide range of specialist strategies especially where they are working with pupils

with the most complex needs whereby there is need for teachers to be able to adapt more generic

strategies to meet the specific needs of an individual pupil.

Other instructional methods used by majority of the teachers were use of teaching teachable

moments; use of speech paired with braille; use of routine, calendar system, discussion boxes

and use of experience and a communication board. This implies that most of the teachers were

using instructional methods to teach learners with deaf blindness. However, teachers conceded to

not using the deaf blind manual alphabet and teaching learners how to make a choice. The deaf-

blind manual alphabet also known as tactile finger spelling is used in other countries to teach

learners who are deaf-blind to communicate (Huebner, 1995). In Kenya, teachers use the tactile

Kenyan sign language. Teachers also conceded to not teaching learners with deaf-blind how to

make a choice on what they eat. Campbell (1987) emphasizes the need to teach choosing what to

eat where the learner eats. The boundary in which the choice making activity takes place should

be defined through the use of appropriate aids and cues. Providing boundaries minimizes the

visual motor and cognitive requirements of orienting and reaching. The teachers selected certain

modes of teaching and not others because the learner‟s needs dictated the choice of the

instructional methods. For instance, learners who were congenitally deaf-blind without a

cognitive disability and other disabilities could be taught using tactile Kenyan sign language,

Tadoma, use of multi sensory approach, use of object of reference among others. Learners who

were deaf-blind with some residual hearing were taught using braille tactile Kenyan sign

language and speech among others. Learners‟ with deaf-blind with mild intellectual disability

could be taught using tactile Kenyan sign language, task analysis among others. All learners who

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were deaf-blind regardless of whether they had a cognitive disability or not were taught using the

Lily Nielson resonance board for assessment and stimulation of their senses among others.

Table 4.4: Instructional methods used for learners with autism blindness

Instructional methods SA A UN D SD Mean Std

Dev. f % f % f % f % f %

Use of real objects 7 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of auditory

activities

7 100.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of Braille as a mode

of communication

7 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Orientation and mobility 7 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of supplementary

aids (e.g. slates &stylus,

abacus, cuberithms)

6 85.7 1 14.3 0 0.0 0 0.0 0 0.0 4.86 .378

Use of frequent

stretch breaks

6 85.7 1 14.3 0 0.0 0 0.0 0 0.0 4.86 .378

Use of Kinesthetic

learning activities

6 85.7 1 14.3 0 0.0 0 0.0 0 0.0 4.86 .378

Independent living skills 6 85.7 1 14.3 0 0.0 0 0.0 0 0.0 4.86 .378

Use of tactile

Kinesthetic and auditory

modalities

5 71.4 2 28.6 0 0.0 0 0.0 0 0.0 4.71 .488

Use of consistent

schedules

5 71.4 1 14.3 1 14.3 0 0.0 0 0.0 4.57 .787

Use of large print,

optical devices

3 42.9 3 42.9 1 14.3 0 0.0 0 0.0 4.29 .756

Use of behavior

management strategies

0 0.0 7 100.0 0 0.0 0 0.0 0 0.0 4.00 .000

Use of speech paired

with tactile strategies

3 42.9 1 14.3 1 14.3 2 28.6 0 0.0 3.71 1.380

Use of regular print 1 14.3 1 14.3 0 0.0 3 42.9 2 28.6 2.43 1.512 Use of recorded materials

to communicate 0 0.0 2 28.6 0 0.0 0 0.0 5 71.4 1.86 1.464

Use of two handed sign

language paired with

speech.

0 0.0 0 0.0 0 0.0 0 0.0 7 100.0 1.00 .000

Key: SA-Strongly Agree A-Agree UN-Undecided D-Disagree SD-Strongly Disagree

Table 4.4 above, illustrates that teachers obtained mean scores ranging from 5.00 to 1.00 on the

various methods used to educate learners with autism blindness. Majority of the respondents

obtained scores of above 3, meaning that they applied most of the instructional methods listed in

the table. Methods that were used by all the study respondents were use of real objects,

supplementary aids, and auditory activities, braille as a mode of communication, orientation and

mobility. Other methods used included; use of consistent schedules, use of frequent stretches and

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use of tactile kinesthetic and auditory modalities. On the other hand, the lowest ranked methods

were; use of two handed sign language paired with speech, behavior management strategies, use

of regular print and use of recorded materials to communicate. Majority of teachers made use of

real objects to teach learners who were autistic blind. The teachers made use of the sense of

touch. It was difficult to teach learners with autism blindness who had communication

difficulties since teachers had only been trained to specifically teach braille.

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Table 4.5: Instructional methods used by teachers to educate learners with

Cerebral palsy intellectual disability

Instructional

methods

SA A UN D SD Mean Std

Dev. f % f % f % f % f %

Breaking down tasks

into simpler activities

30 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of gestures 30 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of observations and

demonstrations

30 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of songs 30 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5.00 .000

Use of pointing 29 96.7 0 0.0 1 3.3 0 0.0 0 0.0 4.93 .365

Use of pictures 28 93.3 2 6.7 0 0.0 0 0.0 0 0.0 4.93 .254

Teachers make use of real

objects

26 86.7 4 13.3 0 0.0 0 0.0 0 0.0 4.87 .346

Use of writing 17 56.7 8 26.7 4 13.3 1 3.3 0 0.0 4.37 .850

Use of group work 7 23.3 7 23.3 9 30.0 6 20.0 1 3.3 3.43 1.165

Use of communication

boards

2 6.7 0 0.0 9 30.0 6 20.0 13 43.3 2.07 1.172

Use of pointers 1 3.3 0 0.0 2 6.7 1 3.3 26 86.7 1.30 .877

Use of the pre-linguistic

milieu teaching

2 6.7 0 0.0 0 0.0 0 0.0 28 93.3 1.27 1.015

Use of pencil grips 1 3.3 0 0.0 0 0.0 1 3.3 28 93.3 1.17 .747

Use of Venn diagrams 1 3.3 0 0.0 0 0.0 0 0.0 29 96.7 1.13 .730

Use of adapted computers 0 0.0 1 3.3 0 0.0 0 0.0 29 96.7 1.10 .548

Use of video and audio

based curriculum

0 0.0 0 0.0 1 3.3 0 0.0 29 96.7 1.07 .365

Use of antecedent

prompting

0 0.0 0 0.0 1 3.3 0 0.0 29 96.7 1.07 .365

Use of page turners 0 0.0 0 0.0 0 0.0 1 3.3 29 96.7 1.03 .183

Use of computer assisted

instruction

0 0.0 0 0.0 0 0.0 0 0.0 30 0.0 1.00 .000

Key: SA-Strongly Agree A-Agree UN-Undecided D-Disagree SD-Strongly Disagree

Mean scores obtained by teachers on instructional methods ranged from 5.00 to 1.00. Teachers

scored above 3 on half of the methods listed in Table 4.5 while on the other half, teachers

obtained mean scores of below 3. The highest ranked methods were; breaking down tasks into

simpler activities, use of gestures, observations and demonstrations, real objects, songs and

pointing. However, the lowest ranked methods were use of; computer assisted instruction, page

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turners, antecedent prompting, video and audio based curriculum. Task analysis was used by the

teachers to teach learners with mild intellectual disability functional skills and cognitive skills.

Learners with cerebral palsy intellectual disability without communication difficulties could be

taught using rhymes or songs. The cognitive ability of the learners determined the instructional

methods not the motor level.

4.2.1 Teachers’ Views on the instructional methods used for learners with multiple

disabilities.

Instructional strategies enable teachers to build upon knowledge and experience in their areas of

specialization. During the interviews, teachers were asked to indicate methods they used to teach

curriculum based contents to learners with multiple disabilities.

Table 4.6: Teachers’ responses on instructional methods used for learners with

Deafblindness

Instructional methods Frequency(N=20) Percentage

Tactile Kenyan sign language 20 100.0

Use of real objects 19 95.0

Braille paired with speech 19 95.0

Task analysis 19 95.0

Activities of daily living(ADL) 18 90

Nielsen resonance boards 18 90

Tadoma 15 75.0

Calendar boxes/structured boards 15 75.0

Experience books 14 70.0

Kenyan sign language 14 70.0

Total communication/multi sensory approach 14 70.0

Use of prevocational skills e.g. beading 14 70.0

Body language 12 60.0

Use of teachable moments 4 20.0

Use of pointing 2 10.0

Home signs 1 5.0

Table 4.6 above shows that majority of the teachers reported that they used tactile Kenyan sign

language 20 (100.0%). Use of tactile sign language is supported by an attribution made by Aslop

(1993) who stated that communication among learners with deaf-blind can take multiple forms

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such as gestures, objects, tactile, photos, symbols, sign language and tactile finger spelling. We

use any means to communicate with a learner who is deaf-blind, adapted to the senses he/she can

use. The different modes of communication reflect the person‟s capacities, and the development

of the learner; that is both cognitive potentials of the learner and the senses he can use in

different situations.

Task analysis and Braille paired with speech was cited by 19 (95%) of the respondents when

teaching learners with deaf blindness. Task analysis is supported by Bigge &Best (2005), as

among the most valuable tools available to teachers of individuals with physical, health, or

multiple disabilities and to the learners themselves. The use of the Lily Nielsen Resonance board

was cited by 18 (90%) of the respondents. Nielsen (1998) supports the use of the Lily Nielsen

board as a tool that can help the brain of learners with Deaf-blind integrate motor activity and

listening skills. Activities of daily living were cited by 18 (90%) of the respondents. This study

report is supported by Ellis (1986), who talks about a functional curriculum as an approach that

takes into account the pupils current individual needs and his or her future needs and is designed

to meet his or her needs. It addresses the needs of the learner with Deaf blindness in the

Independent living activities among others.

Tadoma was cited by 15 (75%) of the respondents. The study report is supported Aslop (2002);

NIMH (2003), as a skill used by the congenitally deaf-blind person where the listener places his

or her hand on the cheek of the speaker with the thumb resting on the throat, such that he or she

feels the vibrations and the mouth movements so that he or she is able to follow the conversation.

The use of calendar boxes was also cited by 15 (75%) of the respondents. This is supported by

Moss & Hagood (1995), who said that language among learners with deaf-blind is developed

through the use of routines, calendar systems and discussion boxes. The multisensory approach

and total communication was cited by 14 (70%) of the respondents. The use of Total

Communication is supported by Young (2007); Aslop (1993) & Andreessen et al., (1998) as a

philosophy that advocates for the use of any modes of communication suited to the individual

child in a given situation. The multi sensory approach can be used to teach learners with deaf-

blind. This approach makes use of all sensory abilities of the child that is seeing, touching,

smelling and movement as supported by (Sense International India, 2010). Use of prevocational

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skills was cited by 14 (70%) of the respondents. Body language was cited by 12 (60%) of the

respondents. The least used instructional methods were use of teachable moments at 4 (20%),

pointing at 2 (10%) and home signs at 1 (5%). Observations that were carried out in schools for

learners with deaf blindness revealed that the instructional methods used by the teachers were

determined by the learner‟s needs. The instructional methods that were commonly used included;

tactile Kenyan sign language, use of real objects, braille paired with speech, task analysis,

activities of daily living, use of Nielsen resonance boards, Tadoma, calendar boxes among

others. The IEP was developed by the teachers without involving the multidisciplinary team as it

is done in other countries; therefore learners were not getting the required support services. In

other countries, an educational team varies according to the educational needs of the individual

learner whom they serve and may change over time as student needs change (Heller et al., 2009).

Table 4.7 Instructional methods used by teachers for learners with autism blindness.

Instructional methods Frequency(N=7) Percentage

Pre Braille activities 7 100.0

Braille 7 100.0

Oral methods 6 85.7

Use of real objects 6 85.7

Singing 4 57.1

Activities of daily living 4 57.1

Prevocational skills 4 57.1

Recitations 3 42.9

Dramatization 3 42.9

From Table 4.7 above, it can be observed that majority 7 (100.0%) teachers reported that they

used, pre-braille and Braille methods to teach learners who are autistic blind. Learners who are

visually impaired will require some preparations as touch readers through the pre-braille

activities as supported by Hatlen (1996). Braille is then taught as a mode of communication. Oral

methods and real objects were also cited as instructional methods to the learners who are autistic

blind at 6 (85%). This is supported by Shaheen (2009), who brailled stories and illustrated with

homemade tactile graphics which often included real objects when teaching a learner who was

autistic blind. Prevocational skills, singing and activities of daily living skills were also cited by

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4 (57%) of the respondents. Four (57%) of the teachers also said that they were teaching the

activities of daily living to the learners who are autistic blind. Hatlen (1996) supports the

teaching of functional academics skills such as the activities of daily living. Konstanareas (1982)

supports the use of music to learners who are kinesthetic. Kinesthetic learners will tend to lose

connection in class if there is little external movement. The methods that were used by the least

number of teachers were recitations and dramatization at 3 (42.9%). This is due to

communication difficulties among learners with autism blindness. The observations made in

schools for learners with autism blindness confirmed that the majority of teachers used the

following instructional methods namely; use of real objects, pre-braille, braille and activities of

daily living as supported by Shaheen (2009); Hatlen (1996). In two schools prevocational skills

were taught to the learners. Teachers focused on the instructional strategies for learners with

visual impairments‟ because the training they had was specifically on visual impairments.

Teachers were not remediating the problems in the learners brought about by autism such as

communication difficulties, lack of social skills and behaviour disorders among others that were

affecting learning among the learners. In other countries teachers combine teaching methods as

dictated by the learner‟s needs. This finding is supported by Shaheen (2009); Hosken, (2008)

who stated that combination of instructional methods intensifies the learning experiences. The

individualized education programme was developed by the teachers without involving the

multidisciplinary team as it is done in other countries. In other countries, an educational team

will vary according to the educational needs of the individual learner whom they serve and may

change over time as student needs change. Those core team members are those individuals who

are directly involved with the design and daily implementation of the learners educational

programme. For example, core team members for a learner with multiple disabilities could

include the learner, family members, special education teacher, general education teachers,

physical or occupational therapists, speech therapists, classroom teaching assistant, and

community work representative (Heller et al., 2009). The classrooms were partly structured with

minimal use of routines. Some classrooms were small and learning areas were not clearly

defined. A learner with autism blindness requires consistent schedules as supported by Vaughn et

al., (2007); Shaheen, (2009) who have stated that learners with autism may be particularly

challenged when a routine is absent or unpredictable.

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Table 4.8: Instructional methods used for learners with cerebral palsy Intellectual

disability.

Instructional methods Frequency (N=30) Percentage

Task analysis 29 96.7

Activities of daily living 29 96.7

Real objects(maize, beans and, rice) 29 96.7

Use of songs/rhymes 25 83.3

Oral recitation/rote learning 25 83.3

Prevocational skills 25 83.3

Observation and demonstration 24 80.0

Use of pictures 24 80.0

Use of pointing/gestures 22 73.3

Use of drama 7 23.3

Question and answers 7 23.3

Group work 2 6.7

Home signs 2 6.7

Writing 1 3.3

Discussion 1 3.3

As shown in Table 4.8 above, majority of the teachers educating learners with cerebral palsy

intellectual disability 29 (96.7%) equally reported that they used, task analysis, activities of daily

living and real objects like, maize, beans, stones among others. Task analysis is supported by

Fey et al., (2006) who stated that breaking down larger tasks into their specific component parts

is an effective technique for teaching any number of skills for learners with cerebral palsy

intellectual disability. Activities of daily living were also taught to learners with cerebral palsy

intellectual disability. This is supported by an attribution made by Fey et al., (2006) who says

that in order to fully cater for limitations in intellectual functioning of learners with cerebral

palsy intellectual disability, teachers need to provide instruction in a number of skills outside the

general curriculum. These skills are more functional in nature but are absolutely essential for the

future independence of the individual. The skills areas include money concepts, time concepts,

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independent living skills, self care and hygiene, community access, leisure activities and

vocational training. Turnbull et al., (2002) supports the use of real materials or actual tools in a

natural environment as an essential component in the effective instruction of learners with

cerebral palsy intellectual disability. Real objects serve to both motivate the learner and facilitate

generalization to multiple environments. Twenty five (83%) of respondents cited the use of

prevocational skills, songs/rhymes, oral recitation and rote learning. Mercer &Mercer (2004)

supports the use of songs or rhymes as a technique that helps a student learn and complete the

task independently. Use of observation demonstration and use of pictures was cited by 24 (80%)

of the respondents. Mercer & Snell (1977); Snell & Brown (2006) & Wrestling (1986) supports

the use of observational learning employing modeling in which correct imitation of a model by

the learner is reinforced and group instruction.

Use of pictures was cited by 24 (80%) of the respondents. Kelly (2005) emphasizes that some

learners with cerebral palsy and intellectual disability can use pictures, and some communication

boards which are designed to match the learner‟s cognitive and receptive language skills and

should be continually monitored and evaluated so that it can be modified with the learner‟s

expanding and changing needs. Twenty two (70%) of respondents cited the use of gestures and

pointing. Kelly (2005) supports the use of gestures and pointing and recommends finding out the

preferred mode of communication for learners with cerebral palsy intellectual disability such as

communicating verbally, using communication boards, gestures, pointing or writing in order for

an education program on communication to be instituted for these learners. The least used

methods were, home signs and group work at 2 (6.7%). discussions and writing at 1 (3.3%). Due

to communication barriers and motor difficulties among learners with cerebral palsy intellectual

disability, discussions, writing and group work may not be possible to many. The observations

made in the schools for learners with cerebral palsy intellectual disability confirmed that the

majority of teachers used the following instructional methods namely; task analysis, real objects,

activities of daily living and prevocational skills among others. Teachers focused more on the

teaching strategies for learners with intellectual impairments‟ without remediating the problems

that were brought about by cerebral palsy that were affecting learning. Learners with cerebral

palsy intellectual disability have communication difficulties, gross motor, behaviour difficulties

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among others. The learner with cerebral palsy intellectual disability with will require widened

aisles, work surface adaptations, speech therapy, physical therapy among others as supported by

(Pellegrino, 2007;Heller et al.,2009). Individualized education programme was developed by the

teachers alone without involving the multidisciplinary team. This is a cause of concern because

the diverse needs of learners were not met.

4.3 Curriculum adaptations for learners with multiple disabilities

The second study objective sought to find out the curriculum adaptations that had been effected

for learners with multiple disabilities (deaf-blind, autistic blind, and cerebral palsy intellectual

disability). To respond to this objective, teachers and head teachers were asked to indicate

curriculum adaptations that had been implemented in their schools to improve teaching and

learning process of learners with multiple disabilities. In response, 3 (15.0%) of the teachers

educating learners with deaf blindness reported that they had implemented use of drafts while 17

(85.0%) of them did not respond. Drafts are preliminary versions of writing of a curriculum.

Head teachers from the schools of learners with deaf blindness said that they were using the third

draft of an adapted curriculum from KIE. However, all teachers educating learners with autism

blindness and cerebral palsy intellectual disability reported that they had not revised curriculum

programmes in their schools. To confirm teachers‟ responses, head teachers of the schools for

cerebral palsy intellectual disability and autism blindness interviewed reported that their schools

had not revised curriculum used in their respective schools. In one of the schools for learners

with autism blindness, teachers conceded to the use of the syllabus for learners with intellectual

impairments. The observations carried out in schools for learners with autism blindness

confirmed that the curricula used for learners with autism blindness were not adapted to cater for

their diverse needs. The curricula used in two schools was the general curriculum and in one

school, teachers conceded to the use of the curriculum for learners with intellectual impairments.

Observations carried out in schools for learners with deaf blindness confirmed that teachers were

using the final or the third draft of an adapted curriculum from Kenya institute of curriculum

development. Observations carried out in schools for learners with cerebral palsy intellectual

disability confirmed that teachers were using the curriculum for learners with intellectual

disabilities and the general curriculum was used in two schools. Learners with multiple

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disabilities should follow a specialist curriculum as supported by (KIE, 1987; Kochung Report,

2003).

4.4 Available teaching resources for learners with multiple disabilities

The third objective of the study was to find out the available teaching resources for learners with

multiple handicaps (deaf-blind, autistic blind, and cerebral palsy intellectual disability).

4.4.1 Teachers’ responses on available teaching resources for learners with multiple

Disabilities

Table 4.9: Teachers’ responses on available resources used for teaching learners

with deaf blindness.

Available resources Frequency(N=20) Percentage

Lilly Nielsen box(resonance boards) 17 85.0

Play area 16 80.0.

Calendar boxes/structured boards 16 80.00

Stimulant board 10 50.0

Utensils, basins, soaps,toothbrushes among others 10 50.0

Manila papers 10 50.0

Washrooms 9 45.0

Felt pens 9 45.0

Dining room 9 45.0

Toys (inadequate) 7 35.0

Language room/sensory room 6 30.0

Kitchen 6 30.0

Braillers/braillons 6 30.0

Real objects(maize,beans,rice,stones among others 4 20.0

Experience book 3 15.0

Balls 3 15.0

Workshop 2 10.0

Beadwork 2 10.0

Object of reference 2 10.0

Communication board 1 5.0

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Table 4.9 above, shows that the most available teaching resources were; Lilly Nielsen box or

Resonance Board 17 (85%), play area and calendar boxes at 16 (80%). Ten (50%) of the

respondents also reported that stimulant boards, utensils, basins, soaps among others and manila

papers were also available. Washrooms, felt pens and dining room were mentioned by 9 (45%)

of the teachers. Other resources mentioned by the teachers included; language room 6 (30%),

sensory room 6 (30%), braillons 6 (30%), real object 4 (20%) experience book and balls 3

(15%), workshop, objects of reference and beadwork were mentioned by 2 (10%) of teachers and

communication boards at 1 (5%). The study found out that some teaching resources were

inadequate. This is supported by Kochung Report (2003) which found out most schools were

operating with barely basic learning aids. For instance, the materials to be used in the workshops

were not there, so learners who were benefitting from the vocational training could not access the

skills so they remained in schools doing nothing. The observations carried out on teaching

resources in schools for learners with deaf-blind revealed that teachers mainly used; real objects,

Lilly Nielsen boards, use of beads, buckets, toothbrushes, braillers among others. In the

classrooms, there were some tables, forms and chairs. Some learners had reading stands. In one

school, there was a workshop but nothing was going on because there were no materials to use.

The teaching resources were inadequate. There were no specialized equipment. Schools for

learners with deaf blindness will require specialized equipment like the adaptive computers with

a Braille display, among others as supported by Moss&Hagood, 1995). These equipment can go

a long way in helping learners‟ access education. In some schools, the physical environment was

barrier free especially in the special schools that were not integrated. The Kochung report (2003)

found that the physical environment in special schools was not barrier free.

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Table 4.10: Teachers’ responses on available resources used for teaching learners

with autism blindness

.

Available resources Frequency(N=7) Percentage

Braillers 7 100.0

Abacus 7 100.0

Braille papers 6 85.7

Toys 4 57.1

Cubarithims (inadequate) 4 57.1

Peg boards 3 42.9

Real objects 2 28.6

Charts 1 14.3

Talking computers (inadequate) 1 14.3

Talking toys 1 14.3

Blocks 1 14.3

Table 4.10 shows that the most available resources used to teach learners with autism blindness

were; braillers and Abacus at 7 (100%) and braille papers at 6 (85.7%). Other resources

available in most schools were toys and cubarithims at 4 (57%) and peg boards at 3 (42.9%).The

least used teaching resources included; real objects at 2 (28.6%), charts, talking computers,

talking toys and blocks at 1 (14.3%) respectively. Some of the teaching resources like cubarithms

and talking toys were inadequate as supported by the Kochung Report (2003), which found

teachers working barely without teaching resources. The observations carried out in schools for

learners with autism blindness on the teaching resources confirmed that majority of teachers

used real objects,braillers,braille papers,abacus,toys, white canes,buckets,utensils among others.

The teaching resources were inadequate.

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Table 4.11: Teachers’ responses on available resource used for teaching learners

with cerebral palsy intellectual disability

Available resources Frequency(N=30) Percentage

Real objects(rice,beans,stones and maize) 21 70.0

Beadwork 20 66.7

Manila papers 19 63.3

Felt pens 17 56.7

Abacus 16 53.3

Buckets 11 36.7

Plasticine 9 30.0

Candles 8 26.7

Blocks 7 23.3

Tooth brushes 6 20.0

Mirrors 6 20.0

Mobility aids 5 16.7

Counters 5 16.7

Textured board 4 13.3

Toys 3 10.0

Pictures 2 6.7

Exercise books/ pencils 1 3.3

Dolls 1 3.3

Large printed books 1 3.3

Walking frame 1 3.3

Table 4.11 illustrates real objects 21 (70.0%) were the most available resources used to teach

learners with cerebral palsy intellectual disability followed by bead work 20 (66.7%) and manila

papers 19 (63.3%). Seventeen (56.7%) of the respondents cited the availability of felt pens.

Abacus was mentioned by 16 (53.3%).Other resources used included; buckets 11 (36.7%),

plasticine 9 (30%), candles 8 (26.7%), blocks 7 (23.3%),

tooth brushes and mirrors 6 (20%), mobility aids and counters 5 (16.7%), texture board 4

(13.3%) andtoys3 (10%) However, it emerged that the least available resources were; exercise

books/ pencils, dolls, large printed books and walking frame at 1(3.3%).

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Observations carried out in schools for learners with cerebral palsy intellectual disability

confirmed that the teaching resources used in the schools included real objects such as rice,

maize beans and blocks. The teaching resources were inadequate as supported by Kochung

Report (2003) which revealed that teachers were working barely without teaching materials.

There were no specialized equipment like adapted computers, prone standers, mechanical lifts,

electronic page turners, shelf liner among others. These equipment can go a long way in

enhancing access to education, mobility and independence among learners with cerebral palsy

intellectual disability. Some schools had a television set and some few computers which were not

used because teachers not computer literate.

4.4.2 Head teachers’ responses on availability of teaching and learning resources

Head teachers from the three sampled schools were asked to indicate available resources in their

schools used to teach learners‟ with multiple disabilities. During the interview 2 (66.7%) out of

the three heads of schools for learners with deaf blindness reported that the most available

resources in their schools were Nielsen box, threading, beadwork, basins of ADL, braillers,

language room, manila papers, real objects felt pens, structured boards, calendar boxes and

stimulant boards and sensory room. Other resources mentioned but were not common in most

schools included; Braille papers, goal balls, toys, and communication boards‟ at1 (33%). All 3

(100.0%) heads of schools for learners with autism blindness interviewed reported that Braillers,

Braille papers and white canes were available. Other resources reported though they were not

common in all the three sampled schools were; peg boards, cubarithms, communication devices

and bead work at 1(33.3%). Observations carried out in schools for learners with autism

blindness confirmed that there were braillers, braillepapers, cubarithms, abacus, real objects and

white canes as teaching resources. During the interview, one of the respondents was asked to say

why the teaching resources were inadequate and this was the response, “The funds we receive

per year is just two thousand shillings per student which is not enough to cater for their needs.

The government should increase the money because some resources such as braillers cost

seventy thousand shillings.” All the three (100%), heads of schools for learners with cerebral

palsy intellectual disability said that, real objects were available for teaching learners with

cerebral palsy intellectual disability. Two out of three heads of schools (66.7%) reported that

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adapted pens, adapted utensils, Abacus, beadwork and blocks were available in their schools.

Resources that were not available in most schools included; special furniture, special pencils,

exercise books, pictures, plasticine, mirrors and walking frames at 1(33.3%) respectively.

Observations carried out in schools for learners with cerebral palsy intellectual disability on

teaching resources confirmed that the teaching resources that were commonly used by the

teachers included; real objects (maize, beans, rice), pictures and blocks. The teaching resources

were inadequate as supported by Kochung Report (2003) which stated that teachers were

working barely without materials.

4.5 Support services for learners with multiple disabilities.

The fourth objective of the study was to find out available support services for learners with

multiple disabilities (deaf-blind, autism blindness and cerebral palsy intellectual disability

(CPID). To answer this research question, study respondents were asked to indicate support

services offered to learners in their respective schools. Nine (45%) of teachers interviewed

reported that learners with deaf blindness were supported by given services by an occupational

therapist. Four (20%) of teachers reported the services of a physiotherapist. Two (10%) reported

that the physiotherapist services were inadequate. One (5.0%) of teachers reported that

occupational therapy was offered but it was inadequate. Related services such as occupational

and physiotherapy are supported by Martinez & Moss (1998). However the support services

were inadequate as supported by the Kochung Report (2003) which found that the support

services from professionals were lacking in the education system. This is a cause of concern

because there are so many learners who are in dire need of support services but they are

unavailable. In the long run these learners may not access appropriate education. In relation to

this,10 (50%) of the teachers recommended that the school administration should ensure that all

the necessary support services for learners with deaf-blind such as speech therapy, sensory

integration, among others are availed effectively to enhance their academic performance.

The observations carried out in schools for learners with deaf blindness revealed that the support

services that were offered included; the related support services of an occupational therapist who

was only one in one of the schools. The occupational therapist was only one serving learners

with deaf blindness and other learners with other disabilities. In another school the

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physiotherapist reported once a month, this is a cause of concern because some of these learners

require the services on a daily basis. The Kochung Report (2003) found that the professionals

apart from the teachers such as the audiologists, sign language interpreters, and physiotherapists

among others were lacking. In one of the schools for learners with deaf blindness, there was a

language room and a sensory room. The sensory room and the language room help learners to

develop language and stimulating other skills (Hopcroft, 2010).

Table 4.12: Teachers’ responses on support services offered to learners with

cerebral palsy intellectual disability

Support Services Frequency

(N=30

Percentage

Physiotherapy 14 46.7

Hydrotherapy 10 33.3

Health services 10 33.3

Inadequate physiotherapy 6 20.0

Reconstruction therapy 5 16.7

Inadequate health service 5 16.7

As shown in Table 4.12 above, learners with cerebral palsy intellectual disability were given the

following services; physiotherapy 14 (46.7%), hydrotherapy 10 (33.3 %,) and health services 10

(33.3%).Inadequate physiotherapy was reported by 6 (20%) of the teachers. The least support

service given to these learners was reconstruction therapy as well as an inadequate health

services at 5 (16.7%). Support services such as physiotherapy hydrotherapy are supported by

Wheless (2004); Hopcroft (2010). Wheless (2004) says that most therapy attempts to reduce

abnormal movement patterns and encourage normal, purposeful movements in an active and

functional manner. The observations carried out in schools for learners with cerebral palsy

intellectual disability confirmed that in most schools, the support services given by the

physiotherapist and occupational therapist were inadequate. There was no speech therapist for

those with communication difficulties. However there was a nurse in two of the schools who

offered medical services. Observations confirmed that there were no specialized equipment like

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adapted computers, prone standers, mechanical lifts, electronic page turners, shelf liner among

others. These equipment can go a long way in enhancing access to education, mobility and

independence among learners with cerebral palsy intellectual disability. Some schools had a

television set and some few computers which were not used because teachers were not computer

literate.

Teachers educating learners with cerebral palsy intellectual disability were asked to say their

recommendations on the support services given. Four (13.3%) teachers suggested that learners

should be offered with speech therapy. Four (13.3%) teachers suggested physiotherapy. Four

(13.3%) teachers suggested adequate health services and three (10.0%) teachers suggested

hydrotherapy. Other services that needed to be improved on were, occupational therapy 2

(6.7%) and reconstruction therapy at 1 (3.3%) respectively. One (33.3%) out of the three heads

of schools for learners with deafblindness interviewed, reported that deaf-blind learners were

offered with transport services, another 1(33.3%) head of school reported that they were given

physiotherapy which was inadequate, while the remaining 1(33.3%) head of school indicated that

they were given occupational therapy. Three heads of schools for learners with multiple

disabilities were asked to say the support services that were offered in their schools. Two

(66.7%) heads of schools for learners with autism blindness reported that learners were offered

with medical services while the remaining 1 (33.3 %) head of school confirmed that they were

not given any support service. Three heads of schools for learners with cerebral palsy intellectual

disability were asked to say the support services offered in their schools. Two (66.7%) out of the

three heads of schools indicated that learners with cerebral palsy intellectual disability were

given hydrotherapy, Physiotherapy and prevocational training services respectively. The only

support service given to learners with autism blindness was medical services reported by 4 (57.1)

of the teachers. All other support services were lacking. In relation to this, 2 (28.6%) teachers

recommended that the school administration should ensure that learners were given support

services in order to enhance their academic performances and also have an environment that was

conducive while at school. The observations carried out in schools for learners with autism

blindness confirmed that the only support services offered in two schools were medical services.

They lacked other support services such as auditory training, sensory integration, speech therapy

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and a special diet, among others. Sensory integration is given to learners with autism blindness

who engages in inappropriate responses to sensory stimuli .In auditory training, an audiogram

identifies frequencies to which the child with autism blindness is hypersensitive (Grandin, 1995).

The diet of learners with autism blindness should be free from casein, gluten, aspartame and

monosodium glutamate (Breton, 2001). A speech language pathologist evaluates and develops

programmes for individuals with speech or language problems (Best et al., 2010). Learners‟ with

autism blindness require the support of speech language pathologists due to their communication

problems (Ministry of Education Special Programs branch, 2000). The observations carried out

in schools for learners with autism blindness confirmed that there were no specialized equipment

such as adapted computers, global positioning devices; note takers among others. The equipment

can go a long way in helping learners‟ access education with ease and also enhance their

independence.

4.6 Training needs of teachers educating learners with multiple disabilities.

The study sought to find out the training needs of teachers educating learners with multiple

disabilities. To address this objective, study respondents (head teachers and teachers) were asked

to indicate whether teachers were competently trained to teach learners with multiple disabilities.

With regard to this, some teachers interviewed confirmed that some teachers were not adequately

trained to teach learners with multiple disabilities and therefore they needed some training.

Research has recently verified that a well-prepared teacher has more influence on a child‟s

learning than any other factor under school control (Darling-Hammond, 2000).

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Table 4.13: Teachers’ responses on training needs of teachers educating learners with Deaf

blindness

Training Needs Frequency(N=20) Percentage

Interdisciplinary courses to be given in details 18 90

Knowledge on deaf blindness/levels/etiologies 18 90

Communication modes/assistive technology 17 85

Adaptation of curriculum/learning environment 17 85

Orientation and mobility 16 80

Transition skills/functional skills/vocational skills 16 80

Behaviour management/social skills 15 75

Assessment and evaluation 15 75

How to source for funding 14 70

Career choices 13 65

Table 4.13 above shows that majority of the teachers 18 (90%) were of the views that in order to

teach learners with deaf blindness effectively, they required to be trained in details the

interdisciplinary courses and knowledge on deaf blindness. During the interview, one of the

respondents was asked to elaborate on what they meant. This was the reply “I was trained in

braille and sign language to teach learners with deaf-blind at KISE but most of the learners in

this school have deaf-blind and other disabilities such as cerebral palsy, physical disabilities,

autism and intellectual disability and health problems. The interdisciplinary courses that we

learnt were very shallow, teachers should be taught every disability and its implication on

learning in details.” This study report is supported by Best et al., (2010) who stated teachers

must have knowledge about a variety of disabling conditions and their implications for function.

The Council of Exceptional Children (1995) has stated that the competencies of a teacher

teaching learners with deaf blindness should include; knowledge on deaf blindness, types and

various etiologies and their implications to learning. Seventeen teachers (85%) were of the views

that they should be taught skills of communicating with learners who are deaf-blind, assistive

technology and on the modifications of the curricula, instructional strategies and learning

environment as supported by Heller & Swine hart-Jones (2003) who stated that teachers must

possess knowledge and skills on curriculum modifications, instructional techniques, arranging

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and adapting the learning environment. Sixteen (80%) teachers said that they required training on

vocational, functional skills, transition and orientation and mobility as supported by Best et al.,

(2010) who says that learners will have to be taught functional living skills for maximum

independence in school, home and community and life experiences.

Transition skills should also be taught to teachers to prepare learners for transition. They also

require skills of self reliance. Self reliance means reliance on one‟s own abilities to perform

tasks. Orientation and mobility and training on assistive technology are supported by the Council

of Exceptional children (1995). Fifteen teachers (75%) were of the views that they required

training on behaviour management, how to teach social skills, assessment and evaluation which

are supported by the Council of Exceptional Children (1995). Fourteen(70%) of teachers were of

the views that teachers should be given training on how to source for funds because the money

given by the government is very little to sustain the special unit. During the interview, one of the

respondents said, “We should be taught skills on how to generate income and on how to

collaborate with other stakeholders’‟. Thirteen teachers (65%) were of the views that they

should be taught skills on career choices for learners with deaf-blind.

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Table 4.14: Teachers’ responses on training needs of teachers educating learners with

Autism blindness

Training Needs Frequency(N=7) Percentage

Knowledge in all areas of disabilities in details

autism blindness

6 85.7

Instructional strategies for the various disabilities 6 85.7

Curriculum adaptations /learning environment 6 85.7

Assessment of autism and other disabilities 6 85.7

Remediation of communication and behayiour 5 71.2

Communication skills/assistive

technology/computers

5 71.2

Support services 5 71.2

Transition/functional/vocational skills 5 71.2

Social skills/special diet 4 57.1

As shown in Table 4.14 above, majority of teachers 6 (85.7%) teaching learners with autism

blindness suggested that they needed training in all areas of disabilities, knowledge on

instructional techniques, curriculum adaptations, assessment and evaluation. Respondents were

asked to explain why they wanted training in all areas. This was the response “Most of the

learners we have in this class are autistic blind with other disabilities such as intellectual

disability, physical, communication difficulties, and cerebral palsy and behaviour challenges.”

This study report is supported by Boyce & Hammond (1996) who have stated that teachers

teaching learners with autism blindness will need core skills that enable them to teach all

learners. Best et al., (2010) also supports the training of teachers dealing with multiple

disabilities on various disabling conditions. Training on autism and blindness is supported by

Shaheen (2009) who trained a learner who was autistic blind. Five (71.2%) teachers suggested to

be given training on remediation of communication and behaviour challenges, use of assistive

technology, use of adaptive computers, support services, transition, functional skills and

vocational training. This study report is supported by Best, Heller,& Bigge (2005);Council for

exceptional children (1998); Heller, Fredrick, Dykes, Best, & Cohen, 1999; Heller & Swinehart-

Jones(2003) who have stated that teachers who instruct learners with multiple disabilities must

possess specific competencies that encompass instruction, physical management of learners,

educational environment, health maintenance, use of assistive technology, communication and

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curricular adaptation. Koech Report (1999) also emphasized on the retraining of teachers in the

evolvement of new knowledge and technology. Four teachers (57.1%) were of the views that

they required training on how to teach social skills and on the special diet given to learners with

autism blindness.

Table 4.15: Teachers’ responses on training needs required to teach learners with

Cerebral palsy intellectual disability

Training Needs Frequency(N=30) Percentage

Knowledge in all areas of disability/cerebral

palsy

30 100

Instructional strategies for the various disabilities 28 93.3

How to remediate communication and behaviour 28 93.3

Assessment modes of various disabilities and CP 28 93.3

Curriculum adaptations/learning environment 28 93.3

Techniques for lifting and devices/physical

management/personal care

24 80

Transition/functional skills/vocational skills 23 76.6

Use of assistive technology/adaptive computers 23 76.6

Career choices 20 66.6

As shown in Table 4.15, 30 (100 %) of the teachers reported that they required training on all

areas of disabilities in details because learners with cerebral palsy intellectual disability have

other disabilities such as hearing,visual,autism, orthopedic and epilepsy among others. During

the interview one of the respondents was asked to elaborate on the training required, these were

the words “. These learners are not just physically disabled with a cognitive disability they also

have health problems, communication challenges, hearing problems and epilepsy how do I help

and my training was for the physically challenged in general only? I will require detailed

information and knowledge on all other disabilities, their remediation strategies and their

instructional strategies”. This study report is supported by Best et al., (2010) who stated that

teachers must have knowledge about a variety of disabling conditions and their implications for

function. Koech Report (1999) also emphasized on the need for re-training of teachers on the

evolvement of new knowledge and technology. The teachers also needed knowledge on the types

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of cerebral palsy and their remediation in details. Twenty eight (93.3%) were of the views that

they needed training on all the instructional strategies for the various disabilities, how to

remediate communication and behaviour disorders, assessment modes and curriculum

modifications and the learning environment. Best et al., (2010) supports the study report where

he stated that in order to reduce the functional impact of disability, teachers and others who work

with individuals with multiple disabilities must develop knowledge, skills, and abilities that

extend beyond standard pedagogy. They must have a thorough understanding of typical

development in motor, sensory, perception, cognition, communication, language, social,

emotional and self-care domains. Training on how to remediate communication and behaviour

disorders can help learners with cerebral palsy. For instance, students with severe cerebral palsy

may have speech that is difficult to understand, especially with people unfamiliar to the student.

AAC can be used to augment the existing communication hence the term Alternative

Augmentative Communication (Romski &Sevcik, 1996). Teachers should be trained on how to

use Alternative and Augmentative communication. Twenty four (80%) of teachers suggested that

they required training on techniques for positioning and lifting, and the devices used. Twenty

three (76.6%) were of the views that they should be given training on transition, functional skills

vocational training and assistive technology. Best et al., (2010) supports this study report where

he states that teachers need to prepare learners for life by offering transition skills, vocational

skills and functional skills for maximum independence in school, home, community and life

experiences. They will require skills for self reliance. Career choices were mentioned by twenty

teachers (66.7%).

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4.7 Strategies to consider in order to improve teaching.

The following were some of the suggestions that were given by the respondents who participated

in the study.

Teachers’ recommendations

Table 4.16: Recommendations from teachers of learners with deaf blindness

Recommendations Frequency(N=20) percentage

Provision of adequate teaching resources/support services 20 100.0

Teacher-pupil ratio should be 1:1 20 100.0

IEP to be done by multidisciplinary team 20 100.0

All teachers should be trained on a variety of disabling

conditions and adaptive technology

20 100.0

Curriculum should be made functional 20 100..0

Frequent refresher courses/exchange programmes 19 95.0

Provision of specialized equipment 15 75.0

Creation of awareness on multiple disabilities 15 75.0

Physical environment should be made barrier free 15 75.0

Proper assessment should be made for proper placement 13 65.0

Heads of institution in integrated and special schools should be

specially trained in the particular category of disabilities

12 60.0

Functional skills to be awarded a certificate 12 60.0

Age of exit of learners should be specified 12 60.0

As shown on Table 4.16 above, 3 (100.0%) teachers recommended that schools should have

enough teaching resources and support services, IEP to be made by a multidisdisciplinary team

and curriculum should be made functional. They also suggested that all teachers be trained on a

variety of disabling conditions and adaptive technology. The respondents further recommended

that teacher‟s work load should be minimized by ensuring that teachers- pupil‟s ratio is 1:1. This

is due to the fact that deaf- blind learner requires considerable modifications to the teaching

content and different teaching strategies. He/she cannot learn from what he/she sees like the deaf

child does. He/she cannot learn from listening like the blind child does. He/she learns only by

what he/she does. This means that no learning is taking place for him/her while waiting for

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others to take their turn. For this reason, a small group or individual instruction becomes more

critical (Moss & Hagood, 1995). Moreover, 19 (95.0%) teachers suggested that teachers should

be taken for frequent refresher courses and exchange programmes to learn and share experiences.

Other suggestions that were given by 15 (75.0%) of the respondents were; provision of

specialized equipment, physical environment to be made barrier free and creation of awareness

on deaf blindness. Thirteen (65.0%) of respondents suggested that proper assessment be made

for proper placement, heads of special institutions be specially trained, functional skills to be

awarded a certificate to learners with multiple disabilities, and age of exit to be specified.

Table 4.17: Recommendations from teachers of learners with Autism blindness

Recommendations Frequency(N=7) Percentage

Teachers should be given further training in a variety of disabling

conditions/autism blindness/instructional strategies

7 100.0

IEP should be designed by a multidisciplinary team 7 100.0

Provision of adequate teaching resources 7 100.0

Provision of support services 7 100.0

Curriculum should be made functional 7 100.0

Teacher: pupil ratio should be 1:1 6 85.7

Physical environment should be made barrier free 6 85.7

Provision of special diet 5 71.4

Exchange programmes 5 71.4

Creation of awareness on multiple disabilities 4 57.1

Head of institution should be specially trained 4 57.1

Age of exit of learners should be specified 3 42.8

As shown in Table 4.17 above, in order to improve teaching and learning process among learners

with autism blindness all 7 (100.0%) study respondents suggested that teachers should be given

training on a variety of disabling conditions because most of the learners with autism blindness

have more than two disabilities. This would make teachers more effective in content delivery and

hence improving their teaching methodologies as well as learners‟ performances. They further

suggested that IEP should be made by multidisciplinary team and there should be adequate

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teaching resources. Additionally, all 7 (100.0%) teachers suggested the provision of adequate

support services and curriculum to be made functional. When a curriculum approach takes into

account the pupils current individual needs and his future needs and is designed to meet his

needs it is known as a functional curriculum (Ellis 1986). Six (85.7%) suggested that the teacher

pupil ratio be 1: 1 and the physical environment be made barrier free. Kochung Report (2003)

recommended that teacher learner ratio for learners with multiple disabilities should be 1:1. Five

(71.4%) of the respondents suggested a special diet and exchange programmes from other

countries. Learners who are autistic require a special diet free from gluten, aspartame and casein

found in milk among others as supported by (Breton, 2001). Exchange programmes would help

teachers to share their experiences and learn from other countries on how to teach learners who

are autistic blind.

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Table 4.18: Recommendations from teachers teaching learners with cerebral palsy

Intellectual disability

Recommendations Frequency

(N=30)

Percentage

Further training on a variety of disabling conditions /instructional

strategies

30 100.0

Provision of adequate teaching resources 30 100.0

IEP to be made by the multidisciplinary team 30 100.0

Provision of adequate support services 30 100.0

curriculum should be made functional 30 100.0

Specialized equipment and adaptive aids 28 93.3

The physical environment should be made disability friendly 28 93.3

Inspection should be made by specialist 28 93.3

Teacher pupil ratio should be 1:1 28 93.3

Acquisition of functional skills be awarded a certificate 28 93.3

Exchange programmes 20 66.6

Creation of awareness 20 66.6

The head of institution should be specially trained 20 66.6

Age of exit of learners should be specified 17 56.6

Provision of special diet 17 56.6

Involve teachers in the making of the curriculum 17 56.6

Mode of assessment to be determined by learners needs 17 56.6

The Joint Admission Board(JAB) should not admit teachers for special

education directly

5 16.6

As shown in Table 4.18 all 30 (100.0%) teachers recommended that teachers should be given

further training on a variety of disabling conditions and their instructional strategies. This would

make them competent in teaching learners with cerebral palsy intellectual disability. The

respondents also suggested that they should be provided with; adequate teaching resources and

support services. Teachers were also of the views that IEP should be developed by the

multidisciplinary team and that the curriculum is made functional. Twenty eight (93.3%) of

teachers suggested the provision of specialized equipment, teacher pupil ratio be made 1:1 and

acquisition of functional skills by learners with multiple disabilities be awarded a certificate.

Twenty (66.6%) suggested the exchange programmes, creation of awareness on disabilities and

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heads of Special institutions be specially trained. Seventeen (56.6%) suggested that the age of

exit be specified, provision of special diet, involvement of teachers when making a curriculum

and mode of assessment of learners be determined by the learners needs. Five (16.6%) of

teachers suggested that the joint admission board (JAB) should not admit teachers of special

education directly. They felt that the teachers should be exposed on what is entailed in the career

on special needs.

4.7.1 Head teachers’ recommendations

Table 4.19: Head teachers recommendations on ways of improving teaching of learners

with Deaf blindness

Recommendations Frequency

(N=3)

Percentage

Further training to teachers on multiple disabilities adaptive

technology

3 100.0

Teacher-pupil ratio should be 1:1 3 100.0

Curriculum should be made functional 3 100.0

Provision of adequate support services 3 100.0

Provision of adequate teaching resources 3 100.0

Creation of awareness on deaf blind and other multiple disabilities 3 100.0

Inspection should be done by specialists 3 100.0

Provision of enough finances 3 100.0

IEP should be made by multidisciplinary team 3 100.0

Provision of adequate medical services 2 66.6

Functional skills awarded with a certificate 2 66.7

Provision of enough beds and beddings and food stuffs 1 33.3

Provision of specialized equipment 1 33.3

Parents should be taught the language of school 1 33.3

Provision of enough classrooms 1 33.3

Provision of enough support staff 1 33.3

Exchange programmes 1 33.3

From Table 4.19 it can be observed that all 3 (100.0%) head teachers recommended that teachers

should be given further training on a variety of disabling conditions and their instructional

methods and adaptive technology, teacher-pupils ratio should be 1:1, curriculum to be made

functional, provision of adequate teaching resources, provision of adequate support services,

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creation of awareness on multiple disabilities, provision of adequate resources, IEP to be

developed by a multidisdisciplinary team and inspections should be done by specialists. Two

head teachers (66.7%) recommended that special schools should be provided with adequate

medical services and those who acquire functional skills are awarded certificates. Functional

skill is supported by Vygotsky (1978), who stated that instead of measuring intelligence by what

a child can do alone, he suggested that intelligence could better be measured by what a child can

do with skilled help. The least recommended strategies were; provision of enough support staff,

provision of enough beddings, exchange programmes, specialized equipment and parents to be

co-therapists with the teachers all at 1(33.3%) respectively.

Table 4.20: Head teachers recommendations on ways of improving teaching of learners

with autism blindness

Recommendations Frequency(N=3) Percentage

Retraining of teachers on a variety of disabling conditions 2 66.7

Train teachers on how to handle multiple disabilities 2 66.7

Provision of enough teaching resources 2 66.7

Provision of support services 2 66.7

IEP to be made by multidisciplinary team 2 66.7

The curriculum should be made functional 2 66.7

Barrier free infrastructure 1 33.3

Specified age of exit 1 33.3

Teacher-pupil ratio should be 1:1 1 33.3

Creation of awareness 1 33.3

Implementation of exchange programmes 1 33.3

As Table 4.20 shows, 2 (66.7%) of the head teachers recommended retraining among teachers on

a variety of disabling conditions because learners with autism blindness have more than two

disabilities and provision of enough teaching resources. This would enhance academic

performance of learners with autism blindness as teachers would be competent enough with the

teaching of the curriculum. Availability of teaching and learning resources would also enhance

smooth teaching and learning process and eventually translate to improved academic

performance among learners and school as a whole. In addition, school heads suggested that

supporting bodies should ensure that learners were provided with the support services they

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required in order to improve on their learning process. They further suggested that IEP should be

developed by a multidisciplinary team 2 (66.7%) and curriculum should be made functional 2

(66.7%). Other recommendations included; implementation of exchange programmes, teacher

pupil ratio to be 1:1 and learners to have a specified age of exit. This is because the transition of

learners with special needs is unspecified.

Table 4.21: Head teachers’ recommendations on ways of improving teaching of

learners with cerebral palsy intellectual disability

Recommendations Frequency(N=3) Percentage

Training of teachers on a variety conditions and instructional methods 3 100.0

Provision of adequate teaching resources 3 100.0

IEP to be made by the multidisciplinary team 3 100.0

Provision of enough finances 2 66.7

Curriculum should be made functional 2 66.7

Provision of specialized equipment 2 66.7

Inspectors should be specially trained 2 66.7

Creation of awareness on the multiple disabilities 2 66.7

The physical environment should be made barrier free 2 66.7

Exchange programmes 2 66.7

Age of exit of learners to be specified 2 66.7

Teacher pupil ratio should be 1:1 2 66.7

Provision of adequate support services 2 66.7

Mode of assessment should vary accordingly 2 66.7

Functional skills should be certified 2 33.3

Parents should be sensitized on disabilities 2 33.3

As shown in Table 4.21 above, all head teachers 3 (100%) interviewed suggested that teachers

should be offered with training on a variety of disabling conditions and their instructional

strategies and they should be provided with adequate teaching/learning resources and IEP should

be developed by a multidisciplinary team. Two of the three headteachers 2 (66.7%) were also of

the views that special schools should be provided with enough finances, adequate support

services and specialized equipment. Curriculum should also be made functional, functional skills

should be awarded a certificate, mode of assessment should vary and school inspectors should be

specially trained. The physical environment was to be made barrier free, age of exit to be

specified, the teacher pupil ratio be made 1:1 and creation of awareness. Gachathi Report (1976)

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recommended the creation of awareness on the part of the public on the causes of disabilities

with a view of facilitating the prevention. Individual attention to learners with multiple

disabilities was not possible because learners exceeded the number of teachers in the schools.

Kochung Report (2003) recommended a ratio of 1:1 among the multiply disabled.

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CHAPTER FIVE

SUMMARY CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This chapter gives a summary of the study in relations to the objectives of the study. It also

presents the implications of the main findings, conclusions, recommendations and areas for

further research.

5.1 Summary of the Findings.

Majority of the teachers 20 (100%) educating learners with deaf blindness used the following

instructional methods namely; tactile Kenyan sign language, use of real objects, use of sign

language, use of speech paired with braille, task analysis and activities of daily living, among

others. However the teachers conceded to not using the Deaf-blind manual alphabet and on

teaching learners to make a choice. The choice of the instructional methods was determined by

the learner‟s needs. For instance, learners who were deaf-blind without any other disability could

be taught using tactile Kenyan sign language, Tadoma and use of object of reference among

other instructional methods. Most of the instructional methods for learners with deaf blindness

were primarily communicative. The observations carried out in schools for learners with deaf

blindness confirmed that most of the learners with deaf blindness had other disabilities such as,

autism, intellectual disability cerebral palsy, behaviour disorders and physical disabilities.

Teachers educating learners with deaf blindness without other disabilities were able to adapt the

generic teaching strategies to cater for the individual needs of the learner.

Majority of teachers 7 (100%) educating learners with autism blindness used the following

instructional methods namely; pre-braille, braille, oral methods, songs, pre-vocational skills and

real objects. The teachers conceded to not using the following methods namely; the use of two

handed sign language paired with speech, behaviour management strategies, use of tactile

kinesthetic modalities and use of recorded materials. The observations carried out in schools for

learners with autism blindness confirmed that teachers educating learners with autism blindness,

focused on the teaching strategies for learners with visual impairments leaving out the symptoms

of autism affecting learning among the learners. For instance, learners with autism display

communication difficulties, lack of social skills and behaviour disorders among others. Teachers

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were not able to differentiate instructions because their training was specifically for learners with

visual impairments. The instructional methods used by the majority of teachers 29 (96.7%)

educating learners with cerebral palsy intellectual disability included; task analysis, activities of

daily living and real objects. The teachers conceded to not using the following methods; use of

antecedent prompting, use of computer based instruction, and use of pre-linguistic milieu

teaching. The observations carried out in schools for learners with cerebral palsy intellectual

disability confirmed that teachers were not able to differentiate instructions for learners with

cerebral palsy intellectual disability because their training was specifically for learners with

physical impairments in general without other disabilities. Another observation was that despite

the fact that learners with cerebral palsy intellectual disability have varying levels of cerebral

palsy and cognitive development; teachers were not individualizing their instructions because

they were inadequate.

Teachers focused more on the teaching strategies for learners with intellectual disability without

remediating the symptoms that were brought about by cerebral palsy that were affecting learning

which hindered the achievement of the teaching objectives. For instance, learners with cerebral

palsy have problems in communication, problems in gross and motor skills and other health

conditions that may affect learning. If those problems are not remediated, then their learning will

be affected. Teachers felt inadequately prepared to handle learners with multiple disabilities. All

the teachers who were educating learners with multiple disabilities developed an individualized

education programme without involving the multidisciplinary team as it is done in other

countries therefore learners were not getting all the required support services. Among the schools

for learners with deaf-blind teachers were using the third draft of an adapted curriculum from

KIE. The teachers felt that the functional academics should be included in the final draft. Among

the schools for learners with cerebral palsy intellectual disability, the curriculum used was for

learners with intellectual disability. In schools for learners with autism blindness some teachers

were using the general syllabus while others used the syllabus for learners with intellectual

disability. No curriculum adaptations had been effected for learners with cerebral palsy

intellectual disability and autism blindness. The teachers proposed a functional curriculum or a

specialist curriculum. The primary concern of the specialist curriculum is to remediate

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fundamental problems in children with special needs. Such problems may include:

communication, speech, mobility and daily living skills among others. Teaching resources that

were available among the schools for the deaf-blind included; Lily Nielsen boards 17 (85%) play

areas and calendar boxes at 16 (80%). Ten (50%) of the respondents also reported that there were

stimulant boards, utensils and manila papers. felt pens, washrooms and dining room. Other

resources mentioned included a language room and a sensory room at 6 (30%) respectively. The

teaching resources were found to be inadequate. In one of the school, there was a workshop but

nothing was going on because there were no materials. In schools for learners with autism

blindness the available resources included braillers and Abacus and real objects 7 (100%), braille

papers at 6 (85.7%), pegboards and cubarithms at 4 (57%) toys among others. Some of the

teaching resources were inadequate. The teaching resources that were most available in schools

for learners with cerebral palsy intellectual disability included; real objects 21 (70%), followed

by beads 20 (66.7%) and manila papers 19(63.3%). Seventeen (56.7%) of the respondents cited

the availability of felt pens. The teaching resources were found to be inadequate.

Among the schools for the learners with deaf blindness, some few teachers had been trained on

braille and sign language to teach learners with deaf blindness from Kenya institute of Special

Education. However, during the interview, the teachers felt that interdisciplinary courses offered

at KISE should be given in details because most of the learners were not just deaf-blind, they had

other additional disabilities. Majority of the teachers 18 (90%) were of the views that in order to

teach learners with deaf blindness effectively, they required to be trained in details the

interdisciplinary courses and knowledge on deaf blindness. Some of the competency areas

teachers suggested included; knowledge on all areas of disabilities in details because learners

with deafblindness have other additional disabilities such as, autism, cerebral palsy, intellectual

disability and physical disabilities. Seventeen teachers (85%) were of the views that they should

be taught skills of communicating with learners who are deaf-blind, assistive technology and on

the modifications of the curricula, instructional strategies and learning environment. Sixteen

(80%) teachers said that they required training on vocational, functional skills, transition skills,

self-reliance, orientation and mobility. Transition and self-reliance skills should also be taught to

teachers to prepare learners for transition and self-reliance. Fifteen teachers (75%) were of the

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views that they required training on behaviour management, how to teach social skills,

assessment and evaluation. Fourteen (70%) of teachers were of the views that teachers should be

given training on how to source for funds because the money given by the government is very

little to sustain the special schools and units. Thirteen teachers (65%) were of the views that they

should be taught skills on career choices for learners with deafblindness.

Majority of teachers 6 (85.7%) teaching learners with autism blindness suggested that they

needed training in all areas of disabilities including autism and knowledge on instructional

techniques, curriculum adaptations, assessment and evaluation. Respondents explained that they

wanted knowledge on all other disabilities in details because most of the learners they had in

class were autistic blind with other additional disabilities such as intellectual disability, physical,

communication difficulties, cerebral palsy and behaviour challenges. Five (71.2%) teachers

suggested to be given training on remediation of communication and behaviour challenges, use

of assistive technology, use of adaptive computers, support services, transition, functional skills

and vocational training. Four teachers (57.1%) were of the views that they required training on

how to teach social skills and on the special diet given to learners with autism blindness. Thirty

(100 %) of the teachers teaching learners with cerebral palsy intellectual disability reported that

they required training on all areas of disabilities in details because learners with cerebral palsy

intellectual disability have other disabilities such as hearing,visual,autism, epilepsy, orthopedic

among others. Twenty eight (93.3%) teachers‟ were of the views that they needed training on all

the instructional strategies for the various disabilities, how to remediate communication and

behaviour disorders, assessment modes and curriculum modifications and the learning

environment. Twenty four (80%) teachers suggested that they required training on techniques for

positioning and lifting, and the devices used. Twenty three (76.6%) were of the views that they

should be given training on transition, functional skills, use of adaptive computers, vocational

training and assistive technology. Career choices were mentioned by twenty teachers (66.7%).

Teachers required further training on multiple disabilities because the training they had was on

educating learners with physical impairment as a specific disability. Learners with deaf

blindness were supported by being given services such as occupational therapy and

physiotherapy. Nine (45%) teachers interviewed reported that learners with deaf blindness were

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supported by given services by an occupational therapist. Four (20%) of teachers reported the

services of a physiotherapist.

Two (10%) teachers reported that the physiotherapist services were inadequate. One (5.0%) of

the teachers reported that occupational therapy was offered but it was inadequate. This is a cause

of concern because there are so many learners who are in dire need of support services but they

are unavailable. In the long run these learners may not access appropriate education. In relation

to this,10 (50%) of the teachers recommended that the school administration should ensure that

all the necessary support services for learners with deaf-blind such as speech therapy, sensory

integration, among others are availed effectively to enhance their academic performance.

The observations carried out in schools for learners with deafblindness revealed that the support

services that were offered included; the related support services of an occupational therapist who

was only one in one of the schools. The occupational therapist was only one serving learners

with deafblindness and other learners with other disabilities. In another school the

physiotherapist reported once a month, this is a cause of concern because some of these learners

require the services on a daily basis. In one of the schools for learners with deafblindness, there

was a language room and a sensory room. Learners with cerebral palsy intellectual disability

were given the following services; physiotherapy 14 (46.7%), hydrotherapy 10 (33.3 %,) and

health services 10 (33.3%). Inadequate physiotherapy was reported by 6 (20%) of the teachers.

The least support service given to these learners was reconstruction therapy as well as inadequate

health services at 5 (16.7%). The observations carried out in schools for learners with cerebral

palsy intellectual disability confirmed that in most schools, the support services given by the

physiotherapist and occupational therapist were inadequate. There was no speech therapist for

those with communication difficulties. However there was a nurse in two of the schools who

offered medical services. Observations confirmed that there were no specialized equipment like

adapted computers, prone standers, mechanical lifts, electronic page turners, shelf liner among

others. These equipment if availed, can go a long way in enhancing access to education, mobility

and independence among learners with cerebral palsy intellectual disability. Some schools had a

television set and some few computers which were not used because teachers were not computer

literate. Minimum adaptations had been made in the schools. The only support service given to

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learners with autism blindness was medical services reported by 4 (57.1) of the teachers. All

other support services were lacking. In relation to this, 2 (28.6%) of teachers recommended that

the school administration should ensure that learners were given support services in order to

enhance their academic performances and also have an environment that was conducive while at

school. The observations carried out in schools for learners with autism blindness confirmed that

the only support services offered in two schools were medical services. They lacked other

support services such as auditory training, sensory integration, speech therapy, occupational

therapy and a special diet, among others. There were no specialized equipment such as adapted

computers, global positioning devices; note takers among others. The equipment if availed can

go a long way in helping learners‟ access education with ease and also enhance their

independence. Teachers did not have consistent schedules for learners with autism blindness and

individual attention of learners was impossible because teachers were inadequate.

To improve teaching for learners with multiple disabilities, learners should be provided with an

adapted or a specialist curriculum, provision of adequate teaching resources, IEP to be designed

by a multidisciplinary team and all teachers to be given further training on how to differentiate

instructions for learners with multiple disabilities. The training should be on a variety of

disabling conditions because most of the learners have more than two disabilities. Teachers

should be trained on how to adapt the curriculum to suit learner‟s needs, adaptations of the

learning materials, learning environment, assessment and evaluation, use of assistive technology

and on the use of adaptive computers among other skills. Teacher pupil ratio should be 1:1,

provision of specialized equipment, age of exit to be specified, creation of awareness on multiple

disabilities, physical environment to be made barrier free, proper assessment for proper

placement and heads of institutions in integrated special schools to be specially trained in a

particular category of disability among others. The government should provide adequate funds,

provision of adequate support services, awarding functional certificate for the functional skills,

age of exit of learners to be specified, provision of enough beddings and foodstuffs, provision of

enough support staff among others.

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5.2 Implications of the Findings

Teachers were found to be inadequately trained to educate learners with multiple disabilities

because the training they had was for a specific disability therefore teachers were unable to

differentiate instructions. This implies that teachers educating learners with multiple disabilities

should have specialized competencies in order to provide the learners with quality education

opportunities. The teachers should be trained in a variety of disabling conditions and their

instructional strategies because most of the learners have more than two disabilities. Personalized

attention to learners with multiple disabilities was not possible since the teachers were not

enough and they were not adequately trained. This implies the need for more teachers who are

trained to handle diverse needs of learners. Teachers should have access to a wide range of

specialist strategies especially where they work with learners with the most complex needs;

there is the need for teachers to be able to adapt more generic strategies to meet the specific

needs of an individual learner. Teachers should demonstrate understanding of their strategies to

ensure they are confident in making adaptations in accordance with the child‟s development and

other needs. The curriculum was also found to be ineffective because it was not catering for the

diverse needs of learners with multiple disabilities. This implies the need for a functional

curriculum or a specialist curriculum, a curriculum that takes into account the current and future

needs of individual learners. The individualized education programme for learners‟ with multiple

disabilities was made by teachers without involving the multidisciplinary team therefore learners

were not getting the required support services. Most of the learners require related support

services from professionals such as speech therapist, occupational therapist among others who

were not available. Lack of support services was impairing the ability of learners to attend to

instructional situation. Teaching resources were also inadequate. This was found to have adverse

effects on their learning. For instance, some schools had workshops but there were no materials

therefore learners could not learn the prevocational and vocational skills.

5.3 Conclusion

Results revealed that teachers were not adequately trained to teach learners with multiple

disabilities. Most of the teachers had training on a specific disability therefore they had problems

of differentiating instructions for the learners. The teaching resources and support services were

145

also inadequate. The choice of the teaching strategies for learners with multiple disabilities

should be determined by the cognitive ability of the learners. The curricular was found to be

ineffective because it was not catering for learners with cerebral palsy intellectual disability and

autism blindness. The following measures should be taken to improve on their teaching they

include; the provision of a functional curriculum, provision of adequate teaching resources,

provision of adequate support services, and training of teachers on a variety of disabling

conditions because learners with multiple disabilities have more than two or more disabilities.

The study observed that much was needed to be done to make lives of learners with multiple

disabilities bearable in order to achieve success in the curriculum instructions given.

5.4 Recommendations

In this subsection a number of recommendations based on the findings of the study have been

made. It is hoped that the Ministry of Health (MOH), Ministry of Education (MOE) Kenya

Institute of Education (KIE), headteachers, teachers, parents and all the stakeholders in education

including Non-Governmental Organizations (NGOs) will find these recommendations helpful in

trying to improve the education of learners with multiple disabilities in the selected counties. The

government should give teachers further training on a variety of disabling conditions because

learners have more than two disabilities. The competencies required include; knowledge in all

areas of disabilities such as autism, cerebral palsy, intellectual disability, physical disabilities,

health problems, visual, hearing, attention deficit and hyperactivity disorders their instructional

methods, curriculum adaptations, assessment and evaluation, adaptations of the learning

environment, use of assistive technology, physical and positioning devices, transition skills,

vocational skills, functional academics, communication modes among others. The government

should provide adequate teaching resources to the schools. All learners with multiple disabilities

should be provided with a language room and a sensory room. These rooms will ensure

assessment of learners and stimulation of senses among other skills. The government should set

up programmes for people to pursue training as speech therapists, audiologists, dieticians,

physiotherapists and occupational therapists among others to support teachers in related support

services. The government should deploy more teachers to special schools so as to enhance the

teacher pupil ratio. This can improve teacher contact as well as the overall quality of

146

instructional attention. The teacher learner ratio of learners with multiple disabilities should be

one to one.

The government in conjunction with the Ministry of Education should create awareness on

multiple disabilities to all stakeholders in education so that the diverse needs of these learners

may be taken into consideration. This can be done for instance in seminars or in workshops, in

barazas, churches and by the media. The awareness will ensure that all learners regardless of

their disability are taken to school because education is a right to all. The government should

provide specialized facilities to learners with multiple disabilities. Specialized facilities such as

adaptive computers, prone standers, motorized wheelchairs, mechanical lifts among others can

go a long way in enhancing their mobility, independence and access to education. The age of exit

of learners with special needs should be specified to all the stakeholders by the ministry of

education. Most of the learners remain in schools without transition. The government should set

up more vocational training centres to enable learners to make transition from school to

employment. Home based programmes should be funded by the government for learners with

severe disabilities. The ministry of education should ensure that the individualized education

programme is made in consultation with a team of experts so that each learner‟s needs are taken

into consideration. The head teachers in integrated and special schools should be specially

trained. The expertise is needed so as to influence the decisions they make in relation to the

diverse needs of the learners. The Ministry of Education in conjunction with Kenya National

Exams Council (KNEC) should award learners with multiple disabilities with a functional

certificate. Intelligence should not be measured by what a child with multiple disabilities can do

alone, but by what a learner can do as dictated by the cognitive ability with skilled help from a

specially trained teacher. KNEC should be flexible with modes of assessment for learners with

Special needs and should be determined by the learner‟s needs. The physical environment should

be made disability friendly in special schools and in integrated settings. For instance, in some

schools there are no handrails in the toilets for learners who are physically disabled, doors are

not adapted for wheelchairs to go through so learners are forced to leave their wheelchairs

outside and crawl into their class. The government in conjunction with the Teachers Service

Commission should deploy more human resource support staff so as to improve services to

learners with multiple disabilities. The Ministry of Education should ensure that parents are

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involved in the education of their learners with multiple disabilities. They should be trained on

communication modes such as sign language, braille, use of adaptive computers among other

skills. This will ensure that the learners continue practicing what teachers teach even when out of

school. The Kenya institute of curriculum Development should come up with a functional

curriculum for all learners with multiple disabilities. The adapted curriculum for learners with

deafblindness can be adapted to cater for other multiple disabilities. The National policy on

special needs should be implemented by the government in full to ensure that the needs of all

learners with special needs are mainstreamed.

5.5 Suggestions for further research

The study focused on teaching strategies for three types of multiple disabilities namely deaf

blindness, autism blindness and cerebral palsy intellectual disability. Further research may be

carried out in other types of multiple disabilities such as autism intellectual disability, cerebral

palsy visual impairment, physically disabled hearing impaired, among others. Research may also

be carried out in relation to the challenges facing learners with multiple disabilities such as

health factors, social factors, and emotional factors among others. A study should be carried out

on the impact of wrong placement for learners with multiple disabilities. A study should also be

carried out to establish the prevalence levels of multiple disabilities. This can help establish the

proportion of cases that are not taken to special schools. This is because every child has a right to

education regardless of his or her disability.

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164

APPENDIX I

AN INTERVIEW GUIDE FOR THE HEADTEACHERS IN SCHOOLS WITH

LEARNERS WITH DEAFBLINDNESS

This interview is part of an educational study that is being conducted by the researcher in the

institution. The information will be treated with utmost confidentiality during and even after the

study. The researcher is therefore requesting for your co-operation and assistance. The

information you give will be very important for this study.

1. Are all teachers specially trained to handle learners with deafblindness? If not what are your

recommendations? (Probe on the number of teachers specially trained and their

qualifications).

2. What teaching resources are required for learners with deaf blindness?

(Probe on the availability and effectiveness) if not available or adequate, what are your

recommendations to improve teaching?

3. Do you think the curriculum in use is designed to cater for learners with deafblindness? If not

what are your recommendations to improve teaching? (Probe on the modifications required.)

4. What support services are given to learners with deaf blindness? (Probe for availability and

effectiveness) What are your suggestions on the support services to improve teaching?

165

APPENDIX II

INTERVIEW GUIDE FOR THE HEADTEACHERS IN SCHOOLS WITH

LEARNERS WITH AUTISM BLINDNESS

This interview is part of an educational study that is being conducted by the researcher in the

institution. The information will be treated with utmost confidentiality during and even after the

study. The researcher is therefore requesting for your co-operation and assistance. The

information you give will be very important for this study.

1. Are all teachers specially trained to handle learners with autism blindness? If not what are

your recommendations?(Probe on number of teachers specially trained and their

qualifications)

2. What teaching resources are required for learners with autism blindness? (Probe for their

availability and effectiveness? If not available what are your recommendations to

improve teaching?

3. Do you think the curriculum in use is designed to cater for learners with autism

blindness? If not what are your recommendations to improve teaching?(Probe on the

modifications required)

4. What support services are given to learners with autism blindness? (Probe on special diet,

auditory training and medical services among others (Probe on the availability and

effectiveness of the support services)

166

APPENDIX III

INTERVIEW GUIDE FOR THE HEADTEACHERS IN SCHOOLS WITH

LEARNERS WHO HAVE CEREBRAL PALSY INTELLECTUAL DISABILITY

This interview is part of an educational study that is being conducted by the researcher in the

institution. The information will be treated with utmost confidentiality during and even after the

study. The researcher is therefore requesting for your co-operation and assistance. The

information you give will be very important for this study.

1. Are all teachers specially trained to teach learners with multiple disabilities? If not what are

your recommendations? (Probe on number of teachers specially trained and their

qualifications)

2. What teaching resources are required for learners with cerebral palsy intellectual disability?

(Probe for their availability and effectiveness). If not available, what are your

recommendations?

3. Do you think the curriculum you use is designed to cater for the learning needs of

learners with multiple disabilities? If not what are your recommendations? (Probe on the

required adaptations.)

4. What support services are given to learners with cerebral palsy intellectual disability? Are the

support services available? If not what are your recommendations on support

services to improve teaching?

167

APPENDIX IV

INTERVIEW GUIDE FOR THE TEACHERS TEACHING LEARNERS WITH

DEAFBLINDNESS

This interview is part of an educational study that is being conducted by the researcher in the

institution. The information will be treated with utmost confidentiality during and even after the

study. The researcher is therefore requesting for your co-operation and assistance. The

information you give will be very important for this study.

1. What guides you in the choice of the instructional strategies for learners with deaf-blind?

(Probe on level of severity, age level among others)?

2. What are the various instructional strategies that you use with learners who are deaf-blind?

(Probe for the effectiveness of the stated strategies).

3. Do you think the curriculum you use is designed to cater for learners with multiple

disabilities? If not what are your recommendations to improve teaching?

4. Do you think you are competently trained to teach learners with deaf-blind?

If not, what are the training needs that you require?

5. What teaching resources are available in your school for learners with deaf- blind

(probe on the effectiveness and availability of the stated teaching resources).

6. What support services are given to learners with deaf-blind in your school?

(Probe for the availability and effectiveness and recommendations on the improvement of

stated support services

7. What suggestions would you recommend on the instructional strategies to improve teaching?

(Probe on retraining on new techniques, curriculum adaptations among other s).

168

APPENDIX V

INTERVIEW GUIDE FOR THE TEACHERS TEACHING LEARNERS WITH

AUTISMBLINDNESS.

This interview is part of an educational study that is being conducted by the researcher in the

institution. The information will be treated with utmost confidentiality during and even after the

study. The researcher is therefore requesting for your co-operation and assistance. The

information you give will be very important for this study.

1. What guides you in the choice of the instructional strategies/methods for learners who are

autistic blind?

2. What are the various instructional methods that you use with the learners who are autistic

blind? (Probe for the effectiveness of the various instructional strategies).

3. Do you think the curriculum you use is designed to cater for learners with multiple

disabilities such as autistic blind? If not what are your recommendations? (Probe on the

required adaptations)

4. Do you think you are competently trained to serve learners with autism blindness? If not,

what are the training needs that you require?

5. What teaching resources are available in your school for learners with autism

blindness? (Probe for their effectiveness and availability of tactile diagrams,

braillers, computers among others).

6. What support services are given to learners with autism blindness in your school?

(Probe for the availability and effectiveness) If not, available what

recommendations would you give for the improvement of the stated support

services.?

7 .What suggestions would you recommend on the instructional strategies to

improve teaching? (Probe on retraining on new techniques, curriculum adaptations).

169

APPENDIX VI

INTERVIEW GUIDE FOR THE TEACHERS TEACHING LEARNERS WITH

CEREBRAL PALSYINTELLECTUAL DISABILITY.

This interview is part of an educational study that is being conducted by the researcher in the

institution. The information will be treated with utmost confidentiality during and even after the

study. The researcher is therefore requesting for your co-operation and assistance. The

information you give will be very important for this study.

1. What guides you in the choice of the instructional strategy that you use for learners with

cerebral palsy intellectual disability? (Probe on age level, level of disability among

others).

2. What are the various instructional strategies for learners with cerebral palsy intellectual

disability? (Probe for the effectiveness of the stated strategies)

3. Do you think the regular curriculum is designed to cater to for learners with multiple

disabilities? If not what are your recommendations? (probe on the required adaptations).

4. Do you think you are competently trained to serve learners with cerebral palsy

intellectual disability? If not, what are the training needs that you require?

5. What available teaching resources do you have for learners with cerebral palsy

intellectual disability? (Probe for mobility aids, page turners, and computer assisted

instructions among others.

6. What support services are given to learners with cerebral palsy intellectual disability?

(Probe for the effectiveness and suggestions on the improvement of the stated support

services?

7. What suggestions would you recommend on the instructional strategies to improve

teaching? (Probe on retraining on the new techniques, curriculum adaptations among

others).

170

APPENDIX VII

QUESTIONAIRES FOR TEACHERS EDUCATING LEARNERS WITH CEREBRAL

PALSYINTELLECTUAL DISABILITY.

Dear respondent,

INSTRUCTIONS

Please tick the column which most represents your views of the following statements. There is

no correct or wrong answer. The best answer is the one that honestly reflects your views. Please,

your name should not appear on your questionnaire.

QUESTONAIRE FOR TEACHERS

Section A: Personal details and general information. Please fill in.

1. Gender Male___________ Female____________

2. Designation Deputy Head ____________

Senior Teacher____________

Teacher__________________

3. Number of years in the school____________________

4. What are your professional qualifications?

Certificate (SNE) _______________ Diploma (SNE) _________________

Degree (SNE) _______________ M.E.D (SNE) _______________

Others (specify) _______________

5. Experience 1-5years___________ 5 years______________ 10-15 years___________

16 years and above___________

171

Key

Strongly agree – SA

Agree – A

Undecided-UN

Disagree-D

Strongly Disagree-SD

Please honestly indicate the extent to which you agree with these statements.

Instructional Methods SA A UN D SD

1. Teachers make use of real objects

2. Breaking down tasks into simpler activities

3. Use of pointers

4. Use of pencil grips

5 Use of page turners

6. Use of computer assisted instruction

7. Use of adapted computers

8. Use of communication boards

9 Use of gestures

10. Use of pointing

11. Use of writing

12. Use of the pre-linguistic milieu teaching

13. Use of pictures

14. Use of observations & demonstrations

15. Use of group work

16. Use of video and audio based curriculum

172

APPENDIX VIII

QUESTIONAIRE FOR THE TEACHERS OF LEARNERS WITH DEAFBLINDNESS

Dear respondent,

INSTRUCTIONS

Please tick the column which most represents your views of the following statements. There is

no correct or wrong answer. The best answer is the one that honestly reflects your views. Please,

your name should not appear on your questionnaire.

QUESTONAIRE FOR TEACHERS

Section A: Personal details and general information. Please fill in.

1. Gender Male___________ Female____________

2. Designation Deputy Head ____________

Senior Teacher____________

Teacher__________________

3. Number of years in the school____________________

4. What are your professional qualifications?

Certificate (SNE) _______________ Diploma (SNE) _________________

Degree (SNE) _______________ M.E.D (SNE) _______________

Others (specify) _______________

5. Experience 1-5years___________ 5 years______________

10-15 years___________ 16 years and above__________

Key

173

Strongly agree – SA

Agree – A

Undecided-UN

Disagree-D

Strongly Disagree-SD

Please honestly indicate the extent to which you agree with these statements

Instructional Methods SA A UN D SD

1. Teachers make use of real objects

2.

Breaking down tasks into simpler activities

3. Allow enough time for task completion

4. Teaching learners how to make a choice

5. Use of behavior management programmes

6. Use of calming or soothing activities

7. Hand over hand guidance, tactual sign

language

8.

Coactive signing

9. Tadoma,Lip reading, body language

10. Use of tactile diagrams

11. Use of speech paired with Braille

12. Use of speech paired with Kenyans sign

language

13. Use of Kenyan sign language

14. Use of routine, calendar system and

discussion boxes

15. Use of the Deafblind manual alphabet

16. Use of objects of reference or pointing

17. Use of experience and picture board

18 Use of Lilli Nielsen resonance board

19 Use of teaching teachable moments

174

APPENDIX IX

QUESTIONAIRE FOR TEACHERS EDUCATING LEARNERS WITH AUTISM

BLINDNESS

Dear respondent,

INSTRUCTIONS

Please tick the column which most represents your views of the following statements. There is

no correct or wrong answer. The best answer is the one that honestly reflects your views. Please,

your name should not appear on your questionnaire.

Section A: Personal details and general information. Please fill in.

1. Gender Male___________ Female____________

2. Designation Deputy Head ____________

Senior Teacher____________

Teacher__________________

3. Number of years in the school____________________

4. Certificate (SNE) _______________ Diploma (SNE) _________________

Degree (SNE) _______________ M.E.D (SNE) _______________

Others (specify) _______________

5. Experience 1-5years___________ 5 years______________

10-15 years___________ 16 years and above____________

Others (specify) _______________

175

Key

Strongly agree – SA

Agree – A

Undecided-UN

Disagree-D

Strongly Disagree-SD

Please indicate honestly the extent to which you agree with these statements

Instructional Methods SA A UN D SD

1. Use of speech paired with tactile strategies

2. Use of real objects(rice,maize,beans among others

3. Use of supplementary aids (e.g. slates & stylus, abacus,

cuberithms)

4. Use of tactile Kinesthetic and auditory modalities

5. Use of frequent stretch breaks

6. Use of auditory activities

7. Use of Kinesthetic learning activities

8 Use of consistent schedules

9. Use of Braille as a mode of communication

10. Use of large print, optical devices

11. Use of regular print

12. Use of recorded materials to communicate

13. Orientation and mobility

14. Independent living skills

15. Use of behavior management strategies.

17. Use of two handed sign language paired with speech.

176

APPENDIX X

OBSERVATION GUIDE FOR USEBY THE RESEARCHER IN SCHOOLS FOR

LEARNERS WITH DEAFBLINDNESS.

ITEM SPECIFIC ITEM CONDITION COMMENTS

Teaching strategies

Developing an IEP

Instructional methods

in use.

Teaching Resources Real objects, use of

experience book

among others

Classroom Adapted desks,

arrangement of the

room among others

Curriculum Specialist curriculum

Support Services Speech therapy,

occupational therapy

among others

Specialized equipment Adapted computers,

Hoyer Hydraulic lifts

among others

Physical environment Barrier free, ramps

among others

177

APPENDIX XI

OBSERVATION GUIDE FORUSE BY THE RESEARCHER IN SCHOOLS WITH

LEARNERS WITH AUTISM BLINDNESS

ITEM SPECIFIC ITEM CONDITION COMMENTS

Teaching strategies

Developing an IEP

Instructional methods

in use

Teaching Resources braillers, white cane

among others

Classroom Arrangement of the

room, use of routines.

Curriculum Adapted curriculum

among others

Special Diet Gluten free, casein

free among others

Support Services Speech therapy,

language pathology

among others

Specialized equipment Adapted computer,

global positioning

device among others

Physical Environment Barrier free among

others

178

APPENDIX XII

OBSERVATION GUIDE FOR USE BY THE RESEARCHER IN SCHOOLS WITH

LEARNERS HAVING CEREBRAL PALSY INTELLECTUAL DISABILITY

ITEM SPECIFIC ITEM CONDITION COMMENTS

Teaching strategies

Developing an IEP

Instructional methods

in use: Antecedent

prompting, , task

analysis among others

Teaching Resources Page turners, paper

grips, AAC devices,

manual signs, adapted

pens, adapted pencils

among others

Classroom

Adapted desks

wedges Prone stander

Mechanical lifts

Curriculum Specialized

curriculum

Mobility devices Braces, splints,

walking frame,

wheelchairs

Support services Physiotherapy, speech

therapy, among

others.

Specialized equipment Adapted computers,

electric wheel chairs

among others

179

AP PENDIX XIII

RESEARCH PERMIT