Bodily-tactile early intervention for a mother and her child with visual impairment and additional disabilities: a case study

Figures & data

Table 1. Summary of the studies exploring the effects of interventions for 0–2-year-olds with VIAD.

Author	Sample qualities	Content of intervention	Results
Rogow [34]	Children with VI and multiple disabilities (N = 10, aged 15 months −7 years) and their parents or teachers	Social routines based on traditional nursery rhymes	Traditional nursery rhymes were found to be useful for developing intentional and communicative behaviors in the participant children. The children showed increased awareness of their role in interaction and participated in the modalities that were most accessible to them.
Chen et al. [22]	Children with VI and hearing loss and AD (N = 27, aged 8–33 months) and their caregivers	Curriculum promoting learning through active interaction	Parents used the strategies successfully and found them useful in supporting their children’s interaction and communication skills.
Metell [41]	Children with VI and multiple disabilities (N = 10, aged 1–4 years) and their caregivers	Music therapy	Music therapy promoted positive bonding and joyful interactions between the children and their caregivers.
Platje et al. [42]	Children with VI or VI and intellectual disability (N = 77, aged 1–5 years) and their parents	Video-feedback intervention to promote positive parenting (VIPP-V)	The VIPP-V did not increase parental sensitivity or parent–child interaction quality. However, the self-efficacy of parents increased, and enhanced self-efficacy predicted an increase in parent–child interaction.
Dyzel et al. [40]	Children with VI or VI and intellectual disability (N = 11, aged 0–4 years) and their caregivers	An interactive technology-based playmat, “Barti-mat,” to promote sensitive caregiving	Caregivers’ mirroring behavior increased. The children experienced more positive emotions and optimal arousal. The caregivers enjoyed using Barti-mat as play material while playing with their children.

Figure 1. Progress of data collection.

Note: The recordings were made weekly during a weekday that was convenient for the family.

The four sections have information on the codes used for different phases of the study, and the duration and frequency of the sessions.

Read the detailed description of this figure

Four sections. A1 contains the interview, A2-A4 contains the baseline sessions, B1-B8 contains the intervention sessions and A13-A15 contains the follow-up sessions. The interview lasted 60 min, the baseline sessions a maximum of 30 min, the intervention sessions a maximum of 90 min, and the follow-up sessions a maximum of 30 min. During the baseline and intervention sessions, the family was visited weekly. The follow-up recordings were made one, five and nine weeks after the final intervention session. The arrows between the sections indicate the course of the study, starting from the interview and followed by baseline, intervention, and follow-up sessions.

Figure 2. Illustrative Examples of Bodily-Tactile Communication: Coactive Signing, Tactile Contact, Imitation in the Bodily-Tactile Modality, and Tactile Pointing Gesture. Drawings by Saara Koivula.

Four drawings. A. The mother helps the child to make a sign. B. The child is laying on the floor and touches his mother with his toes. C. The child taps on his mother’s hand and the mother responds by tapping on his hand. D. The child’s hand is on his mother’s hand during the mother’s pointing gesture.

Table 2. The categories of the coding procedures for the mother’s use of bodily-tactile modality in interactions and Robin’s expressions.

Participants and categories	Description of the categories
THE MOTHER	The intervention-based bodily-tactile forms of communication
Signs	Signs from the Finnish Sign Language and self-created signs were counted as signs. It was coded whether signs were made in a tactile or non-tactile way. Whether the mother made a sign during a song or during spontaneous speech was also marked.
Touches and movements connected to play	Touches and body movements connected to songs and games that Robin could perceive through the sense of touch were coded (e.g., bouncing). Tickles and playful touches with objects or blowing on the skin were registered. The sensations created with air flow were coded if there was tactile contact between Robin and his mother during the play. This was due to the qualitative aspect of the interaction of being in contact with the communication partner.
Tactile attention-directing gestures	Tactile attention-directing gestures were defined as tactile gestures aiming to help direct attention or explore objects [33,49]. The subcategories were: (a) hand-under-hand guidance, which was defined as guidance in which the mother placed her hand slightly under Robin’s hand to examine toys or other objects, and (b) tactile pointing (Figure 2(D)). Non-tactile pointing was also coded but differentiated from tactile pointing.
Touches related to anticipating and noticing	An anticipatory touch was defined as a touch that preceded an action or a touch related to Robin’s body (e.g., a touch on the armpits before lifting him up). Touches related to noticing were touches that the mother made on Robin’s body after noticing his movement or gesture (e.g., the mother touches Robin’s hands and tells him that she noticed his gesture but did not understand it yet).
Bodily-tactile imitation	Bodily-tactile imitation was defined as the imitation of Robin’s hand or body movements (Figure 2(C)). Only the imitations that Robin was able to perceive through the sense of touch were coded. The mother’s imitation had to appear within 3 s from Robin’s action. The 3 s criterion was used, as the data showed that Robin’s mother typically imitated him in this time frame.
	The non-intervention-based bodily-tactile forms of communication
Conventional gestures	Conventional gestures that have a culturally defined meaning (e.g., clapping hands) were coded if they were not part of the play. Whether conventional gestures were made in a tactile or non-tactile way was marked.
Tactile attention-directing gestures	The subcategories were (a) hand-over-hand guidance (e.g., the mother takes Robin’s hand and makes him touch an object), (b) other tactile attention-directing gestures created by the mother (e.g., the mother tries to get Robin’s attention by lifting his head up).
Touches connected to naming	The touches accompanying the mother’s verbal naming (e.g., the mother touches Robin’s hand and names it).
Bodily-tactile emotional expressions	The positive emotional expressions that Robin was able to perceive through the sense of touch (e.g., kissing and hugging).
ROBIN
Signs	Signs from the Finnish Sign Language and self-created mimetic gestures that had a negotiated meaning were coded as signs. If there were less than 2 s between two similar consequent signs, they were coded as one expression. Sign imitations were differentiated from spontaneous signs. An imitation had to appear within 4 s of the mother’s previous sign.
Reaching and requesting	Gestures with the intent of communicating requesting actions were coded. Reaching was coded if Robin reached one or both of his hands toward the mother or some object. Intentional actions with objects were coded (e.g., pulling a scarf from the mother’s face in peekaboo). If there were less than 2 s between two subsequent reaching or requesting gestures, they were coded as one expression.
Motor imitation	Robin imitates his mother’s preceding hand or body movement within 4 s. Both tactile and non-tactile imitative movements were coded.
Vocal expressions	In each recording, the highest level of Robin’s vocal expression was marked. The categories were non-canonical vocalization, canonical vocalization, and single words. Canonical vocalization was defined as a vocalization in which Robin produces at least two subsequent consonant–vowel syllables (e.g., ma-ma).

Figure 3. The mother’s use of bodily-tactile modality in interactions and touches and movements connected to play as a percentage of time per session.

Note: The total amount of bodily-tactile modality in interactions includes the use of all intervention-based and non-intervention based bodily-tactile forms of communication.

A line graph plotting the percentage of time the mother used touches and movements connected to play and the total amount of bodily-tactile modality in interaction. The percentage of time for both increased during the intervention and follow-up sessions.

Table 3. Frequencies of the mother’s signs and Robin’s gestural expressions.

	A2	A3	A4	B1	B5	B8	A13	A14	A15
The mother
Tactile signs in total	16	6	12	20	20	17	21	15	18
Tactile signs per minute	1.6	0.5	1.2	1.8	1.7	1.7	1.9	1.4	1.6
Tactile signs during speech	0	0	0	6	8	14	5	7	11
Tactile signs during songs	16	6	12	14	12	3	16	8	7
Robin
Spontaneous signs	7	5	7	12	20	15	4	12	5
Signs per minute	0.7	0.4	0.7	1.1	1.7	1.5	0.4	1.1	0.5
Sign imitations	0	1	1	1	0	1	2	1	0
Reaching and requesting	4	8	1	4	12	4	4	7	9
Motor imitation	0	1	0	1	1	3	0	4	0
Robin's gestures in “Magpie Makes Porridge”
Mimetic gesture (Magpie)^a	0	0	0	0	2	3	2	2	0
Anticipatory gestures	0	0	0	0	1	2	6	0	2

A2–A4 refer to baseline, B1–B8 to intervention, and A13–A15 to follow-up sessions.

^aMimetic gestures are included in Robin’s spontaneous signs.

Table 4. Robin’s and his mother’s sign vocabulary.

	Baseline sessions	Intervention sessions	Follow-up sessions
THE MOTHER
Tactile signs	SUN, JUMP, SPIDER, ANTHILL, ANT, SLEEP, RAIN, TAKE AWAY, VIOLIN, DILIGENT	SUN, JUMP, SPIDER, VIOLIN, SLEEP, RAIN, TAKE AWAY	DILIGENT, JUMP, SLEEP, ANTHILL, SPIDER, ANT, VIOLIN
		CAT, DOG, COW, PIGGY, BLOWING ON THE SKIN GAME, MAGPIE, THE END, EAT, ROBIN’S NAME SIGN, LAMP, MOTHER	MAGPIE, CAT, DOG, COW, PIGGY, THE END, RUB EYES, GO ON
ROBIN
Spontaneous signs	ANT, VIOLIN, SPIDER	ANT, VIOLIN, SPIDER, MAGPIE	ANT, VIOLIN, SPIDER, MAGPIE, DOG
Imitated signs	SPIDER	DOG	ANT, VIOLIN, EAT ^a

The bolded words are signs belonging to the song “Itsy Bitsy Spider.”

^aThe sign was detected in a separate video clip in the last follow-up recordings.

Table 5. Emotional availability between Robin and his mother.

	A2	A3	A4	B1	B5	B8	A13	A14	A15
Sensitivity	5.5	6.5	5.5	6	6	6	6.5	5.5	6
Structuring	5.5	6	5.5	5.5	6.5	6	6.5	5.5	6
Nonintrusiveness	5	5.5	5	5.5	5.5	6	6	5	5
Nonhostility	6.5	6	6	6.5	6.5	6.5	7	6.5	6
Child responsiveness	5.5	5	5	5.5	6	6	6.5	5	5.5
Child involvement	5	6	5	5	5.5	5	5.5	4	3.5

Table

Overlaps and pauses
(0.5)	A pause and its duration in tenths of seconds
(.)	A micropause (less than 0.2 s)
[ ]	Beginning and end of overlap
Signs and nonverbal actions
MAGPIE	Sign or gesture
TURNS	Non-verbal action
…….	Preparation
,,,,,,	Retraction
++	Descriptions of embodied movements are delimited between two identical symbols
**	(one symbol per participant’s line of action) and are synchronized with corresponding periods of speech or lapses of time
*----->	The action described continues across subsequent lines
---->*	until the same symbol is reached
mother	Participant doing the embodied action is identified when she is not the speaker
Speech volume and duration
°Oh°	Silent voice
mum-	A cut-off word
Other
((mimetic gesture))	Transcriber’s comments
.hhh	Inhalation
fig	The exact moment at which a screen shot has been taken is indicated
#	by a symbol showing its temporal position within turn at talk or segments of time

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Data availability statement

The data cannot be shared due to ethical restrictions.